bluuebunny/crossref_metadata_2025 huggingface dataset:
Constitutive signaling activity of a receptor-associated protein links fertilization with embryonic patterning in
Arabidopsis thaliana
Authors: Neu Ancilla , Eilbert Emily , Asseck Lisa Y. , Slane Daniel , Henschen Agnes , Wang Kai , Bürgel Patrick , Hildebrandt Melanie , Musielak Thomas J. , Kolb Martina , Lukowitz Wolfgang , Grefen Christopher , Bayer Martin
Published: March 2019

Significance

In flowering plants, membrane-associated kinases of the BRASSINOSTEROID SIGNALING KINASE (BSK) family are ubiquitous, receptor-associated signaling partners in various receptor kinase pathways, where they function in signaling relay. The Brassicaceae-specific BSK family member SHORT SUSPENSOR (SSP), however, acts as a patterning cue in the zygote, initiating the apical-basal patterning process in a signal-like manner. The SSP protein has lost a regulatory, intramolecular interaction and activates the MAPKKK YODA signaling pathway constitutively, in principle, enabling the protein to initiate embryonic patterning without receptor activation. We further show that the BSK family members BSK1 and BSK2, both conserved in flowering plants, activate the same signaling pathway in parallel to SSP and might constitute remnants of an older, canonical signaling pathway still active in
Arabidopsis
.
The relationship between implicit intergroup attitudes and beliefs
Authors: Kurdi Benedek , Mann Thomas C. , Charlesworth Tessa E. S. , Banaji Mahzarin R.
Published: March 2019

Intergroup attitudes (evaluations) are generalized valence attributions to social groups (e.g., white–bad/Asian–good), whereas intergroup beliefs (stereotypes) are specific trait attributions to social groups (e.g., white–dumb/Asian–smart). When explicit (self-report) measures are used, attitudes toward and beliefs about the same social group are often related to each other but can also be dissociated. The present work used three approaches (correlational, experimental, and archival) to conduct a systematic investigation of the relationship between implicit (indirectly revealed) intergroup attitudes and beliefs. In study 1 (
n
= 1,942), we found significant correlations and, in some cases, evidence for redundancy, between Implicit Association Tests (IATs) measuring attitudes toward and beliefs about the same social groups (mean
r
= 0.31, 95% confidence interval: [0.24; 0.39]). In study 2 (
n
= 383), manipulating attitudes via evaluative conditioning produced parallel changes in belief IATs, demonstrating that implicit attitudes can causally drive implicit beliefs when information about the specific semantic trait is absent. In study 3, we used word embeddings derived from a large corpus of online text to show that the relative distance of 22 social groups from positive vs. negative words (reflecting generalized attitudes) was highly correlated with their distance from warm vs. cold, and even competent vs. incompetent, words (reflecting specific beliefs). Overall, these studies provide convergent evidence for tight connections between implicit attitudes and beliefs, suggesting that the dissociations observed using explicit measures may arise uniquely from deliberate judgment processes.
Molecular Biology Information Service: an innovative medical library-based bioinformatics support service for biomedical researchers
Authors: Chattopadhyay Ansuman , Iwema Carrie L , Epstein Barbara A , Lee Adrian V , Levine Arthur S
Published: March 2019

Biomedical researchers are increasingly reliant on obtaining bioinformatics training in order to conduct their research. Here we present a model that academic institutions may follow to provide such training for their researchers, based on the Molecular Biology Information Service (MBIS) of the Health Sciences Library System, University of Pittsburgh (Pitt). The MBIS runs a four-facet service with the following goals: (1) identify, procure and implement commercially licensed bioinformatics software, (2) teach hands-on workshops using bioinformatics tools to solve research questions, (3) provide in-person and email consultations on software/databases and (4) maintain a web portal providing overall guidance on the access and use of bioinformatics resources and MBIS-created webtools. This paper describes these facets of MBIS activities from 2006 to 2018, including outcomes from a survey measuring attitudes of Pitt researchers about MBIS service and performance.
Phosphodiesterase 1 Bridges Glutamate Inputs with NO- and Dopamine-Induced Cyclic Nucleotide Signals in the Striatum
Authors: Betolngar Dahdjim B , Mota Élia , Fabritius Arne , Nielsen Jacob , Hougaard Charlotte , Christoffersen Claus T , Yang Jun , Kehler Jan , Griesbeck Oliver , Castro Liliana R V , Vincent Pierre
Published: March 2019

The calcium-regulated phosphodiesterase 1 (PDE1) family is highly expressed in the brain, but its functional role in neurones is poorly understood. Using the selective PDE1 inhibitor Lu AF64196 and biosensors for cyclic nucleotides including a novel biosensor for cGMP, we analyzed the effect of PDE1 on cAMP and cGMP in individual neurones in brain slices from male newborn mice. Release of caged NMDA triggered a transient increase of intracellular calcium, which was associated with a decrease in cAMP and cGMP in medium spiny neurones in the striatum. Lu AF64196 alone did not increase neuronal cyclic nucleotide levels, but blocked the NMDA-induced reduction in cyclic nucleotides indicating that this was mediated by calcium-activated PDE1. Similar effects were observed in the prefrontal cortex and the hippocampus. Upon corelease of dopamine and NMDA, PDE1 was shown to down-regulate the D1-receptor mediated increase in cAMP. PDE1 inhibition increased long-term potentiation in rat ventral striatum, showing that PDE1 is implicated in the regulation of synaptic plasticity. Overall, our results show that PDE1 reduces cyclic nucleotide signaling in the context of glutamate and dopamine coincidence. This effect could have a therapeutic value for treating brain disorders related to dysfunctions in dopamine neuromodulation.
Sex Differences in the Incidence and Clearance of Anogenital Human Papillomavirus Infection in Liuzhou, China: An Observational Cohort Study
Authors: Wei Feixue , Guo Meng , Huang Shoujie , Li Mingqiang , Cui Xuelian , Su Yingying , Wu Xin , Ma Xinjing , Zheng Ya , Huang Yue , Wang Lin , Pan Lili , Wu Ting , Zhang Jun , Xia Ningshao
Published: March 2019

Background

Human papillomavirus (HPV) causes anogenital warts and cancers in men and women. However, little is known about sex differences regarding the natural history of anogenital HPV infection.

Methods

Starting in May 2014, an observational cohort study including 2309 men and 2378 women aged 18–55 years was conducted in Liuzhou, China. Samples from anogenital sites were tested for HPV genotypes by multicolor real-time polymerase chain reaction and melting curve analysis biannually for ~1 year.

Results

The incidence of oncogenic HPV infection was similar in men and women (10.3 and 11.5/1000 person-months; P = .275), whereas the incidence of HPV-6/11 infection was higher in men than in women (2.0 vs 1.1; P = .018). The incidence of both oncogenic HPV and HPV-6/11 infections was significantly higher in women in the 18- to 25-year age group than in the older age groups (P = .006 and .011, respectively), whereas it did not vary by age among men (P = .552 and .425, respectively). Additionally, men were more likely than women to clear oncogenic infections (101.5 vs 58.6/1000 person-months; P < .001), but no significant difference was found in the clearance of HPV-6/11 by sex (111.7 vs 84.8; P = .266). The median time to clearance of oncogenic type and type 6/11 infections was not age dependent for either sex (all P > .05).

Conclusions

The natural history of oncogenic and nononcogenic HPV infection differs by sex, which implies that sex-specific vaccination strategies should be considered for oncogenic and nononcogenic HPV.

Clinical Trials Registration

NCT02188004.
Use and Success of In Vitro Fertilisation Following Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. A Nationwide 17-year Cohort Study
Authors: Pachler Frederik R , Toft Gunnar , Bisgaard Thue , Laurberg Søren
Published: March 2019

Background and Aims

Fertility decreases in women following restorative proctocolectomy for ulcerative colitis. The use and success of in vitro fertilisation [IVF] after restorative proctocolectomy for ulcerative colitis is not systematically studied. We aimed to estimate the use and success of in vitro fertilisation treatment in female ulcerative colitis patients, with and without restorative proctocolectomy.

Methods

Women of fertile age [15–49 years] with restorative proctocolectomy for ulcerative colitis were compared with females with ulcerative colitis without restorative proctocolectomy. Data from the IVF registry from 1994–2010 were cross-linked with data from the National Danish Patient Registry and the Medical Birth Registry.

Results

In vitro fertilisation is significantly more frequent in females with restorative proctocolectomy compared with females without restorative proctocolectomy, adjusted hazard ratio 3.2, 95% confidence interval [CI] [2.5;4.0]. The odds for having a live birth after in vitro fertilisation are no different in females with restorative proctocolectomy compared with females without restorative proctocolectomy, adjusted odds ratio 0.8, 95% CI [0.6;1.1]. The percentage of children born as a result of in vitro fertilisation is significantly higher in females with restorative proctocolectomy compared with females without restorative proctocolectomy (31.0%, 95% CI [24.1; 37.7] vs 5.0%, 95% CI [4.4; 5.6]).

Conclusions

Females with restorative proctocolectomy for ulcerative colitis have increased incidence of in vitro fertilisation by more than a factor three, the odds that a treatment results in a live birth are similar and six times more children are born as a result of in vitro fertilisation compared with females without restorative proctocolectomy.
Long-term results of ventricular septation for double-inlet left ventricle†
Authors: Shimada Masatoshi , Hoashi Takaya , Nakata Tomohiro , Kurosaki Kenichi , Kanzaki Suzu , Shiraishi Isao , Ichikawa Hajime
Published: March 2019

OBJECTIVES

To review the long-term surgical outcomes of ventricular septation for double-inlet left ventricle and reconsider the possibility of ventricular septation as an option of surgical treatments.

METHODS

Between 1978 and 1994, 22 patients with double-inlet left ventricle underwent ventricular septation. The mean age at operation was 5.3 years (range 0–22 years). Follow-up was carried out in 20 of 22 patients (91%) and the mean follow-up period was 14.7 years (range 0–39 years).

RESULTS

Actuarial survival and reoperation-free survival rates at 30 years were 49% and 21%, respectively. To date, 8 patients have been followed up. Among them, atrioventricular valve replacement and permanent pacemaker were required in 4 and 7 patients, respectively. Late cardiac catheter examination at 25.5 years after surgery showed that the median cardiac index was 2.6 l/min/m2 (range 2.1–3.4 l/min/m2), left ventricular end-diastolic pressure was 7 mmHg (range 4–11 mmHg), left ventricular ejection fraction was 50% (range 27–63%), right ventricular ejection fraction was 53% (range 31–66%) and central venous pressure was 6 mmHg (range 4–11 mmHg). At the latest follow-up, the New York Heart Association Functional Classification was I for 5 patients, II for 2 patients and III for 1 patient. The median peak oxygen uptake was 52.9% (range 44.1–93.5%).

CONCLUSIONS

Some patients with double-inlet left ventricle were able to maintain low central venous pressure and a sufficient cardiac index long after ventricular septation. Although the single ventricle strategy remains a first-line treatment, ventricular septation can be a surgical treatment option.
A century of changing fire management alters ungulate forage in a wildfire-dominated landscape
Authors: Proffitt Kelly M , DeVoe Jesse , Barker Kristin , Durham Rebecca , Hayes Teagan , Hebblewhite Mark , Jourdonnais Craig , Ramsey Philip , Shamhart Julee
Published: March 2019

Forestry practices such as prescribed fire and wildfire management can modify the nutritional resources of ungulates across broad landscapes. To evaluate the influences of fire and forest management on ungulate nutrition, we measured and compared forage quality and abundance among a range of land cover types and fire histories within 3 elk ranges in Montana. We used historical fire data to assess fire-related variations in elk forage from 1900 to 2015. Fire affected summer forage more strongly than winter forage. Between 1900–1990 and 1990–2015, elk summer range burned by wildfire increased 242–1772 per cent, whereas the area on winter range burned by wildfire was low across all decades. Summer forage quality peaked in recently burned forests and decreased as time since burn increased. Summer forage abundance peaked in dry forests burned 6–15 years prior and mesic forests burned within 5 years. Forests recently burned by wildfire had higher summer forage quality and herbaceous abundance than those recently burned by prescribed fire. These results suggest that the nutritional carrying capacity for elk varies temporally with fire history and management practices. Our methods for characterizing nutritional resources provide a relatively straightforward approach for evaluating nutritional adequacy and tracking changes in forage associated with disturbances such as fire.
A High-Quality Grapevine Downy Mildew Genome Assembly Reveals Rapidly Evolving and Lineage-Specific Putative Host Adaptation Genes
Authors: Dussert Yann , Mazet Isabelle D , Couture Carole , Gouzy Jérôme , Piron Marie-Christine , Kuchly Claire , Bouchez Olivier , Rispe Claude , Mestre Pere , Delmotte François
Published: March 2019

Downy mildews are obligate biotrophic oomycete pathogens that cause devastating plant diseases on economically important crops. Plasmopara viticola is the causal agent of grapevine downy mildew, a major disease in vineyards worldwide. We sequenced the genome of Pl. viticola with PacBio long reads and obtained a new 92.94 Mb assembly with high contiguity (359 scaffolds for a N50 of 706.5 kb) due to a better resolution of repeat regions. This assembly presented a high level of gene completeness, recovering 1,592 genes encoding secreted proteins involved in plant–pathogen interactions. Plasmopara viticola had a two-speed genome architecture, with secreted protein-encoding genes preferentially located in gene-sparse, repeat-rich regions and evolving rapidly, as indicated by pairwise dN/dS values. We also used short reads to assemble the genome of Plasmopara muralis, a closely related species infecting grape ivy (Parthenocissus tricuspidata). The lineage-specific proteins identified by comparative genomics analysis included a large proportion of RxLR cytoplasmic effectors and, more generally, genes with high dN/dS values. We identified 270 candidate genes under positive selection, including several genes encoding transporters and components of the RNA machinery potentially involved in host specialization. Finally, the Pl. viticola genome assembly generated here will allow the development of robust population genomics approaches for investigating the mechanisms involved in adaptation to biotic and abiotic selective pressures in this species.
Embedding C*-Algebras Into the Calkin Algebra
Authors: Farah Ilijas , Katsimpas Georgios , Vaccaro Andrea
Published: March 2019

We prove that, under Martin’s axiom, every ${\mathrm{C}}^\ast $-algebra of density character less than continuum embeds into the Calkin algebra. Furthermore, we show that it is consistent with Zermelo-Fraenkel set theory plus the axiom of choice, ZFC, that there is a $\mathrm{C}^\ast $-algebra of density character less than continuum that does not embed into the Calkin algebra.
How to optimize the therapeutic effect of free autogenous fibula graft and wrist arthroplasty for giant cell tumors of distal radius?
Authors: Liu Qing , Luo Wei , Zhang Can , Liao Zhan , Liu Yupeng , He Hongbo
Published: March 2019

Objective

The purpose of this study is to retrospectively analyze the clinical efficacy of free fibula autograft and wrist arthroplasty in the treatment of giant cell tumors (GCT) of distal radius.

Methods

We retrospectively reviewed 26 patients with GCT of distal radius who underwent free autogenous fibula graft and wrist arthroplasty for repairing residual defect after en-block resection. The length of the fibula graft was 8.2 cm (6–10 cm). Postoperative follow-up regularly for an mean of 66.9 months. Bone healing was assessed by radiographs, pain was assessed by Visual Analog Scale (VAS) score and limb function was evaluated by Musculoskeletal Tumor Society (MSTS) score and disabilites of the arm, shoulder and hand (DASH) score. The range of motion (ROM) of wrist and grip strength were also evaluated.

Result

There were four males and 22 females with an mean age of 36.7 years (19–60 years); the mean length of lesions was 4.8 cm (2.3–6.6 cm); 21 primary cases and five recurrent cases; eight cases of Campanacci Grade II, 18 cases of Grade III. We had no postoperative lung metastasis and only one case had a local recurrence, three cases (11%) with subluxation of lower ulnoradial joints and five cases (19%) showed narrowing of wrist joint space. The mean postoperative VAS pain score was 0.7 ± 0.7 and grip strength retained 71% of the normal hand, MSTS score was 27.7 ± 1.1 and DASH score was 9.0 ± 3.7. The ROM of the involved wrist only slightly restricted and no donor complications. Postoperative wrist joint function was significantly improved.

Conclusion

Strict surgical resection boundary and solid reconstruction of wrist joint capsule are the key to achieving excellent oncological prognosis and function of distal radius GCT.
Comparing Asset Pricing Models by the Conditional Hansen-Jagannathan Distance*
Authors: Gagliardini Patrick , Ronchetti Diego
Published: March 2019

We compare nonnested parametric specifications of the stochastic discount factor (SDF) using the conditional Hansen–Jagannathan (HJ-) distance. This distance measures the discrepancy between a parametric model-implied SDF and the admissible SDF’s satisfying all the conditional (dynamic) no-arbitrage restrictions, instead of just few unconditional no-arbitrage restrictions for managed portfolios chosen through the instrument selection. We estimate the conditional HJ-distance by a generalized method of moments estimator and establish its large sample properties for model selection purposes. We compare empirically several SDF models including multifactor beta pricing specifications and some recently proposed SDF models that are conditionally linear in consumption growth.
The synchrotron maser emission from relativistic shocks in Fast Radio Bursts: 1D PIC simulations of cold pair plasmas
Authors: Plotnikov Illya , Sironi Lorenzo
Published: March 2019

The emission process of Fast Radio Bursts (FRBs) remains unknown. We investigate whether the synchrotron maser emission from relativistic shocks in a magnetar wind can explain the observed FRB properties. We perform particle-in-cell (PIC) simulations of perpendicular shocks in cold pair plasmas, checking our results for consistency among three PIC codes. We confirm that a linearly polarized X-mode wave is self-consistently generated by the shock and propagates back upstream as a precursor wave. We find that at magnetizations σ ≳ 1 (i.e. ratio of Poynting flux to particle energy flux of the pre-shock flow) the shock converts a fraction $f_\xi ^{\prime } \approx 7 \times 10^{-4}/\sigma ^2$ of the total incoming energy into the precursor wave, as measured in the shock frame. The wave spectrum is narrow-band (fractional width ≲1−3), with apparent but not dominant line-like features as many resonances concurrently contribute. The peak frequency in the pre-shock (observer) frame is $\omega ^{\prime \prime }_{\rm peak} \approx 3 \gamma _{\rm s | u} \omega _{\rm p}$, where γs|u is the shock Lorentz factor in the upstream frame and ωp the plasma frequency. At σ ≳ 1, where our estimated $\omega ^{\prime \prime }_{\rm peak}$ differs from previous works, the shock structure presents two solitons separated by a cavity, and the peak frequency corresponds to an eigenmode of the cavity. Our results provide physically grounded inputs for FRB emission models within the magnetar scenario.
Caring for children with neurofibromatosis type 1
Authors: Sampson Janice , Thompson Heather L. , Parilo Denise M. Wall
Published: March 2019

This article discusses the variable physical manifestations of neurofibromatosis type 1 among children in terms of presentation, disease severity, and prognosis, and addresses appropriate nursing interventions and patient teaching.
Queer Phenomenology, the Disruption of Heteronormativity, and Structurally Responsive Care
Authors: Searle Jennifer
Published: March 2019

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) health disparities persist and reflect larger structural inequities that negatively impact the health of historically marginalized communities. By way of using queer phenomenology, the author analyzes a personal experience that was harmful to her as a lesbian patient who required emergency medical attention. Also a registered nurse, the author draws on her lived experiences to reveal heteronormativity as a prevalent, but largely unacknowledged, source of structural harms for LGBTQ patients. This aims to bring about an appreciation among nurses and other health care professionals to locate themselves within systems of privilege and oppression and gain an awareness on how they might better respond to ongoing structural harms that are disproportionately experienced by vulnerable patient populations.
State of the Profession
Authors: Engelman Alina , Valderama-Wallace Claire , Nouredini Sahar
Published: March 2019

The nursing profession can both perpetuate inequities and elevate the discourse around disability. Our article uses an intersectional lens to discuss the scope, magnitude, and determinants of health inequities that people with disabilities experience and the ways in which theoretical models of disability used in nursing education can further contribute to inequities. Our article makes the case for an intersectional social justice approach to nursing education by contextualizing the current state of affairs within historical and contemporary models of disability. This has the potential to be a revolutionary leap toward promoting health equity and upholding the Code of Ethics.
The Evolution of HIV Prevention
Authors: O'Byrne Patrick , Jacob Jean Daniel
Published: March 2019

HIV prevention has changed since the identification of AIDS in 1981, the discovery of HIV in 1983, and the rollout of HIV antibody testing in 1985. Since this time, HIV prevention changed from behavior modification to testing to treatment as prevention to chemoprophylaxis using HIV medications among HIV-negative persons. While these modifications have been heralded as public health successes, critical evaluations are needed. In this article, we present one such review in which we argue that HIV prevention, while previously disciplinary in the Foucauldian sense, has become controlling in the Deleuzian sense. In this way, the parameters of context are targeted and behavior change is less relevant. This highlights the importance of questioning public health “advancements” and using novel theoretical lens to do so.
Global PD-L1 Signals and Tumor-Infiltrating Lymphocytes: Markers of Immunogenicity in Different Subsets of Merkel Cell Carcinoma and Potential Therapeutic Implications
Authors: Walsh Noreen M. , Castonguay Mathieu C. , Carter Michael D. , Pasternak Sylvia , Ly Thai Yen , Doucette Steve , Hanly John G. , Saggini Andrea , Cerroni Lorenzo
Published: March 2019

We previously studied the genetic and immunohistochemical profiles of subsets of Merkel cell carcinoma (MCC) stratified by morphology and Merkel cell polyomavirus (MCPyV) status. Recent advances in the immunotherapy of this disease prompted us to examine markers of immunogenicity [PD-L1 expression and tumor-infiltrating lymphocytes (TILS) in these subsets]. The observed clinical responses to checkpoint inhibition of the PD-1/PD-L1 pathway have not correlated with PD-L1 expression by MCC cells, and recent evidence suggests that functions of this pathway within the immune tumor microenvironment may be relevant. We conducted a semiquantitative (high, moderate, and minimal) immunohistochemical evaluation of the global PD-L1 signal in 52 cases of MCC, segregated in 3 subsets [pure MCPyV-positive (n = 28), pure MCPyV-negative (n = 9), and combined MCPyV-negative (n = 15)]. TILS were categorized as brisk, nonbrisk, or absent. Intersubset comparisons revealed that high global PD-L1 signals were exclusively associated with pure MCPyV-positive MCCs contrasted with virus-negative cases (P = 0.0003). Moderate signals were seen across all 3 groups. Brisk TILS were significantly associated with MCPyV-positive MCCs compared with MCPyV-negative cases (P = 0.029). Neither parameter (PD-L1 or TILS) was significantly different between the MCPyV-negative groups. Of potential clinical relevance, MCPyV seems to convey greater immunogenicity to MCCs than the high mutational burden/greater neoantigen load of MCPyV-negative cases. Interesting too is the fact that subset-related profiles of these markers mirrored those noted at genetic and immunohistochemical levels, separating pure MCPyV-positive MCCs from the virus-negative subsets.
Differential Expression of PLAG1 in Apocrine and Eccrine Cutaneous Mixed Tumors: Evidence for Distinct Molecular Pathogenesis
Authors: Russell-Goldman Eleanor , Dubuc Adrian , Hanna John
Published: March 2019

Cutaneous mixed tumors, also known as chondroid syringomas, are benign adnexal neoplasms that share histomorphologic features with pleomorphic adenomas of the salivary gland. Recent work suggests that the similarity between these 2 tumor types extends to the molecular level because both harbor identical chromosomal rearrangements involving the PLAG1 gene. The resulting nuclear PLAG1 overexpression can be detected by immunohistochemistry and has become a useful diagnostic adjunct for both tumor types. In the skin, however, there are 2 morphologically distinct types of mixed tumor, which have been referred to as apocrine-type cutaneous mixed tumor (AMT) and eccrine-type cutaneous mixed tumor (EMT). Previous studies of PLAG1 expression in cutaneous mixed tumor did not distinguish between these types. Here, we evaluated PLAG1 expression by immunohistochemistry in a cohort of 25 cutaneous mixed tumors stratified by type. PLAG1 was overexpressed in the majority of AMT cases (14 of 16) but in none of the EMT cases (0 of 9). A second gene, HMGA2, known to be upregulated in a subset of salivary gland pleomorphic adenomas, was overexpressed in only 1 case of AMT (1 of 16) and in none of the cases of EMT (0 of 9). Our results indicate that apocrine- and eccrine-type mixed tumors are associated with different pathways of molecular pathogenesis and suggest that the emerging relationship between skin and salivary gland mixed tumors is likely limited to those of apocrine type.
Expression of Connexin 43 (Cx43) in Benign Cutaneous Tumors With Follicular Differentiation
Authors: Fernandez-Flores Angel , Varela-Vazquez Adrian , Mayan Maria D. , Fonseca Eduardo
Published: March 2019

Introduction:

Benign cutaneous tumors with follicular differentiation are alleged to differentiate toward parts of the hair follicle. Connexin 43 (Cx43) is a gap junction protein, the tumoral role of which has been investigated in several types of tumors.

Objective:

To study the pattern of expression of Cx43 in benign cutaneous tumors with follicular differentiation and to compare it with that shown by their alleged anatomical counterparts of the hair follicle.

Materials and Methods:

Five cases each of trichofolliculoma, trichilemmoma, fibrofolliculoma/trichodiscoma, trichoblastoma, trichoepithelioma, pilomatrixoma, and proliferating trichilemmal tumor, 3 cases of pilar sheath acanthoma, and 1 case of tumor of the follicular infundibulum were examined. Anti-Cx43 antibody was used.

Results:

Cx43 was expressed by all follicular tumors studied. Comparisons between trichoblastoma and trichoepithelioma and their respective normal counterparts could not be made. In 3 tumors (trichofolliculoma, pilomatrixoma, and the spectrum fibrofolliculoma/trichodiscoma), there was a parallelism between their Cx43 expression pattern and that of their alleged anatomical counterparts. In pilar sheath acanthoma, trichilemmoma, and the tumor of the follicular infundibulum, we only found partial similarities in Cx43 expression. Only the proliferating trichilemmal tumor showed a discordant pattern of expression.

Conclusions:

Cx43 expression is preserved in benign cutaneous tumors with follicular differentiation and the patterns of Cx43 expression in benign cutaneous tumors with follicular differentiation parallel those of their alleged anatomical counterparts in 5 types (either totally or partially). This preservation might be related to the good behavior of the entities studied.
IgG4-Related Skin Disease Presenting as a Pseudolymphoma in a White Adolescent Girl
Authors: Shakeri Aria , Kindley Kimball Jade , Noland Mary Margaret , Gru Alejandro Ariel
Published: March 2019

Immunoglobulin gamma (Ig) type 4–related disease (IgG4-RD) is a chronic immunologic systemic disorder that has gained worldwide recognition in the past decade. This entity can affect almost every organ system, and its characteristic lesions have been found in a variety of organs such as lacrimal and salivary glands, pancreas, liver, bile ducts, lungs, kidneys, retroperitoneum, breast, aorta, thyroid, and prostate. This case reports a very rare case of IgG4-RD presenting with a cutaneous lesion in a young female patient mimicking a lymphoproliferative disorder. IgG4-RD affecting the skin is a rare entity and has mostly been reported in Japanese men of middle to older age. IgG4-RD with cutaneous involvement should be in the differential of non-neoplastic, lymphomas, autoimmune, and infectious disorders of the skin.
Somatotopically specific primary somatosensory connectivity to salience and default mode networks encodes clinical pain
Authors: Kim Jieun , Mawla Ishtiaq , Kong Jian , Lee Jeungchan , Gerber Jessica , Ortiz Ana , Kim Hyungjun , Chan Suk-Tak , Loggia Marco L. , Wasan Ajay D. , Edwards Robert R. , Gollub Randy L. , Rosen Bruce R. , Napadow Vitaly
Published: March 2019

Although several studies have found that chronic pain is characterized by increased cross-network connectivity between salience network, sensorimotor network, and default mode network (DMN), a large sample-size investigation allowing for a more reliable evaluation of somatotopic specificity and subgroup analyses with linkage to clinical pain intensity has been lacking. We enrolled healthy adults and a large cohort of patients (N = 181) suffering from chronic low back pain (cLBP). To specifically link brain connectivity with clinical pain intensity, patients were scanned at baseline and after performing physical maneuvers that exacerbated pain. Compared with healthy adults, patients with cLBP demonstrated increased connectivity between the functionally localized back representation in the primary somatosensory cortex (S1back) and both salience network and DMN. Pain exacerbation maneuvers increased S1back connectivity to salience network regions, but decreased connectivity to DMN, with greater pain intensity increase associated with greater shifts in these connectivity patterns. Furthermore, only in patients with cLBP reporting high pain catastrophizing, DMN connectivity was increased to a cardinal node of the salience network, anterior insula cortex, which was correlated with increased postmaneuver pain in this cLBP subgroup. Hence, increased information transfer between salience processing regions, particularly anterior insula, and DMN may be strongly influenced by pain catastrophizing. Increased information transfer between the salience network and S1 likely plays an important role in shifting nociceptive afference away from self-referential processing, reallocating attentional focus, and affective coding of nociceptive afference from specific body areas. These results demonstrate S1 somatotopic specificity for cross-network connectivity in encoding clinical back pain and moderating influence of catastrophizing for DMN/insula connectivity.
People in pain make poorer decisions
Authors: Attridge Nina , Pickering Jayne , Inglis Matthew , Keogh Edmund , Eccleston Christopher
Published: March 2019

Chronic pain affects 1 in 5 people and has been shown to disrupt attention. Here, we investigated whether pain disrupts everyday decision making. In study 1, 1322 participants completed 2 tasks online: a shopping-decisions task and a measure of decision outcomes over the previous 10 years. Participants who were in pain during the study made more errors on the shopping task than those who were pain-free. Participants with a recurrent pain condition reported more negative outcomes from their past decisions than those without recurrent pain. In study 2, 44 healthy participants completed the shopping-decisions task with and without experimentally induced pain. Participants made more errors while in pain than while pain-free. We suggest that the disruptive effect of pain on attending translates into poorer decisions in more complex and ecologically valid contexts, that the effect is causal, and that the consequences are not only attentional but also financial.
Reducing Rejected Fecal Immunochemical Tests Received in the Laboratory for Colorectal Cancer Screening
Authors: Cheng Caleb , Ganz David A. , Chang Evelyn T. , Huynh Alexis , De Peralta Shelly
Published: March 2019

Background:

Colorectal cancer (CRC) screening decreases CRC incidence; however, many patients are not successfully screened.

Purpose:

To improve screening rates at our institution by decreasing the rate of rejected fecal immunochemical tests (FITs), a means of CRC screening, from 28.6% to <10% by December 2017.

Methods:

Specimens were rejected for the following reasons: expired specimen, lack of recorded collection date/time, lack of physician orders, incomplete patient information, and illegible handwriting. Multidisciplinary teams devised the following interventions: FIT envelope reminder stickers, automated FIT patient reminder phone calls, a laboratory standard operating procedure, an accessioning process at satellite laboratories, revisions to a clinical reminder when offering FIT, and provision of FIT-compatible printers to clinics.

Results:

Total specimens received each month ranged from 647 to 970. Fecal immunochemical test rejection rates fell from 28.6% in June 2017 to 6.9% in December 2017 with a statistically significant decrease (p-value = .015) between the intervention period (May 2017–October 2017) and the postintervention period (November 2017–May 2018).

Conclusions:

Targeted interventions with stakeholder involvement are essential in reducing the rejection rate.

Implications:

The decreased rejection rate saves resources by decreasing the need to rescreen patients whose specimens were rejected, and may improve CRC screening rates.
Veterans Health Administration Primary Care Provider Adherence to Prescribing Guidelines for Systemic Hormone Therapy in Menopausal Women
Authors: Cordasco Kristina M. , Yuan Anita H. , Danz Marjorie J. , Jackson LaShawnta , Yee Ellen F. , Tcheung Lueng Sophia , Washington Donna L.
Published: March 2019

Background:

Systemic hormone therapy (HT) is effective for treating menopausal symptoms but also confers risks. Therefore, experts have developed clinical guidelines for its use.

Purpose:

We assessed primary care guideline adherence in prescribing systemic HT, and associations between adherence and provider characteristics, in four Veterans Health Administration (VA) facilities.

Methods:

We abstracted medical records associated with new and renewal systemic HT prescriptions examining adherence to guidelines for documenting indications and contraindications; prescribing appropriate dosages; and prescribing progesterone.

Results:

Average guideline adherence was 58%. Among new prescriptions, 74% documented a guideline-adherent indication and 28% documented absence of contraindications. Among renewals, 39% documented a guideline-adherent indication. In prescribing an appropriate dose, 45% of new prescriptions were guideline-adherent. Among renewal prescriptions with conjugated equine estrogen doses ≥0.625 mg or equivalent, 16% documented the dosing rationale. Among 116 prescriptions for systemic estrogen in women with a uterus, progesterone was not prescribed in 8.

Conclusions:

Guideline adherence in prescribing systemic HT was low among VA primary care providers. Failures to coprescribe progesterone put women at increased risk for endometrial cancer.

Implications:

Intervention development is urgently needed to improve guideline adherence among primary care prescribers of systemic HT for menopause. Similar assessments should be conducted in community settings.
Hepatic steatosis and patients with inflammatory bowel disease: when transient elastography makes the difference
Authors: Arieira Cátia , Monteiro Sara , Xavier Sofia , Dias de Castro Francisca , Magalhães Joana , Moreira Maria J. , Marinho Carla , Cotter José
Published: March 2019

Background

Recent studies suggest an increased prevalence of hepatic steatosis (HS) in patients with inflammatory bowel disease (IBD). Features such as chronic inflammation, previous surgeries, drug-induced hepatotoxicity, malnutrition, and intestinal dysbiosis seem to be involved in its pathogenesis.

Aims

The aim of this study was to assess the frequency of HS in patients with IBD quantified by controlled attenuation parameter (CAP) and by clinical–analytical scores: Hepatic Steatosis Index (HSI) and Fatty Liver Index (FLI). The secondary aim was to investigate risk factors associated with HS in patients with IBD.

Patients and methods

A cross-sectional study was carried out including consecutive outpatients observed in our department between January and March 2017. HS was defined as HSI of at least 36 or FLI of at least 60 or CAP of greater than 248.

Results

A total of 161 patients were included, with a mean age of 40.6±12.8 years. There were 86 (53.4%) female patients. Overall, 62.7% had Crohn’s disease and 37.1% had ulcerative colitis. Moreover, 73 (45.3%) patients had CAP greater than 248, 27 (16.8%) had FLI greater than 60, and 46 (28.6%) had HSI greater than 36.

We found that patients with CAP of greater than 248 were more frequently obese (28.8 vs. 0.0% P<0.001), male (57.5 vs. 37.5% P=0.011), and presented more frequently with metabolic syndrome (23.9 vs. 4.5% P <0.001). With regard to IBD factors, patients with HS had a higher frequency of previous surgeries (31.5 vs. 12.5% P=0.003). In multivariate analysis, only male sex [odds ratio: 5.7 (95% confidence interval: 2.0–15.9); P=0.001] and previous surgeries [odds ratio: 5.9 (95% confidence interval: 1.5–22.9); P=0.011] were independent risk factors of HS.

Conclusion

In our cohort, the frequency of HS varied between 16.8 and 45.3% defined by noninvasive methods. We found that male sex and previous history of surgery were the independent risk factors of HS when quantified by transient elastography.
Benefits and Risks of Anticoagulation in Acute Coronary Syndrome
Authors: Pop Calin , Matei Claudia
Published: March 2019

Background:

Both antiplatelets and anticoagulants are necessary in the management of acute coronary syndrome (ACS), although the exact proportion of antithrombotic effect that each drug and class should ideally provide remains a matter of ongoing study.

Area of Uncertainty:

Defining the best combination between the antiplatelet agents and oral anticoagulants (OACs) can be challenging. The choice is particularly important for special categories of patients with ACS who have an indication of a long-term OAC.

Data Sources:

A literature search regarding benefits and risks of anticoagulation in ACS was conducted through MEDLINE and EMBASE (past 20 years until September 2018).

Therapeutic Advances:

Many patients with ACS have an indication for long-term OACs. Those receiving dual antiplatelet therapy and anticoagulants are considered to be at a high bleeding risk. The addition of a vitamin K antagonist (VKA) imposes a target international normalized ratio of 2.0–3.0. When non-VKA oral anticoagulants are used, the lowest effective tested dose for stroke prevention should be applied. For most patients, triple therapy in the form of an OAC plus dual antiplatelet therapy [aspirin and P2Y12 inhibitors (usually clopidogrel)] should be considered for 3–6 months. Later, dual therapy (OAC plus aspirin or clopidogrel) should be considered for an additional 6 months. After 1 year, it is recommended that only the OAC is maintained. In cases of very high bleeding risk, triple therapy can be reduced to 1 month after ACS, continuing on dual therapy up to 1 year, and thereafter only anticoagulation. In general, the bleeding risk seems to be lower with non-VKA oral anticoagulants than VKA plus antiplatelet combination.

Conclusions:

Many risk factors for ischemic events and bleeding overlap. The clinician's challenges include monitoring patients' adherence and global assessment of the antithrombotic effect that incorporates antiplatelet and anticoagulant effects.
Contemporary management of hepatoblastoma
Authors: Hafberg Einar , Borinstein Scott C. , Alexopoulos Sophoclis P.
Published: March 2019

Purpose of review

Hepatoblastoma is the most common primary pediatric liver malignancy. The goal of treatment in hepatoblastoma is complete surgical resection. Recently published multinational collaborative studies are better defining risk factors for disease recurrence and guide optimal treatment strategy.

Recent findings

Successful margin-negative resection of hepatoblastoma is dependent on the location and extent of disease as defined by the PRETEXT classification. Liver transplantation is an appropriate treatment modality when complete oncological resection requires total hepatectomy. In general, advanced PRETEXT class as well as histologic features, age at presentation, tumoral production of α-feto protein and the presence of metastatic disease adversely affect outcome. Hepatoblastoma is chemosensitive and significant downstaging can occur with the use of neoadjuvant chemotherapy allowing for less extensive hepatectomy. In addition, patients at moderate-to-high risk of postresection recurrence should receive neoadjuvant chemotherapy. Cisplatin-based chemotherapy can allow for resection of transplantation of patients with metastatic disease when complete metasatectomy can be achieved albeit with inferior results.

Treatment of hepatoblastoma with surgical resection or liver transplantation is associated with excellent long-term results in the setting of modern chemotherapy.
Clinical Nurse Leader Knowledge Production to Quality Improvement in a Seamless Trajectory
Authors: Bender Miriam , Spiva LeeAnna , Patrick Sara , Meffert Sarah , Moton Lonnie , Clarke Sharee , Mathis Kendra , Leclerc Lucy , Knotts Kimberly , Mount April
Published: March 2019

Background:

Health systems are actively implementing Clinical Nurse Leader (CNL)-integrated care delivery across the United States.

Problem:

However, the CNL model is a complex health care intervention, making it difficult to generate evidence of effectiveness using traditional research frameworks.

Approach:

Participatory research is a growing alternative to traditional research frameworks, emphasizing partnership with target community members in all phases of research activities. This article describes a system-based participatory study that leveraged academic and practice knowledge to conduct research that was feasible and relevant, and which produced findings that were easily translated into systematic action by the health system.

Outcomes:

Study data were used to produce improvements in the health system's CNL onboarding process, role differentiation, performance, recruitment, and growth plus development.

Conclusions:

A participatory approach can be used in future CNL studies, providing a framework for research efforts and potentially speeding up CNL evidence generation and utilization in practice.
Patient Satisfaction With Telephone Nursing
Authors: Gustafsson Silje , Wälivaara Britt-Marie , Gabrielsson Sebastian
Published: March 2019

Background:

Studies of patient satisfaction with telephone nursing can provide a better understanding of callers' needs and inform the improvement of services.

Purpose:

This study described patients' experiences and perceptions of satisfaction with telephone nursing.

Methods:

The design was nonexperimental and descriptive, with an inductive approach. Data were collected using open-ended questions in a questionnaire that was dispatched to 500 randomly selected callers to the Swedish Healthcare Direct in Northern Sweden.

Results:

Patients' satisfaction with telephone nursing was related to calm, clarity, and competence. Calm referred to the nurse remaining calm and composed during the call. Clarity was described as distinct, concrete, and practical advice on how to act, what to observe, and where to seek further assistance. Competence referred to both health care knowledge and caring skills.

Conclusion:

These aspects of nursing are dependent on each other and on-call telephone nursing services, which value patient satisfaction need to target all 3.
Associations Between Hospital-Level Patient Satisfaction Scores and Hospital-Acquired Pressure Ulcer Occurrences Among Medicare Stroke Patients
Authors: Odom-Maryon Tamara , Hu Hsou Mei , Tzeng Huey-Ming
Published: March 2019

Background:

Limited research has explored the associations between the US Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings data and hospital-acquired pressure ulcer (HAPU) occurrences.

Purpose:

We examined the associations between the hospital-level patient satisfaction HCAHPS scores with hospital care experience reported by Medicare patients 65 years or older and the occurrence of HAPUs among Medicare patients with stroke.

Methods:

A matched case-control design was used. Patients with a history of stroke were identified using the 2011 Medicare fee-for-service patient data. Medicare Beneficiary Summary and Medicare Provider Analysis and Review files processed by the Chronic Conditions Data Warehouse were analyzed. Conditional logistic regression was used.

Results:

HAPUs occur less frequently among Medicare patients with stroke who received inpatient care at hospitals with higher patient satisfaction HCAHPS scores for nurses' communication skills and quietness at night for the areas around patient rooms.

Conclusions:

Using hospital-level patient satisfaction HCAHPS scores to monitor and project HAPU occurrences is recommended.