bluuebunny/crossref_metadata_2025 huggingface dataset:
New populations of the black-flanked rock-wallaby (Petrogale lateralis) from the Little Sandy Desert and Murchison, Western Australia
Authors: Turpin J. M. , White N. E. , Dunlop J. A. , Bamford M. J.
Published: February 2018

During two independent fauna surveys, rock-wallaby (Petrogale) scats were recorded from caves located outside the current known Petrogale distribution. Scats collected from Desert Queen Baths (Little Sandy Desert, Western Australia, 2012), and the Barr Smith Range (Murchison, Western Australia, 2015) were genetically analysed and a follow-up motion camera survey confirmed an extant rock-wallaby population at Desert Queen Baths. The combination of sampling techniques overcame the detection difficulties associated with rare and cryptic taxa, and together were important in establishing the presence of Petrogale lateralis from regions where the species has been poorly documented. At both locations, P. lateralis scats were recorded from deep caves situated close to permanent water, reflecting the species’ physiological constraints in the arid zone. These records represent significant range extensions of a highly threatened macropod.
Dietary rumen-protected arginine and N-carbamylglutamate supplementation enhances fetal growth in underfed ewes
Authors: Sun Lingwei , Zhang Hao , Wang Ziyu , Fan Yixuan , Guo Yixuan , Wang Feng
Published: February 2018

The present study was conducted with an ovine intrauterine growth restriction (IUGR) model to test the hypothesis that dietary rumen-protected l-arginine (RP-Arg) or N-carbamylglutamate (NCG) supplementation in underfed ewes is effective in enhancing fetal growth. Between Days 35 and 110 of pregnancy, 32 multiparous ewes carrying two fetuses were randomly assigned to one of four groups: a control (CG) group (n = 8; 100% National Research Council (NRC) requirements for pregnant sheep), a nutrient-restricted (RG) group (n = 8; fed 50% NRC requirements, and two treatment (ARG and NCG) groups (n = 8 in each group; fed 50% NRC requirements supplemented with 20 g day−1 RP-Arg or 5 g day−1 NCG. All ewes were killed on Day 110 of pregnancy to determine fetal weight and fetal organ weights, and metabolites and hormones in fetal plasma, amino acid concentrations in the fetal liver and longissimus dorsi muscle, and expression of mRNAs in the somatotropic axis. Maternal and fetal bodyweight and the weight of most fetal organs expressed as a percentage of bodyweight increased in response to ARG and NCG compared with values for fetuses from RG ewes. Fetal plasma concentrations of insulin, insulin-like growth factor 1, total amino acids, lactate, thyroxine, and the thyroxine/tri-iodothyronine ratio were lower in fetuses from RG ewes compared with the other treatment groups, but concentrations of growth hormone, non-esterified fatty acids, and total cholesterol were greater in fetuses from RG ewes. Maternal RP-Arg or NCG supplementation increased concentrations of amino acids in fetal tissues and expression of mRNAs for somatotropic axis proteins in fetuses from RG ewes. These findings suggest that maternal RP-Arg and NCG supplementation of underfed ewes decreases fetal IUGR by improving metabolic homeostasis of fetal endocrinology, increasing the availability of amino acids in the fetal liver and longissimus dorsi muscle and affecting the expression of somatotropic axis genes.
Social media in/and the politics of the European Union
Authors: Krzyżanowski Michał
Published: February 2018

This paper looks at how social/online media – using the example of Twitter – are used in the politico-organizational communication of the European Union at a time when it faces multiple crises and is in acute need of effectively communicating its politics to the European demos. Proposing a critical discourse framework for the analysis of the politico-organizational use of Twitter, the paper shows that while, to some extent, bringing change or ‘modernization’ to EU political communication patterns, social/online media help in sustaining some of the deep-seated dispositions in EU communicative and organizational practices as well as political discourses. As deployed by the EU’s – and specifically the European Commission’s – spokesperson service, social/online help in solidifying some of the controversial patterns in EU political communication. They also bring in other, more contemporary, challenges as regards using Twitter and social media as parts of political and institutional/organizational communication.
Multiplicative reasoning: teaching primary pupils in ways that focus on functional relations
Authors: Askew Mike
Published: February 2018

This paper examines a problem described as widespread and long‐standing in mathematics education: supporting pupils into multiplicative reasoning, a form of reasoning that has been noted as central to large tracts of secondary mathematics and beyond. Also noted, however, is a persistent perception of multiplicative situations only in terms of repeated addition – a perception held not only primary pupils, but also among primary teachers and curriculum developers. The focus of this paper is to synthesize literature on multiplicative reasoning as a conceptual field together with a sociocultural discussion of the role of mediating artifacts in the development of this conceptual field. Bringing MR into the primary classroom can then be achieved, I propose, through a pedagogy oriented toward model‐eliciting and teacher appropriation of pupils’ models as pedagogic tools with the subsequent re‐appropriation of refined models by pupils. This pedagogy is illustrated through the analysis of two vignettes from a teaching experiment which demonstrate the beginnings of MR as an emergent conceptual field in the classroom. The paper concludes that it is possible to move primary teaching and learning toward understanding the functional aspects of multiplicative reasoning, but that any such moves requires attention to teachers’ pedagogic and content knowledge.
Large‐scale isolation and cytotoxicity of extracellular vesicles derived from activated human natural killer cells
Authors: Jong Ambrose Y. , Wu Chun‐Hua , Li Jingbo , Sun Jianping , Fabbri Muller , Wayne Alan S. , Seeger Robert C.
Published: February 2018

Extracellular vesicles (EVs) have been the focus of great interest, as they appear to be involved in numerous important cellular processes. They deliver bioactive macromolecules such as proteins, lipids, and nucleic acids, allowing intercellular communication in multicellular organisms. EVs are secreted by all cell types, including immune cells such as natural killer cells (NK), and they may play important roles in the immune system. Currently, a large‐scale procedure to obtain functional NK EVs is lacking, limiting their use clinically. In this report, we present a simple, robust, and cost‐effective method to isolate a large quantity of NK EVs. After propagating and activating NK cells ex vivo and then incubating them in exosome‐free medium for 48 h, EVs were isolated using a polymer precipitation method. The isolated vesicles contain the tetraspanin CD63, an EV marker, and associated proteins (fibronectin), but are devoid of cytochrome C, a cytoplasmic marker. Nanoparticle tracking analysis showed a size distribution between 100 and 200 nm while transmission electron microscopy imaging displayed vesicles with an oval shape and comparable sizes, fulfilling the definition of EV. Importantly, isolated EV fractions were cytotoxic against cancer cells. Furthermore, our results demonstrate for the first time that isolated activated NK (aNK) cell EVs contain the cytotoxic proteins perforin, granulysin, and granzymes A and B, incorporated from the aNK cells. Activation of caspase ‐3, ‐7 and ‐9 was detected in cancer cells incubated with aNK EVs, and caspase inhibitors blocked aNK EV‐induced cytotoxicity, suggesting that aNK EVs activate caspase pathways in target cells. The ability to isolate functional aNK EVs on a large scale may lead to new clinical applications.

Abbreviations: NK: natural killer cells; activated NK (aNK) cells; EVs: extracellular vesicles; ALL: acute lymphoblastic leukaemia; aAPC: artificial antigen‐presenting cell; TEM: transmission electron microscope; PBMC: peripheral blood mononuclear cells; FBS: foetal bovine serum.
Extracellular vesicles yield predictive pre‐eclampsia biomarkers
Authors: Tan Kok Hian , Tan Soon Sim , Ng Mor Jack , Tey Wan Shi , Sim Wei Kian , Allen John Carson , Lim Sai Kiang
Published: February 2018

Circulating extracellular vesicles (EVs) such as cholera toxin B chain (CTB)‐ or annexin V (AV)‐binding EVs were previously shown to be rich sources of biomarkers. Here we test if previously identified pre‐eclampsia (PE) candidate biomarkers, TIMP‐1 in CTB‐EVs (CTB‐TIMP) and PAI‐1 in AV‐EVs (AV‐PAI) complement plasma PlGF in predicting PE in a low‐risk obstetric population. Eight hundred and forty‐three prospectively banked plasma samples collected at 28 + 0 to 32 + 0 gestation weeks in the Neonatal and Obstetrics Risk Assessment (NORA) cohort study were assayed by sandwich ELISAs for plasma PlGF, CTB‐TIMP1 and AV‐PAI1. Nineteen patients subsequently developed PE 7.3 (±2.9) weeks later at a mean gestational age of 36.1 ± 3.5 weeks. The biomarkers were assessed for their predictive accuracy for PE using stepwise multivariate logistic regression analysis with Firth correction and Areas under the curve (AUC). To achieve 100% sensitivity in predicting PE, the cut‐off for plasma PlGF, CTB‐TIMP1 & AV‐PAI1 were set at <1235, ≤300 or >1300 and <10,550 pg/mL plasma, respectively. The corresponding AUCs, specificity and PPV at a 95% confidence interval were 0.92, 52.1% and 4.7%; 0.72, 44.5% and 4.0%; and 0.69, 21.5% and 2.9%, respectively. At 100% sensitivity, the three biomarkers had a combined AUC of 0.96, specificity of 78.6%, and PPV of 9.9%.

This is the first large cohort validation of the utility of EV‐associated analytes as disease biomarkers. Specifically, EV biomarkers enhanced the predictive robustness of an existing PE biomarker sufficiently to justify PE screening in a low‐risk general obstetric population.
The Cdx2 homeobox gene suppresses intestinal tumorigenesis through non–cell-autonomous mechanisms
Authors: Balbinot Camille , Armant Olivier , Elarouci Nabila , Marisa Laetitia , Martin Elisabeth , De Clara Etienne , Onea Alina , Deschamps Jacqueline , Beck Felix , Freund Jean-Noël , Duluc Isabelle
Published: February 2018

Developmental genes contribute to cancer, as reported for the homeobox gene Cdx2 playing a tumor suppressor role in the gut. In this study, we show that human colon cancers exhibiting the highest reduction in CDX2 expression belong to the serrated subtype with the worst evolution. In mice, mosaic knockout of Cdx2 in the adult intestinal epithelium induces the formation of imperfect gastric-type metaplastic lesions. The metaplastic knockout cells do not spontaneously become tumorigenic. However, they induce profound modifications of the microenvironment that facilitate the tumorigenic evolution of adjacent Cdx2-intact tumor-prone cells at the surface of the lesions through NF-κB activation, induction of inducible nitric oxide synthase, and stochastic loss of function of Apc. This study presents a novel paradigm in that metaplastic cells, generally considered as precancerous, can induce tumorigenesis from neighboring nonmetaplastic cells without themselves becoming cancerous. It unveils the novel property of non–cell-autonomous tumor suppressor gene for the Cdx2 gene in the gut.
Copper Nanoparticles: Synthesis and Biological Activity
Authors: Satyvaldiev A S , Zhasnakunov Z K , Omurzak E , Doolotkeldieva T D , Bobusheva S T , Orozmatova G T , Kelgenbaeva Z
Published: February 2018

By means of XRD and FESEM analysis, it is established that copper nanoparticles with sizes less than 10 nm are formed during the chemical reduction, which form aggregates mainly with spherical shape. Presence of gelatin during the chemical reduction of copper induced formation of smaller size distribution nanoparticles than that of nanoparticles synthesized without gelatin and it can be related to formation of protective layer. Synthesized Cu nano-powders have sufficiently high activity against the Erwinia amylovora bacterium, and the bacterial growth inhibition depends on the Cu nanoparticles concentration. At a concentration of 5 mg / ml of Cu nanoparticles, the exciter growth inhibition zone reaches a maximum value within 72 hours and the lysis zone is 20 mm, and at a concentration of 1 mg / ml this value is 16 mm, which also indicates the significant antibacterial activity of this sample.
The coarse geometry of Tsirelson’s space and applications
Authors: Baudier F. , Lancien G. , Schlumprecht Th.
Published: February 2018

The main result of this article is a rigidity result pertaining to the spreading model structure for Banach spaces coarsely embeddable into Tsirelson’s original space

T
∗

T^*

. Every Banach space that is coarsely embeddable into

T
∗

T^*

must be reflexive, and all of its spreading models must be isomorphic to

c
0

c_0

. Several important consequences follow from our rigidity result. We obtain a coarse version of an influential theorem of Tsirelson:

T
∗

T^*

coarsely contains neither

c
0

c_0

nor

ℓ
p

\ell _p

for

p
∈
[
1
,
∞
)

p\in [1,\infty )

. We show that there is no infinite-dimensional Banach space that coarsely embeds into every infinite-dimensional Banach space. In particular, we disprove the conjecture that the separable infinite-dimensional Hilbert space coarsely embeds into every infinite-dimensional Banach space. The rigidity result follows from a new concentration inequality for Lipschitz maps on the infinite Hamming graphs that take values into

T
∗

T^*

, and from the embeddability of the infinite Hamming graphs into Banach spaces that admit spreading models not isomorphic to

c
0

c_0

. Also, a purely metric characterization of finite dimensionality is obtained.
The Tendril Plot—a novel visual summary of the incidence, significance and temporal aspects of adverse events in clinical trials
Authors: Karpefors Martin , Weatherall James
Published: February 2018

Background

In contrast to efficacy, safety hypotheses of clinical trials are not always pre-specified, and therefore, the safety interpretation work of a trial tends to be more exploratory, often reactive, and the analysis more statistically and graphically challenging.

Methods

We introduce a new means of visualizing the adverse event data across an entire clinical trial.

Results

The approach overcomes some of the current limitations of adverse event analysis and streamlines the way safety data can be explored, interpreted and analyzed. Using a phase II study, we describe and exemplify how the tendril plot effectively summarizes the time-resolved safety profile of two treatment arms in a single plot and how that can provide scientists with a trial safety overview that can support medical decision making.

Conclusion

To our knowledge, the tendril plot is the only way to graphically show important treatment differences with preserved temporal information, across an entire clinical trial, in a single view.
A Multicenter Consortium to Define the Epidemiology and Outcomes of Pediatric Solid Organ Transplant Recipients With Inpatient Respiratory Virus Infection
Authors: Danziger-Isakov Lara , Steinbach William J , Paulsen Grant , Munoz Flor M , Sweet Leigh R , Green Michael , Michaels Marian G , Englund Janet A , Murray Alastair , Halasa Natasha , Dulek Daniel E , Madan Rebecca Pellett , Herold Betsy C , Fisher Brian T
Published: February 2018

Background

Respiratory virus infection (RVI) in pediatric solid organ transplant (SOT) recipients poses a significant risk; however, the epidemiology and effects of an RVI after pediatric SOT in the era of current molecular diagnostic assays are unclear.

Methods

A retrospective observational cohort of pediatric SOT recipients (January 2010 to June 2013) was assembled from 9 US pediatric transplant centers. Charts were reviewed for RVI events associated with hospitalization within 1 year after the transplant. An RVI diagnosis required respiratory symptoms and detection of a virus (ie, human rhinovirus/enterovirus, human metapneumovirus, influenza virus, parainfluenza virus, coronavirus, and/or respiratory syncytial virus). The incidence of RVI was calculated, and the association of baseline SOT factors with subsequent pulmonary complications and death was assessed.

Results

Of 1096 pediatric SOT recipients (448 liver, 289 kidney, 251 heart, 66 lung, 42 intestine/multivisceral), 159 (14.5%) developed RVI associated with hospitalization within 12 months after their transplant. RVI occurred at the highest rates in intestine/abdominal multivisceral (38%), thoracic (heart/lung) (18.6%), and liver (15.6%) transplant recipients and a lower rate in kidney (5.5%) transplant recipients. RVI was associated with younger median age at transplant (1.72 vs 7.89 years; P < .001) and among liver or kidney transplant recipients with the receipt of a deceased-donor graft compared to a living donor (P = .01). The all-cause and attributable case-fatality rates within 3 months of RVI onset were 4% and 0%, respectively. Multivariable logistic regression models revealed that age was independently associated with increased risk for a pulmonary complication (odds ratio, 1.24 [95% confidence interval, 1.02–1.51]) and that receipt of an intestine/multivisceral transplant was associated with increased risk of all-cause death (odds ratio, 24.54 [95% confidence interval, 1.69–327.96]).

Conclusions

In this study, hospital-associated RVI was common in the first year after pediatric SOT and associated with younger age at transplant. All-cause death after RVI was rare, and no definitive attributable death occurred.
An NMRA-Like Protein Regulates Gene Expression in Phytophthora capsici to Drive the Infection Cycle on Tomato
Authors: Pham Jasmine , Stam Remco , Heredia Victor Martinez , Csukai Michael , Huitema Edgar
Published: February 2018

Phytophthora spp. cause devastating disease epidemics on important crop plants and pose a grave threat to global crop production. Critically, Phytophthora pathogens represent a distinct evolutionary lineage in which pathogenicity has been acquired independently. Therefore, there is an urgent need to understand and disrupt the processes that drive infection if we aspire to defeat oomycete pathogens in the field. One area that has received little attention thus far in this respect is the regulation of Phytophthora gene expression during infection. Here, we characterize PcNMRAL1 (Phyca11_505845), a homolog of the Aspergillus nidulans nitrogen metabolite repression regulator NMRA and demonstrate a role for this protein in progression of the Phytophthora capsici infection cycle. PcNmrAL1 is coexpressed with the biotrophic marker gene PcHmp1 (haustorial membrane protein 1) and, when overexpressed, extends the biotrophic infection stage. Microarray analyses revealed that PcNmrAL1 overexpression in P. capsici leads to large-scale transcriptional changes during infection and in vitro. Importantly, detailed analysis reveals that PcNmrAL1 overexpression induces biotrophy-associated genes while repressing those associated with necrotrophy. In addition to factors controlling transcription, translation, and nitrogen metabolism, PcNMRAL1 helps regulate the expression of a considerable effector repertoire in P. capsici. Our data suggests that PcNMRAL1 is a transcriptional regulator that mediates the biotrophy to necrotrophy transition. PcNMRAL1 represents a novel factor that may drive the Phytophthora disease cycle on crops. This study provides the first insight into mechanisms that regulate infection-related processes in Phytophthora spp. and provides a platform for further studies aimed at disabling pathogenesis and preventing crop losses.
Development of SNP-Based Markers to Identify Colletotrichum gossypii in Upland Cotton
Authors: Nawaz Hafiz Husnain , Anam Usmani , Rajaofera M. J. Nelly , He Qiguang , Liu Wenbo , Miao Weiguo
Published: February 2018

Colletotrichum gossypii is a causal agent of anthracnose in upland cotton (Gossypii hirsutum). C. gossypii belongs to the C. gloeosporioides species complex. However, the high level of genetic similarity among the species within the C. gloeosporioides species complex makes the development of a diagnostic assay for C. gossypii challenging. Furthermore, the spore size and cultural characteristics of C. gossypii from different geographical areas can vary. In this study, we examined the morphological variance, growth pattern, and pathogenicity of C. gossypii and developed a molecular diagnostic assay to detect C. gossypii in cotton plants from different regions of China. To overcome any ambiguity in morphological and pathogenic characteristics, a set of primers targeting the β-tubulin (TUB) gene of C. gossypii was designed. Single-nucleotide polymorphisms (SNP) were used to identify C. gossypii at the species level using DNA sequence alignments of the TUB gene. The SPSCG/F and SPSCG/R primer pair only amplified C. gossypii, and was able to amplify C. gossypii in mixtures of other Colletotrichum spp., even when DNA concentrations were up to 10 times lower than that of the other species. This is the first report of the development of SNP-based markers for the specific identification of C. gossypii.
The Prevalence of Multiple-Choice Testing in Registered Nurse Licensure-Qualifying Nursing Education Programs in New York State
Authors: Birkhead Susan , Kelman Glenda , Zittel Barbara , Jatulis Linnea
Published: February 2018

AIM

The aim of this study was to describe nurse educators' use of multiple-choice questions (MCQs) in testing in registered nurse licensure-qualifying nursing education programs in New York State.

METHOD

This study was a descriptive correlational analysis of data obtained from surveying 1,559 nurse educators; 297 educators from 61 institutions responded (response rate [RR] = 19 percent), yielding a final cohort of 200.

RESULTS

MCQs were reported to comprise a mean of 81 percent of questions on a typical test. Baccalaureate program respondents were equally likely to use MCQs as associate degree program respondents (p > .05) but were more likely to report using other methods of assessing student achievement to construct course grades (p < .01). Both groups reported little use of alternate format-type questions.

CONCLUSION

Respondent educators reported substantial reliance upon the use of MCQs, corroborating the limited data quantifying the prevalence of use of MCQ tests in licensure-qualifying nursing education programs.
Maternal Malignancy Evaluation After Discordant Cell-Free DNA Results
Authors: Carlson Laura M. , Hardisty Emily , Coombs Catherine C. , Vora Neeta L.
Published: February 2018

Cell-free DNA screening for fetal aneuploidy is a commonly used testing strategy in pregnancies at high risk for fetal aneuploidy. The use of cell-free DNA screening is expanding to the low-risk population, because the detection rate for trisomy 21 surpasses that of traditional screening modalities. Although the sensitivity and specificity of cell-free DNA are superior to traditional screening, false-positive results do occur and may indicate an adverse maternal health condition, including maternal mosaicism or, rarely, malignancy. The risk of maternal cancer is significantly elevated when more than one aneuploidy is detected that is discordant from fetal karyotype. Given this risk as well as the rising incidence of cancer in pregnancy, patient counseling and malignancy evaluation should be considered in women when more than one aneuploidy is detected. We reviewed the published literature and developed an algorithm to evaluate women when these results are identified.
Catholic Health Care and Women's Health
Authors: Guiahi Maryam
Published: February 2018

Catholic health care facilities account for approximately one sixth of the U.S. health care market, have recently demonstrated successful growth, and serve as the only local hospital in certain remote locations. The Ethical and Religious Directives for Catholic Health Care Services is a set of guidelines created and revised by church leaders that applies the church's teaching, particularly as it relates to concern for human dignity, to modern-day medical practice; all Catholic health care facilities and providers within these facilities are required to abide. Strict interpretation of these directives limits family planning and most infertility services. Many women, however, do not anticipate differences to reproductive health care based on Catholic affiliation, and recent patient reports and legal enactments have highlighted the tension that arises when women are unable to receive medically indicated family planning services. In this article, I demonstrate that reproductive health care services are not consistently prohibited and that clinics often do not inform patients when scheduling appointments when restrictions exist. I highlight ethical concerns about patient autonomy as it relates to modern-day practice and recommend solutions including greater transparency and efforts to improve uniformity of practice at Catholic health care facilities.
The Comprehensive Addiction and Recovery Act
Authors: Murphy Jeanne , Goodman Daisy , Johnson M. Christina , Terplan Mishka
Published: February 2018

The federal response to the opioid use disorder crisis has included a mobilization of resources to encourage office-based pharmacotherapy with buprenorphine, an effort culminating in the 2016 Comprehensive Addiction and Recovery Act, signed into law as Public Law 114-198. The Comprehensive Addiction and Recovery Act was designed to increase access to treatment with special emphasis on services for pregnant women and follow-up for infants affected by prenatal substance exposure. In this effort, the Comprehensive Addiction and Recovery Act laudably expands eligibility for obtaining a waiver to prescribe buprenorphine to nurse practitioners and physician assistants. However, certified nurse–midwives and certified midwives, who care for a significant proportion of pregnant and postpartum women and attend a significant proportion of births in the United States, were not included in the Comprehensive Addiction and Recovery Act legislation. In this commentary, we argue that an “all-hands” approach to providing office-based medication-assisted treatment for opioid use disorder is essential to improving access to treatment. Introduced in the House of Representatives in September 2017, the Addiction Treatment Access Improvement Act (H.R. 3692) would allow midwives to apply for the federal waiver to prescribe buprenorphine and is supported by the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives. We support this change and encourage the U.S. Congress to act quickly to allow midwives to prescribe medication-assisted treatment for pregnant women with opioid use disorder.
Delayed Presentation of Cecal Perforation With Tension-Free Vaginal Tape
Authors: Mayhew Allison C. , Ford Alexcis T. , Northington Gina M. , Shaffer Virginia O. , Kelley Robert S.
Published: February 2018

BACKGROUND:

Tension-free vaginal tape (TVT) is a popular operative treatment for stress urinary incontinence (SUI). It has a low risk of adverse events, and injuries, particularly to the bowel, are rare. Case reports that have previously discussed these injuries and subsequent removal of TVT have not provided additional insight into management of SUI after these injuries occur.

CASE:

A postmenopausal woman with persistent SUI presented more than 1 year after TVT placement with bowel perforation incidentally discovered on routine screening colonoscopy. She underwent removal of the TVT and subsequent placement of a fascial sling with postoperative resolution of SUI.

CONCLUSION:

This case provides additional evidence for bowel injury as a postoperative TVT complication and describes an approach to complicated TVT and persistent SUI.
Cancer Risk After Midurethral Sling Surgery Using Polypropylene Mesh
Authors: Altman Daniel , Rogers Rebecca G. , Yin Li , Tamussino Karl , Ye Weimin , Iglesia Cheryl B.
Published: February 2018

OBJECTIVE:

To assess whether there is any association between the implantation of synthetic polypropylene mesh slings for the treatment of stress urinary incontinence (SUI) and risk of cancer.

METHODS:

We performed a nationwide cohort study based on the general female population in Sweden. All women entered the observational period as unexposed on January 1, 1997, and contributed person-time as unexposed unless they underwent a midurethral sling procedure for SUI, after which they contributed person-time as exposed until first occurrence of any cancer, death, emigration, or end of the observational period (December 31, 2009). Occurrence of primary cancer was ascertained from the Cancer Register. Hazard ratios (HRs) with 95% CIs were calculated by Cox proportional hazards regression.

RESULTS:

The final study population included 5,385,186 women, including 20,905 exposed, encompassing a total of 44,012,936 person-years at risk. Other than an inverse association with rectal cancer (HR 0.5, 95% CI 0.3–0.8), there were no significant differences in risk between exposed and unexposed women for pelvic organ cancers including ovarian (HR 0.8, 95% CI 0.5–1.2), endometrial (HR 1.1, 95% CI 0.8–1.4), cervical (HR 0.4, 95% CI 0.2–1.0), bladder, and urethra (HR 0.7, 95% CI 0.4–1.2). No significant association was observed between exposed women and primary cancer in any organ system when compared with unexposed women. The relative risk for cancer after exposure showed little variation over time except for an inverse overall correlation within the first 4 years of surgery (HR 0.7, 95% CI 0.7–0.8). The incidence rates per 100,000 person-years (95% CIs) for exposed vs unexposed women were 20.5 (14.3–29.5) vs 21.0 (20.6–21.5) for rectal cancer, 25.5 (18.4–35.3) vs 19.8 (19.4–20.2) for ovarian cancer, 65.0 (53.0–79.8) vs 33.1 (32.6–33.7) for endometrial cancer, 5.7 (2.8–11.3) vs 11.9 (11.6–12.2) for cervical cancer, and 19.1 (13.1–27.8) vs 13.3 (13.0–13.7) for bladder and urethra cancer.

CONCLUSION:

Our results suggest that midurethral polypropylene sling surgery for SUI is not associated with an increased cancer risk later in life.
A Population-Based Study of Complications After Colorectal Surgery in Patients Who Have Received Bevacizumab
Authors: Baxter Nancy N. , Fischer Hadas D. , Richardson Devon P. , Urbach David R. , Bell Chaim M. , Rochon Paula , Brade Anthony , Earle Craig C.
Published: February 2018

BACKGROUND:

Patients receiving Bevacizumab, a vascular endothelial growth factor inhibitor used to treat metastatic colorectal cancer, may be at greater risk of complications after colorectal surgery because of impaired healing.

OBJECTIVE:

The purpose of this study was to describe population-based rates of complications of colorectal surgery after Bevacizumab treatment and evaluate the relationship between time since last treatment and risk of complications.

DESIGN:

This was a population-based retrospective cohort study using administrative and cancer registry data.

SETTINGS:

The study was conducted in Ontario, Canada.

PATIENTS:

Patients with metastatic colorectal cancer receiving Bevacizumab between January 2008 and December 2011 were followed for a year after treatment or until death.

MAIN OUTCOME MEASURES:

Administrative data were used to identify patients who underwent colorectal surgery after initiation of Bevacizumab and to determine whether they experienced a complicated postoperative course. The relationship between time since last Bevacizumab treatment (≤28 d, 29 d to 3 mo, and >3 mo) and risk of postoperative complications was evaluated using logistic regression.

RESULTS:

Of the 2759 patients who received Bevacizumab for the treatment of metastatic colorectal cancer, 265 underwent a colorectal procedure after exposure. The majority had a bowel resection or repair with no stoma (47.5%) and had emergency surgery (61.1%). Overall, 96 (36.2%) had a complicated postoperative course, including 20.4% readmission, 12.5% wound complications, and 7.9% mortality rate within 30 days of surgery. Adjusted multivariate analysis showed no difference in the likelihood of a complicated postoperative course among patients undergoing surgery within 28 days of receiving their last Bevacizumab dose compared with 29 days to 3 months (OR = 1.23 (95% CI, 0.53–2.84), or 3 to 12 months (OR = 0.98 (95% CI, 0.46–2.09) after receiving Bevacizumab.

LIMITATIONS:

Reliance on administrative data to measure complications limited the scope of this study.

CONCLUSIONS:

Patients with metastatic colorectal cancer requiring colorectal surgery after exposure to Bevacizumab experience substantial morbidity and mortality. The risk of complications is not detectably associated with time since exposure. See Video Abstract at http://links.lww.com/DCR/A474.
Challenges in Transition of Care for Patients With Anorectal Malformations: A Systematic Review and Recommendations for Comprehensive Care
Authors: Cairo Sarah B. , Gasior Alessandra , Rollins Michael D. , Rothstein David H.
Published: February 2018

BACKGROUND:

Anorectal malformations are one of the most common congenital intestinal anomalies affecting newborns. Despite advances in neonatal care and surgical techniques, many patients with a history of anorectal malformations are affected by long-term challenges involving bowel and bladder dysfunction, sexual dysfunction, and psychosocial issues. These outcomes or challenges are additionally exacerbated by the lack of a structured transition of care from the pediatric to the adult setting.

OBJECTIVE:

The purpose of this review is to describe the long-term outcomes affecting patients with a history of anorectal malformations, review the current literature on transition of care, and make recommendations for developing a standardized program for transitioning care for a select group of colorectal surgical patients.

DATA SOURCES:

An extensive PubMed review of articles in English was performed to evaluate current best practices for chronic illnesses of childhood with residual symptoms or need for medical care into adulthood.

STUDY SELECTION:

Meta-Analysis of Observational Studies in Epidemiology group guidelines were followed.

MAIN OUTCOME MEASURES:

The primary outcome for this review was the existence of transitional services for patients with a history of anorectal malformations and evaluations of long-term outcomes affecting patients with a history of anorectal malformations.

RESULTS:

Systematic review revealed improved results in transition programs as determined by patient follow-up, medication adherence, and patient and family satisfaction through the use of multidisciplinary teams. Standardized tools for assessing all aspects of patient outcomes and quality of life are essential for describing the burden of disease affecting a transitioning population.

LIMITATIONS:

This is a retrospective review of the current status of a complex and rapidly evolving field of delivery of care. More work is needed to apply uniform approaches and assess the impact, patient outcomes, and quality of life.

CONCLUSIONS:

Patients who undergo childhood procedures for anorectal malformations often experience chronic symptoms related to the bowel, bladder, and reproductive organs, as well as psychosocial disturbances. This population will benefit from appropriate engagement in transitional care plans. See Video Abstract at http://links.lww.com/DCR/A543.
Corneal Biomechanical Properties in Obstructive Sleep Apnea Syndrome
Authors: Dikkaya Funda , Yildirim Rengin , Erdur Sevil Karaman , Benbir Gülçin , Aydin Rukiye , Karadeniz Derya
Published: February 2018

Objectives:

To investigate the corneal biomechanical properties and anterior segment parameters in patients with obstructive sleep apnea syndrome (OSAS).

Methods:

Fifty-four eyes of 54 patients with OSAS and 20 eyes of 20 healthy subjects were included. Patients with mild and moderate OSAS (Respiratory Disturbance Index [RDI] <30) enrolled in group 1, those with severe OSAS (RDI≥30) in group 2 and controls in group 3. Corneal biomechanical properties including corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) were measured with ocular response analyzer. Maximum (Kmax), minimum (Kmin), and mean simulated (SimKm) keratometry values, corneal astigmatism (CA), and central corneal thickness (CCT) were evaluated with Pentacam Scheimpflug imaging.

Results:

The mean CH and CRF were significantly lower in group 2. The mean CH was 10.9±1.4 mm Hg in group 1, 10.1±1.1 mm Hg in group 2, and 12.1±1.2 mm Hg in group 3 (P<0.001). The mean CRF was 11.1±1.8 mm Hg in group 1, 9.9±1.1 mm Hg in group 2, and 12.2±1.2 mm Hg in group 3 (P<0.001). The CH and CRF values were similar between the groups 1 and 3 (P=0.867 and P=0.743). Corneal-compensated intraocular pressure, IOPg, Kmax, Kmin, SimKm, CA, and CCT values were not statistically different among the three groups.

Conclusions:

Patients with severe OSAS had lower CH and CRF values. The lower CH and CRF values in the severe group were possibly related to changes of the structural properties in the cornea.
Lesions on the Lower Eyelids
Authors: No Daniel J. , Jacob Sharon E.
Published: February 2018

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of lesions on the lower eyelids.
Nurse Practitioner Student Knowledge and Attitudes Toward Skin Cancer Assessments
Authors: Woodmansee Ryan , Turnage Dawn , Loerzel Victoria
Published: February 2018

Early detection and treatment of skin cancer is directly related to patient outcomes. However, little is known about how prepared nurse practitioner students are to assess and manage skin lesions. Therefore, the purpose of this study was to assess nurse practitioner student knowledge to determine how well they are being prepared to perform skin cancer assessments. This exploratory, descriptive study surveyed 20 nurse practitioner students about their knowledge, attitudes, and confidence in identifying different skin lesions. Most participants had average knowledge scores related to general skin cancer knowledge (6.4/13 correct) and photo lesion identification (9.65/20 correct). Most students felt they lacked enough dermatology training to prepare them for practice. Most students did not feel confident performing skin cancer assessments, had a hard time differentiating between benign and malignant lesions, and would rather refer patients to a specialist for diagnosis. Nurse practitioner curricula should consider allotting more time for dermatology topics, especially learning to recognize whether a lesion is benign or malignant.
Clusterin in Neuroendocrine Epithelial Neoplasms: Absence of Expression in a Well-differentiated Tumor Suggests a Jejunoileal Origin
Authors: Czeczok Thomas W. , Stashek Kristen M. , Maxwell Jessica E. , O’Dorisio Thomas M. , Howe James R. , Hornick Jason L. , Bellizzi Andrew M.
Published: February 2018

Clusterin, a widely expressed, tissue-specific glycoprotein, is a diagnostic marker of several tumor types, including anaplastic large cell lymphoma, follicular dendritic cell sarcoma, and tenosynovial giant cell tumor. A recent study has suggested it is highly expressed by well-differentiated neuroendocrine tumors (NET) arising at most anatomic sites, with the exception of jejunoileal tumors, and that it is similarly not expressed by poorly differentiated neuroendocrine carcinomas (NEC). We sought to validate this result in a large cohort of NETs and NECs. Clusterin immunohistochemistry was performed on tissue microarrays of 255 NETs [45 lung, 4 stomach, 8 duodenum, 75 pancreas (62 primary, 13 metastatic), 107 jejunoileum (69 primary, 38 metastatic), 16 appendix] and 88 NECs (43 visceral, 45 Merkel cell). Extent (%) and intensity (0, 1+, 2+, 3+) of staining were assessed and an H-score (extent x intensity) calculated. An average H-score >5 was considered positive. Clusterin expression was noted in 82.4% of 148 nonjejunoileal NETs (average H-score 183) and only 8.4% of 107 jejunoileal NETs (average H-score, 31), as well as 19.3% of NECs (average H-score, 36). Clusterin is frequently, strongly expressed by NETs of diverse anatomic sites, with the exception of jejunoileal tumors, in which it is only rarely, weakly expressed. It is occasionally, weakly expressed by NECs. Most metastatic NETs of occult origin arise in the pancreas or the jejunoileum. For cases in which an initial site of origin immunopanel (eg, islet 1, PAX6, CDX2) is ambiguous, addition of clusterin may be diagnostically useful, with absence of expression suggesting a jejunoileal origin.
Examining the Relationship of an All-Cause Harm Patient Safety Measure and Critical Performance Measures at the Frontline of Care
Authors: Sammer Christine , Hauck Loran D. , Jones Cason , Zaiback-Aldinger Julie , Li Michael , Classen David
Published: February 2018

Background

In 2015, the Institute of Medicine Vital Signs report called for a new patient safety composite measure to lessen the reporting burden of patient harm. Before this report, two patient safety organizations had developed an electronic all-cause harm measurement system leveraging data from the electronic health record, which identified and grouped harms into five broad categories and consolidated them into one all-cause harm outcome measure.

Objectives

The objective of this study was to examine the relationship between this all-cause harm patient safety measure and the following three performance measures important to overall hospital safety performance: safety culture, employee engagement, and patient experience.

Methods

We studied the relationship between all-cause harm and three performance measures on eight inpatient care units at one hospital for 7 months.

Results

The findings demonstrated strong correlations between an all-cause harm measure and patient safety culture, employee engagement, and patient experience at the hospital unit level. Four safety culture domains showed significant negative correlations with all-cause harm at a P value of 0.05 or less. Six employee engagement domains were significantly negatively correlated with all-cause harm at a P value of 0.01 or less, and six of the ten patient experience measures were significantly correlated with all-cause harm at a P value of 0.05 or less.

Conclusions

The results show that there is a strong relationship between all-cause harm and these performance measures indicating that when there is a positive patient safety culture, a more engaged employee, and a more satisfying patient experience, there may be less all-cause harm.
Modified Lengthening Temporalis Myoplasty Involving an Extended Lazy-S Incision to Avoid Facial Scar Formation
Authors: Oji Tomito , Hayashi Akiteru , Ogino Akihiro , Onishi Kiyoshi
Published: February 2018

Background:

Lengthening temporalis myoplasty is a faster and less invasive alternative to free muscle transfer for smile reconstruction. However, it requires a nasolabial fold incision, which leaves a midfacial scar. Based on esthetic considerations, a modified approach, involving an extended lazy-S (parotidectomy) incision instead of a nasolabial fold incision, was developed.

Methods:

A cadaveric study involving 10 hemifaces was conducted. From February 2013 to March 2016, the modified lengthening temporalis myoplasty procedure was employed in 10 patients. The results were graded from 1 (poor) to 5 (excellent) according to the Terzis grading system. The excursion of the oral commissure was also measured.

Results:

The extended lazy-S incision provides easy and safe access to the coronoid process and good visibility. The patients’ mean age was 56.5 years, and the mean duration of the postoperative follow-up period was 22.2 months. The patients’ underlying conditions included acoustic neuroma (n = 2), Bell palsy (n = 3), congenital conditions (n = 2), brain infarction (n = 1), Ramsay Hunt syndrome (n = 1), and malignant parotid lymphoma (n = 1). One patient suffered a surgical site infection, which was successfully treated with irrigation. All the patients achieved improvements in smile symmetry: 2, 5, and 3 patients obtained excellent, good, and moderate results, respectively. The excursion of the oral commissure ranged from 5 to 10 mm.

Conclusion:

The modified lengthening temporalis myoplasty procedure provides satisfactory functional outcomes without causing significant complications. It does not leave a facial scar and is a preferable option, especially for young and female patients, and patients who have undergone ablative surgery involving the parotid region.
Clinical Outcomes of Digital Three-Dimensional Hydroxyapatite in Repairing Calvarial Defects
Authors: Chen Hongbo , Sun Jiaming , Wang Jie-cong
Published: February 2018

Purpose:

The objective of this article is to present the long-term outcomes of digital three-dimensional (3D) hydroxyapatite (HA) implants used for calvarial defects. Porous HA provide good results and have many characteristics, making it suitable for calvarial defect reconstruction. However, using HA may be associated with potentially serious complications, including infection and exposure. The authors used digital 3D HA for cranioplasty for many years and accumulated considerable experience from using it. The authors found that digital 3D HA is an effective method for cranioplasty, showing low complication rate.

Methods:

A total of 57 patients underwent calvarial defect reconstruction with 3D HA from June 2009 to August 2016. The follow-up period was 1 to 5 years.

Results:

Most patients (91.2%) were greatly satisfied with the esthetic outcomes of the surgery. The highest rate of complication was seroma (8.8%). Two patients developed postoperative infections (3.5%). One patient with infections was successfully treated with antibiotic therapy. Another patient was required to undergo an extensive surgical debridement followed by delayed autogenous bone reconstruction. One patient suffered from implant exposure. No hematoma, unexpected fractures, asymmetry, and contour or implant abnormalities occurred.

Conclusions:

The digital 3D HA implant was highly biocompatible and durable for the reconstruction of calvarial defects. With appropriate treatment, the proposed method was able to achieve a functional and cosmetic reconstruction with lesser complications.
A Rare Cause of Objective Tinnitus: Jugular Diverticulum
Authors: Gözen Emine Deniz , Erdur Zülküf Burak , Karaman Emin , Yener Murat , Kizilkiliç Osman
Published: February 2018

The jugular bulb is a venous structure linking the sigmoid sinus with the internal jugular vein. Jugular diverticulum is a rare condition characterized by extraluminal outpouching from the jugular bulb. As the patients may be totally asymptomatic, but sensorineural symptoms such as sensorineural hearing loss, tinnitus and vertigo can also occur. Diagnosis of these patients can be made by some radiologic methods such as high-resolution computerized tomography, magnetic resonance imaging, or a novel radiologic technique flat panel computed tomography. In this paper we report a 22-year-old female patient with jugular diverticulum presenting with tinnitus complaint.