bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial Nerve Hematoma After Penetrating Middle Ear Trauma
Authors: Han Kyujin , Roh Hong Gee , Shin Jung Eun , Kim Chang-Hee
Published: July 2019

Penetrating middle ear injury may cause hearing loss, vertigo, or facial nerve injury, although facial nerve paralysis followed by head trauma is a rare condition. In this study, we report a case of a 3-year-old patient with delayed facial palsy on the left side that developed 4 days after an accidental tympanic membrane perforation caused by a cotton-tipped swab. Otoendoscopic examination revealed a perforation in the posterosuperior quadrant of the tympanic membrane. Audiometry revealed no hearing loss on the injured side, and eye movement examination did not reveal spontaneous or positional nystagmus. Pre- and postcontrast T1-weighted magnetic resonance imaging demonstrated high signal intensity along the tympanic portion of the fallopian canal, which suggested that hemorrhage within the facial canal may be a cause of delayed facial palsy. It can be assumed that traumatic injury at the dehiscent facial nerve in the tympanic portion caused hematoma within the fallopian canal, resulting in delayed facial nerve palsy.
Reevaluation of FAST Sensitivity in Pediatric Blunt Abdominal Trauma Patients
Authors: Riera Antonio , Hayward Harrison , Torres Silva Cicero , Chen Lei
Published: July 2019

Background

The utility of the focused assessment with sonography in trauma (FAST) examination in hemodynamically stable pediatric blunt abdominal trauma (BAT) patients is controversial.We report our 3-year experience with FAST performance to detect greater than physiologic amounts of intraperitoneal fluid after BAT.

Methods

We performed a retrospective chart review of all FAST examinations performed from July 2015 to June 2018 at a level I pediatric trauma center. The main outcome of interest was the performance of a concerning FAST (cFAST) compared with a computed tomography scan diagnosis for greater than physiologic levels of free fluid (FF) and clinical follow-up. A cFAST was defined by the presence of any FF in the upper abdomen or by a moderate to large amount of FF present in the pelvis. The interobserver reliability of cFASTwas assessed with Cohen κ coefficient. Locations of FF were assessed.

Results

A total of 448 FAST cases were eligible for review. The median age was 11 years with 64% male. Thirty-one FAST examinations (6.9%) were positive for some amount of FF; 18 (4.0%) were cFASTs. In the cFAST group, 11 patients (61%) were hemodynamically stable. The cFAST had a sensitivity of 89% (95% confidence interval [CI], 65%–99%), specificity of 99% (95% CI, 98%–100%), positive predictive value of 89% (95% CI, 67%–97%), and negative predictive value of 99% (95% CI, 98%–100%). The positive and negative likelihood ratios were 191 (95% CI, 47–769) and 0.11 (95% CI, 0.03–0.41). The κ coefficient for cFASTwas 0.72 with 86% agreement. Free fluid on cFAST cases was observed in the pelvis (78%), right upper quadrant (44%), and left upper quadrant (44%).

Conclusions

In pediatric BAT patients, a cFAST has acceptable sensitivity and remains a highly specific test to rule in greater than physiologic quantities of FF with confidence.
What Do Saudi Children Ingest?
Authors: Ibrahim Ahmed H. , Andijani Abdurahman , Abdulshakour Muhammed , Algain Sulwan , Thamrah Asma Abu , Ali Mariam M. , Marwah Haifa , Aldaher Anwaar , Bashir Salman , Alsaleem Badr , Asery Ali , Al-Hussaini Abdulrahman
Published: July 2019

Objectives

Few studies investigated the correlation between foreign body (FB) ingestion and occurrence of complications. The local literature is limited to case reports and small case series on esophageal FBs. We conducted this study to identify the high-risk factors predisposing to complications among Saudi children ingesting FBs.

Methods

The medical records of 436 children (boys, 59.6%; mean age, 4.4 ± 2.7 years) presenting to the emergency department (ED) between 2007 and 2016 were retrospectively reviewed. Relative risk analysis of clinical variables was performed between 2 groups: The first group constituted children without FB-related complications (n = 389), and the second group included those with major complications (n = 14). Major complication was defined as any event associated with significant morbidity such as esophageal stricture, esophageal perforation, esophageal fistula, and intestinal perforation or fistula formation.

Results

Most of the 436 cases presented between ages 2 and 4 years (35.1%). Coin was the most commonly ingested FB (22.9%) followed by button battery (19.5%). Most of the ingested FBs passed spontaneously without intervention (69%). Upper endoscopy was performed in 121 cases (27.7%). By multivariate analysis, the variables that were significantly associated with major complications included the following: very young age group (0–2 years; odds ratio [OR], 11.5), button battery (OR, 4), FB impacted at upper esophagus (OR, 8.7), and longer time duration to visit the ED (OR, 14.7).

Conclusion

Button battery impaction at upper esophagus in very young children and delayed presentation to the ED were the most significant risk factors of FB-related complications.
Effect Modification of the Association Between Race and Stage at Colorectal Cancer Diagnosis by Socioeconomic Status
Authors: McGrew Kaitlin M. , Peck Jennifer D. , Vesely Sara K. , Janitz Amanda E. , Snider Cuyler A. , Dougherty Tyler M. , Campbell Janis E.
Published: July 2019

Objectives:

To compare risks of distant-stage colorectal cancer (CRC) diagnosis between whites and American Indian/Alaska Natives (AI/ANs) and to explore effect modification by area-based socioeconomic status (SES).

Design:

Retrospective cohort study using data from the Oklahoma Central Cancer Registry.

Setting:

Oklahoma.

Participants:

White and AI/AN cases of CRC diagnosed in Oklahoma between 2001 and 2008 (N = 8 438). A subanalysis was performed on the cohort of those aged 50 years and older (N = 7 728).

Main Outcome Measure:

Risk of distant-stage CRC diagnosis stratified by SES score.

Results:

Race and SES were independently associated with distant-stage diagnosis. In SES-stratified analyses, AI/ANs in the 2 lowest SES groups experienced increased risks in the overall cohort and among those aged 50 years and older. In multivariable models, risks remained significant among those aged 50 years and older in the lowest SES groups (Adjusted risk ratio SES score of 2: 1.31, 95% confidence interval: 1.06-1.63 and adjusted risk ratio SES score of 1: 1.21, 95% confidence interval: 1.01-1.44).

Conclusion:

Socioeconomic status is an effect modifier in the association between race/ethnicity and stage at CRC diagnosis. Disparities in stage at CRC diagnosis exist between AI/ANs and whites with lower estimated SES. Efforts are needed to increase CRC screening among lower SES AI/ANs.
Racial Misclassification in Mortality Records Among American Indians/Alaska Natives in Oklahoma From 1991 to 2015
Authors: Dougherty Tyler M. , Janitz Amanda E. , Williams Mary B. , Martinez Sydney A. , Peercy Michael T. , Wharton David F. , Erb-Alvarez Julie , Campbell Janis E.
Published: July 2019

Objective:

The primary purpose of this study was to compare age-adjusted mortality rates before and after linkage with Indian Health Service records, adjusting for racial misclassification. We focused on differences in racial misclassification by gender, age, geographic differences, substate planning districts, and cause of death. Our secondary purpose was to evaluate time trends in misclassification from 1991 to 2015.

Design:

Retrospective, descriptive study.

Setting:

Oklahoma.

Participants:

Persons contained in the Oklahoma State Health Department Vital Records.

Main Outcome Measures:

To evaluate the age-adjusted mortality ratio pre– and post–Indian Health Service record linkage (misclassification rate ratio) and to evaluate the overall trend of racial misclassification on mortality records measured through annual percent change (APC) and average annual percent change (AAPC).

Results:

We identified 2 stable trends of racial misclassification upon death for American Indians/Alaska Natives (AI/ANs) from 1991 to 2001 (APC: −0.2%; 95% confidence interval: −1.4% to 1.0%) and from 2001 to 2005 (APC: −6.9%; 95% confidence interval: −13.7% to 0.4%). However, the trend identified from 2005 to 2015 decreased significantly (APC: −1.4%; 95% confidence interval: −2.5% to −0.2%). For the last 5 years available (2011-2015), the racial misclassification adjustment resulted in higher mortality rates for AI/ANs reflecting an increase from 1008 per 100 000 to 1305 per 100 000 with the linkage process. There were an estimated 3939 AI/ANs in Oklahoma who were misclassified as another race upon death in those 5 years, resulting in an underestimation of actual AI/AN deaths by nearly 29%.

Conclusions:

An important result of this study is that misclassification is improving; however, this effort needs to be maintained and further improved. Continued linkage efforts and public access to linked data are essential throughout the United States to better understand the burden of disease in the AI/AN population.
Improving Tribal Nation–Specific Mortality Numerators in the South and Eastern Tribes
Authors: Duke Christy , Hendrix Bryan , Reaves Toria
Published: July 2019

The United South and Eastern Tribes, Inc, Tribal Epidemiology Center (TEC) has been conducting a Tribal Nation–specific mortality surveillance project for approximately 13 years. Coded death records are received from states via one of 3 data release methods (open, closed, direct) and matched to Tribal Nation electronic health records. Data quality varies depending on the method of data release. The TEC plans a new method to better identify Tribal Nation decedents and return more robust information to improve Tribal Nation–specific mortality data and strengthen Tribal data sovereignty.
How Are Telehealth Laws Intersecting With Laws Addressing the Opioid Overdose Epidemic?
Authors: Pepin Dawn , Hulkower Rachel , McCord Russell F.
Published: July 2019

Opioid-involved drug overdose deaths have been a growing concern in the United States for several decades. The Centers for Disease Control and Prevention identified several strategies to address the opioid overdose epidemic, including increased availability of and access to medication-assisted treatment and guidance on safer opioid prescribing practices. Telehealth offers the potential for increasing access and availability to these strategies, and laws governing telehealth have implications for their utilization. To understand how state telehealth laws intersect with the opioid overdose epidemic, we conducted a legal mapping study, a type of legal epidemiological assessment, of statutes and regulations that intersect at telehealth and opioids. This search yielded 28 laws from 17 states. These laws intersect both telehealth and the opioid overdose epidemic in different ways including prescribing limitations, opioid treatment through medication and counseling, patient plan review, and professional collaboration. Continued legal and policy surveillance is needed to be able to evaluate the impact of law in addressing opioid overdose outcomes.
A Forgotten Danger: Burden of Influenza Mortality Among American Indians and Alaska Natives, 1999-2016
Authors: Doxey Matthew , Chrzaszcz Lyle , Dominguez Adrian , James Rosalina D.
Published: July 2019

American Indians and Alaska Natives (AI/ANs) are the only racial group in the United States that is identified as having a higher risk for developing influenza-related complications. As such, influenza-related mortality has consistently been one of the leading causes of death among AI/ANs. In addition, estimating influenza-related mortality is hampered by significant degrees of racial misclassification and underreporting of both morbidity and mortality data in the AI/AN population. Using data available from the Centers for Disease Control and Prevention, we analyzed influenza mortality by geography, race, gender, and age group to improve our understanding of the influenza burden on AI/AN communities. We found that while mortality rates generally declined across the AI/AN population, significant disparities exist between AI/ANs and non-Hispanic whites (NHWs). The greatest disparities occurred at the earliest stages of life, with mortality rates for AI/AN children younger than 5 years being more than 2 times higher than for NHW children. Similarly, the burden of influenza-related mortality among AI/AN adults emerged much earlier in life compared with NHWs. Perhaps most important, though, we found significant disparities in the geographic distribution of influenza-related mortality among AI/ANs. Because these are largely vaccine-preventable deaths, these results identify an area for targeted intervention to reduce the overall deaths attributable to influenza.
Assessing Retrobulbar Hyaluronidase as a Treatment for Filler-Induced Blindness in a Cadaver Model
Authors: Paap Michael K. , Milman Tatyana , Ugradar Shoaib , Silkiss Rona Z.
Published: July 2019

Background:

Retrobulbar injection of hyaluronidase is a proposed but unproven treatment for blindness induced by hyaluronic acid gel fillers. This study examines the viability of this treatment by determining whether hyaluronidase can diffuse through the dural sheath of the optic nerve to clear a filler-mediated occlusion of the central retinal artery.

Methods:

Six human cadaveric optic nerves were studied in vitro. One optic nerve was selected as a control and maintained at physiologic temperature, without any exposure to hyaluronic acid gel or hyaluronidase. Another optic nerve was randomly selected to simulate the filler-induced central retinal artery occlusion with subsequent retrobulbar hyaluronidase injection. To simulate a central retinal artery occlusion, this experimental nerve and additional controls were injected with hyaluronic acid gel. These hyaluronic acid gel–injected nerves were then either injected directly with hyaluronidase to establish a control for intraneural hyaluronidase exposure, or immersed in undiluted hyaluronidase to simulate retrobulbar hyaluronidase injection. To control for passive diffusion of hyaluronic acid gel from neural parenchyma, one nerve was immersed in saline. Following fixation, the nerves were grossly and microscopically assessed for the quantity and distribution of hyaluronic acid.

Results:

Intact hyaluronic acid gel was observed grossly and microscopically in the control optic nerves injected directly with filler and not with hyaluronidase. The control optic nerve injected with intraneural hyaluronidase exhibited partial digestion of the filler. Immersion in undiluted hyaluronidase led to no apparent gross or microscopic digestion of injected intraneural hyaluronic acid gel.

Conclusion:

Hyaluronidase does not demonstrate the ability to cross the dural sheath of the optic nerve, suggesting that retrobulbar hyaluronidase injection is unlikely to alleviate hyaluronic acid gel–mediated central retinal artery occlusion and blindness.
Survival following Self-Inflicted Gunshots to the Face
Authors: Elegbede Adekunle , Wasicek Philip J. , Mermulla Sara , Dunlow Ryan , Rasko Yvonne M. , Aarabi Bizhan , Liang Fan , Grant Michael P. , Nam Arthur J.
Published: July 2019

Background:

Self-inflicted gunshot wounds involving the face are highly morbid. However, there is a paucity of objective estimates of mortality. This study aims to provide prognostic guidance to clinicians that encounter this uncommon injury.

Methods:

A retrospective review of patients presenting to R Adams Cowley Shock Trauma Center (a Level I trauma center) with self-inflicted gunshot wounds to the face from 2007 to 2016. Isolated gunshot wounds to the calvaria or neck were excluded. The data were analyzed to determine predictors of survival.

Results:

Of the 69 patients that met inclusion criteria, 90 percent were male and 80 percent were Caucasian, with an age range of 21 to 85 years. The most frequently seen injury patterns showed submental (57 percent), intraoral (22 percent), and temporal (12 percent) entry sites. Fewer than half (41 percent) of the cohort sustained penetrative brain injury. Overall, there were 18 deaths (overall mortality, 26 percent), 17 of which were secondary to brain injury. Independent predictors of death included penetrative brain injury (OR, 17; p < 0.0001) and age. Mortality was 17 percent among patients younger than 65 years, compared with 73 percent for those aged 65 years or older (p = 0.0001). Gastrostomy placement was independently associated with 25 percent reduction in length of hospitalization (p = 0.0003).

Conclusions:

Despite tremendous morbidity, the overwhelming majority of patients who present with facial self-inflicted gunshot wounds will survive, especially if they are young and have no penetrative brain injury. These findings should help guide clinical decisions for this devastating injury.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Treating Craniofacial Dysostoses with Hypertelorism by Monobloc Facial Bipartition Distraction: Surgical and Educational Videos
Authors: Raposo-Amaral Cassio Eduardo , Denadai Rafael , Ghizoni Enrico , Raposo-Amaral Cesar Augusto
Published: July 2019

Simultaneously advancing and medializing the orbital segments in a stable bone bloc constitutes a major advancement in craniofacial surgery. Monobloc bipartition enables destigmatization of the syndromic face by correcting the abnormal orbital axis and interorbital distance. The authors stratified this complex surgical approach into five major steps to facilitate a holistic understanding of the surgical sequence. The rationale for latency and activation periods and the advantages and disadvantages of this technique are described.
A Smart Sensing Cannula for Fat Grafting
Authors: Turer David M. , Qaium Ehsan B. , Lawrence April M. , Clark William W. , Rubin J. Peter
Published: July 2019

Gluteal fat grafting has been highlighted as a significant safety issue in plastic surgery, with a mortality rate as high as one in 3000 cases. Injury to the gluteal veins resulting in fat emboli has been identified as the cause of these mortalities. The gluteal veins lie deep to the gluteal musculature in the buttocks, and it has been suggested that avoiding intramuscular injection of fat may prevent these complications. The authors present a novel injection cannula design that uses impedance sensing to determine the location of the cannula tip. Specifically, the system can determine when the tip of the cannula leaves the subcutaneous plane and enters muscle. The use of this system may prevent inadvertent injury to the gluteal veins and subsequent embolic complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Female Genital and Vaginal Plastic Surgery: An Overview
Authors: Placik Otto J. , Devgan Lara L.
Published: July 2019

Learning Objectives:

After studying this article and viewing the video, the participant should be able to: 1. Accurately describe the relevant aesthetic anatomy and terminology for common female genital plastic surgery procedures. 2. Have knowledge of the different surgical options to address common aesthetic concerns and their risks, alternatives, and benefits. 3. List the potential risks, alternatives, and benefits of commonly performed female genital aesthetic interventions. 4. Be aware of the entity of female genital mutilation and differentiation from female genital cosmetic surgery.

This CME activity is intended to provide a brief 3500-word overview of female genital cosmetic surgery. The focus is primarily on elective vulvovaginal procedures, avoiding posttrauma reconstruction or gender-confirmation surgery. The goal is to present content with the best available and independent unbiased scientific research. Given this relatively new field, data with a high level of evidence are limited. Entities that may be commonly encountered in a plastic surgery practice are reviewed. The physician must be comfortable with the anatomy, terminology, diagnosis, and treatment options. Familiarity with requested interventions and aesthetic goals is encouraged.
Influence of Biological Parameters Assessed in [18F]FDG PET/CT on Overall Survival in Cervical Cancer Patients
Authors: Cegla Paulina , Burchardt Ewa , Roszak Andrzej , Czepczynski Rafal , Kubiak Anna , Cholewinski Witold
Published: July 2019

Aim

The aim of this study was to estimate the influence of biological parameters assessed in [18F]FDG PET/CT on overall survival (OS) in cervical cancer patients.

Methods

Retrospective analysis was performed on a group of 371 patients with newly diagnosed and histologically confirmed cervical cancer. PET biological parameters in primary tumor including SUVmax, SUVmean, total lesion glycolysis (TLG), metabolic tumor volume (MTV), heterogeneity, and parameters referring both to primary tumor and metastatic lesions: SUVtotal, TLGtotal, and MTVtotal, were analyzed.

Results

Based on PET/CT results, 3 subgroups were identified: cervical only—with disease limited only to the cervix (38%), +regional nodes—where increased glucose accumulation in addition to the cervical area was also observed in regional lymph nodes (36%), and +distal metastases—where PET scan showed a disseminated disease (26%). Depending on the stage of the disease, in the cervical-only group, 5-year survival rate was 86%; in the +regional nodes group, it was 80%; whereas in the +distal metastases group, 5-year survival rate was only 55%. However, based on Cox regression model, significant influence on OS was found only in heterogeneity of primary tumor; more inhomogeneous tumors suggest worse prognosis (0.25 ± 0.04 vs 0.16 ± 0.09, P < 0.001), SUVtotal (76.6 ± 130.1 vs 45.4 ± 73.4, P = 0.002), and MTVtotal (79.03 ± 88.27 vs 63.00 ± 83.80 cm3, P = 0.03). For heterogeneity, cutoff point suggesting worse prognosis was 0.18; for SUVtotal, 52.3; and for MTVtotal, 66.55 cm3.

Conclusions

Stage of disease assessed in [18F]FDG PET/CT significantly influences survival rate in patients with cervical cancer. SUVtotal, MTVtotal, and heterogeneity of primary tumor are independent prognostic factors on OS in cervical cancer patients.
68Ga-DOTATATE PET/CT in Focal Fatty Sparing of the Liver
Authors: Hod Nir , Levin Daniel , Anconina Reut , Taragin Benjamin H. , Dudnik Julia , Lantsberg Sophie
Published: July 2019

68Ga-DOTATATE imaging is commonly used for the detection of metastatic disease in neuroendocrine tumors. We present a case of a 69-year-old woman postsurgery for lung carcinoid tumor in which sequential follow-up 68Ga-DOTATATE PET/CT studies identified focal hepatic uptake that was presumed to represent a liver metastasis. However, correlative imaging with MRI revealed a focal fatty sparing of the liver composed of benign hepatic parenchyma at that area accompanied with diffuse liver steatosis in the background of the “pseudolesion.” This report demonstrates a potential “false-positive” hepatic finding that can strikingly mimic a metastasis in neuroendocrine tumor imaging.
The Use of Random Forests to Classify Amyloid Brain PET
Authors: Zukotynski Katherine , Gaudet Vincent , Kuo Phillip H. , Adamo Sabrina , Goubran Maged , Scott Christopher , Bocti Christian , Borrie Michael , Chertkow Howard , Frayne Richard , Hsiung Robin , Laforce Robert , Noseworthy Michael D. , Prato Frank S. , Sahlas Demetrios J. , Smith Eric E. , Sossi Vesna , Thiel Alexander , Soucy Jean-Paul , Tardif Jean-Claude , Black Sandra E.
Published: July 2019

Purpose

To evaluate random forests (RFs) as a supervised machine learning algorithm to classify amyloid brain PET as positive or negative for amyloid deposition and identify key regions of interest for stratification.

Methods

The data set included 57 baseline 18F-florbetapir (Amyvid; Lilly, Indianapolis, IN) brain PET scans in participants with severe white matter disease, presenting with either transient ischemic attack/lacunar stroke or mild cognitive impairment from early Alzheimer disease, enrolled in a multicenter prospective observational trial. Scans were processed using the MINC toolkit to generate SUV ratios, normalized to cerebellar gray matter, and clinically read by 2 nuclear medicine physicians with interpretation based on consensus (35 negative, 22 positive). SUV ratio data and clinical reads were used for supervised training of an RF classifier programmed in MATLAB.

Results

A 10,000-tree RF, each tree using 15 randomly selected cases and 20 randomly selected features (SUV ratio per region of interest), with 37 cases for training and 20 cases for testing, had sensitivity = 86% (95% confidence interval [CI], 42%–100%), specificity = 92% (CI, 64%–100%), and classification accuracy = 90% (CI, 68%–99%). The most common features at the root node (key regions for stratification) were (1) left posterior cingulate (1039 trees), (2) left middle frontal gyrus (1038 trees), (3) left precuneus (857 trees), (4) right anterior cingulate gyrus (655 trees), and (5) right posterior cingulate (588 trees).

Conclusions

Random forests can classify brain PET as positive or negative for amyloid deposition and suggest key clinically relevant, regional features for classification.
Reassessment of the Need for an Oxygen Carrier for the Treatment of Traumatic Hemorrhage When Blood is not an Option
Authors: Pusateri Anthony E. , Glassberg Elon , Weiskopf Richard B.
Published: July 2019

Approximately 10 years ago, the development of hemoglobin-based oxygen carriers (HBOCs) was largely stalled after two large phase 3 clinical trials failed to achieve licensure primarily because the safety profile was viewed as unsatisfactory when HBOCs were compared with red cells. Concerns were also raised that HBOCs, as a class, had inherent toxicities. Since then, clinical experience with HBOCs in expanded access programs and under licensure in South Africa has demonstrated that HBOCs can be used safely and effectively. In recent years, clinical studies have demonstrated that prehospital blood transfusion improves survival in severely injured patients with hemorrhage, especially when transport times are longer than 20 to 30 min. Yet, logistical constraints still limit use of blood products in the prehospital setting. As the urgent need for oxygen-carrying capacity for trauma patients for whom red cells are not available is becoming much more apparent, it is imperative that we reexamine the possibility of using HBOCs when red blood cell transfusion is not an option.
Mitigating Racial and Sex Disparities in Access to Living Donor Kidney Transplantation
Authors: Mustian Margaux N. , Kumar Vineeta , Stegner Katie , Mompoint-Williams Darnell , Hanaway Michael , Deierhoi Mark H. , Young Carlton , Orandi Babak J. , Anderson Douglas , MacLennan Paul A. , Reed Rhiannon D. , Shelton Brittany A. , Eckhoff Devin , Locke Jayme E.
Published: July 2019

Objective:

In this study, we sought to assess likelihood of living donor kidney transplantation (LDKT) within a single-center kidney transplant waitlist, by race and sex, after implementation of an incompatible program.

Summary Background Data:

Disparities in access to LDKT exist among minority women and may be partially explained by antigen sensitization secondary to prior pregnancies, transplants, or blood transfusions, creating difficulty finding compatible matches. To address these and other obstacles, an incompatible LDKT program, incorporating desensitization and kidney paired donation, was created at our institution.

Methods:

A retrospective cohort study was performed among our kidney transplant waitlist candidates (n = 8895). Multivariable Cox regression was utilized, comparing likelihood of LDKT before (era 1: 01/2007–01/2013) and after (era 2: 01/2013–11/2018) implementation of the incompatible program. Candidates were stratified by race [white vs minority (nonwhite)], sex, and breadth of sensitization.

Results:

Program implementation resulted in the nation's longest single-center kidney chain, and likelihood of LDKT increased by 70% for whites [adjusted hazard ratio (aHR) 1.70; 95% confidence interval (CI), 1.46–1.99] and more than 100% for minorities (aHR 2.05; 95% CI, 1.60–2.62). Improvement in access to LDKT was greatest among sensitized minority women [calculated panel reactive antibody (cPRA) 11%–49%: aHR 4.79; 95% CI, 2.27–10.11; cPRA 50%–100%: aHR 4.09; 95% CI, 1.89–8.82].

Conclusions:

Implementation of an incompatible program, and the resulting nation's longest single-center kidney chain, mitigated disparities in access to LDKT among minorities, specifically sensitized women. Extrapolation of this success on a national level may further serve these vulnerable populations.
Identification and phylogenetic analysis of herpes simplex virus-1 from clinical isolates in India
Authors: Nyayanit Dimpal A. , Sahay Rima R. , Sakpal Gajanan N. , Shete Anita M. , Chaubal Gouri C. , Sarkale Prasad , Srivastava Rashi , Mohandas Sreelekshmy , Yadav Pragya D.
Published: July 2019

Human herpes simplex virus (HSV)-1 infection is acquired in childhood and persists throughout a person’s lifetime. Here, we present two cases from India; one showing symptoms of postpartum haemorrhage with disseminated intravascular coagulation, and the second one showing signs of acute encephalitis syndrome. The aetiological agent in both cases was identified as HSV-1 using the PCR method. The next-generation sequencing method retrieved ~97 % of the viral genome from the isolates of the clinical samples. The phylogenetic analysis of the retrieved genomes revealed that they belong to clade II of HSV-1. This study identifies a few sequence variations in the glycoprotein region of HSV-1 during two different clinical manifestations. There are a couple of papers that analyse variations in the glycoprotein region of clinical samples. Further, this study also highlights the importance of considering HSV-1 during differential diagnosis when analysing the nosocomial infection.
Rapid leaf trait response to growing-season meteorology inVitis:Implications for leaf physiognomic paleoclimate reconstructions
Authors: Baumgartner Aly , Donahoo Michaela , Chitwood Daniel H. , Peppe Daniel J.
Published: July 2019

PREMISE OF THE STUDY

The size and shape (physiognomy) of woody, dicotyledonous angiosperm leaves are correlated with climate and these relationships have been used to develop. proxies. These proxies assume that leaf morphology plastically responds to meteorological conditions and that leaf traits change isometrically through development.

METHODS

We used Digital Leaf Physiognomy (DiLP) to measure leaf characters of multipleVitisspecies from the USDA Germplasm Repository in Geneva, NY from the 2012-2013 and 2014-2015 growing seasons. These growing seasons had different temperature and precipitation.

KEY RESULTS

We found three primary results: (1) there were predictable significant differences in leaf characters in leaves of different developmental stages along the vine, (2) there were significant differences in leaf characters in leaves of the same developmental stage between the growing seasons, and (3) there were significant differences in leaf characters between growing seasons.

CONCLUSIONS

We found thatVitisleaf shape had the strongest relationship with growing season meteorological conditions in taxa growing in their native range. In addition, leaves have variable phenotypic plasticity along the vine. We interpret that the meteorological signal was strongest in those leaves that have completed allometric expansion. This is significant for leaf physiognomic-paleoclimate proxies because these leaves are most likely to be preserved in leaf litter and reflect the type of leaves included in paleoclimate reconstructions. We found that leaf development does have the potential to be a confounding factor, but it is unlikely to exert a significant influence on analysis due to differential preservation potential.
Thermodynamic and Kinetic Characterization of Protein Conformational Dynamics within a Riemannian Diffusion Formalism
Authors: Goolsby Curtis , Fakharzadeh Ashkan , Moradi Mahmoud
Published: July 2019

We have formulated a Riemannian framework for describing the geometry of collective variable spaces of biomolecules within the context of collective variable based molecular dynamics simulations. The formalism provides a theoretical framework to develop enhanced sampling techniques, path-finding algorithms, and transition rate estimators consistent with a Riemannian treatment of the collective variable space, where the quantities of interest such as the potential of the mean force, minimum free energy path, the diffusion constant, and the transition rate remain invariant under coordinate transformation due to the Riemannian treatment of the collective variable space. Specific algorithms within this framework are discussed such as the Riemannian umbrella sampling, the Riemannian string method, and a Riemannian-Bayesian estimator of free energy and diffusion constant, which can be used to estimate the transition rate along a minimum free energy path.
What threatens Brazilian endangered species and how they are Red-Listed
Authors: Bernard Enrico , de Barros Fernanda Silva , Felix Vitória Edna Fernandes , Lacher Thomas E.
Published: July 2019

Brazil is a continental-sized megadiverse country with high rates of habitat loss and degradation. Part of the Brazilian biodiversity – including endemic species – is recognized as threatened. By following the IUCN standards, we review the classification of all the 1172 endangered species in Brazil, analyzing differences among categories and groups. Based on a subsample of all 464 terrestrial vertebrates we identified 1036 records of threats affecting them. Criterion B was the most used (56% overall; 70% for CR species; 75% for EN), mainly related to reductions in their habitat area, extent and/or quality due to deforestation. Data on population declines (criterion A), number of reproductive individuals (criterion C), and population sizes (criterion D) are available for only a small fraction of the Brazilian fauna. Criterion E (probability of extinction in the wild) was used for only one species. Birds and mammals had the highest diversity of used criteria, while marine fish the lowest (90% related to declining populations). Two out of three of the 464 vertebrate species analyzed were negatively impacted by agribusiness. Other major threats are hunting, urban sprawl, rural settlements, and the construction of hydroelectric dams. Birds and mammals experience more co-occurrence of threats. Some threats are clearly underestimated in Brazil: climate change was indicated for only 2% species analyzed, but included no birds or amphibians. The main threats identified are linked to the patterns of economic development in Brazil and the current political and economic context points to a worrisome conservation scenario in the near future.
Microtubule Disruption does not Impair Learning in the Unicellular Organism Paramecium: Implications for Information Processing in Microtubules
Authors: Alipour A. , Hatam G. , Seradj H.
Published: July 2019

Information processing in microtubules is an open question that has not been properly addressed yet. It was suggested that microtubules could store and process information in the nervous system or even support consciousness. The unicellular organism,Paramecium caudatum, that has a microtubular structure but does not have a neuron or neural network, shows intelligent behaviors such as associative learning. This may suggest that the microtubules are involved in intelligent behavior, information storage or information processing in paramecium. To test this hypothesis, we have utilized a paramecium learning task in which the organism associates brightness in its swimming medium with attractive cathodal shocks to study the role of microtubules in paramecium learning. We used an antimicrotubular agent (parbendazole) and disrupted microtubular dynamics in paramecium to see if microtubules are an integral part of information storage and processing in paramecium’s learning process. We observed that a partial allosteric modulator of GABA (midazolam) could disrupt the learning process in paramecium, but the antimicrotubular agent could not. Therefore, our results suggest that microtubules are probably not vital for the learning behavior inP. caudatum. Consequently, our results call for a further revisitation of the microtubular information processing hypothesis.
Brain-age in midlife is associated with accelerated biological aging and cognitive decline in a longitudinal birth-cohort
Authors: Elliott Maxwell L. , Belsky Daniel W. , Knodt Annchen R. , Ireland David , Melzer Tracy R. , Poulton Richie , Ramrakha Sandhya , Caspi Avshalom , Moffitt Terrie E. , Hariri Ahmad R.
Published: July 2019

An individual’s brain-age is the difference between chronological age and age predicted from machine-learning models of brain-imaging data. Brain-age has been proposed as a biomarker of age-related deterioration of the brain. Having an older brain-age has been linked to Alzheimer’s, dementia and mortality. However, these findings are largely based on cross-sectional associations which can confuse age differences with cohort differences. To illuminate the validity of brain-age a biomarker of accelerated brain aging, a study is needed of a large cohort all born the same year who nevertheless vary on brain-age. In a population-representative 1972-73 birth cohort we measured brain-age at age 45, as well as the pace of biological aging and cognitive decline in longitudinal data from childhood to midlife (N=869). In this cohort, all chronological age 45 years, brain-age was measured reliably (ICC=.81) and ranged from 24 to 72 years. Those with older midlife brain-ages tended to have poorer cognitive function in both adulthood and childhood, as well as impaired brain health at age 3. Furthermore, those with older brain-ages had an accelerated pace of biological aging, older facial appearance and early signs of cognitive decline from childhood to midlife. These findings help to validate brain-age as a potential surrogate biomarker for midlife intervention studies that seek to measure treatment response to dementia-prevention efforts in midlife. However, the findings also caution against the assumption that brain-age scores represent only age-related deterioration of the brain as they may also index central nervous system variation present since childhood.
Allicin regulates energy homeostasis through brown adipose tissue
Authors: Zhang Chuanhai , He Xiaoyun , Sheng Yao , Xu Jia , Yang Cui , Zheng Shujuan , Liu Junyu , Li Haoyu , Ge Jianbing , Yang Minglan , Zhai Baiqiang , Xu Wentao , Luo Yunbo , Huang Kunlun
Published: July 2019

Background/objectives:

Disorder of energy homeostasis can lead to a variety of metabolic diseases, especially obesity. Brown adipose tissue (BAT) is a promising potential therapeutic target for the treatment of obesity and related metabolic diseases. Allicin, a main bioactive ingredient in garlic, has multiple biology and pharmacological function. However, the role of Allicin, in the regulation of metabolic organ, especially the role of activation of BAT, has not been well studied. Here, we analyzed the role of Allicin in whole-body metabolism and the activation of BAT.

Results:

Allicin had a significant effect in inhibiting body weight gain, decreasing adiposity, maintaining glucose homeostasis, improving insulin resistance, and ameliorating hepatic steatosis in diet-introduced obesity (DIO) mice. Then we find that Allicin can strongly activate brown adipose tissue (BAT). The activation of brown adipocyte treated with Allicin was also confirmed in mouse primary brown adipocytes.

Conclusion:

Allicin can ameliorate obesity through activating brown adipose tissue. Our findings provide a promising therapeutic approach for the treatment of obesity and metabolic disorders.
On the discovery of subpopulation-specific state transitions from multi-sample multi-condition single-cell RNA sequencing data
Authors: Crowell Helena L. , Soneson Charlotte , Germain Pierre-Luc , Calini Daniela , Collin Ludovic , Raposo Catarina , Malhotra Dheeraj , Robinson Mark D.
Published: July 2019

Single-cell RNA sequencing (scRNA-seq) has quickly become an empowering technology to profile the transcriptomes of individual cells on a large scale. Many early analyses of differential expression have aimed at identifying differences between subpopulations, and thus are focused on finding subpopulation markers either in a single sample or across multiple samples. More generally, such methods can compare expression levels in multiple sets of cells, thus leading to cross-condition analyses. However, given the emergence of replicated multi-condition scRNA-seq datasets, an area of increasing focus is making sample-level inferences, termed here as differential state analysis. For example, one could investigate the condition-specific responses of cell subpopulations measured from patients from each condition; however, it is not clear which statistical framework best handles this situation. In this work, we surveyed the methods available to perform cross-condition differential state analyses, including cell-level mixed models and methods based on aggregated “pseudobulk” data. We developed a flexible simulation platform that mimics both single and multi-sample scRNA-seq data and provide robust tools for multi-condition analysis within the muscat R package.
Fluorometric intracellular Na+ measurement as compared with flame emission assay: An unexpected problem with gramicidin-based calibration
Authors: Yurinskaya Valentina E. , Aksenov Nikolay D. , Moshkov Alexey V. , Goryachaya Tatyana S. , Vereninov Alexey A.
Published: July 2019

Fluorescent probes are a popular and indispensable tool for monitoring sodium concentration in living cells in situ. Calibration of fluorescent probes inside cells commonly uses ionophores to equilibrate intracellular and external ion concentrations. Here we test this calibration method using in parallel classical flame emission assay. Suspension human lymphoma cells allow both flow cytometry fluorometric study and flame emission assay. The most sensitive Na+ fluorescent probe ANG-2 and the most common ionophores were tested. Cellular Na+ was altered for calibration in three different ways: by stopping the sodium pump with ouabain, by inducing of apoptosis with staurosporine, and by gramicidin or amphotericin B treatment. We found that ANG-2 fluorescence in cells treated with gramicidin or amphotericin was about two fold lower than in the cells with the same sodium concentration but without ionophores. The equal fluorescence measured in the absence and in the presence of ionophores corresponds to different cell sodium concentrations. No effect of gramicidin on hydrolyzed ANG was observed in vitro. The mechanism, by which gramicidin decreases ANG fluorescence in cells is unlikely to be physical quenching and remains obscure. We conclude that ANG fluorescence does not display realistic cell Na+ if fluorescence in cell is measured in ionophore absence while calibrated in its presence.
Dietary vs non-dietary fatty acid profiles of lake trout ecotypes from Lake Superior and Great Bear Lake: Are fish really what they eat?
Authors: Chavarie L , Hoffmann J. , Muir A.M. , Krueger C.C. , Bronte C.R. , Howland K.L. , Gallagher C.P. , Sitar S.P. , Hansen M.J. , Vinson M.R. , Baker L.F. , Loseto L.L. , Tonn W. , Swanson H.
Published: July 2019

Fatty acids are well-established biomarkers used to characterize trophic ecology, food-web linkages, and the ecological niche of many different taxa. Most often, fatty acids that are examined include only those previously identified as “dietary” or “extended dietary” biomarkers. Fatty acids considered as non-dietary biomarkers, however, represent numerous fatty acids that can be extracted. Some studies may include non-dietary fatty acids (i.e., combined with dietary fatty acids), but do not specifically assess them, whereas in other studies, these data are discarded. In this study, we explored whether non-dietary biomarkers fatty acids can provide worthwhile information by assessing their ability to discriminate intraspecific diversity within and between lakes. Non-dietary fatty acids used as biomarkers delineated variation among regions, among locations within a lake, and among ecotypes within a species. Physiological differences that arise from differences in energy processing can be adaptive and linked to habitat use by a species’ ecotypes, and likely explains why non-dietary fatty acids biomarkers can be a relevant tool to delineate intraspecific diversity. Little is known about the non-dietary-mediated differences in fatty acid composition, but our results showed that non-dietary fatty acids biomarkers can be useful tool in identifying variation.
The Quantification of Antibody Elements and Receptors subunit expression using qPCR: The Design of VH, VL, CH, CL, FcR subunits primers for a more holistic view of the immune system
Authors: Ling Wei-Li , Ng Yuen-Ling , Wipat Anil , Lane David Philip , Gan Samuel-Ken-En
Published: July 2019

The expression levels of Immunoglobulin elements and their receptors are important markers for health and disease. Within the immunoglobulin locus, the constant regions and the variable region families are associated with certain pathologies, yet a holistic view of the interaction between the expression of the multiple genes remain to be fully characterized. There is thus an important need to quantify antibody elements, their receptors and the receptor subunits in blood (PBMC cDNA) for both screening and detailed studies of such associations. Leveraging on qPCR, we designed primers for all Vκ 1-6, VH1-7, Vλ1-11, nine CH isotypes, Cκ, Cκ, Cλ1 &3, FcεRI α,β, and γ subunits, all three FcγR and their subunits, and FcαR. Validating this on a volunteer PBMC cDNA, we show a qPCR primer set repertoire that can quantify the relative expression of all the above genes to GAPDH housekeeping gene, with implications and uses in both clinical monitoring and research.
Different aspects of social relationships contribute to subjective well-being via different functional connectomes
Authors: Itahashi Takashi , Kosibaty Neda , Hashimoto Ryu-ichiro , Aoki Yuta Y.
Published: July 2019

The achievement of improved subjective well-being (SWB) is a worldwide issue. Prior studies using self-report questionnaires have demonstrated that better social relationships (SR) form the foundation for better SWB. To confirm the relationships with objective measure and investigate the biological underpinning, we conducted connectome-based prediction modeling with a 10-fold cross-validation, utilizing resting state functional magnetic resonance imaging data (n = 761). Two aspects of SWB (life satisfaction and positive affect) were successfully predicted using SR-related functional connections (FCs). The models also showed good prediction performance in a validation sample (n = 91), suggesting that our models are generalizable. All six aspects of SR considered were related to different sets of FCs with minimal overlap in edge level. The contributions of these FC sets to the two aspects of SWB were substantially different. In the future, effort should be made to improve all aspects of SR to achieve better SWB.