bluuebunny/crossref_metadata_2025 huggingface dataset:
Varietal and Developmental Susceptibility of Tart Cherry (Rosales: Rosaceae) to Drosophila suzukii (Diptera: Drosophilidae)
Authors: Kamiyama Matthew T , Guédot Christelle
Published: April 2019

Drosophila suzukii (Matsumura) is an invasive species of vinegar fly that infests soft-skinned and stone fruits. Since its first detection in the United States, D. suzukii has become a prominent economic threat in fruit crop industries, particularly affecting caneberry and sweet cherry growers. This study examined the susceptibility of tart cherries (Prunus cerasus) to D. suzukii and sampled for larvae and adult D. suzukii during the tart cherry growing season. Four tart cherry cultivars (Montmorency, Balaton, Carmine Jewel, and Kántorjánosi) were tested at three different ripeness stages (unripe, ripening, and ripe), in no-choice laboratory bio-assays. Field monitoring and sampling revealed that first adult D. suzukii detection occurred on 16 June, and first field larval D. suzukii detection occurred on 28 July. Adult D. suzukii populations increased through late August, and high numbers of adults overlapped with the tart cherry harvest. Lab assays indicated that tart cherry cultivars generally became more susceptible to D. suzukii as they ripened. As the fruit developed, °Brix (sugar content) increased and firmness generally decreased. Tart cherry °Brix and firmness were not correlated with the number of D. suzukii eggs per gram of fruit, but showed a significant interaction effect with the number of larvae and adults per gram of fruit. This study shows that tart cherries are largely not susceptible to D. suzukii when unripe and become susceptible as soon as the fruits change color, suggesting that fruits should be protected as soon as they begin to ripen and D. suzukii populations begin to rise.
Can the Environment have a Genetic Basis? A Case Study of Seedling Establishment in Arabidopsis thaliana
Authors: D’Aguillo Michelle C , Edwards Brianne R , Donohue Kathleen
Published: April 2019

The timing of seed germination determines the environment experienced by a plant’s most vulnerable life stage—the seedling. Germination is environmentally cued, and genotypes can differ in their sensitivity to environmental cues. When genotypes differ in their response to cues, and when cues accurately predict the postgermination environment, the postgermination environment experienced by seedlings can itself have a genetic basis and potential to evolve. We tested for genetic differences in the postgermination environment using Arabidopsis thaliana genotypes that vary in seed dormancy, a trait known to alter germination time. We dispersed seeds into the field in 5 seasonal cohorts over 1.5 years, observed germination timing for 5297 individuals, and measured the soil temperature and moisture experienced by individuals throughout their life cycle. We found that genotypes differed in the environments they experienced during seedling establishment. This environmental variation occurred because genotypes differed in their environmental sensitivity to germination cues, and pregermination cues were correlated with postgermination environments. Seeds exhibited temporal habitat selection by germinating into a nonrandom subset of environmental conditions available, and seed dormancy increased the consistency of habitat selection. Strikingly, the postgermination environment affected fitness by altering the probability of seedling survival such that genotypes that engaged in stronger habitat selection were less likely to reach reproduction. Our results suggest that environmentally cued development may be a widespread mechanism by which genotypes can differ in the environment they experience, introducing the possibility that the environment itself can be inherited and can evolve.
Molecular Phylogeny of Dermacentor parumapertus (Acari: Ixodidae) from Two Locations Within Its Geographical Range
Authors: Portugal J Santos , Allerdice Michelle , Moraru Gail M , King Jonas , Paddock Christopher D , Becker Tom , Smith Travis C , Goddard Jerome
Published: April 2019

Dermacentor parumapertus Neumann (Acari: Ixodidae) is a rather obscure tick found on jackrabbits in the western United States and parts of Canada and Mexico. Specimens from the northern part of their range are consistently different morphologically from ones found in southern and eastern parts of their range (particularly west Texas), leading some researchers to declare the southern form a variety or subspecies. This study examined field-collected adult D. parumapertus from two main locations—Utah and Texas—within its geographic distribution to ascertain the degree of genetic divergence in the two populations based upon both nuclear and mitochondrial DNA sequences. In total, 30 D. parumapertus were analyzed by PCR using both mtDNA and nDNA genes, and one D. nitens was included for comparison. Trees were constructed for all mtDNA genes individually, as well as after concatenating mtDNA (COI, COII, 12S) and nDNA (2 ITS2 primers), respectively. All constructed trees were exported to FigTree v1.4.3 and TreeGraph v2.14.1–771 beta for visualization. The majority of the Utah and Texas populations of D. parumapertus separated molecularly in both mtDNA and nDNA trees; however, analysis with mtDNA genes showed that 3/13 (23%) of Utah tick specimens were removed molecularly from other specimens collected at the same location. Thus, there was not enough evidence to declare these two disparate and morphologically different populations as distinct and separate species.
The Epworth Sleepiness Scale in Service Members with Sleep Disorders
Authors: Hurlston April , Foster Shannon N , Creamer Jennifer , Brock Matthew S , Matsangas Panagiotis , Moore Brian A , Mysliwiec Vincent
Published: April 2019

Introduction

Excessive daytime sleepiness affects an estimated 20% of the general population. While the prevalence of sleepiness in the military is largely unknown, it is well established that short sleep duration is endemic. The reasons for this include: the demanding nature of their duties, shift work and 24-hour duty periods, deployments and exigencies of military service as well as sleep disorders. The Epworth Sleepiness Scale (ESS) is the most widely used sleep questionnaire and provides a self-assessment of daytime sleepiness. To date the clinical utility of this questionnaire in differentiating sleep disorders in military patients with sleep disorders has never been evaluated.

Materials and Methods

The primary aim of this manuscript was to assess if Epworth Sleepiness Scale (ESS) scores differed between military personnel with insomnia, obstructive sleep apnea (OSA), comorbid insomnia/obstructive sleep apnea (COMISA), and a group with neither insomnia nor obstructive sleep apnea (NISA). This study assessed the clinical utility of the ESS in differentiating sleep disorders amongst a sample (N = 488) of U.S. military personnel with insomnia (n = 92), OSA (n = 142), COMISA (n = 221), and a NISA group (n = 33) which served as the control population.

Results

In the present sample, 68.4% of service members reported excessive daytime sleepiness (EDS) with an ESS > 10. ESS scores differed between military personnel with COMISA (13.5 ± 4.83) and those with OSA only (11.5 ± 4.08; p < 0.001) and the NISA group (9.46 ± 4.84; p < 0.001). Also, ESS scores differed between patients with insomnia only (13.0 ± 4.84) and the NISA group (p < 0.01).

Conclusions

Overall, the ESS had poor ability to differentiate sleep disorders. In military personnel, the ESS appears elevated in the most common sleep disorders, likely due to their insufficient sleep, and does not help to differentiate OSA from insomnia. Further studies are required to validate this questionnaire and determine an appropriate threshold value for abnormal sleepiness in the military population.
Naturalness as a Constraint on Priors
Authors: Bradley Darren
Published: April 2019

Many epistemological problems can be solved by the objective Bayesian view that there are rationality constraints on priors, that is, inductive probabilities. But attempts to work out these constraints have run into such serious problems that many have rejected objective Bayesianism altogether. I argue that the epistemologist should borrow the metaphysician’s concept of naturalness and assign higher priors to more natural hypotheses.
Robust Estimation of Recent Effective Population Size from Number of Independent Origins in Soft Sweeps
Authors: Khatri Bhavin S , Burt Austin
Published: April 2019

Estimating recent effective population size is of great importance in characterizing and predicting the evolution of natural populations. Methods based on nucleotide diversity may underestimate current day effective population sizes due to historical bottlenecks, whereas methods that reconstruct demographic history typically only detect long-term variations. However, soft selective sweeps, which leave a fingerprint of mutational history by recurrent mutations on independent haplotype backgrounds, holds promise of an estimate more representative of recent population history. Here, we present a simple and robust method of estimation based only on knowledge of the number of independent recurrent origins and the current frequency of the beneficial allele in a population sample, independent of the strength of selection and age of the mutation. Using a forward-time theoretical framework, we show the mean number of origins is a function of θ=2Nμ and current allele frequency, through a simple equation, and the distribution is approximately Poisson. This estimate is robust to whether mutants preexisted before selection arose and is equally accurate for diploid populations with incomplete dominance. For fast (e.g., seasonal) demographic changes compared with time scale for fixation of the mutant allele, and for moderate peak-to-trough ratios, we show our constant population size estimate can be used to bound the maximum and minimum population size. Applied to the Vgsc gene of Anopheles gambiae, we estimate an effective population size of roughly 6×107, and including seasonal demographic oscillations, a minimum effective population size >3×107, and a maximum <6×109, suggesting a mean ∼109.
Cell-specific CRISPR–Cas9 activation by microRNA-dependent expression of anti-CRISPR proteins
Authors: Hoffmann Mareike D , Aschenbrenner Sabine , Grosse Stefanie , Rapti Kleopatra , Domenger Claire , Fakhiri Julia , Mastel Manuel , Börner Kathleen , Eils Roland , Grimm Dirk , Niopek Dominik
Published: April 2019

The rapid development of CRISPR–Cas technologies brought a personalized and targeted treatment of genetic disorders into closer reach. To render CRISPR-based therapies precise and safe, strategies to confine the activity of Cas(9) to selected cells and tissues are highly desired. Here, we developed a cell type-specific Cas-ON switch based on miRNA-regulated expression of anti-CRISPR (Acr) proteins. We inserted target sites for miR-122 or miR-1, which are abundant specifically in liver and cardiac muscle cells, respectively, into the 3′UTR of Acr transgenes. Co-expressing these with Cas9 and sgRNAs resulted in Acr knockdown and released Cas9 activity solely in hepatocytes or cardiomyocytes, while Cas9 was efficiently inhibited in off-target cells. We demonstrate control of genome editing and gene activation using a miR-dependent AcrIIA4 in combination with different Streptococcus pyogenes (Spy)Cas9 variants (full-length Cas9, split-Cas9, dCas9-VP64). Finally, to showcase its modularity, we adapted our Cas-ON system to the smaller and more target-specific Neisseria meningitidis (Nme)Cas9 orthologue and its cognate inhibitors AcrIIC1 and AcrIIC3. Our Cas-ON switch should facilitate cell-specific activity of any CRISPR–Cas orthologue, for which a potent anti-CRISPR protein is known.
Effects of dietary nitrate on inflammation and immune function, and implications for cardiovascular health
Authors: Raubenheimer Kyle , Bondonno Catherine , Blekkenhorst Lauren , Wagner Karl-Heinz , Peake Jonathan M , Neubauer Oliver
Published: April 2019

Inorganic dietary nitrate, found abundantly in green leafy and some root vegetables, elicits several beneficial physiological effects, including a reduction in blood pressure and improvements in blood flow through nitrate–nitrite–nitric oxide signaling. Recent animal and human studies have shown that dietary nitrate and nitrite also modulate inflammatory processes and immune cell function and phenotypes. Chronic low-grade inflammation and immune dysfunction play a critical role in cardiovascular disease. This review outlines the current evidence on the efficacy of nitrate-rich plant foods and other sources of dietary nitrate and nitrite to counteract inflammation and promote homeostasis of the immune and vascular systems. The data from these studies suggest that immune cells and immune–vasculature interactions are important targets for dietary interventions aimed at improving, preserving, or restoring cardiovascular health.
COMPREHENSIVE EXPRESSION ANALYSIS OF MIRNAS IN MICE EXPOSED TO LETHAL RADIATION AND/OR RADIO-MITIGATIVE DRUG
Authors: Yamaguchi M , Tsujiguchi T , Kashiwakura I
Published: April 2019

New minimally invasive indicators that are capable of predicting the biological effects and radiation damage to various organs and systems are urgently needed for the development of optimal treatment protocols for victims of radiation accidents. In the present study, we focused on microRNA (miRNA) that have recently emerged as biomarkers for predicting and diagnosing various pathological conditions and identified the serum miRNA signatures. All of the mice treated with lethal radiation alone strongly expressed certain serum miRNAs detectable for 24 h after radiation exposure, whereas the administration of radio-mitigative drug immediately after irradiation suppressed these miRNA expressions to the same levels as in control mice. These results suggest that serum miRNAs may reflect the degree of radiation damage and can be used to predict the radiation-mitigative information in victims of accidental radiation exposure.
Digestibility of amino acids, energy, acid hydrolyzed ether extract, and neutral detergent fiber, and concentration of digestible and metabolizable energy in low-oil distillers dried grains with solubles fed to growing pigs1
Authors: Espinosa Charmaine D , Lee Su A , Stein Hans H
Published: April 2019

Two experiments were conducted to test the hypothesis that digestibility of amino acids (AA), gross energy (GE), acid hydrolyzed ether extract (AEE), and neutral detergent fiber (NDF), and values for metabolizable energy (ME) in low-oil distillers dried grains with solubles (DDGS) vary among suppliers. In Exp. 1, the apparent total tract digestibility (ATTD) of GE, AEE, and NDF, and concentration of ME were determined in eight sources of DDGS (sources A, B, C, D, E, G, H, and I). A corn-based basal diet and eight diets containing corn and each source of DDGS were fed to 72 barrows (initial body weight = 18.1 ± 1.3 kg) with eight pigs per diet. Feces and urine were collected for 5 d after 7 d of adaptation. The ME did not differ among the eight sources of DDGS with the exception that DDGS source E contained less (P < 0.05) ME than DDGS source D. The ATTD of GE did also not differ among the eight sources of DDGS, but ME and ATTD of GE in corn were greater (P < 0.05) than in the eight sources of DDGS. However, the ATTD of AEE in corn and the eight sources of DDGS was not different, but the ATTD of AEE in DDGS source E was greater (P < 0.05) than in DDGS source A. The ATTD of NDF in DDGS source D was also greater (P < 0.05) than in DDGS sources E, G, and H, but ATTD of NDF did not differ between corn and the eight sources of DDGS. In Exp. 2, standardized ileal digestibility (SID) of AA was determined in seven sources of DDGS (sources A, B, C, D, E, G, and H). Twenty-four barrows (initial body weight = 63.4 ± 3.4 kg) that had a T-cannula installed in the distal ileum were allotted to a two-period incomplete Latin square design with eight diets. Seven diets were formulated to contain each of the seven sources of DDGS and an N-free diet was also used. Ileal digesta were collected for 2 d after 5 d of adaptation. There were no differences between pigs fed DDGS sources A and B in SID of AA, and the SID of Lys, Met, and Trp did not differ among DDGS sources A, B, and E. However, SID of most indispensable and dispensable AA except Gly were greater (P < 0.05) in DDGS source B than in DDGS sources C, D, E, G, and H. In conclusion, variability in SID of AA, ATTD of NDF and AEE, and ME were observed among the sources of DDGS used in this experiment.
Infection, Survival, and Growth of Clavibacter nebraskensis on Crop, Weed, and Prairie Plant Species
Authors: Webster B. T. , Curland R. D. , McNally R. R. , Ishimaru C. A. , Malvick D. K.
Published: April 2019

Clavibacter nebraskensis is the causal agent of Goss’s leaf blight and wilt, an important disease of maize in the United States and Canada. The epidemiology and ecology of this bacterial pathogen are poorly understood. Infested maize residue is often considered to be the primary source of inoculum for maize; however, the potential for many other plant species to be infected and serve as inoculum sources is unknown. The goal of this study was to determine if C. nebraskensis could infect, survive, and grow on common weed, crop, and grass species. Seedling leaves of 18 plant species that grow in maize production areas in the United States were inoculated with this pathogen in a controlled environment and in the field. Lesion development, bacterial streaming, and pathogen population size on leaves were then determined and used as criteria to evaluate host–pathogen interactions. Woolly cupgrass (Eriochloa villosa) and the native prairie grasses big bluestem (Andropogon gerardii) and little bluestem (Schizachyrium scoparium) developed lesions and bacterial streaming, identifying them as hosts and susceptible to infection. To our knowledge, this is the first report of these grass species being hosts of C. nebraskensis. Ten other grass species, including wheat and oats, were identified as potential sustaining hosts that maintained epiphytic or endophytic pathogen populations >106 colony forming units per leaf sample but displayed no evidence of infection. Five broadleaf species tested were nonhosts based on the three criteria. This study suggests that multiple plant species support infection and growth of C. nebraskensis and further elucidates the ecology of this pathogen and the epidemiology of Goss’s wilt.
Assessing Fitness Costs and Phenotypic Instability of Fentin Hydroxide and Tebuconazole Resistance in Venturia effusa
Authors: Standish Jeffrey R. , Brenneman Timothy B. , Brewer Marin T. , Stevenson Katherine L.
Published: April 2019

Sensitivity monitoring of Venturia effusa, cause of pecan scab, has revealed insensitivity to fentin hydroxide and tebuconazole, but recent research indicates that the insensitivity to fentin hydroxide is not stable. A study was undertaken to determine if a fitness cost may be responsible for this instability. In this study, experiments were conducted to evaluate fitness components and phenotypic stability of insensitivity of V. effusa to fentin hydroxide and tebuconazole. Conidial production, conidial germination, microcolony growth, sensitivity to osmotic stress, and sensitivity to oxidative stress in the absence of fungicide were compared for isolates with differing sensitivities to both fungicides. Percent conidial germination decreased linearly with increasing fentin hydroxide insensitivity, and microcolony growth on 1.0 mM H2O2 decreased linearly with increasing tebuconazole insensitivity. Stability of resistance was assessed on concentrations of 1.0, 3.0, and 10 µg/ml of both fungicides prior to and after five transfers on non-fungicide-amended medium. Tebuconazole insensitivity was stable after transfers, but fentin hydroxide insensitivity on 1.0 and 3.0 µg/ml decreased significantly after transfers, indicating instability. Here we provide evidence that in V. effusa tebuconazole insensitivity is stable and fentin hydroxide insensitivity is not. These results suggest that fentin-hydroxide-resistant V. effusa isolates have reduced conidial viability compared with sensitive isolates, which may allow the population to regain sensitivity in the absence of this frequently used fungicide.
A New Comprehensive Paradigm for Prenatal Diagnosis: Seeing the Forest Through the Trees
Authors: Borrell A.
Published: April 2019

(Abstracted from Ultrasound Obstet Gynecol 2018;52:563–568)

The prevalence of birth disorders is estimated to be 3% for major fetal malformations, which are thought to be mainly multifactorial in origin, and 3% for genetic anomalies, distributed almost equally between chromosomal anomalies (1%), submicroscopic anomalies (1%), and single-gene disorders (1%) (excluding cancer-predisposing and metabolic syndromes). From their introduction in the 1970s, prenatal diagnosis programs focused primarily on the detection of Down syndrome, the most common cause of intellectual disability, and neural tube defects.
Length of Catheter Use After Hysterectomy as a Risk Factor for Urinary Tract Infection
Authors: Karp Natalie E. , Kobernik Emily K. , Kamdar Neil S. , Fore Amanda M. , Morgan Daniel M.
Published: April 2019

(Abstracted from Female Pelvic Med Reconstr Surg 2018;24:430–434)

A known risk factor for urinary tract infection (UTI) is placement of an indwelling Foley catheter at the time of hysterectomy. To reduce catheter-associated UTI, it is recommended that catheters be removed as soon as possible after surgery.
The American Medical Association Medical Education Innovation Challenge: Incorporating the Student Voice Into Medical Education Transformation
Authors: Elliott Victoria Stagg , Dekhtyar Michael , Pouwels Mellie Villahermosa , Skochelak Susan E.
Published: April 2019

Problem

Medical education needs to evolve to continue producing physicians who are able to meet the needs of diverse patient populations. Students can be a unique source of ideas about medical education transformation.

Approach

In the fall of 2015, the authors created the American Medical Association Medical Education Innovation Challenge, an incentive-based competition for teams of two to four students. The challenge called for teams to “turn medical education on its head” by proposing a change to some aspect of medical education that would better prepare students to meet the health care needs of the future.

Outcomes

Teams submitted 154 proposals. Themes from the winning teams and those that received an honorable mention included innovative uses of technology, creating physical spaces to pursue solutions to health care problems, wellness education, and longitudinal learning experiences around health equity and advocacy. The authors invited all teams to submit an abstract of their proposal to be published in an abstract book. The four winning teams and the 24 teams that received an honorable mention and submitted an abstract were surveyed to assess the impact of the challenge. Fifteen teams (54%) responded. Ten of those teams (67%) were implementing their idea or a related innovation to some degree.

Next Steps

The American Medical Association continues to run a wide variety of innovation challenges (e.g., Healthier Nation Innovation Challenge, Health Care Interoperability & Innovation Challenge) that draw in diverse stakeholders to solve problems in medical education and the health care system more broadly.
Continuation in Treatment and Maintenance of Custody of Newborns After Delivery in Women With Opioid Use Disorder
Authors: Schauberger Charles W. , Borgert Andrew J. , Bearwald Brent
Published: April 2019

Objective:

To identify variables associated with continuation in treatment and maintenance of custody after pregnancies in women with opioid use disorder (OUD).

Methods:

The medical records of pregnant women with documented OUD from 2011 to 2018 and with at least 6 months follow-up postpartum were retrospectively reviewed.

Results:

Via multivariate analysis, women on opioid maintenance therapy (OMT) were more likely to continue in treatment and maintain custody, whereas women enrolled in a residential treatment program during pregnancy were less likely to continue in treatment or maintain custody. Women who continued in treatment were significantly more likely to maintain custody of their children than those who did not.

Conclusions:

Continuation in treatment and maintenance of custody were closely related. Care providers should attempt to improve both outcomes.
Multimodal Neurological Enhancement Intervention for Self-regulation in Premature Infants
Authors: Cevasco-Trotter Andrea M. , Hamm Ellyn L. , Yang Xin , Parton Jason
Published: April 2019

Background:

The neonatal intensive care unit is often a noisy, overstimulating environment that disrupts infants' regulation of physiological and behavioral states and interrupts caregiver bonding; however, infants benefit from early intervention, including the use of multimodal neurological enhancement (MMNE) intervention to provide appropriate neurodevelopmental stimulation. No one has investigated whether it assists infants in self-regulation.

Purpose:

The purpose of this retrospective longitudinal analysis was to examine the effect of a music therapy intervention, MMNE, on self-regulation of premature infants as measured by changes in heart rate (HR).

Methods:

A convenience sample of 60 premature infants received 486 MMNE sessions provided by a board-certified music therapist (MT-BC). Documentation, taken during routine clinical services, involved recording infant's HRs from the standard monitor for 3 minutes at baseline, during, and after a 20-minute MMNE intervention.

Results:

Infants' mean HRs were decreased during and post-MMNE sessions compared with baseline (P < .004 and P < .001, respectively). Furthermore, infants with a baseline HR above 170 had significant decreases both during and after the MMNE session (P < .001 for both time periods).

Implications for Practice:

Results of this study support the existing body of evidence showing the benefits of MMNE with premature infants. Based on our results, MMNE may help infants develop and demonstrate self-regulation as indicated by maintained HRs during and after the intervention as well as a lowered HR for infants who had high HRs prior to MMNE.

Implications for Research:

Further research needs to be done regarding how infants process MMNE and its potential to aid sensory processing.
Searching for the Genetic Determinants of Peripheral Arterial Disease
Authors: Kellogg Dean L. , Fisher-Hoch Susan , McCormick Joseph B. , Prasad Anand
Published: April 2019

Peripheral arterial disease (PAD) is a significant but under-recognized disease that is poorly understood despite population-scale genetic studies. To address this morbid disease, clinicians need additional tools to identify, prevent, and treat patients at risk for PAD. Genetic studies of coronary artery disease have yielded promising results for clinical application, which have thus far been lacking in PAD. In this article, we review recent findings, discuss limitations, and propose future directions of genomic study and clinical application. However, despite many studies, we still lack definitive genetic markers for PAD. This can be attributed to the heterogeneity of PAD’s pathogenesis and clinical manifestations, as well as inconsistencies in study methodologies, limitations of current genetic assessment techniques, incompletely comprehended molecular pathophysiology, and confounding generalized atherosclerotic risk factors. The goals of this review are to evaluate the limitations of our current genetic knowledge of PAD and to propose approaches to expedite the identification of valuable markers of PAD.
Immunohistochemical Study of 2 Cases of Coxsackie A6–Induced Atypical Hand-Foot-and-Mouth Disease
Authors: Herrero Maria , Kutzner Heinz , Fraga Javier , Llamas-Velasco Mar
Published: April 2019

An atypical clinical variant of hand-foot-and-mouth disease (HFMD) with more extensive lesions and affecting adults has emerged during the past years, usually associated to the Coxsackievirus serotype A6 (CV-A6). We present a 19-year-old woman with a 3-day evolution eruption of papulovesicular lesions, which first appeared around the mouth and frontal area and rapidly spread. In addition, we present a 61-year-old man with a 4-day evolution asymptomatic eruption of papulovesicular lesions in both the hands and feet after suffering a cold 1 week before. Skin biopsies of both patients showed intraepidermal vesicles with spongiosis and ballooning, leading to reticular degeneration, apoptotic keratinocytes, and epidermal necrosis of the upper layers with neutrophil sloughing. Immunohistochemical studies for Coxsackie, Enterovirus, herpes virus, adenovirus, and measles were all negative. Cultures of blister fluid, reverse transcription polymerase chain reaction of skin biopsies, blood tests and serologies for exanthematic virus, and serum viral arrays were also negative. Only reverse transcription polymerase chain reaction of blister fluid confirmed Cocksakie A6. In conclusion, immunohistochemical studies with the commercially available viral antibodies do not seem to be useful in atypical HFMD cases. In these cases, to determine the typical histopathological features in HE is the fastest diagnostic aid.
Clear Cell Primary Cutaneous Anaplastic Large Cell Lymphoma
Authors: Ronen Shira , Rothschild Matan , Ollague Jose , Suster Saul
Published: April 2019

A case of primary cutaneous anaplastic large cell lymphoma that was characterized by a striking clear cell appearance occurring in the thigh of a 38-year-old man is described. The tumor presented as a large ulcer with indurated borders and serosanguinous base measuring 9.0 × 4.0 cm. A biopsy of the lesion showed a dense mononuclear cell infiltrate replacing the dermis and focally infiltrating the epidermis. The infiltrate consisted of nests and sheets of large pleomorphic tumor cells with large atypical nuclei displaying nuclear irregularities with occasional prominent nucleoli. The tumor cells were surrounded by an ample rim of clear cytoplasm imparting them with a clear cell appearance. The cells splayed the collagen in the dermis creating a compartmentalized appearance suggestive of an epithelial neoplasm. Immunohistochemical stains showed positivity of the tumor cells for CD3, CD4, CD30, and CD45RO, and negative staining for cytokeratin AE1/AE3, p63, S-100 protein, ALK-1, PAX5, CD8, CD15, CD20, CD43, and CD56, and Epstein-Barr–encoded RNA test in situ hybridization. A MIB-1 proliferation marker showed nuclear positivity in approximately 40% of the tumor cells. This case is remarkable for its striking clear cell appearance, which may lead to confusion for other tumors. Awareness of this unusual morphologic appearance in anaplastic large cell lymphoma is of important for proper diagnosis and treatment.
Extracorporeal Life Support in Adult Patients
Authors: Kurniawati Eva R. , Weerwind Patrick W.
Published: April 2019

Extracorporeal life support (ECLS) is an external medical device to treat critically ill patients with cardiovascular and respiratory failure. In a nutshell, ECLS is only a “bridging” mechanism that provides life support while the heart and/or the lungs is recovering either by therapeutic medical interventions, transplantation, or spontaneously. Extracorporeal life support has been developed since 1950s, and many studies were conducted to improve ECLS techniques, but unfortunately, the survival rate was not improved. Because of Dr Bartlett's success in using ECLS to treat neonates with severe respiratory distress in 1975, ECLS is made as a standard lifesaving therapy for neonates with severe respiratory distress. However, its use for adult patients remains debatable. The objectives of this study are to outline and provide a general overview of the use of ECLS especially for adult patients for the past 10 years and to elaborate on the challenges encountered by each stakeholder involved in ECLS. The data used for this study were extracted from the ELSO Registry Report of January 2018. Results of this study revealed that the number of ECLS centers and the use of ECLS are increasing over the year for the past decade. There was also a shift of the patient's age category from neonatal to adult patients. However, the survival rates for adult patients are relatively low especially for cardiac and extracorporeal cardiopulmonary resuscitation cases. To date, the complications are still the major challenge of ECLS. Other challenges encountered by the stakeholders in ECLS are the limited amount of well-trained and experienced ECLS teams and centers, the limited government expenditure on health, and the lack of improvement and development of ECLS techniques and devices. Further studies are needed to evaluate the value of ECLS for adult patients.
A Quality Improvement Project to Increase Adherence to a Pain, Agitation, and Delirium Protocol in the Intensive Care Unit
Authors: Yan Wendy , Morgan Brett T. , Berry Peter , Matthys Mary K. , Thompson Julie A. , Smallheer Benjamin A.
Published: April 2019

Background

In recent years, the incidence of delirium has grown to epidemic proportions in the intensive care setting with up to 80% of mechanically ventilated patients being affected. This can lead to adverse patient outcomes such as increased lengths of hospital stay, increased mortality rates, and increased long-term cognitive impairment.

Objectives

The objective of this project is to determine whether a quality improvement project can increase adherence to an existing pain, agitation, and delirium (PAD) protocol for enhanced patient outcomes.

Methods

Chart audits were conducted to determine baseline compliance, use of the PAD protocol was measured, and the type of medications administered to each mechanically ventilated patient was assessed. Using the Knowledge-to-Action framework, a multidisciplinary, multidimensional educational module was then developed and implemented that included an online tutorial, point-of-care reminders, written materials, and verbal coaching. A 3-month postimplementation chart audit was conducted to determine whether increased protocol competence was achieved.

Results

Protocol use unexpectedly decreased from 74% to 41% (P < .01);however, compliance with medication recommendations did increase despite the decrease in use. Intravenous opioid use increased from 12% to 40% (P ≤ .001), whereas sedative propofol infusions decreased from 82% to 35% (P ≤ .001).

Conclusions

The implementation of a multidimensional, multidisciplinary project was successful in increasing compliance to the clinical practice guidelines for the management of PAD in adult intensive care unit patients, despite a decrease in protocol use. This unanticipated decrease in protocol use indicates the need for additional research in this area. Future recommendations also include a review of the existing PAD protocol to determine whether revisions could be made to better suit the needs of the staff while also improving patient outcomes in the arena of delirium experienced during critical care stays.
Validation of the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) Acuity Tool for Pediatric Critical Care Nursing
Authors: Connor Jean A. , LaGrasta Christine , Gauvreau Kimberlee , Porter Courtney , Hickey Patricia A.
Published: April 2019

Background

The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity in a large, freestanding children's hospital in the United States.

Objectives

To describe the acuity and complexity of pediatric critical care nursing at a large children's hospital and correlate the CAMEO II with pediatric physiologic measures.

Methods

Construct validation was conducted correlating the CAMEO II to a pediatric classification system and 2 physiologic acuity tools. Descriptive statistics summarized patient characteristics. Construct validity across tools was evaluated using the Spearman correlation coefficient.

Results

CAMEO II was described both continuously and as ordinal complexity levels (I-V). Among 235 patients who completed CAMEO II across 4 intensive care units (ICUs), the mean total score was 99.06 (median, 97; range, 59-204). The CAMEO II complexity classification for 235 patients was as follows: I: 22 (9.4%), II: 53 (22.6%), III: 56 (23.8%), IV: 66 (28.1%), and V: 38 (16.2%). Findings from the 235 patients across the 4 ICUs revealed a significant correlation between the CAMEO II and the Therapeutic Intervention Scoring System–Children (ρ = 0.567, P < .001),
CAMEO II and Pediatric Risk of Mortality III (ρ = 0.446, P < .001), and the CAMEO II and Score for Neonatal Acute Physiology Perinatal Extension II (ρ = 0.359, P = .013).

Discussion

Utilization of CAMEO II across ICUs provides an opportunity to validate the current complexity of pediatric critical care nursing in a large children's hospital.
Scaling the Measurement of Pediatric Acuity Using the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) Tool
Authors: Connor Jean A. , LaGrasta Christine , Gauvreau Kimberlee , Porter Courtney , O'Brien Kendra , Hickey Patricia A.
Published: April 2019

Background: The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity. An expert panel including representatives from 4 intensive care units (ICUs) convened to scale and implement the CAMEO II across the ICUs in a large, freestanding children's hospital in the United States.

Objectives: The aims of this study were to scale and implement a standardized acuity measure of pediatric critical care nursing.

Method: This study used a modified Delphi technique.

Results: Through a series of 3 Delphi rounds, the expert panel identified care items not characterized in the original CAMEO and assigned each of these items a cognitive workload scale of 1 to 5. The expert panel identified 4 additional Domains of Care while confirming the original 14 Domains of Care in the first CAMEO version. The panel agreed that a number of care items could be classified as “Standard of Care,” reducing items in the CAMEO and generating a baseline score. The panel, serving as ambassadors and unit-based experts, then implemented the refined CAMEO II in each of the 4 ICUs.

Discussion: Utilization of the CAMEO II across ICUs provides a standardized measure to describe and quantify the acuity of pediatric critical care nursing. Use of this acuity measure informs projection of staffing models and benchmarking across pediatric ICUs. Further research is needed to validate the CAMEO II for multisite use.
Natural History and Surgical Management of Colonic Perforations in Vascular Ehlers-Danlos Syndrome: A Retrospective Review
Authors: Adham Salma , M. Zinzindohoué Franck , Jeunemaitre Xavier , Frank Michael
Published: April 2019

BACKGROUND:

Vascular Ehlers-Danlos syndrome is a rare and severe genetic condition leading to spontaneous, potentially life-threatening arterial and digestive complications. Colonic ruptures are a common feature of the disease, but clear recommendations on their management are lacking.

OBJECTIVE:

This study aimed to identify surgery-related morbidity and 30-day postoperative mortality after colonic perforation.

DESIGN:

This was a retrospective review.

SETTING:

A large cohort of patients with vascular Ehlers-Danlos syndrome was followed in a tertiary referral center.

PATIENTS:

Between 2000 and 2016, the French National Reference Centre for Rare Vascular Diseases (HEGP, AP-HP, Paris, France) followed 148 patients with molecularly proven vascular Ehlers-Danlos syndrome.

MAIN OUTCOME MEASURES:

The primary outcomes measured were surgery-related morbidity and 30-day postoperative mortality.

RESULTS:

Of 133 patients with molecularly proven vascular Ehlers-Danlos syndrome, 30 (22%) had a history of colonic perforation and 15 (50%) were males. These subjects were diagnosed with vascular Ehlers-Danlos syndrome at a younger age than patients with a history of GI events without colonic perforation (p = 0.0007). There were 46 colonic perforations, median 1.0 event per patient (interquartile range, 1.0–2.0). Reperforations occurred in 14 (47%) patients, mostly males. Surgical management consisted of Hartmann procedures or subtotal abdominal colectomies, with a nonnegligible rate of reperforation following partial colonic resection (11 patients, 41%).

LIMITATIONS:

The main limitations of this work are its retrospective design and that the diagnosis of vascular Ehlers-Danlos syndrome was made after colonic perforations in a majority of patients.

CONCLUSION:

Colonic perforations seem more severe in males, with a high rate of reperforation after Hartmann procedure. Subtotal colectomy may reduce digestive morbidity, particularly in male patients. Additional studies are required to identify other predictors of reperforation. See Video Abstract at http://links.lww.com/DCR/A937.
Current treatment of older patients with recurrent gynecologic cancer
Authors: Yoshida Yoshio
Published: April 2019

Purpose of review

Gynecologic cancer patients of elderly has been increasing rapidly. Useful information on older patients, especially, with recurrent gynecological cancer is extremely limited.

Recent findings

A unified concept for assessing treatment risk was proposed when providing cancer treatment to older patients. Fit: patients capable of withstanding the same standard treatment as healthy younger patients; Vulnerable: patients incapable of withstanding the same standard treatment as healthy younger patients, but capable of undergoing some sort of treatment; and Frail: patients incapable of withstanding the same standard treatment as healthy younger patients, and also unsuitable to undergo any kind of active treatment.

It is important to identify vulnerability by using geriatric assessment as a patient background factor, to intervene if treatment is required, and to modify the intensity of treatment in an attempt to extend overall survival, decrease adverse events, improve health-related quality of life, and reduce medical costs.

It is important to carry out a pretreatment functional assessment of older cancer patients using the geriatric assessment, and to choose the method of treatment for older patients in light of its results with recurrent gynecological cancer in addition to chronological age.
A Step-by-Step Approach to a Successful Cosmetic Breast Reduction
Authors: Guridi Rodrigo , Rodriguez José Ramón
Published: April 2019

Evolution of breast reduction techniques has been a result of combining different skin marking patterns with a wide variety of pedicles. Despite the many differences that may exist among these procedures, they all rely on a few key principles. To make surgery more expeditious and minimize technical challenges, these principles can be incorporated into simple surgical strategies. The authors present a step-by-step approach to help to achieve a successful cosmetic breast reduction for patients with small to moderate breast hypertrophy. Special emphasis is given to intraoperative clues that make this procedure more reproducible and straightforward.
Internet and Social Media as a Source of Information About Plastic Surgery: Comparison Between Public and Private Sector, A 2-center Study
Authors: Janik Piotr E. , Charytonowicz Michał , Szczyt Marek , Miszczyk Jakub
Published: April 2019

Background:

The popularity of social media among plastic surgeons and patients has increased in the last years. We conducted this study to explore the differences in patients’ social media habits between public and private aesthetic plastic surgery practice.

Methods:

A 2-cohort study was conducted in aesthetic plastic surgery clinic and public department of plastic and surgery by surveying consecutive first-time patients.

Results:

Two hundred patients completed a 18-question survey at a private aesthetic plastic surgery clinic. The questionnaire was also filled by 113 patients at a public plastic surgery department. Facebook was the most popular social media platform in both groups. Word of mouth from other patients and the clinic’s website were the most-valued source of information about the surgeon and surgical procedure for patients of both studied groups. Patients from the aesthetic group were mainly women from small towns; they were significantly younger and better educated and used Instagram more frequently than patients from public group. The aesthetic group patients focused significantly more often on the surgeon’s credentials and on before and after photographs. They appreciated social media as a source of information for patients significantly more than public group patients who stated that social media were the worst source of information.

Conclusions:

Word of mouth from other patients remains the most-valued source of information about plastic surgery. However, proper use of social media and building online image in a professional manner can provide attract more patients to the aesthetic plastic surgery practice.
Lymphostasis and Hemostasis in Body-Contouring Surgery Using a Polysaccharide Based Hemostat (4DryField PH)
Authors: Rudolph Mona , Vogt Peter M. , Müller Klaus , Mett Tobias R.
Published: April 2019

Background:

Following liposuction, abdominoplasty is the most frequent body-contouring intervention in the world. The transection of small blood vessels in large areas and subsequent bleeding is a viable risk during this procedure. The resulting microvascular bleedings should be stopped thoroughly to reduce the probability of related complications. In this prospective, monocentric, randomized study, the efficacy of the polysaccharide-based hemostat 4DryField PH (4DF) (PlanTec Medical, Lueneburg, Germany) is examined in classic abdominoplasty and lower body lift after Lockwood.

Methods:

For this prospective, monocentric, randomized study, 40 patients underwent surgery for both interventions. Twenty patients received an abdominoplasty, and 20 patients underwent a body lift. In each group, 10 patients have been treated with 4DF, whereas 10 have been served as the untreated control group.

Results:

4DF had neither a beneficial nor a negative effect on necessity of drainages, drainage volume and duration, length of hospital stay or frequency of postoperative seromas, wound healing disturbances, and infections, independent of surgical intervention. Patients in the 4DF group, however, had more individual risk factors, and required extended surgical interventions that might mask primary outcome results.

Conclusions:

This is the first prospective, monocentric, randomized study on 4DF in body-contouring surgery. The use of 4DF did not lead to a better postoperative outcome regarding hemostasis and lymphostasis. Potential benefits need further evaluation in high-volume studies.