bluuebunny/crossref_metadata_2025 huggingface dataset:
Overrepresentation of Injection Drug Use Route of Infection Among Human Immunodeficiency Virus Long-term Nonprogressors: A Nationwide, Retrospective Cohort Study in China, 1989–2016
Authors: Han Jing , Wu Zunyou , McGoogan Jennifer M , Mao Yurong , Tang Houlin , Li Jian , Zhao Yan , Jin Cong , Detels Roger , Brookmeyer Ron , Lima Viviane D , Montaner Julio S G
Published: May 2019

Background

Why some persons living with human immunodeficiency virus (HIV) (PLWH) progress quickly and others remain “healthy” for a decade or more without treatment remains a fundamental question of HIV pathology. We aimed to assess the epidemiological characteristics of HIV long-term nonprogressors (LTNPs) based on a cohort of PLWH in China observed between 1989 and 2016.

Methods

We conducted a nationwide, retrospective cohort study among Chinese PLWH with HIV diagnosed before 1 January 2008. Records were extracted from China’s national HIV/AIDS database on 30 June 2016. LTNPs were defined as those with AIDS-free, antiretroviral therapy–naive survival, with CD4 cell counts consistently ≥500/μL for ≥8 years after diagnosis. Prevalence was calculated, characteristics were described, and determinants were assessed by means of logistic regression. Potential sources of bias were also investigated.

Results

Our cohort included 89 201 participants, of whom 1749 (2.0%) were categorized as LTNPs. The injection drug use (IDU) route of infection was reported by 70.7% of LTNPs, compared with only 37.1% of non-LTNPs. The odds of LTNP status were greater among those infected via IDU (adjusted odds ratio [95% confidence interval], 2.28 [1.94–2.68]) and with HIV diagnosed in settings with large populations of persons who inject drugs (1.75 [1.51–2.02] for detention centers, 1.61 [1.39–1.87] for Yunnan, 1.94 [1.62–2.31] for Guangdong, and 2.90 [2.09–4.02] for Xinjiang).

Conclusions

Overrepresentation of the IDU route of infection among LTNPs is a surprising finding worthy of further study, and this newly defined cohort may be particularly well suited to exploration of the molecular biological mechanisms underlying HIV long-term nonprogression.
APPLICATION OF THE FOREST SHIELDING FACTOR TO THE MAXIMUM-LIKELIHOOD EXPECTATION MAXIMIZATION METHOD FOR AIRBORNE RADIATION MONITORING
Authors: Sasaki M , Sanada Y , Yamamoto A
Published: May 2019

The maximum-likelihood expectation maximization (ML-EM) method is expected to improve the accuracy of airborne radiation monitoring using an unmanned aerial vehicle. The accuracy of the ML-EM method depends on various parameters, including detector efficiency, attenuation factor, and shielding factor. In this study, we evaluate the shielding factor of trees based on several field radiation measurements. From the actual measurement, the shielding factors were well correlated with the heights of the trees. The evaluated shielding factors were applied to the ML-EM method in conjunction with the measured data obtained from above the Fukushima forest. Compared with the conventional methods used for calculating the dose rate, the proposed method is found to be more reliable.
Warm-season annual forages in forage-finishing beef systems: I. Forage yield and quality
Authors: Harmon Deidre D , Hancock Dennis W , Stewart Robert L , Lacey Jenna L , Mckee Robert W , Hale John D , Thomas Chevise L , Ford Elyse , Segers Jacob R , Teutsch Chris D , Stelzleni Alexander M
Published: May 2019

The demand for a year-round supply of fresh, locally grown, forage-finished beef products has created a need for forage-finishing strategies during the summer months in the southeast. A 3-yr study was conducted to evaluate four warm-season annual forages in a southeastern forage-finishing beef production system. Treatments were four forage species and included brown-midrib sorghum × sudangrass (Sorghum bicolor var. bicolor*bicolor var. sudanense; BMR), sorghum × sudangrass (SS), pearl millet [Pennisetum glaucum (L.) R. Br.; PM], or pearl millet planted with crabgrass [Digitaria sanguinalis (L.) Scop.; PMCG]. Treatments were distributed in a randomized complete block design with four replicates. Pastures (0.81 ha, experimental unit) were assigned to one of four forage treatments, subdivided, and rotationally stocked with a variable stocking density. British-cross beef steers (n = 32; 3-yr average: 429 ± 22 kg) grazed for 70, 63, and 56 d in 2014, 2015, and 2016, respectively. Put-and-take animals were used to maintain a forage allowance of 116 kg forage dry matter /100 kg body weight. Forage mass was measured by clipping a 4.3-m2 area in triplicate on d 0 and on 14-d intervals. Hand grab samples for forage nutritive value determination and quadrat clippings for species compositions were measured on d 0 and on 34-d intervals until termination of the trial. Forage mass was lowest (P < 0.01) for PMCG at the initiation of the grazing trial, whereas BMR was greater (P < 0.01) than SS at wk 6. Total digestible nutrients in 2014 were greater for SS compared to BMR and PM at the middle harvest (P < 0.01) and BMR, PM, and PMCG at the final harvest (P < 0.01). At the middle and final harvests in both 2015 and 2016, PM and PMCG contained greater (P < 0.01) concentrations of crude protein than SS. These results suggest that BMR, SS, PM, and PMCG may all be used in southeastern forage-finishing beef production systems, as long as the producer strategically accounts for the slight growth and nutritive value differences throughout the season.
The Trial of Convoy PQ17 and the Royal Navy in Post-War British Cultural Memory
Authors: Houghton Frances
Published: May 2019

This article explores the 1970 case of Broome v. Cassell & Co. in which an elderly wartime naval officer was awarded unprecedented damages for defamation in David Irving’s account of the sinking of wartime Allied convoy PQ17 in 1942. The article examines the discourses and images deployed in this landmark British libel action, as a means of analysing how cultural memories of convoy PQ17 and the wartime Royal Navy were shaped and transmitted in post-war Britain. It is argued here that the trial offers a prism through which to explore wider anxieties that the generation who fought the Second World War held during the late 1960s. It maps how contemporary generational tensions, fears of national decline, and concerns about distorted cultural representations of war in Britain were embedded into the trial. This libel case thus became invested with considerable cultural significance among an ageing community of wartime survivors who were intent upon safeguarding wider memories of ‘their’ war.
Primitive Neuroectodermal Tumor in a Child with Human Immunodeficiency Virus Infection: A Rare Association
Authors: Gupta Aman , Bhattarai Dharmagat , Thapa Bishnu Kumar , Parkhi Mayur , Vignesh Pandiarajan , Vasishta Rakesh K , Tripathi Manjul , Vyas Sameer , Gupta Anju
Published: May 2019

Children with human immunodeficiency virus (HIV) infection are reported to have various malignancies, most common being Non-Hodgkin lymphoma. Despite higher risk of malignancies, brain tumors are infrequently described in these children. We report Primitive Neuroectodermal tumor (PNET) in a young boy with HIV infection. PNET has never been described in association with HIV infection. Though a causative association cannot be established, it does emphasize that with longer survivals on effective antiretroviral therapy, we may see a wide range of malignancies more frequently.
Why viruses sometimes disperse in groups†
Authors: Sanjuán Rafael , Thoulouze María-Isabel
Published: May 2019

Many organisms disperse in groups, yet this process is understudied in viruses. Recent work, however, has uncovered different types of collective infectious units, all of which lead to the joint delivery of multiple viral genome copies to target cells, favoring co-infections. Collective spread of viruses can occur through widely different mechanisms, including virion aggregation driven by specific extracellular components, cloaking inside lipid vesicles, encasement in protein matrices, or binding to cell surfaces. Cell-to-cell viral spread, which allows the transmission of individual virions in a confined environment, is yet another mode of clustered virus dissemination. Nevertheless, the selective advantages of dispersing in groups remain poorly understood in most cases. Collective dispersal might have emerged as a means of sharing efficacious viral transmission vehicles. Alternatively, increasing the cellular multiplicity of infection may confer certain short-term benefits to viruses, such as overwhelming antiviral responses, avoiding early stochastic loss of viral components required for initiating infection, or complementing genetic defects present in different viral genomes. However, increasing infection multiplicity may also entail long-term costs, such as mutation accumulation and the evolution of defective particles or other types of cheater viruses. These costs and benefits, in turn, should depend on the genetic relatedness among collective infectious unit members. Establishing the genetic basis of collective viral dispersal and performing controlled experiments to pinpoint fitness effects at different spatial and temporal scales should help us clarify the implications of these spread modes for viral fitness, pathogenicity, and evolution.
The Role of SreA-Mediated Iron Regulation in MaintainingEpichloë festucae–Lolium perenneSymbioses
Authors: Forester Natasha T. , Lane Geoffrey A. , McKenzie Catherine M. , Lamont Iain L. , Johnson Linda J.
Published: May 2019

In ascomycetes and basidiomycetes, iron-responsive GATA-type transcriptional repressors are involved in regulating iron homeostasis, notably to prevent iron toxicity through control of iron uptake. To date, it has been unknown whether this iron regulator contributes toward mutualistic endosymbiosis of microbes with plants, a system where the endophyte must function within the constraints of an in-host existence, including a dependency on the host for nutrient acquisition. Functional characterization of one such protein, SreA from Epichloë festucae, a fungal endosymbiont of cool-season grasses, indicates that regulation of iron homeostasis processes is important for symbiotic maintenance. The deletion of the sreA gene (ΔsreA) led to iron-dependent aberrant hyphal growth and the gradual loss of endophyte hyphae from perennial ryegrass. SreA negatively regulates the siderophore biosynthesis and high-affinity iron uptake systems of E. festucae, similar to other fungi, resulting in iron accumulation in mutants. Our evidence suggests that SreA is involved in the processes that moderate Epichloë iron acquisition from the plant apoplast, because overharvesting of iron in ΔsreA mutants was detected as premature chlorosis of the host using a hydroponic plant growth assay. E. festucae appears to have a tightly regulated iron management system, involving SreA that balances endophyte growth with its survival and prevents overcompetition with the host for iron in the intercellular niche, thus promoting mutualistic associations. Mutations that interfere with Epichloë iron management negatively affect iron-dependent fungal growth and destabilize mutualistic Epichloë –ryegrass associations.
Positive and Negative Regulation of the Virulence-Associated Coronafacoyl Phytotoxin in the Potato Common Scab Pathogen Streptomyces scabies
Authors: Cheng Zhenlong , Bown Luke , Piercey Brandon , Bignell Dawn R.D.
Published: May 2019

The potato common scab pathogen Streptomyces scabies produces N-coronafacoyl-l-isoleucine (CFA-Ile), which is a member of the coronafacoyl family of phytotoxins that are synthesized by multiple plant pathogenic bacteria. The CFA-Ile biosynthetic gene cluster contains a regulatory gene, cfaR, which directly controls the expression of the phytotoxin structural genes. In addition, a gene designated orf1 encodes a predicted ThiF family protein and is cotranscribed with cfaR, suggesting that it also plays a role in the regulation of CFA-Ile production. In this study, we demonstrated that CfaR is an essential activator of coronafacoyl phytotoxin production, while ORF1 is dispensable for phytotoxin production and may function as a helper protein for CfaR. We also showed that CFA-Ile inhibits the ability of CfaR to bind to the promoter region driving expression of the phytotoxin biosynthetic genes and that elevated CFA-Ile production by overexpression of both cfaR and orf1 in S. scabies increases the severity of disease symptoms induced by the pathogen during colonization of potato tuber tissue. Overall, our study reveals novel insights into the regulatory mechanisms controlling CFA-Ile production in S. scabies and it provides further evidence that CFA-Ile is an important virulence factor for this organism.
Tomato Seed-Associated Bacteria Confer Protection of Seedlings Against Foliar Disease Caused by Pseudomonas syringae
Authors: Morella Norma M. , Zhang Xuening , Koskella Britt
Published: May 2019

The plant microbiome is known to benefit host health in numerous ways, including providing protection against pathogens. Here, we provide evidence that tomato seed-associated microbiota play an important role in early seedling health. To test the importance of seed epiphytic communities for seedling susceptibility to the common bacterial pathogen, Pseudomonas syringae pv. tomato, we transplanted naturally occurring seed epiphytic microbial communities back onto seeds prior to germination and compared disease susceptibility to those that were not reinoculated after surface sterilization. We found that the epiphytic microbiome can protect seedlings against Pseudomonas syringae pv. tomato establishment and disease, and we further show that this protective effect is not due to a genotype by microbiome interaction. Using 16S amplicon sequencing, we found that these microbiomes were dominated by species of Pantoea, and we took a culturing approach to show that these isolates, including both Pantoea agglomerans and Pantoea dispersa, are sufficient to protect against Pseudomonas syringae pv. tomato. By varying concentration of first the pathogen and then the protective symbiont, we then examined the dose response of protection and found that applying a higher concentration of protective inoculum to the seeds does not correlate to a lessened Pseudomonas syringae pv. tomato load but does reduce disease burden. Instead, the most protective dose of Pantoea in terms of Pseudomonas syringae pv. tomato growth corresponds to the original density at which protective bacteria were found on seeds. Overall, our findings contribute to a broader understanding of the importance of vertically transmitted plant-associated microbes, with implications for the design and efficacy of biocontrol agents.
Genomics-Informed Molecular Detection of Xanthomonas vasicola pv. vasculorum Strains Causing Severe Bacterial Leaf Streak of Corn
Authors: Stulberg Michael J. , Santillana Gem , Studholme David J. , Kasiborski Beth , Ortiz-Castro Mary , Broders Kirk , Arias Silvina , Block Charles , Munkvold Gary , Rascoe John
Published: May 2019

Xanthomonas vasicola pv. vasculorum (syn. X. campestris pv. vasculorum) was initially identified as the causal agent of bacterial leaf streak of corn in South Africa. The pathovar vasculorum causes disease on sugarcane and corn, but a subset of these strains was noted for its increased disease severity in corn. This subset was reclassified as X. campestris pv. zeae in the early 1990s and was found to have slightly different biochemical and genetic properties than isolates from sugarcane. There has been an emergence of X. campestris pv. zeae-like strains of X. vasicola pv. vasculorum in both the United States and Argentina since 2010. We performed whole genome sequencing on U.S. isolates to confirm their identity. Informed by comparative genomics, we then developed specific TaqMan qPCR and loop-mediated isothermal amplification (LAMP) assays for the detection of this specific subset of X. vasicola pv. vasculorum strains. The qPCR 4909 assay was tested against 27 xanthomonads (diverse representation), 32 DNA extractions from corn leaves confirmed as positive or negative for the bacterium, 41 X. vasicola pv. vasculorum isolates from corn in the United States and Argentina, and 31 additional bacteria associated with corn, sugarcane, or sorghum. In all cases the assay was shown to be specific for the X. vasicola pv. vasculorum isolates that cause more severe disease on corn. We then tested the LAMP 166 assay against the 27 xanthomonads and 32 corn leaf DNA samples, and we found this assay was also specific for this subset of X. vasicola pv. vasculorum isolates. We also developed a live/dead cells distinction protocol using propidium monoazide prior to DNA extraction for analyzing seed washes using these assays. These two detection assays can be useful for both diagnosticians and researchers to specifically identify the X. vasicola pv. vasculorum isolates that cause more severe symptoms on corn.
The NIH Minimal Dataset for Chronic Low Back Pain
Authors: Dutmer Alisa L. , Reneman Michiel F. , Schiphorst Preuper Henrica R. , Wolff André P. , Speijer Bert L. , Soer Remko
Published: May 2019

Study Design.

Prospective cohort study.

Objective.

To analyze responsiveness and minimal clinically important change (MCIC) of the US National Institutes of Health (NIH) minimal dataset for chronic low back pain (CLBP).

Summary of Background Data.

The NIH minimal dataset is a 40-item questionnaire developed to increase use of standardized definitions and measures for CLBP. Longitudinal validity of the total minimal dataset and the subscale Impact Stratification are unknown.

Methods.

Total outcome scores on the NIH minimal dataset, Dutch Language Version, were calculated ranging from 0 to 100 points with higher scores representing worse functioning. Responsiveness and MCIC were determined with an anchor-based method, calculating the area under the receiver operating characteristics (ROC) curve (AUC) and by determining the optimal cut-off point. Smallest detectable change (SDC) was calculated as a parameter of measurement error.

Results.

In total 223 patients with CLBP were included. Mean total score on the NIH minimal dataset was 44 ± 14 points at baseline. The total outcome score was responsive to change with an AUC of 0.84. MCIC was 14 points with a sensitivity of 72% and specificity 82%, and SDC was 23 points. Mean total score on Impact Stratification (scale 8–50) was 34.4 ± 7.4 points at baseline, with an AUC of 0.91, an MCIC of 7.5 with a sensitivity 96% of and specificity of 78%, and an SDC of 14 points.

Conclusion.

The longitudinal validity of the NIH minimal dataset is adequate. An improvement of 14 points in total outcome score and 7.5 points in Impact Stratification can be interpreted as clinically important in individual patients. However, MCIC depends on baseline values and the method that is chosen to determine the optimal cut-off point. Furthermore, measurement error is larger than the MCIC. This means that individual change scores should be interpreted with caution.

Level of Evidence: 2
AAFD: Is the Gastroc Just Pulling Some Strings?
Authors: Chang Song Ho , Waryasz Gregory R. , Morris Brandon , Hagemeijer Noortje , Guss Daniel , DiGiovanni Christopher W.
Published: May 2019

Whether ankle equinus predominantly contributes to or ensues from an adult-acquired flatfoot deformity (AAFD) remains unknown. Regardless of the exact nature of this relationship, current evidence supports a distinct role for concomitant gastrocnemius recession or Achilles tendon lengthening during surgical correction of significant AAFD deformity. Achieving the appropriate degree of surgical correction for components of ankle equinus, hindfoot valgus, and/or Chopart collapse that may contribute to AAFD requires proper clinical evaluation and an appreciation of contributory pathophysiology. Review of recent literature describing gastrocnemius contracture and its potential role in AAFD provides a platform from which to approach this challenging problem.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Exploring Slow Release Oral Morphine (SROM) As a Transition Bridge for Medium to High Doses of Methadone Conversion to Buprenorphine/Naloxone Sublingual: A Calgary Concept and Approach
Authors: Ghosh S. Monty , Vezina Lydia , Yu Alvis , Jariwala Abhishek , Lim Ronald , Tanguay Robert
Published: May 2019

ABSTRACTRésumé

Introduction:

Buprenorphine/naloxone sublingual (SL) has recently become the first-line treatment in the management of opioid use disorder. Due to a legacy effect, numerous individuals have been on methadone for an extended period of time, on high doses, and are hesitant to try buprenorphine/naloxone SL due to difficulties in getting into adequate withdrawal for induction due to methadone's prolonged half-life.

Case presentation:

We present 2 cases in which slow release oral morphine was utilized to help convert individuals successfully from methadone to buprenorphine/naloxone SL.

Management and outcomes:

Patients were successfully transitioned with minimal withdrawal concerns, cravings, and adverse effects.

Discussion:

The Calgary slow release oral morphine transition approach presented herein provides a novel, relevant, and reliable way to transition patients from high dose methadone to buprenorphine/naloxone SL in an outpatient setting.

Introduction:

La buprénorphine / naloxone sublinguale (SL) est récemment devenue le traitement de première ligne dans la gestion des troubles de la consommation d’opioïdes. En raison de l’effet de conséquence, de nombreuses personnes ayant pris de la méthadone pendant une période prolongée, à des doses élevées, hésitent à essayer la buprénorphine / naloxone SL en raison de la difficulté d’obtenir un sevrage adéquat pour l’induction en raison de l’effet d’une utilisation prolongée de la méthadone.

Présentation de cas:

Nous présentons deux cas dans lesquels la morphine orale à libération prolongée (SROM) a été utilisée pour aider à sevrer avec succès des individus de la méthadone en buprénorphine / naloxone SL.

Gestion et résultats:

Les patients ont réussi la transition avec des problèmes légers de sevrage, d’envies et autres effets indésirables minimes.

Discussion:

L’approche de transition SROM de Calgary ici présentée offre un moyen novateur, pertinent et fiable pour aider les patients à faire la transition de la méthadone à forte dose à la buprénorphine / naloxone SL en consultation externe.
Adult-Onset Still Disease Presenting With Dermatomyositis-Like Persistent Pruritic Lesions
Authors: Qiao Jianjun , Pan Yunlei , Li Sheng , Tang Shunli , Zheng Siting , Zhu Dingxian , Sun Chuanyin , Fang Hong
Published: May 2019

Adult-onset Still disease (AOSD) is a rare autoinflammatory condition. The presence of an evanescent, salmon-pink, nonpruritic rash is one of the major diagnostic criteria for the disease. The rash occurs with fever and subsides with defervescence. The presence of dyskeratotic keratinocytes in the upper one-third layer of the epidermis is a distinctive histopathological feature of persistent pruritic lesions associated with AOSD. Here, we report 2 cases of AOSD characterized by persistent pruritic lesions resembling those observed in dermatomyositis. Identifying the clinical and histopathological manifestation of the cutaneous lesions is essential for the early diagnosis of AOSD and for differentiating this condition from those presenting with dyskeratotic cells in the epidermis.
Promyelocytic Differentiation in Infiltrates of Prurigo Pigmentosa: An Analogy to Histiocytoid Sweet Syndrome
Authors: Pirrone Johanna , Böer-Auer Almut
Published: May 2019

Prurigo pigmentosa (PP) is a rare inflammatory dermatosis of unknown etiology. Young women are affected most commonly. Clinically, heavily itchy papules erupt mainly on the trunk healing with residual reticulate pigmentation. Histopathologic descriptions of PP are somewhat controversial. First, PP was reported as lichenoid-interface dermatitis, and later, neutrophils were recognized as the characteristic feature, and the variation in histopathologic patterns was interpreted as a time-dependent phenomenon. Immunohistochemical studies on PP are rare. Biopsies of 5 patients with clinically typical PP were examined histopathologically, and infiltrates were characterized immunohistochemically: myeloperoxidase, CD11c, CD68, CD4, CD8, tryptase, and langerin. In all cases, myeloperoxidase-positive cells with band forms of nuclei and with histiocytoid cytomorphology were identified. They were seen in the epidermis (4/5) and in the dermal infiltrate (5/5). On staining with CD11c, myeloid dendritic cells could be demonstrated in the infiltrate (5/5). In conclusion, myeloid progenitor cells are part of the infiltrate in PP, and they may sometimes be more numerous than mature neutrophils, akin to the situation in histiocytoid Sweet syndrome. This supports the classification of PP as a “neutrophilic dermatosis.” In biopsies of suspected PP in which mature neutrophils are sparse, the section should be searched for neutrophilic band forms and histiocytoid promyelocytic cells. Immunohistochemical staining with myeloperoxidase helps to identify such cells and may enable a diagnosis of PP even when mature neutrophils are few.
The Association Between Acculturation and Parental Feeding Practices in Families With Overweight and Obese Hispanic/Latino Children
Authors: Mojica Cynthia M. , Liang Yuanyuan , Foster Byron A. , Parra-Medina Deborah
Published: May 2019

This study examines the association between acculturation and parental feeding practices in low-income Latinos. Overweight/obese children (N = 117), aged 5 to 14 years, and their parents were recruited from a rural health clinic. Findings show that more acculturated parents have greater control over their child's eating behavior (P = .04). Parents who perceive their child as having a weight problem also have more control over their child's eating behavior (P = .02). Control measured from regulation of how much and when the child should eat to offering sweets and screen time for good behavior. Results underscore the need for interventions to consider parental acculturation and perceptions of child weight.
Delivering Tobacco Cessation Through Community Health Workers
Authors: Lautner Shelby , Garney Whitney , Nimmons Katherine , Macareno Blanca , Harvey Idethia Shevon , Garcia Kristen
Published: May 2019

Texas faces unique barriers in health status and risk behaviors such as smoking. To address tobacco use, community health workers (CHWs) are a resource for disseminating education among a population. To promote smoking cessation in Texas, there is a need for the development of a smoking cessation training program for CHWs. The National Community Health Worker Training Center used an approach with CHWs to develop a curriculum. From the curriculum development and with feedback from CHWs, 4 training courses were produced: online and in person, and in English and Spanish. The curriculum meets a need that disseminates smoking cessation strategies through peer-led, culturally relevant messages.
Disentangling Race and Place in Depressive Symptoms in Men
Authors: Hale Diamond , Smith Genee , Bowie Janice , LaVeist Thomas A. , Thorpe Roland J.
Published: May 2019

African American men report lower levels of depressive symptoms that their white peers in national data. However, the value of these studies is often undermined by data that confound race, socioeconomic status, and segregation. We sought to determine whether race differences in depressive symptoms were present after minimizing the effects of socioeconomic status and segregation within a cohort of southwest Baltimore (SWB) men using the data from the Exploring Health Disparities in Integrated Communities (EHDIC), a novel study of racial disparities within communities where African American and non-Hispanic white males live together and have similar median incomes. Using the Patient Health Questionnaire, a standard instrument for assessing mental disorders, we categorized participants as experiencing depressive symptoms (including depressive syndrome and major depression) or not experiencing depressive symptoms. Logistic regression was performed to examine the association between depressive symptoms and race in EHDIC-SWB, adjusting for age, marital status, income, education, insurance, physical inactivity, current smoking or drinking status, poor/fair health, hypertension, heart disease, diabetes, stroke, and obesity. Of the 628 study participants, 12.6% of white men and 8.6% of African American men reported depressive symptoms. African American males had similar odds of reporting depressive symptoms (odds ratio = 0.61, 95% confidence interval = 0.34-1.11) as compared with white men. Within this low-income urban racially integrated community, race differences in depressive symptoms among men were not observed. This finding suggests that social and environmental conditions may impact the race differences in depressive symptoms.
Autologous Fat Grafting Restores Soft-tissue Contour Deformities after Vascular Anomaly Surgery
Authors: O Teresa Minjung , Chan Kimberly , Brennan Tara , Roden Dylan , Shamouelian David , Chung Ho Yun , Waner Milton
Published: May 2019

Background:

Soft-tissue loss is expected after resection of large vascular lesions. Autologous fat transfer improves asymmetries; however, systematic outcomes are not previously described for vascular anomaly reconstruction.

Methods:

Retrospective chart review from 2012 to 2015 included patients receiving autologous fat transfers for soft-tissue defects during or following vascular anomaly surgery at a tertiary care center. Patients received dermal en bloc fat grafts, lipoaspirates, or both. Pre- and postoperative photographs were blindly reviewed by 3 facial plastic surgeons using a 5-point scale. Dermal abdominal en bloc fat grafts were placed immediately after excision of a vascular anomaly. Lipoaspirate fat grafting was performed using liposuction (modified Coleman technique) and centrifugation. The effectiveness of fat transfers was assessed using patients’ photographs. Final follow-up was 6 months to 5 years.

Results:

There were 35 autologous fat transfer surgeries in 27 patients. Fourteen patients received en bloc dermal fat grafts (14 total), 13 lipoaspirate transfers (21 total), and 3 both. Ages ranged from 2 to 69 years (mean = 25 years). Majority of patients (81%) had head and neck lesions. Average volume of fat injected was 16.5 mL (range 0.8–100 mL). The average observer rating score was 2.45 [1–5 (5-point scale)] in the en bloc fat graft group versus 3.83 in the lipoaspirate group (P < 0.0001) with acceptable inter-rater reliability between 3 observers (coefficient of concordance = 0.76). Follow-up ranged from 6 months to 5 years. There were 2 complications in the dermal fat graft group and none in the lipoaspirate group.

Conclusions:

Autologous fat transfer improves symmetry and scarring after surgical treatment of vascular anomalies. Fat grafting is permanent and reliable and creates a more symmetric soft-tissue contour compared with dermal fat grafts.
Bone Transport Distraction Osteogenesis in the Reconstruction of Pediatric Posttraumatic Calvarial Defects
Authors: Elbanoby Tarek , Aly Gaber M. , Abdelfattah Usama , Choi Jong-Woo , Power Hollie A. , Abd El Fattah Yasser A.
Published: May 2019

Reconstruction of posttraumatic calvarial bone defects in pediatric patients is a challenge due to the growing brain and limited autogenous bone supply. Traditional techniques such as split calvarial and particulate bone grafts are associated with prolonged operative time and significant blood loss, which is a major concern in children under the age of 3 years. Bone transport distraction osteogenesis has proven efficacy and safety in the reconstruction of other craniofacial deformities. This procedure is less invasive and requires shorter operative times and hospital stay. We report our experience with 2 cases of bone transport distraction osteogenesis for the reconstruction of large posttraumatic calvarial defects in pediatric patients.
Innovative Surgical Approaches and Selection Criteria of Large Acne Keloidalis Nuchae Lesions
Authors: Umar Sanusi , David Consuelo V. , Castillo Jason R. , Queller Jenna , Sandhu Sophia
Published: May 2019

Background:

Acne keloidalis nuchae is a debilitating condition mainly affecting the occipital region or nape of the neck. Surgical approaches are limited in aesthetic outcomes. Three innovative surgical approaches based on selection criteria are presented for enhanced and more predictable wound healing and posterior hairline cosmesis.

Methods:

“Bat excision” and secondary intention healing are shown for 2 of 37 representative patients and confined to the area between the occipital protuberance superiorly and posterior hairline inferiorly. Lesions with ≤3 cm vertical width were required to be in the lower one-half portion of this zone. The same procedure was aided by the use of tension sutures for lesions with >3 cm vertical width area within the defined zone. It was also suitable for breaches of the 2 horizontal lines defined above but generally located in the nuchal area. Debridement of premature epithelizing granulation tissue is shown in 2 additional patients.

Results:

Use of these procedures with debridement in selected patients allowed fine control over the hairline shape and resulted in narrower scars. The mean maximum sagittal width of excised lesions was 5.4 cm. Excised lesion width ≥6.5 cm was highly predictive of >2.5 cm wide scar (P = 0.001).

Conclusion:

Innovative procedures based on selection criteria can extend the approach of acne keloidalis nuchae excision with secondary intention healing to better control the final hairline shape and minimize scarring.
Plastic Surgery Medical Tourism in Colombia: A Review of 658 International Patients and 1,796 Cosmetic Surgery Procedures
Authors: Campbell Christopher Alexander , Restrepo Carolina , Navas Genesis , Vergara Ileyna , Peluffo Laura
Published: May 2019

Background:

Cosmetic surgery is at the forefront of a $60 billion medical tourism industry. Patients are now able to research options globally through the internet, and increasing numbers are seeking improved service, quality, and value through surgery overseas. This study examines 658 consecutive patients receiving 1,796 cosmetic surgery procedures at a private plastic surgery practice in Cartagena, Colombia.

Methods:

We retrospectively reviewed the medical records of 658 consecutive international patients receiving cosmetic surgery at a private plastic surgery practice in Cartagena, Colombia.

Results:

Patients traveled to Colombia from 34 different countries spread across 6 continents. Ninety percent of patients came from North America. Patients from the United States represented 38 states and the District of Columbia, and Canadian patients represented 7 provinces. Eighty-three percent of patients were women and 90% were between the age of 20 and 54. The 658 patients in this study had a total of 1,796 cosmetic surgery procedures, involving 5,456 surgical sites. Seventy-two percent of patients received combination procedures with an average of 2.7 procedures per patient. Ninety-nine percent of cases were performed under general anesthesia and 100% were performed in an accredited hospital.

Conclusions:

Our data highlight trends defining plastic surgery medical tourism. Our data indicate that traveling for surgery is widely appealing, with women and men from diverse backgrounds traveling to Colombia from all over the world for a variety of procedures.
Computational Analysis of the Mature Unilateral Cleft Lip Nasal Deformity on Nasal Patency
Authors: Frank-Ito Dennis O. , Carpenter David J. , Cheng Tracy , Avashia Yash J. , Brown David A. , Glener Adam , Allori Alexander , Marcus Jeffrey R.
Published: May 2019

Background:

Nasal airway obstruction (NAO) due to nasal anatomic deformities is known to be more common among cleft patients than the general population, yet information is lacking regarding severity and variability of cleft-associated nasal obstruction relative to other conditions causing NAO. This preliminary study compares differences in NAO experienced by unilateral cleft lip nasal deformity (uCLND) subjects with noncleft subjects experiencing NAO.

Methods:

Computational modeling techniques based on patient-specific computed tomography images were used to quantify the nasal airway anatomy and airflow dynamics in 21 subjects: 5 healthy normal subjects; 8 noncleft NAO subjects; and 8 uCLND subjects. Outcomes reported include Nasal Obstruction Symptom Evaluation (NOSE) scores, cross-sectional area, and nasal resistance.

Results:

uCLND subjects had significantly larger cross-sectional area differences between the left and right nasal cavities at multiple cross sections compared with normal and NAO subjects. Median and interquartile range (IQR) NOSE scores between NAO and uCLND were 75 (IQR = 22.5) and 67.5 (IQR = 30), respectively. Airflow partition difference between both cavities were: median = 9.4%, IQR = 10.9% (normal); median = 31.9%, IQR = 25.0% (NAO); and median = 29.9%, IQR = 44.1% (uCLND). Median nasal resistance difference between left and right nasal cavities were 0.01 pa.s/ml (IQR = 0.03 pa.s/ml) for normal, 0.09 pa.s/ml (IQR = 0.16 pa.s/ml) for NAO and 0.08 pa.s/ml (IQR = 0.25 pa.s/ml) for uCLND subjects.

Conclusions:

uCLND subjects demonstrated significant asymmetry between both sides of the nasal cavity. Furthermore, there exists substantial disproportionality in flow partition difference and resistance difference between cleft and noncleft sides among uCLND subjects, suggesting that both sides may be dysfunctional.
A Middle-Ground Proposal for Making Health Care Premiums More Affordable
Authors: Averill Richard F. , Hughes John S.
Published: May 2019

Passage of any health care reform that addresses the rising cost of health care in the United States will be a difficult political challenge unless a middle-ground compromise between government control of health care insurance and free market approaches can be found. On the basis of the competitive market for Medicare supplemental insurance, a Medicare Adherence Policy insurance option is proposed that would leverage Medicare's authority to set prices to create a practical middle-ground reform that can strike a balance between the role of government and the free market.
The Effect of a Nurse-Led Cognitive Behavioral Protocol on Depressive Symptoms and Coping Strategies of Dementia Caregivers
Authors: PAN Yuqin , CHEN Ruyi
Published: May 2019

Background

Family caregivers of patients with dementia (PWD) often experience depressive symptoms and use poor coping strategies. Cognitive behavioral interventions may enhance positive appraisals of caregiving-related issues and the utilization of active coping strategies among caregivers, which may help prevent caregiver depression. However, there is a shortage of primary, community-based mental health services in China, and little research has been conducted on the effect of nurse-led mental health programs in this population.

Purpose

This study explored the effect of a nurse-led cognitive behavioral intervention on depressive symptoms and coping strategies among family caregivers of PWD in China.

Methods

This randomized controlled trial used data from a sample of 112 caregivers screened from 276 potential participants in a city in southeastern China. The sample was randomly assigned to an intervention group (n = 56) and a control group (n = 56). The intervention group received five monthly in-home, nurse-led cognitive behavioral sessions and telephone consultations after each session. The control group received five monthly, short, general conversations with nurse interventionists at the participants' homes, in the hospital, or via telephone. Depressive symptoms, coping strategies, and the demographics of caregiving dyads were collected at Time 1 (baseline), Time 2 (the end of the 5-month intervention), and Time 3 (2-month follow-up). IBM SPSS Statistics Version 19.0 was used for data analysis.

Results

Eighty-two participants (intervention group: n = 47, control group: n = 35) completed the three evaluations. No significant group differences were found in baseline characteristics between the two groups. The general linear model repeated-measures analysis of variance indicated a significant difference in depressive symptoms and active coping between groups over time, with p < .001 for the interaction between depressive symptoms and groups and p < .01 for the interaction between active coping and groups. A similar result did not occur for passive coping. The t tests further supported a significant interventional effect on participants' depressive symptoms and active coping.

Conclusions/Implications for Practice

This nurse-led cognitive behavioral intervention was effective in decreasing depressive symptoms and improving active coping among study participants. The findings suggest the improvement of mental health services and social policies in China to support family caregivers of PWD.
Young age and tobacco use are predictors of lower medication adherence in inflammatory bowel disease
Authors: Bruna-Barranco Ignacio , Lué Alberto , Gargallo-Puyuelo Carla J. , Arroyo María T. , Alfambra Erika , Montero Jessica , Gomollón Fernando
Published: May 2019

Background

Medication adherence is crucial in the management of patients with inflammatory bowel disease (IBD) because medication nonadherence in these patients is associated with an increased risk of flare-up, relapse, recurrence, loss of response to anti-tumour necrosis factor agents, morbidity and mortality, and poor quality of life. Data on risk factors are very controversial in the literature.

Aim

To assess the prevalence of medication nonadherence and to identify predictors of low medication adherence in Spanish patients with IBD.

Patients and methods

We carried out a cross-sectional study that included consecutive outpatients with IBD attending in our adult tertiary clinic in a 3-month period. Morisky 8-Item Medication Adherence Scale questionnaire as well as a survey of sociodemographic data were used.

Results

A total of 181 patients were evaluated. Almost half of the patients (46.4%) had high medication adherence, 30.9% had medium adherence, and 22.7% had low adherence. In relation to predictive factors of medication adherence, multivariate analysis showed that age was associated with high adherence [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.01–1.06; P=0.002]. However, being a smoker and presence of Crohn’s disease were associated with low adherence (OR: 3.47; 95% CI: 1.36–8.90; P<0.01 and OR: 2.54; 95% CI: 1.12–5.79; P<0.05, respectively).

Conclusion

Only half of patients were high medication adherers. Young age, active smoking, and Crohn’s disease seems to be predictors of low medication adherence. On the basis of these data, efforts for reinforce medication adherence should be especially directed to young patients and smokers.
Noninvasive inflammatory markers for assessing liver fibrosis stage in autoimmune hepatitis patients
Authors: Yuan Xiaoling , Duan Sheng-Zhong , Cao Junying , Gao Nan , Xu Jie , Zhang Lanjing
Published: May 2019

Objective

To examine the accuracy of noninvasive inflammatory markers in predicting liver fibrosis stage in patients with autoimmune hepatitis (AIH).

Patients and methods

We enrolled 55 patients with AIH and 60 healthy controls in this study, and divided them into three groups: F0 (control); F1–F3 (noncirrhotic fibrosis); and F4 (cirrhosis). The following markers were analyzed for all participants: lymphocyte-to-neutrophil ratio (LNR); lymphocyte-to-platelet ratio (LPR); lymphocyte-to-monocyte ratio (LMR); immunoglobulin-to-platelet ratio (IGPR); aminotransferase-to-platelet ratio index (APRI); aspartate aminotransferase-to-alanine aminotransferase ratio (AAR); and fibrosis-4 score (FIB-4). The predictive accuracy of these noninvasive markers was assessed using area under the receiver operating characteristic curve. Multivariate ordinal logistic regression models were used to analyze associations between the noninvasive markers and liver fibrosis stage.

Results

AAR, LPR, LMR, IGPR, APRI, and FIB-4 were linked to liver fibrosis-stage (P < 0.05), with correlation indices of − 0.219, 0.258, − 0.149, 0.647, 0.841, and 0.704, respectively, but not LNR (P = 0.093). area under the receiver operating characteristic curves of LPR, IGPR, AAR, LMR, APRI, and FIB-4 for detecting cirrhosis (F4 vs. F0–F3) were 0.936 (95% confidence interval: 0.870–1.000, P < 0.001), 0.939 (0.875–1.000, P < 0.001), 0.528 (0.319–0.738, P = 0.768), 0.555 (0.409–0.700, P = 0.568), 0.798 (0.694–0.902, P = 0.002), and 0.881 (0.796–0.967, P < 0.001). Our multivariate ordinal regression analysis showed that LPR and IGPR were associated independently with liver fibrosis stage, with a coefficient of 0.385 (95% confidence interval: 0.103–0.667, P = 0.007) and 14.903 (2.091–27.786, P = 0.023), respectively.

Conclusion

LPR and IGPR were associated independently with liver fibrosis stage in treatment-naive AIH, and were superior to APRI and FIB-4 in detecting cirrhosis.
Impact of occupational stress on irritable bowel syndrome pathophysiology and potential management in active duty noncombat Greek military personnel: a multicenter prospective survey
Authors: Papaefthymiou Apostolis , Doulberis Michael , Kountouras Jannis , Kolokytha Christina , Galanopoulos Michail , Liatsos Christos , Kyriakos Nikolaos , Giakoumis Marios , Papadomichelakis Michail , Polyzos Stergios A. , Kotronis Georgios , Katsinelos Panagiotis
Published: May 2019

Introduction

Irritable bowel syndrome (IBS) is one of the gut–brain axis interaction disorders. It has global distribution with varying prevalence and particular financial and psychological consequences. IBS has been associated with stress and anxiety, conditions that are usually prevalent in the army. There are scarce data investigating the impact of IBS on noncombat active duty military without reports of Greek military or stress in the occupational environment.

Materials and methods

The main exclusion criteria in our noncombat military multicenter prospective survey were gastrointestinal pathologies, malignancies, hematochezia, recent infections and antibiotics prescription, and pregnancy. Questionnaires included a synthesis of baseline information, lifestyle, and diet, psychological and stress-investigating scales and the IBS diagnosis checklist. Hospital Anxiety and Depression Scale and Rome IV criteria were utilized.

Results

Among 1605 participants included finally, the prevalence of IBS was 8% and 131 cases were identified. Women were more vulnerable to IBS, although male sex was prevalent at a ratio of 3.5 : 1 (male:female) in the entire sample. The mean age of all participants was 23.85 years; most of the IBS patients were older than thirty. Abnormal anxiety scores and high levels of occupational stress were related to an IBS diagnosis.

Discussion

This prospective multicenter survey showed, for the first time, the potential impact of occupational stress on IBS in active duty noncombat Greek Military personnel. The diagnosis of IBS by questionnaire is a quick, affordable way that can upgrade, by its management, the quality of life and relieve from the military burden. Our results are comparable with previous studies, although large-scale epidemiological studies are required for the confirmation of a possible causative relationship.