bluuebunny/crossref_metadata_2025 huggingface dataset:
A Clinical Rule for Preoperative Prediction of BRAF Mutation Status in Craniopharyngiomas
Authors: Fujio Shingo , Juratli Tareq A , Arita Kazunori , Hirano Hirofumi , Nagano Yushi , Takajo Tomoko , Yoshimoto Koji , Bihun Ivanna V , Kaplan Alexander B , Nayyar Naema , Fink Alexandria L , Bertalan Mia S , Tummala Shilpa S , Curry, Jr William T , Jones Pamela S , Martinez-Lage Maria , Cahill Daniel P , Barker Fred G , Brastianos Priscilla K
Published: November 2018

BACKGROUND

Papillary craniopharyngiomas are characterized by BRAF
V600E mutations. Targeted therapy can elicit a dramatic radiographic regression of these tumors. Therefore, prediction of BRAF mutation status before definitive surgery could enable neoadjuvant treatment strategies.

OBJECTIVE

To establish preoperative prediction criteria to identify patients with a BRAF mutant craniopharyngioma.

METHODS

Sixty-four patients with craniopharyngioma were included in this study. We determined BRAF mutation status by targeted sequencing. After scoring interobserver variability between presurgical clinical data and radiographic features, we established a diagnostic rule for BRAF mutation in our discovery cohort. We then validated the rule in an independent cohort.

RESULTS

The BRAF
V600E mutation was detected in 12 of 42 patients in the discovery cohort. There were no patients under age 18 with BRAF mutation. Calcification was rare in tumors with BRAF mutation (P < .001), and 92% of them were supradiaphragmatic in location. Combining these 3 features—older than 18 years, absence of calcification, and supradiaphragmatic tumor location—we established a rule for predicting BRAF mutation. In cases where all 3 criteria were fulfilled, the sensitivity and specificity for the presence of BRAF mutation were 83% and 93%, respectively. In the validation cohort (n = 22), the sensitivity was 100% and specificity was 89%.

CONCLUSION

We propose predictive criteria for a BRAF mutation in craniopharyngioma using preoperative clinical and radiographic data. This rule may be useful in identifying patients who could potentially benefit from neoadjuvant BRAF
V600E-targeted systemic therapies.
E-Cigarette Use Is Associated With Intentions to Lose Weight Among High School Students
Authors: Mantey Dale S , Omega-Njemnobi Onyinye , Kelder Steven H
Published: November 2018

Introduction

Recent literature has demonstrated individuals may be using electronic cigarettes (e-cigarettes) as a method of weight loss and/or management. Furthermore, e-cigarette companies are developing and patenting technologies related to e-cigarettes and weight loss. This study aims to determine the association between intentions to lose weight and e-cigarette use behaviors among a nationally representative sample of high school students.

Methods

Data were obtained from the 2015 Youth Risk Behavior Surveillance survey. Participants were 12 847 students in grades 9–12 in the United States. Multivariate multinomial logistic regression models assessed the association between past 30-day e-cigarette use and weight loss intentions among 9–12 grade students. Subsample analyses were conducted, stratified by sex. Covariates included perceived weight, sex, race/ethnicity, grade, and past 30-day tobacco use.

Results

Overall, 23.7% of the sample used e-cigarettes in the past 30 days. E-cigarette use was associated with 1.38 (95% CI = 1.07% to 1.78%) greater risk of intentions to lose weight among the full sample, controlling for covariates. Among girls, e-cigarette use was associated with 1.44 (95% CI = 1.05% to 1.97%) greater risk of intentions to lose weight, controlling for covariates. Among boys, e-cigarette use was associated with 1.40 (95% CI = 1.04% to 1.88%) greater odds of intentions to gain weight, controlling for covariates.

Conclusion

Findings show a significant association between e-cigarette use and intentions to lose weight among high school students, among the full sample. Interestingly, e-cigarette use was statistically associated with intentions to gain weight among boys. Longitudinal study is needed to further examine this relationship.

Implications and Contribution

This is the one of the first studies reporting on e-cigarette use and weight loss intentions among adolescents, both highly prevalent among this population. These findings are an important development in the study of e-cigarette use given the established link between conventional cigarette smoking and weight loss and/or management.
Clinical, Histopathological, and Virological Evaluation of 203 Patients With a Clinical Diagnosis of Molluscum Contagiosum
Authors: Trčko Katarina , Hošnjak Lea , Kušar Blanka , Zorec Tomaž Mark , Kocjan Boštjan J , Križmarić Miljenko , Seme Katja , Miljković Jovan , Luzar Boštjan , Poljak Mario
Published: November 2018

Molluscum contagiosum (MC) manifests as small, umbilicated papules caused by the molluscum contagiosum virus (MCV). The extent of clinical misdiagnosis of MC is unknown. Combined clinical, histopathological, and virological evaluation of 203 consecutive patients with clinical diagnosis of MC treated at a university hospital during a 5-year period showed the correct clinical diagnosis in 188 of 203 (92.6%) patients. All 15 clinically misdiagnosed MC lesions were histopathologically and virologically confirmed as either common or anogenital warts caused by different human papillomaviruses. The MCV1/MCV2 subtypes ratio was 1.54:1, and the distribution of MCV subtypes differed across patients’ age and anatomical location of lesions.
EQUAL Cryptococcus Score 2018: A European Confederation of Medical Mycology Score Derived From Current Guidelines to Measure QUALity of Clinical Cryptococcosis Management
Authors: Spec Andrej , Mejia-Chew Carlos , Powderly William G , Cornely Oliver A
Published: November 2018

Cryptococcocis is an opportunistic fungal infection with high morbidity and mortality. Guidelines to aid clinicians regarding diagnosis, management, and treatment can be extensive and challenging to comply with. There is no tool to measure guideline adherence. To create such a tool, we reviewed current guidelines from the Infectious Diseases Society of America, the World Health Organization, the American Society of Transplantation, and recent significant publications to select the strongest recommendations as vital components of our scoring tool. Items included diagnostic tests (blood, tissue, and cerebrospinal fluid cultures, Cryptococcus antigen, India ink, histopathology with special fungal stains, central nervous system imaging), pharmacological (amphotericin B, flucytosine, azoles) and nonpharmacological treatments (intracranial pressure management, immunomodulation, infectious disease consultation), and follow-up of central nervous system complications. The EQUAL Cryptococcus Score 2018 weighs and aggregates the recommendations for the optimal management of cryptococcosis. Providing a tool that could measure guideline adherence or facilitate clinical decision-making.
Innate immunity and interferons in the pathogenesis of Sjögren’s syndrome
Authors: Bodewes Iris L A , Björk Albin , Versnel Marjan A , Wahren-Herlenius Marie
Published: November 2018

Primary SS (pSS) is a rheumatic disease characterized by an immune-mediated exocrinopathy, resulting in severe dryness of eyes and mouth. Systemic symptoms include fatigue and joint pain and a subset of patients develop more severe disease with multi-organ involvement. Accumulating evidence points to involvement of innate immunity and aberrant activity of the type I IFN system in both the initiation and propagation of this disease. Analysis of the activity of IFN-inducible genes has evidenced that more than half of pSS patients present with a so-called ‘type I IFN signature’. In this review, we examine activation of the IFN system in pSS patients and how this may drive autoimmunity through various immune cells. We further discuss the clinical value of assessing IFN activity as a biomarker in pSS patients and review novel therapies targeting IFN signalling and their potential use in pSS.
Relationships of retained energy and retained protein that influence the determination of cattle requirements of energy and protein using the California Net Energy System
Authors: Tedeschi Luis O
Published: November 2018

Interrelationships between retained energy (RE) and retained protein (RP) that are essential in determining the efficiency of use of feeds and the assessment of energy and protein requirements of growing cattle were analyzed. Two concerns were identified. The first concern was the conundrum of a satisfactory correlation between observed and predicted RE (r = 0.93) or between observed and predicted RP when using predicted RE to estimate RP (r = 0.939), but a much lower correlation between observed and predicted RP when using observed RE to estimate RP (r = 0.679). The higher correlation when using predicted vs. observed RE is a concern because it indicates an interdependency between predicted RP and predicted RE that is needed to predict RP with a higher precision. These internal offsetting errors create an apparent overall adequacy of nutrition modeling that is elusive, thus potentially destabilizing the predictability of nutrition models when submodels are changed independently. In part, the unsatisfactory prediction of RP from observed RE might be related to the fact that body fat has a caloric value that is 1.65 times greater than body protein and the body deposition of fat increases exponentially as an animal matures, whereas body deposition of protein tends to plateau. Thus, body fat is more influential than body protein in determining RE, and inaccuracies in measuring body protein will be reflected in the RP comparison but suppressed in the RE calculation. The second concern is related to the disconnection when predicting partial efficiency of use of metabolizable energy for growth (kG) using the proportion of RE deposited as protein—carcass approach—vs. using the concentration of metabolizable energy of the diet—diet approach. The culprit of this disconnection might be related to how energy losses that are associated with supporting energy-expending processes (HiEv) are allocated between these approaches. When computing kG, the diet approach likely assigns the HiEv to the RE pool, whereas the carcass approach ignores the HiEV, assigning it to the overall heat production that is used to support the tissue metabolism. Opportunities exist for improving the California Net Energy System regarding the relationships of RE and RP in computing the requirements for energy and protein by growing cattle, but procedural changes might be needed such as increased accuracy in the determination of body composition and better partitioning of energy.
Differences in Performance on Developmental Tasks in Young Children Across Digital and Paper-Based Modalities: A Feasibility Trial
Authors: Dempsey Allison G. , Barton Amy K. , Duncan Andrea F.
Published: November 2018

Objective:

To determine whether use of digital-based screening is a feasible approach to monitoring child development, it is necessary to assess young children's abilities to interface with touch screen technology. The primary objectives of this exploratory feasibility study with a randomized experimental design were to determine (1) whether young children respond differently to developmental tasks on paper versus tablet device and (2) whether responses to items presented digitally differed according to hours of weekly exposure to touch screen technology in the home.

Methods:

Eighty children attending 18-, 24-, 36-, or 48-month pediatrician well-child checks were randomly assigned to complete a series of 70 examiner-facilitated, developmental tasks across 7 domains (receptive language, expressive language, early literacy, early numeracy, social emotional, cognition, and fine motor) presented either digitally or on paper. Parents provided information about use of technology in the home. A series of t tests assessed for main effects of presentation modality (digital vs paper) on each of the domains.

Results:

Raw scores across the 7 domains did not differ by presentation modality. Hours of technology use per week was not related to raw scores among children in the digital condition.

Conclusion:

Young children do not respond differentially to items when presented in a digital format in comparison to a paper-based format. Use of manipulatives for assessing developmental skills may be needed for children 2 years and younger, as they displayed a limited range of responses to items in both conditions at these age groups.
Acceptance of the Chest Pain Unit Certification Process
Authors: Breuckmann Frank , Rassaf Tienush
Published: November 2018

The nationwide German certification process of specialized chest pain units is unique in Europe. By February 2018, 269 units had already been successfully certified. With that number, more than half of all catheter laboratories across the country offering service on a 24/7 basis for interventional treatment in myocardial infarction take part in that certified chest pain program – with still increasing tendency. Currently, those units provide a mean of one chest pain unit bed per 65,000 inhabitants. Thereby, a high percentage of recertification of about 95% reflects a high acceptance of the concept by the health care providers. Structured in-hospital procedures, increasing awareness within the community and among the emergency medical services as well as increasing numbers of self-referrals guarantee higher work-flow, improving performance and an even increasing demand for those units. Complimentary patient awareness campaigns focusing on early symptom recognition might further improve, expand and redirect patient flow, shorten patient-related delay and have to become the next level in chest pain patient care in Germany. Transferring the idea of early heart attack care to the community as a new way of thinking might be able to more significantly decrease future symptoms-to-therapy times as the current chest pain unit program can solely achieve.
Implementation of High-Sensitivity Cardiac Troponin: Challenges From the International Experience
Authors: Howell Stacey J. , Amsterdam Ezra A. , Mumma Bryn E. , López Javier E. , Tran Nam K.
Published: November 2018

Objective:

Implementation of the newly approved high-sensitivity cardiac troponin (hs-cTn) in the United States presents a challenge for clinical practice. Sex-specific cutoffs, clinical protocols, and workflows will likely require modifications before implementation.

Methods:

We conducted a cross-sectional survey of international physicians and laboratorians already utilizing hs-cTn for the evaluation of acute myocardial infarction.

Results:

Twenty-two of 54 (41%) eligible participants completed the survey, representing 9 countries and 18 hospitals. All reported successful hs-cTn implementation and diagnostic utility (mean 8.6 + 1.2 out of 10 for best implementation). The major perceived benefit was more rapid evaluation of acute myocardial infarction (14/19, 74%), and the most frequently cited limitation was an increase in the number of measurable hs-cTn values that required further evaluation (8/18, 44%). Institutions using the hs-cTnI assay favored sex-specific cutoffs (5/6, 83%), whereas institutions employing the hs-cTnT assay favored a combined cutoff (12/12, 100%). Timing of serial hs-cTn measurements varied, with 0–3 hours (8/17, 47%) most frequent, followed by 0–2 hours (4/17, 24%), 0–1 hour (3/17, 18%), and other (2/17, 12%).

Conclusions:

Our survey of hs-cTn implementation at international institutions reveals satisfaction with new assays but reflects important variations in clinical practice. The use of sex-specific vs. combined cutoffs and timing of serial hs-cTn measurements varies across institutions and are subjects that United States centers must define without consensus from international practices.
Prognostic Utility of the HEART Score in the Observation Unit
Authors: Michaels Alexander , Gibbs Joseph , Mawri Sagger , Dirani George , Aurora Lindsey , Jacobsen Gordon , Nowak Richard , McCord James
Published: November 2018

The evaluation of individuals with possible acute myocardial infarction (AMI) is time consuming and costly. Risk stratification early during an acute care encounter presents an opportunity for increased delivery of high-value care. We sought to evaluate if the HEART score could be used in the triage of low-risk versus high-risk patients directly home without cardiac testing. Retrospective review of 838 patients placed in an observation unit for evaluation of AMI was done at a single-center, tertiary care teaching hospital. Primary outcome was major adverse cardiac event—death, AMI, or revascularization—at 30 days from the index encounter. Participants’ average age was 60.1 years, 40% were male, and 67% were African American. Complete data were available for all 838 patients, including 30-day follow-up at study completion. The primary endpoint was met in 14 patients (1.7%), all of whom were in the high-risk group, with HEART score ≥4. Of the low-risk patients, 8 (2.8%) had a positive functional study, 5 underwent subsequent coronary angiography, with none (0%) found to have obstructive coronary disease. In conclusion, our results suggest that patients with a HEART score ≤3 being evaluated for chest pain are at extremely low risk for major adverse cardiac events and may be safely discharged without provocative testing. Positive cardiac testing in this population is more likely to represent a false-positive finding, resulting in unnecessary testing. These findings should be prospectively validated.
Spatiotemporal Analysis and Epidemiology of Kawasaki Disease in Western New York
Authors: Chang Arthur , Delmerico Alan M. , Hicar Mark D.
Published: November 2018

Background:

Kawasaki disease (KD) is one of the leading causes of acquired heart disease in children in developed nations. Epidemiologic evidence suggests that KD is related to an infectious agent; however, the cause remains unknown. Yearly incidence in Japan has been steadily increasing, but few long-term databases of KD cases from North America have been reviewed.

Methods:

We reviewed the epidemiology of local cases over a 16-year period to study incidence with time and temporal and geographic clustering of cases in a representative cohort in North America.

Results:

The yearly incidence in cases per population <5 years old per 100,000 was 20.2 and 15.9, using International Classification of Disease, ninth revision and detailed chart review, respectively. Using International Classification of Disease, ninth revision alone overestimates our incidence by 27%. We show a distinct seasonality of cases with winter predominance. Applying Kulldorff’s spatial scan statistic revealed no significant clustering of cases with either purely spatial or space-time analyses. On purely nonconstrained temporal SaTScan analysis, there was a significant clustering of cases in a 67- to 68-week period in 2000–2001.

Conclusions:

Our analysis reveals an apparent outbreak of KD in our region in 2000–2001. In contrast to Japan, for the last 14 years, the incidence in our region has been stable.
Preseptal Upper Eyelid Lipoma
Authors: Maeng Michelle M. , Godfrey Kyle J. , Kazim Michael
Published: November 2018

Superficial subcutaneous lipomas are benign, slow-growing neoplasms comprised mature adipose cells that may be surrounded by a fibrous tissue capsule. While found commonly on the body, simple lipomas are rarely described in the eyelids. Reports of two eyelid lipomas in the literature describe the anatomy to be posterior to the orbital septum. The presenting authors report the case of a simple lipoma of the eyelid found fully in the preseptal plane. Lipomas can occur anterior to the orbital septum and should be considered in the differential when presented with a painless, slow-growing eyelid mass in adults.
Effect of β-Lactam Plus Macrolide Versus Fluoroquinolone on 30-Day Readmissions for Community-Acquired Pneumonia
Authors: Gilbert Travis T. , Arfstrom Rachel J. , Mihalovic Scott W. , Dababneh Ala S. , Varatharaj Palraj Bharath Raj , Dierkhising Ross A. , Mara Kristin C. , Lessard Sarah R.
Published: November 2018

Background:

Antibiotic therapy with a macrolide and β-lactam or a fluoroquinolone for the empirical treatment of community-acquired pneumonia (CAP) in an inpatient non–intensive care setting is recommended per guidelines. Studies show that these treatments have similar outcomes, including death, adverse effects, and bacterial eradication. However, a comparison of 30-day readmission rates between these treatments is limited.

Study Question:

To determine whether 30-day readmissions for patients treated for CAP in a regional hospital differed between a fluoroquinolone monotherapy and a β-lactam plus macrolide combination therapy.

Study Design:

Retrospective cohort study of patients aged ≥18 years with a CAP diagnosis who were admitted to the same regional hospital from December 1, 2011, through December 1, 2016.

Measures and Outcomes:

Patients receiving a third-generation cephalosporin plus macrolide were compared with those receiving a respiratory fluoroquinolone. Exclusion criteria were concurrent or recent use of the study antibiotics; death, transfer, or transition to hospice; and diagnosis of hospital-acquired pneumonia or health care–associated pneumonia. The collected data were 30-day readmission rates, antibiotic regimens, demographic characteristics, and pneumonia severity index and comorbidity scores. Association between treatment group and readmissions was assessed with logistic regression. Association between readmissions and individual data points between the 2 treatment groups was calculated with multivariate regression and odds ratio (95% confidence interval).

Results:

Of 432 patients, 171 met inclusion criteria (fluoroquinolone group, n = 101; β-lactam plus macrolide group, n = 70). Thirty-day readmissions were not significantly different between the fluoroquinolone group and β-lactam plus macrolide group (P = 0.58). Increased 30-day readmissions were independently associated with male sex and hospital length of stay (P < 0.05). Length of stay was approximately 3 days and did not differ between treatment groups.

Conclusions:

No difference was seen in 30-day readmissions between CAP patients who received fluoroquinolone monotherapy and those who received β-lactam plus macrolide combination therapy.
Virulence factors genotyping of Klebsiella pneumoniae clinical isolates from Baghdad
Authors: Ali Ali M. , Al-kakei Sana’a N.
Published: November 2018

Seventy of Klebsiella pneumoniae isolates had been collected from some Hospitals in Baghdad city from October to December 2017. The 70 isolates were taken from diverse clinical specimens. All K. pneumoniae isolates were identified based on API 20 E and Vitek2 compact system. Antibiotics sensitivity test was carried out toward 10 antibiotics using discs diffusion method. The level of antibiotics resistance was 81.42% for Ceftriaxone, whereas the low level of antibiotics resistance was 37.14% for Piperacillin. K. pneumoniae isolates were typed genotypically by using two different methods of amplification, multiplex-PCR and enterobacterial repetitive intergenic consensus (ERIC)-PCR typing methods. Results showed that out of 70 isolates, there were 60 isolates (85.71%) positive to entB, 58 isolates (82.85%) to ybtS and mrkD, 48 isolates (68.57%) to iutA, 27 isolates (38.57%) to K2, 24 isolates (34.28%) to kfu, six isolates (8.57%) to alls, one isolate (1.42%) that gave positive to rmpA, whereas 70 isolates (0%) did not give positive result to magA. The second method of genotyping of K. pneumoniae was ERIC-PCR method. ERIC dendrogram of K. pneumoniae isolates showed two main clusters A and B. Cluster B was bigger 33 (52.38%) isolates than cluster A 30 (47.61%) isolates, the most common cluster was A1b subcluster consisted from 14 (22.22%) isolates. The percentage level of similarity clearly showed level of 90% in ERIC-PCR. Statistical analysis found correlation coefficient of ERIC genotyping method with virulence genetic profile and antibiotype was significant at P less than 0.05 (two-tailed), whereas not found correlation with capsular typing and mucoviscosity was NS.
The Spectrum of EBV-Positive Mucocutaneous Ulcer
Authors: Prieto-Torres Lucía , Eraña Itziar , Gil-Redondo Rocio , Gómez de la Riva Inés , Manso Rebeca , Pajares Raquel , Córdoba Raúl , Machan Salma , Ara Mariano , Requena Luís , Piris Miguel Á. , Rodríguez-Pinilla Socorro M.
Published: November 2018

We describe a series of 9 patients with Epstein-Barr virus (EBV)-positive mucocutaneous lymphoproliferative lesions that broadens the concept of EBV-positive mucocutaneous ulcer. We report 5 female and 4 male patients, with an average age of 74 years (range, 55 to 87 y), 2 of whom were HIV-positive. The lesions were located in the oropharynx, skin, and rectal and/or genital mucosa. Histopathologically, 6 cases showed a polymorphic pattern and 3 had a monomorphic and diffuse one, with angiotropism in 4 cases (2 each with the polymorphic and monomorphic patterns). Three of the cases expressed PDL1. In addition to its presence in the neoplastic lymphoid cells, EBV was also detected in adjacent epithelial cells in an oropharyngeal lesion. All cases responded to local therapy or adapted systemic chemotherapy in selected cases. This series extends the spectrum of this disorder to include some HIV-positive cases, patients with multiple lesions confined to a single anatomic area, lesions with an angiocentric pattern, and some cases with monomorphous large-cell cytology. We discuss the differential clinicopathologic diagnosis of this disorder and that of classic EBV large B-cell lymphoma.
A Cross-Sectional Analysis of Compassion Fatigue, Burnout, and Compassion Satisfaction in Pediatric Critical Care Physicians in the United States*
Authors: Gribben Jeanie L. , Kase Samuel M. , Waldman Elisha D. , Weintraub Andrea S.
Published: November 2018

Objectives:

To determine the prevalence of compassion fatigue, burnout, and compassion satisfaction and identify potential personal and professional predictors of these phenomena in pediatric critical care providers.

Design:

Cross-sectional, online survey.

Setting:

Pediatric critical care practices in the United States.

Subjects:

Pediatric critical care fellows and attending physicians.

Interventions:

None.

Measurement and Main Results:

A modified Compassion Fatigue and Satisfaction Self-Test for Helpers and a questionnaire of personal and professional characteristics were distributed electronically to pediatric critical care physicians nationally. Prevalence of these phenomena was calculated. Hierarchical linear regression models for compassion fatigue, burnout, and compassion satisfaction as a function of potential risk factors were constructed. The survey response rate was 35.7%. The prevalence of compassion fatigue, burnout, and compassion satisfaction was 25.7%, 23.2%, 16.8%, respectively. Burnout score, emotional depletion, and distress about a patient and/or the physical work environment were each significant determinants of higher Compassion Fatigue scores. Preparing for didactics, Compassion Fatigue score, distress about administrative issues and/or coworkers, and “self-care is not a priority” were each significant determinants of higher burnout scores, whereas female sex, Compassion Satisfaction score, and distress about the physical work environment were each significant determinants of lower burnout scores. Prayer/meditation, talking with colleagues, senior faculty level, and student and/or chaplain involvement when delivering bad news were each significant predictors of higher Compassion Satisfaction scores, whereas female sex, burnout score, emotional depletion, and distress about coworkers were each significant predictors of lower Compassion Satisfaction scores.

Conclusions:

In our population, chronic exposure to distress in patients and families puts pediatric critical care physicians at risk for compassion fatigue and low compassion satisfaction. Awareness of compassion fatigue, burnout, and compassion satisfaction and their predictors may benefit providers both personally and professionally by allowing them to proactively manage their distress.
Two Cases of 188Re Microspheres for Inoperable Hepatocellular Carcinoma
Authors: Shukla Jaya , Kalra Naveen , Kumar Rajender , Bhusari Priya , Chhabra Anupriya , Parmar Madan , Vatsa Rakhee , Singh Harmandeep , Duseja Ajay , Mittal B. R.
Published: November 2018

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies. Often, patients present with inoperable and advanced disease. Selective internal radionuclide therapy offers prolonged survival and improved quality of life by delivering high radiation dose to the tumor with minimal complications. We report 2 inoperable cases of HCC treated with therapeutic dose of indigenously developed 188Re microspheres delivered to the hepatic lesions by transarterial catheterization. Follow-up CT revealed necrosis within the lesion, suggesting response to selective internal radionuclide therapy. 188Re microspheres may be a potential treatment option for inoperable HCC with or without portal vein thrombosis.
The role of optical coherence tomography in the evaluation of compressive optic neuropathies
Authors: Micieli Jonathan A. , Newman Nancy J. , Biousse Valérie
Published: November 2018

Purpose of review

Optical coherence tomography (OCT) is a noninvasive imaging tool routinely used in ophthalmology that provides cross-sectional images of the retina. Compression of the anterior visual pathways results in progressive thinning of the retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) and this review will highlight the utility of OCT in evaluating patients with this condition.

Recent findings

The RNFL and macular GCC have been found to highly correlate with visual function in patients with compressive optic neuropathies. Preoperative RNFL and macular GCC thickness have emerged as the most reliable and consistent prognostic factors for visual recovery after surgery. Patients with an otherwise normal neuroophthalmic examination, including automated perimetry, may have macular GCC or RNFL thinning as the only manifestation of compression, enabling compressive optic neuropathies to be diagnosed at an earlier stage and managed accordingly.

Recent findings indicate that OCT is an important tool in the evaluation of patients with compressive optic neuropathies, particularly for prognosis in patients with visual field defects and diagnosis in patients with preserved or mildly reduced visual function. Anatomical changes detected by OCT may precede visual loss and allow for earlier diagnosis and presumably better visual outcomes.
Methods to Assess Ocular Motor Dysfunction in Multiple Sclerosis
Authors: Sheehy Christy K. , Beaudry-Richard Alexandra , Bensinger Ethan , Theis Jacqueline , Green Ari J.
Published: November 2018

From the Section Editor: The JNO “Disease of the Year: Multiple Sclerosis” series concludes with a focus on cutting edge techniques used to qualitatively and quantitatively evaluate ocular motility abnormalities. In their article, “Methods to Assess Ocular Motor Dysfunction in Multiple Sclerosis,” Sheehy and colleagues expand on the earlier works published by Lee et al, and Nerrant et al, which provide an elegant overview of extra-ocular movement findings associated with brainstem disorders, and multiple sclerosis, respectively. The tools highlighted by Sheehy and colleagues add to our understanding of structure-function relationships in multiple sclerosis, and further expand the role of visual system models in multiple sclerosis research and clinical trials. In the series finale, “The International Multiple Sclerosis Visual System Consortium: Advancing Visual System Research in Multiple Sclerosis,” Balcer and colleagues chronicle the inception, development, and achievements of IMSVISUAL, a consortium created by clinicians and researchers committed to advancing the role of visual outcomes in the care of multiple sclerosis patients. The ingenuity and accomplishments of IMSVISUAL will serve to inspire other international collaborations, and further advance scientific discovery in the field of neuro-ophthalmology.

Background:

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system causing the immune-mediated demyelination of the brain, optic nerve, and spinal cord and resulting in ultimate axonal loss and permanent neurological disability. Ocular motor dysfunction is commonly observed in MS but can be frequently overlooked or underappreciated by nonspecialists. Therefore, detailed and quantitative assessment of eye movement function has significant potential for optimization of patient care, especially for clinicians interested in treating visual symptoms or tracking disease progression.

Methods:

A brief history of eye tracking technology followed by a contextualized review of the methods that can be used to assess ocular motor dysfunction in MS—including a discussion of each method's strengths and limitations. We discuss the rationale for interest in this area and describe new tools capable of tracking eye movements as a possible means of monitoring disease.

Results/Conclusions:

This overview should inform clinicians working with patients with MS of how ocular motor deficits can best be assessed and monitored in this population. It also provides a rationale for interest in this field with insights regarding which techniques should be used for studying which classes of eye movements and related dysfunction in the disease.
Quantitative EEG After Subarachnoid Hemorrhage Predicts Long-Term Functional Outcome
Authors: Gollwitzer Stephanie , Müller Tamara M. , Hopfengärtner Rüdiger , Rampp Stephan , Merkel Jasmin , Hagge Mareike , Jukic Jelena , Lang Johannes , Madžar Dominik , Onugoren Müjgan Dogan , Huttner Hagen B. , Schwab Stefan , Hamer Hajo M.
Published: November 2018

Purpose:

Delayed cerebral ischemia is a major complication after subarachnoid hemorrhage. Our previous study showed that alpha power reduction in continuous quantitative EEG predicts delayed cerebral ischemia. In this prospective cohort, we aimed to determine the prognostic value of alpha power in quantitative EEG for the long-term outcome of patients with subarachnoid hemorrhage.

Methods:

Adult patients with nontraumatic subarachnoid hemorrhage were included if admitted early enough for EEG to start within 72 hours after symptom onset. Continuous six-channel EEG was applied. Unselected EEG signals underwent automated artifact rejection, power spectral analysis, and detrending. Alpha power decline of ≥40% for ≥5 hours was defined as critical EEG event based on previous findings. Six-month outcome was obtained using the modified Rankin scale.

Results:

Twenty-two patients were included (14 male; mean age, 59 years; Hunt and Hess grade I–IV; duration of EEG monitoring, median 14 days). Poor outcome (modified Rankin scale, 2–5) was noted in 11 of 16 patients (69%) with critical EEG events. All six patients (100%) without EEG events achieved an excellent outcome (modified Rankin scale 0, 1) (P = 0.0062; sensitivity 100%, specificity 54.5%). Vasospasm detected with transcranial Doppler/Duplex sonography appeared 1.5 days after EEG events and showed weaker association with outcome (P = 0.035; sensitivity 100%, specificity 45.5%). There was no significant association between EEG events and ischemic lesions on imaging (P = 0.1). Also, no association between ischemic lesions and outcome was seen (P = 0.64).

Conclusions:

Stable alpha power in quantitative EEG reflects successful therapy and predicts good functional outcome after subarachnoid hemorrhage. Critical alpha power reduction indicates an increased risk of poor functional outcome.
On the possibility of spontaneous chemomechanical oscillations in adsorptive porous media
Authors: Bullara D. , De Decker Y. , Epstein I. R.
Published: November 2018

We derive general conditions for the emergence of sustained chemomechanical oscillations from a non-oscillatory adsorption/desorption reaction in a gas/solid porous medium. The oscillations arise from the nonlinear response of the solid matrix to the loading of the adsorbed species. More particularly, we prove that, in order for oscillations to occur, adsorption of the gas must in general cause a swelling of the solid matrix. We also investigate the prototypical case of Langmuir kinetics both numerically and analytically.

This article is part of the theme issue ‘Dissipative structures in matter out of equilibrium: from chemistry, photonics and biology (part 2)’.
Stabilizing a homoclinic stripe
Authors: Kolokolnikov Theodore , Ward Michael , Tzou Justin , Wei Juncheng
Published: November 2018

For a large class of reaction–diffusion systems with large diffusivity ratio, it is well known that a two-dimensional stripe (whose cross-section is a one-dimensional homoclinic spike) is unstable and breaks up into spots. Here, we study two effects that can stabilize such a homoclinic stripe. First, we consider the addition of anisotropy to the model. For the Schnakenberg model, we show that (an infinite) stripe can be stabilized if the fast-diffusing variable (substrate) is sufficiently anisotropic. Two types of instability thresholds are derived: zigzag (or bending) and break-up instabilities. The instability boundaries subdivide parameter space into three distinct zones: stable stripe, unstable stripe due to bending and unstable due to break-up instability. Numerical experiments indicate that the break-up instability is supercritical leading to a ‘spotted-stripe’ solution. Finally, we perform a similar analysis for the Klausmeier model of vegetation patterns on a steep hill, and examine transition from spots to stripes.

This article is part of the theme issue ‘Dissipative structures in matter out of equilibrium: from chemistry, photonics and biology (part 2)’.
Modular co-option of cardiopharyngeal genes during non-embryonic myogenesis
Authors: Mandela Prünster Maria , Ricci Lorenzo , Brown Federico , Tiozzo Stefano
Published: November 2018

Background

In chordates cardiac and body muscles arise from different embryonic origins. Myogenesis can in addition be triggered in adult organisms, during asexual development or regeneration. In the non-vertebrate ascidians, muscles originate from embryonic precursors regulated by a conserved set of genes that orchestrate cell behavior and dynamics during development. In colonial ascidians, besides embryogenesis and metamorphosis, an adult can propagate asexually via blastogenesis, skipping embryo and larval stages, and form anew the adult body, including the complete body musculature.

Results

To investigate the cellular origin and mechanisms that trigger non-embryonic myogenesis, we followed the expression of ascidian myogenic genes duringBotryllus schlosseriblastogenesis, and reconstructed the dynamics of muscle precursors. Based on the expression dynamics ofTbx1/10, Ebf, Mrf, Myh3for body wall and ofFoxF, Tbx1/10, Nk4, Myh2for heart development we show that the embryonic factors regulating myogenesis are only partially co-opted in blastogenesis, and propose that the cellular precursors contributing to heart or body muscles have different origins.

Conclusions

Regardless of the developmental pathway, non-embryonic myogenesis shares a similar molecular and anatomical setup as embryonic myogenesis, but implements co-option and loss of molecular modules.
Ultra-high field MRI reveals mood-related circuit disturbances in depression: A comparison between 3-Tesla and 7-Tesla
Authors: Morris Laurel S , Kundu Prantik , Costi Sara , Collins Abigail , Schneider Molly , Verma Gaurav , Balchandani Priti , Murrough James W
Published: November 2018

Ultra-high field 7-Tesla (7T) MRI has the potential to advance our understanding of neuropsychiatric disorders, including major depressive disorder (MDD). To date, few studies have quantified the advantage of resting state functional MRI (fMRI) at 7T compared to 3-Tesla (3T). We conducted a series of experiments that demonstrate the improvement in temporal signal-to-noise ratio (TSNR) of a multi-echo fMRI protocol with ultra-high field 7T, compared to 3T MRI in healthy controls (HC). We also directly tested the enhancement in ultra-high field 7T fMRI signal power by examining the ventral tegmental area (VTA), a small midbrain structure that is critical to the expected neuropathology of MDD but difficult to discern with standard 3T MRI. We demonstrate 200-300% improvement in TSNR and resting state functional connectivity coefficients provided by ultra-high field 7T fMRI compared to 3T, indicating enhanced power for detection of functional neural architecture. A multi-echo based acquisition protocol and signal denoising pipeline afforded greater gain in signal power at ultra-high field compared to classic acquisition and denoising pipelines. Furthermore, ultra-high field fMRI revealed mood-related neuro-circuit disturbances in patients with MDD compared to HC, which were not detectable with 3T fMRI. Ultra-high field 7T fMRI may provide an effective tool for studying functional neural architecture relevant to MDD and other neuropsychiatric disorders.
A Proof Of Concept For A Syndromic Surveillance System Based On Routine Ambulance Records In The South-west Of England, For The Influenza Season 2016/17
Authors: Reich Thilo , Budka Marcin
Published: November 2018

The introduction of electronic patient records in the ambulance service provides new opportunities to monitor the population. Most patients presenting to British ambulance services are discharged at scene. Ambulance records are therefore an ideal data source for syndromic early event detection systems to monitor infectious disease in the prehospital population. It has been previously found that tympanic temperature records can be used to detect influenza outbreaks in emergency departments. This study investigated whether routine tympanic temperature readings collected by ambulance crews can be used to detect seasonal influenza. Here we show that these temperature readings do allow the detection of seasonal influenza before methods applied to conventional data sources. The counts of pyretic patients were used to calculate a sliding case ratio (CR) as a measurement to detect seasonal influenza outbreaks. This method does not rely on conventional thresholds and can be adapted to the data. The data collected correlated with seasonal influenza. The 2016/17 outbreak was detected with high specificity and sensitivity, up to 9 weeks before other surveillance programs. An unanticipated outbreak of E. coli was detected in the same dataset. Our results show that ambulance records can be a useful data source for biosurveillance systems. Two outbreaks caused by different infectious agents have been successfully detected. The routine ambulance records allowed to use tympanic temperature readings that can be used as surveillance tool for febrile diseases. Therefore, this method is a valuable addition to the current surveillance tools.
The association between low-density lipoprotein cholesterol predicted by HMGCR genetic variants and breast cancer risk may be mediated by body mass index
Authors: Kar Siddhartha P. , Brenner Hermann , Giles Graham G. , Huo Dezheng , Milne Roger L. , Rennert Gad , Simard Jacques , Zheng Wei , Burgess Stephen , Pharoah Paul D. P.
Published: November 2018

Orho-Melander et al. recently reported that lower low-density lipoprotein cholesterol (LDLC) as predicted by the T-allele of the variant rs12916 in HMGCR is associated with a decreased risk of developing breast cancer [odds ratio (OR) = 0.89; 95% confidence interval (CI): 0.82–0.96].1 This analysis was embedded in a wider Mendelian randomization (MR) study performed using genotype data from a prospective cohort of 26,589 individuals that included 16,022 women and 1176 incident breast cancer cases. HMGCR encodes 3-hydroxy-3-methylglutaryl-coenzyme A reductase, the enzyme inhibited by statins. The T-allele of rs12916 is associated with reduced HMGCR expression and therefore, in principle, its effects should be analogous to the effects of lifelong statin administration starting at birth.2 The MR study of Orho-Melander et al. also found that a genome-wide LDLC score based on 32 independent LDLC-associated single nucleotide polymorphisms (SNPs) was not associated with breast cancer. In light of this finding, they suggest that the protective effect of the rs12916 T-allele on breast cancer may either be specific to LDLC lowering via genetic inhibition of HMGCR or be the result of a distinct mechanism that is regulated by rs12916 and HMGCR.
The Effect of Oral Tactile Sensitivity on Texture Perception and Mastication Behavior in Humans
Authors: Shupe Grace E. , Wilson Arran , Luckett Curtis R.
Published: November 2018

Mastication behavior is a notable source of interindividual variation in texture perception and could be linked to oral sensitivity. As oral sensitivity declines so does the amount of tactile feedback relayed to the brain, resulting in less effective manipulation or food and a reduced ability to discriminate differences. To address these hypotheses, we measured masticatory behavior and related this to texture discrimination and oral sensitivity. The study was performed on 41 participants in two groups, with high (n = 20) or low (n=21) sensitivity. Oral sensitivity was measured using a battery of tests that included: oral stereognosis, lingual tactile acuity, and bite force sensitivity. Sensitivity to texture changes was measured using a series of triangle tests with confectionaries of different hardness, with masticatory patterns and behaviors being video recorded and analyzed using jaw tracking software. Overall, there was no significant difference between high and low sensitivity participants and their ability to distinguish texture changes. But, there were significantly different trends found between the groups based on their masticatory behaviors including chewing pattern and overall number of chews. But, it was found that multiple masticatory behaviors were being modulated by oral sensitivity, including overall chewing cycles used (p < 0.0001). More, specifically those in the high sensitivity group used more stochastic chewing movements, while those in the low sensitivity group were found to use crescent-shaped chewing cycles. It was also noted that in the high sensitivity group the jaw moved further distances (p < 0.0001) in all phases and moved at a higher velocity when opening (p < 0.0001) but not when closing, when compared to the low sensitivity group. These results help bolster evidence that mastication and oral sensitivity are related.