bluuebunny/crossref_metadata_2025 huggingface dataset:
Orbital Diffuse Large B-Cell Lymphoma Initially Presenting as Neovascular Glaucoma
Authors: Aldaas Khalid M. , Randall Cara , Eftekhari Kian , Zhang Alice Y.
Published: October 2019

Orbital lymphoma can result in rapid loss of vision if not diagnosed and treated in a timely manner. This patient presented with rapid visual loss and on examination had a rubeosis iridis with a hyphema as well as neovascular glaucoma with vitreous hemorrhage. His medical history included systemic diffuse large B-cell lymphoma and a workup ultimately revealed an orbital mass in the body of the optic nerve. Optic nerve biopsy demonstrated diffuse large B-cell lymphoma. To the authors' knowledge, neovascular glaucoma as the presentation of an extraocular diffuse large B-cell lymphoma has not been reported previously. Lymphomas of the orbit and its adnexa constitute roughly 1% of all non-Hodgkin lymphoma.
1
Most cases are marginal-zone B-cell lymphomas, with the second most common being diffuse large B-cell lymphomas.
2
Orbital lymphomas can rapidly progress to complete visual loss when not diagnosed early. The authors report a patient who presented with rapid visual loss due to hyphema, rubeosis iridis, neovascular glaucoma and vitreous hemorrhage secondary to orbital diffuse large B-cell lymphoma. Research methods were adherent to the ethical principles outlined in the Declaration of Helsinki as amended in 2013. The collection and evaluation of protected patient health information was Health Insurance Portability and Accountability Act compliant.

The authors report a case of lymphoma metastatic to the optic nerve masquerading as neovascular glaucoma with vitreous hemorrhage.
Computational Modeling of Gold Nanoparticle in Lung Cancer Photothermal Therapy
Authors: Yahya Ibtihag , Eltayeb Megdi
Published: October 2019

Today, the biological compatibility properties of gold nanoparticles (AuNPs) have made them an important area for research in medical applications such as cancer diagnosis, treatment, and imaging. This article seeks to address the potential of precious metals such as AuNPs in the treatment of cancerous cells using COMSOL Multiphysics to model heat transfer in lung carcinoid tumor. The study also investigated and discussed how to harness the gold power and properties in killing cancer cells without harming the healthy ones. One of the more significant findings to emerge from this study is that both PDE (diffusion equation) and heat transfer modules can model the thermal activation of the AuNP and predict the thermal profile inside the tumor successfully.
Dynamic Stiffness of Pediatric Prostheses During Rapid Loading
Authors: Agnew Sarah , Geil Mark D. , Gharai Mohammad H.
Published: October 2019

Introduction

Individuals with limb loss rely on the use of prostheses to maintain functional independence and ambulatory capabilities. Because of the relatively higher and more rapid loads imposed by active children upon lower-limb prosthetic components, it is essential to understand the response of pediatric prostheses to dynamic loading. The purpose of this study was to quantify the stiffness characteristics of four pediatric prosthetic feet under different drop heights and contact orientations.

Materials and Methods

Single-leg drop-landing was simulated with four pediatric prosthetic feet (College Park: Truper; Össur: Cheetah Junior, Flex-Foot Junior, Vari-Flex Junior). Each device was dropped from two different heights at two different contact orientations (forefoot, midfoot).

Results

Stiffness ranged from 586.3 N/cm to 10,628.4 N/cm. The running-specific Cheetah Junior was the least stiff. All feet were stiffer for flatfoot contact, but the Cheetah was least sensitive to foot angle. The Flex-Foot Junior and Truper had the largest increases in stiffness for flatfoot contact. Stiffness was not significantly different across the two drop heights, although individual feet showed differing responses.

Conclusions

Forefoot contact mitigates force transmission in landing. Overall, the feet exhibited a large range of force, deformation, and stiffness results, indicating the possibility of activity-specific individualized prescription.
Effect of an Electronic Health Record Decision Support Alert to Decrease Excess Cervical Cancer Screening
Authors: Teoh Deanna , Vogel Rachel I. , Langer Adam , Bharucha Jinai , Geller Melissa A. , Harwood Eileen , Kulasingam Shalini , Melton Genevieve B.
Published: October 2019

Objective

Cervical cancer screening is often conducted in excess of current screening guidelines. The objective of this study was to evaluate the effect of an electronic health record (EHR) clinical decision support alert to decrease guideline-nonadherent cervical cancer screening beyond the age limits of screening or posthysterectomy.

Materials and Methods

The proportion of guideline-nonadherent Pap tests in women younger than 21 years or older than 65 years or posthysterectomy were compared 4 months before and 3 months after implementation of an EHR clinical decision support alert warning providers that a Pap test is not indicated. Providers could cancel the Pap test or override the alert and place the order. Provider characteristics and Pap test indications were summarized by preintervention/postintervention period using descriptive statistics. The proportions of nonindicated Pap tests were compared by intervention period and provider characteristics using generalized estimating equation models.

Results

In women beyond the screening age limits or posthysterectomy, a total of 388 Pap tests were ordered before intervention, and 313 tests were ordered after intervention. Proportion of guideline-nonadherent tests was similar before (62%) and after intervention (63%); thus, implementation of the clinical decision support alert did not change the proportion of guideline-nonadherent Pap tests ordered (OR = 1.08, 95% CI = 0.77–1.52). It is notable that 52% of guideline-nonadherent tests were ordered by 11 providers. Even when controlling for providers who ordered more than 1 test during the study period, multivariate analysis showed that male providers were more likely to order guideline-nonadherent Pap tests (OR = 2.30, 95% CI = 1.36–3.89); no other differences by provider characteristics were observed.

Conclusions

An EHR clinical decision support alert does not decrease guideline-nonadherent cervical cancer screening. These data suggest efforts to optimize clinical decision support should be focused on other aspects of cervical cancer prevention.
Low-Risk Human Papillomavirus Types in Cervical Intraepithelial Neoplasia 2–3 and in Invasive Cervical Cancer Patients
Authors: Siegler Efraim , Reichman Yael , Kugelman Nir , Mackuli Lena , Lavie Ofer , Ostrovsky Ludmila , Shaked-Mishan Pninint , Segev Yakir
Published: October 2019

Objectives

A total of 95% to 99% of patients with invasive cervical cancer (CC) are infected with human papillomavirus (HPV). The aim of the study was to evaluate the incidence of low-risk HPV (LR-HPV) types among women with cervical intraepithelial neoplasia (CIN 2–3) and CC.

Materials and Methods

We conducted a nested cohort study of patients diagnosed with CIN 2–3 or CC. Inclusion criteria were diagnosis of CIN 2–3 or CC and HPV-DNA testing from the cervix.

Results

During the study period, we collected clinical data on 608 women of whom 402 were with CIN 2–3 and 206 with diagnosis of CC. When examining 14 high-risk HPV (HR-HPV) types, patients with CIN 2–3, 90.3% were found positive to at least one type of HR-HPV, 89.8% from CC patients were found positive to at least one type of HR-HPV. A total of 4.5% of patients with CIN 2–3 and 3.9% of those with CC were positive to only one LR-HPV or to some of a few LR-HPV types. Among 5.2% with CIN 2–3 and 6.3% of those with CC, no HPV types were detected.

Conclusions

The prevalence of the LR-HPV in high-grade squamous intraepithelial lesion cervical lesions is low but is expected to increase in the future because of the expected decrease in CC caused by HPV types that are included in the bi-, quadri-, and nanovalent vaccine. The CIN 2–3 and CC patients with LR-HPV types and with negative HPV, challenge HPV screening sensitivity, which is based on a limited number of HR-HPV types.
Association of rosacea with inflammatory bowel disease
Authors: Wang Fang-Ying , Chi Ching-Chi
Published: October 2019

Rosacea has been reported with several systemic comorbidities, but its relationship with inflammatory bowel disease (IBD) is unclear. Thus, our objective is to conduct a meta-analysis on the association of rosacea with IBD.

We conduct a meta-analysis and searched MEDLINE, CENTRAL, and Embase databases for case-controlled and cohort studies that assessed the association of rosacea with IBD from inception to July 2nd, 2018. Two authors independently selected studies, extracted data, and assessed the risk of bias of included studies. Disagreement was resolved by discussion. We performed random-effects model meta-analysis to obtain the pooled risk estimates for Crohn disease (CD) and ulcerative colitis (UC) in patients with rosacea.

We included three case-control and three cohort studies. The risk of bias of included studies was generally low. The meta-analysis on case-control studies showed marginally increased odds of CD (pooled odds ratio (OR) 1.30, 95% confidence interval (CI) 0.99–1.69) and a significantly increased odds of UC (pooled OR 1.64, 95% CI 1.43–1.89) in patients with rosacea. The meta-analysis on cohort studies demonstrated significant increased risk of CD (pooled hazard ratio (HR) 1.58, 95% CI 1.14–2.20) and UC (pooled HR 1.18, 95% CI 1.01–1.37) in patients with rosacea.

The evidence indicates an association of rosacea with IBD. If patients with rosacea suffer from prolonged abdominal pain, diarrhea, and bloody stool, referral to gastroenterologists may be considered.
Clinicopathological analysis of IgA nephropathy combined with other glomerular diseases
Authors: Jiang Lei , Dong Bao , Yan Yu , Zheng Shuying , Hu Yanan , Zuo Li , Shi Hongxia
Published: October 2019

It is not rare to find Immunoglobulin A (IgA) nephropathy (IgAN) combined with other glomerular diseases, which can be called compound IgAN (cIgAN). Till now, clinical-pathological investigation of cIgAN was lacking, especially the severity of “background IgAN lesions.” This research aimed to investigate the incidence, clinical and pathological characteristics of cIgAN, and thus improve the understanding of the clinical significance of this combination.

Patients with cIgAN diagnosed in Peking University People's Hospital from November 2012 to April 2018 were retrospectively analyzed. Patients with IgAN without compound glomerular diseases (sIgAN) were enrolled as a control group.

Among 1407 patients diagnosed with IgAN, 80 (5.69%) were cIgAN patients. Compared with sIgAN, cIgAN patients had a significantly lower prevalence of microscopic hematuria and more urine protein. There were 10 pathological types of glomerular diseases combined with IgAN, led by diabetic nephropathy 37 (46.25%) and membranous nephropathy 14 (17.5%). Histologically, although the mesangial hypercellularity was comparable in 2 groups, cIgAN patients had a lower prevalence of endocapillary proliferation, segmental glomerulosclerosis, and cellular or fibrocellular crescents formation, as well as weaker immunofluorescence intensity for IgA and C3 (all P < .05). Eight out of 27 (29.63%) cIgAN patients with follow-up data (5–48 months) developed irreversible end-stage renal disease requiring dialysis.

The order of incidence of concomitant diseases was similar to that of the pure diseases. The “background IgAN associated lesions” except mesangial hypercellularity were relatively mild in cIgAN group. Those might suggest that in some cases, IgAN seems to be a chance finding, and the combined diseases may play a more important role in the clinicopathological features of the patients than the nephritis caused by IgA deposition. While diagnosing IgAN, other combined glomerular diseases need to be carefully considered by nephrologists and pathologists.
Evaluation of quality of life in patients with oral cancer after mandibular resection
Authors: Davudov Mahammad M. , Harirchi Iraj , Arabkheradmand Ali , Garajei Ata , Mahmudzadeh Habibollah , Shirkhoda Mohammad , Motiee-Langroudi Maziar , Mirzajani Zoheir , Zebardast Jayran , Montazeri Ali
Published: October 2019

This cross-sectional study aimed to assess and compare quality of life in patients with advanced oral cavity tumors after mandibular resection in 3 groups (no reconstruction, reconstruction with plate, and reconstruction with flap) at the Cancer Institute, affiliated to Tehran University of Medical Sciences. Quality of life was measured using the European Organization for Research and Treatment of Cancer core quality of life questionnaire and European Organization for Research and Treatment of Cancer head and neck cancer-specific quality of life questionnaire-35 items. The comparison was tested using Kurskal–Wallis analysis. All 120 patients were entered into the study. The mean age of patients was 48.5 (standard deviation = 18.1) years. Patients presented with advanced stage of the disease and underwent mandibular resection with no reconstruction (n = 40), reconstruction with plate (n = 41), and reconstruction with flap (n = 39). The findings showed that in general, there were no statistically significant differences in quality of life among 3 groups except for speech problem (P = .4), dry mouth (P = .03), and feeling ill (P = .04). Although there were no significant differences in quality of life among patients in 3 groups, overall patients who received reconstruction with flap reported better functioning and fewer symptoms. Those who did not receive any reconstruction reported the worse conditions.
Differences in corpus callosum injury between cerebral concussion and diffuse axonal injury
Authors: Jang Sung Ho , Kim Oh Lyong , Kim Seong Ho , Lee Han Do
Published: October 2019

Background:

We investigated differences in corpus callosum (CC) injuries between patients with concussion and those with diffuse axonal injury (DAI) by using diffusion tensor tractography (DTT).

Methods:

Twenty-nine patients with concussion, 21 patients with DAI, and 25 control subjects were recruited. We reconstructed the whole CC and 5 regions of the CC after applying Hofer classification (I, II, III, IV, and V). The whole CC and each region of the CC were analyzed to measure DTT parameters (fractional anisotropy [FA], apparent diffusion coefficient [ADC], and fiber number [FN]).

Results:

In the whole CC, significant differences were observed in all DTT parameters between the concussion and control groups and the DAI and control groups (P < .05). Among the 5 regions of the CC, significant differences were observed in FA and ADC between the concussion and control groups and the DAI and control groups (P < .05). Significant differences in FN were observed in CC regions I and II (connected with the prefrontal lobe and secondary motor area) between the concussion and control groups, in CC regions I, II, III, and IV (connected with the frontoparietal lobes) between the DAI and control groups, and in CC regions III, IV (connected with the motor-sensory cortex) between the concussion and DAI groups (P < .05).

Conclusion:

It was observed that both concussion and DAI patients showed diffuse neural injuries in the whole CC and all 5 regions of the CC. Neural FN results revealed that concussion patients appeared to be specifically injured in the anterior part of the CC connected with the frontal lobe, whereas DAI patients were injured in more diffuse regions connected with whole frontoparietal lobes.
Differential proteomic analysis of serum exosomes reveals alterations in progression of Parkinson disease
Authors: Jiang Ruilai , Rong Chunjiao , Ke Ronghu , Meng Shuiyan , Yan Xiumei , Ke Honglin , Wu Shaochang
Published: October 2019

Exosomes are nanometer-sized vesicles with intercellular communication functions, and their encapsulated proteins may participate in the pathological process of neurodegenerative disorders. The aim of this study was to identify the protein changes of serum exosomes in Parkinson disease (PD) patients with different disease progress types, and to identify potential biomarkers. The exosomes of PD patients with different severity and healthy control group were isolated from serum. The exosome proteins were analyzed by mass spectrometry with label-free quantitative proteomics. A total of 429 proteins were identified, of which 14 were significantly different in mild and severe PD patients. The expression levels of 7 proteins, including pigmented epithelium-derived factor, afamin, apolipoprotein D and J, were significantly increased in PD patients. The expression levels of 7 proteins, including complement C1q and protein Immunoglobulin Lambda Variable 1-33 (IGLV1-33)Cluster -33, were decreased in PD patients. These differentially expressed proteins were analyzed by gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis, which confirmed that the interaction between prion diseases and ECM receptors was the most significant pathways of enrichment. The changes of proteins and pathways may be related to the pathophysiological mechanism of PD. Therefore, some of these proteins could be considered as potential biomarkers for early PD diagnosis.
Successful management of the supraclavicular artery island flap combined with a sternohyoid muscle flap for hypopharyngeal and laryngeal reconstruction
Authors: Wang Qinying , Chen Ruixiang , Zhou Shuihong
Published: October 2019

This retrospective study evaluated operative outcomes when using a supraclavicular artery island flap (SAIF) combined with a sternohyoid muscle flap (SHMF) to reconstruct defects after hypopharyngeal carcinoma resection. Reconstructive surgery for hypopharyngeal and laryngeal defects was performed with the SAIF + SHME combination in 6 patients during 2016 to 2018. Within 14 to 16 days after the surgery, all 6 patients could ingest food and block the tube (avoiding aspiration), with no pharyngeal fistulas. They then underwent irradiation up to a total of 60.5 Gy during the 4 weeks postoperatively. All 6 flaps survived, and there were no donor-site complications except minor dehiscence in 1 patient. Thus, the SAIF + SHMF combination can be used to reconstruct hypopharyngeal and laryngeal defects after hemi-laryngectomy in patients with hypopharyngeal carcinoma involving the unilateral larynx. This technique effectively preserved the swallowing function and phonation of the patients, thereby improving their quality of life.
Age-specific reference values for cerebrospinal fluid protein concentrations in children in southern China
Authors: Liu Zhigang , Jia Deqin , Dai Jieming , Zhou Xing , Qin Zhoulian , Chen Liang , Zhang Jieyan , Chen Guohua , He Xiaocheng , Wan Ruipin , Ye Xingguang
Published: October 2019

Cerebrospinal fluid (CSF) protein values decline over the first few months of life as the infant's blood-CSF barrier matures. However, published studies have not reported CSF protein reference values of Chinese infants and differ in the reported rate, timing, and magnitude of this decline. The objective of this study was to determine reference intervals for CSF protein using available data of children in southern China. This retrospective study included infants who had a lumbar puncture (LP) performed in the Department of Pediatrics of Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan of an urban tertiary care children's hospital between January 1, 2008 and May 31, 2018. Infants with conditions suspected or known to cause elevated CSF protein concentrations were excluded. Of 3712 infants undergoing LP, 1043 (28.1%) met inclusion criteria. Results showed that there is an age-related decline in CSF protein concentration. The median CSF protein value was 62 mg/dL [interquartile range (IQR): 47–81 mg/dL] in infants aged 0 to 56 days (group 1). The 95th percentile values were 116 mg/dL for infants 0 to 28 days and 80 mg/dL for infants 29 to 56 days. The 95th percentile values by age category were as follows: ages 0 to 14 days, 117 mg/dL; ages 15 to 28 days, 107 mg/dL; ages 29 to 42 days, 96 mg/dL; and ages 43 to 56 days, 74 mg/dL. The median CSF protein value was 21 mg/dL (IQR: 16–31 mg/dL) in infants aged 2 months to <3 years (group 2). The 95th percentile values were 57 mg/dL for infants 2 to <6 months and 34 mg/dL for infants 6 to ≤24 months. The 95th percentile values by age category were as follows: ages 2 to <3 months, 66 mg/dL; ages 3 to <4 months, 52 mg/dL; ages 4 to <5 months, 53 mg/dL; and ages 5 to <6 months, 42 mg/dL. We quantify the age-related decline in CSF protein concentrations among infants 2 years of age and younger and provide age-specific reference values. The values reported here can be used to interpret the results of LP in infants ≤2 years of age.
Benefit of small dose antidepressants for functional dyspepsia
Authors: Luo Liang , Du Lijun , Shen Jinhua , Cen Mengsha , Dai Ning
Published: October 2019

Background:

Traditional treatment of functional dyspepsia (FD) is unsatisfactory in a subgroup of patients with FD, and the potential role of antidepressant medications also has not been definitely clarified. To provide more evidence for future optimal practice recommendations, we reviewed a 1-year clinical database of antidepressant agents applied in outpatients with FD.

Methods:

Clinical presentations, treatment course, and outcomes were determined by chart review of patients referring to the functional gastrointestinal disorders specialist clinic. One hundred thirty patients with FD were included for further analysis.

Results:

Patients were treated with different antidepressant drugs according to individual symptoms. The most commonly used drugs were flupenthixol melitracen and fluoxetine. Improvement and complete remission occurred in 93.8% and 54.6% of patients, respectively. There was a trend toward superior outcome for citalopram compared to sulpiride and mirtazapine in overall analysis. Meanwhile, regimens containing fluoxetine had significant increased remission rate compared to any other antidepressant regimens in postprandial distress syndrome subgroup analysis. Furthermore, older patients were more likely to achieve remission. However, sex and symptom duration were not associated with symptom remission. Finally, 11.5% of patients experienced adverse events.

Conclusions:

This retrospective cohort study indicated that small dose antidepressant therapy, especially citalopram and fluoxetine, is an effective and well tolerated treatment option for refractory FD.
Choropleth map legend design for visualizing the most influential areas in article citation disparities
Authors: Chien Tsair-Wei , Wang Hsien-Yi , Hsu Chen-Fang , Kuo Shu-Chun
Published: October 2019

Background:

Disparities in health outcomes across countries/areas are a central concern in public health and epidemiology. However, few authors have discussed legends that can be complemental to choropleth maps (CMs) and merely linked differences in outcomes to other factors like density in areas. Thus, whether health outcome rates on CMs showing the geographical distribution can be applied to publication citations in bibliometric analyses requires further study. The legends for visualizing the most influential areas in article citation disparities should have sophisticated designs. This paper illustrates the use of cumulative frequency (CF) map legends along with Lorenz curves and Gini coefficients (GC) to characterize the disparity of article citations in areas on CMs, based on the quantile classification method for classes.

Methods:

By searching the PubMed database (pubmed.com), we used the keyword “Medicine” [journal] and downloaded 7042 articles published from 1945 to 2016. A total number of 41,628 articles were cited in Pubmed Central (PMC). The publication outputs based on the author's x-index were applied to plot CM about research contributions. The approach uses two methods (i.e., quantiles and equal total values for each class) with CF legends, in order to highlight the difference in x-indices across geographical areas on CMs. GC was applied to observe the x-index disparities in areas. Microsoft Excel Visual Basic for Application (VBA) was used for creating the CMs.

Results:

Results showed that the most productive and cited countries in Medicine (Baltimore) were China and the US. The most-cited states and cities were Maryland (the US) and Beijing (China). Taiwan (x-index = 24.38) ranked behind Maryland (25.97), but ahead of Beijing (16.9). China earned lower disparity (0.42) than the US (0.49) and the rest of the world (0.53) when the GCs were applied.

Conclusion:

CF legends, particularly using the quantile classification for classes, can be useful to complement CMs. They also contain more information than those in standard CM legends that are commonly used with other classification methods. The steps of creating CM legends are described and introduced. Bibliometric analysts on CM can be replicated in the future.
Where are we in patient safety in the ED in Turkey?
Authors: Aksu Nalan M. , Akkaş Meltem
Published: October 2019

Near misses and unsafe conditions have become more serious for patients in emergency departments (EDs). We aimed to search the near misses and unsafe conditions that occurred in an ED to improve patient safety.

This was a retrospective analysis of a 10-year observational period from January 1, 2007 to December 31, 2016. We gained access to the adverse event notification forms (AENFs) sent to the hospital quality department from the ED. Patient age, sex, and date of presentation were recorded. The near misses and unsafe conditions were classified into 7 types: medication errors, falls, management errors, penetrative-sharp tool injuries, incidents due to institution security, incidents due to medical equipment, and forensic events. The outcome of these events was recorded.

A total of 220 AENF were reported from 294,673 ED visits. The median age of the 166 patients was 60 (21–95) years. Of these, 57.1% of the patients were females and 47.9% were males. The most commonly reported events were medication errors (32.7%) and management errors (27.3%). The median age of falling patients was 67.5 years. The nurse–patient ratio between 2007 to 2011 and 2011 to 2016 were 1/10 and 1/7, respectively. We found that when this ratio increased, the adverse events results were less significant (P < .003).

This was the 1st study investigating the adverse events in ED in Turkey. The reporting ratio of 0.07% for the total ED visits was too low. This showed that adverse events were under-reported.
Percutaneous endoscopic thoracic discectomy via posterolateral approach
Authors: Liu Wei , Yao Liyu , Li Xingchen , Tian Zhisen , Ning Cong , Yan Ming , Wang Yuanyi
Published: October 2019

Rationale:

Minimally invasive surgeries for thoracic disc herniation (TDH) evolved rapidly in recent years, and multiple approaches have been put forward. Thoracic discectomy via percutaneous spine endoscopy (PSE) is inadequately documented because of the low prevalence of TDH and the high difficulty of thoracic spine endoscopy techniques. Herein, we present a TDH case who underwent percutaneous endoscopic thoracic discectomy.

Patient concerns:

A 28-year-old male suffered backpain and partial paralysis in lower extremities.

Diagnoses:

Magnet resonance imaging demonstrated T11-12 TDH, with cranially migrated disc fragment.

Interventions:

The patient underwent percutaneous endoscopic thoracic discectomy via posterolateral approach with the assistance of endoscopic reamer in the procedure of foramino-laminaplasty.

Outcomes:

The patient's muscle force improved immediately, and the backpain relieved after 5 days post-surgery. In the 6-month follow-up, he had normal muscle force without paresthesia in lower limbs.

Lessons:

The innovative design of endoscopic reamer provides effective plasty and access establishment with lower risk and difficulty, which ensures the vision and the operating space of the procedure of decompression. With this technique, the indications of thoracic PSE were broadened to both ventral and dorsal thoracic stenosis.
Predrainage and Postdrainage Prognostic Nomograms to Predict Outcome of Percutaneous Drainage for Infected Pancreatic and Peripancreatic Necrotic Collections
Authors: Gupta Rajesh , Kulkarni Aditya A. , Babu Raghavendra , Shenvi Sunil , Gupta Rahul , Sharma Gopal , Kang Mandeep , Sharma Vishal , Singh Harjeet , Kumar-M Praveen , Rana Surinder
Published: October 2019

Objectives

This study aimed to identify factors affecting outcome of percutaneous catheter drainage (PCD) in management of infected pancreatic necrosis treated with step-up approach.

Methods

This was a single-center retrospective cohort study that included patients with infected necrosis undergoing PCD as initial intervention. Patients who did not respond underwent necrosectomy. Predictors of PCD failure (ie, mortality or need for necrosectomy) were analyzed. Models were constructed for predrainage and postdrainage use and were internally validated.

Results

Of 304 patients included, catheter drainage was successful in 59.8%, with overall mortality of 22%. Predrainage model consisted of Acute Physiologic and Chronic Health Evaluation II score at admission, early organ failure, and pancreatic necrosis of greater than 50%. Postdrainage model consisted of Acute Physiologic and Chronic Health Evaluation II at first PCD, early organ failure, pancreatic necrosis of greater than 50%, sepsis reversal within 1 week of PCD and Escherichia coli in PCD culture. Both models were internally validated with area under receiver operating characteristics curve of 71.2% for pre-PCD and 81.2% for post-PCD model. Prognostic nomograms were constructed using the models.

Conclusions

Percutaneous catheter drainage alone was successful in 59.8% with mortality of 22%. The nomograms can help in guiding treatment strategy and referral of high-risk cases.
A Study on the Effect of Patient Characteristics, Geographical Utilization, and Patient Outcomes for Total Pancreatectomy Alone and Total Pancreatectomy With Islet Autotransplantation in Patients With Pancreatitis in the United States
Authors: Lara Luis F. , Bellin Melena D. , Ugbarugba Emmanuel , Nathan Jaimie D. , Witkowski Piotr , Wijkstrom Martin , Steel Jennifer L. , Smith Kerrington D. , Singh Vikesh K. , Schwarzenberg Sarah J. , Pruett Timothy L. , Naziruddin Bashoo , Long-Simpson Leslie , Kirchner Varvara A. , Gardner Timothy B. , Freeman Martin L. , Dunn Ty B. , Chinnakotla Srinath , Beilman Gregory J. , Adams David B. , Morgan Katherine A. , Abu-El-Haija Maisam A. , Ahmad Syed , Posselt Andrew M. , Hughes Michael G. , Conwell Darwin L.
Published: October 2019

Objectives

A selective therapy for pancreatitis is total pancreatectomy and islet autotransplantation. Outcomes and geographical variability of patients who had total pancreatectomy (TP) alone or total pancreatectomy with islet autotransplantation (TPIAT) were assessed.

Methods

Data were obtained from the Healthcare Cost and Utilization Project National Inpatient Sample database. Weighed univariate and multivariate analyses were performed to determine the effect of measured variables on outcomes.

Results

Between 2002 and 2013, there were 1006 TP and 825 TPIAT in patients with a diagnosis of chronic pancreatitis, and 1705 TP and 830 TPIAT for any diagnosis of pancreatitis. The majority of the TP and TPIAT were performed in larger urban hospitals. Costs were similar for TP and TPIAT for chronic pancreatitis but were lower for TPIAT compared with TP for any type of pancreatitis. The trend for TP and TPIAT was significant in all geographical areas during the study period.

Conclusions

There is an increasing trend of both TP and TPIAT. Certain groups are more likely to be offered TPIAT compared with TP alone. More data are needed to understand disparities and barriers to TPIAT, and long-term outcomes of TPIAT such as pain control and glucose intolerance need further study.
The Effect of Neuromuscular Electrical Stimulation During Walking on Muscle Strength and Knee Pain in Obese Women With Knee Pain
Authors: Matsuse Hiroo , Segal Neil A. , Rabe Kaitlin G. , Shiba Naoto
Published: October 2019

Objective

The aim of the study was to assess the effectiveness of a hybrid training system with walking that simultaneously applies electrical stimulation to the knee extensors/flexors during walking in obese women with knee pain.

Design

This is a randomized, single-blind (assessor), controlled trial. Twenty-eight obese women with knee pain were randomized to 12 weeks of biweekly walking with either hybrid training system with walking or with transcutaneous electrical nerve stimulation (control). Primary outcomes (maximum isokinetic knee extensor torque and maximum isokinetic knee flexor torque) and secondary outcomes (20-m walk time, chair-stand time, stair-climb time, knee pain, and knee-related quality life) were evaluated. Change-point regression analyses were used to model the interaction for the primary outcomes. Two-sample t tests were used on pre-post change scores in secondary outcomes.

Results

Knee extensor torque increased significantly more in the hybrid training system with walking group than the control group when baseline knee extensor torque was greater than 57.2 Nm (P = 0.0033). When baseline knee flexor torque was at 30 or 50 Nm, there was a trend toward greater increase in the hybrid training system with walking group than the control group (P = 0.0566, P = 0.0737, respectively). There were no significant differences between groups in secondary outcomes.

Conclusions

These results suggest that hybrid training system with walking is effective for improving knee extensor torque in obese women with knee pain. However, the superiority of hybrid training system with walking may vary depending on baseline knee muscle strength.
The Effect of Therapeutic Exercises on Balance, Quality of Life, and Pain in Patients Who Were Receiving Neurotoxic Chemotherapy
Authors: Bahar-Ozdemir Yeliz , Akyuz Gulseren , Kalkandelen Melihat , Yumuk Perran Fulden
Published: October 2019

Objective

The aim of the study was to evaluate the effect of lower limb strengthening and balance exercises on balance, quality of life and neuropathic pain of the cancer patients receiving neurotoxic chemotherapy.

Design

Patients who were planning to receive neurotoxic chemotherapy agents were included in the first group. They were trained before the neurotoxic chemotherapy sessions with the 10-wk home-based exercise program including lower limb strengthening and balance exercises. The second group of patients who had received the third cycle of neurotoxic chemotherapy had no exercise program. Both groups were evaluated after the third cycle. Neurocom Balance Master and Berg Balance Scale were used to evaluate balance. The neuropathic pain was questioned by PainDETECT questionnaire and the quality of life was assessed with the European Organization for Research and Treatment of Cancer’s Quality of Life Questionnaire.

Results

Sixty patients were admitted to this study. Twenty-four patients were in the exercise group (F = 14, M = 10) and 36 patients were in the control group (F = 17, M = 19). Sociodemographic and clinical data of both groups were similar. Berg Balance Scale (P = 0.005), European Organization for Research and Treatment of Cancer’s Quality of Life Questionnaire global quality of life, physical function, and emotional status were higher, and symptom scores and PainDETECT questionnaire score were lower in the exercise group (P < 0.05). Balance tests were different between the groups.

Conclusions

Strengthening and balance exercises have a valuable effect on balance, quality of life, and neuropathic pain in patients receiving neurotoxic chemotherapy.
Significantly Increased Accumulation of 18F-FDG Throughout the Left Middle Cerebral Artery Territory Corresponding to Acute-Phase Infarction
Authors: Okuyama Chio , Nakae Takuro , Oka Satoshi , Nohara Jun , Yamauchi Hiroshi
Published: October 2019

A 70-year-old woman had spontaneous resolution of an embolism in her right middle cerebral artery (MCA) (day 1); another embolism occurred in her left MCA (day 3), which was promptly removed. On day 5, 18F-FDG PET/CT performed for staging mediastinal lymphoma showed marked FDG accumulation in the left MCA territory, whereas a defect was seen in the right insular region. Eventually, bilateral lesions developed irreversible infarction. Anaerobic metabolism and/or inflammation in acute-phase infarction were the supposed mechanism for the increased accumulation of FDG in her left MCA territory.
Antimicrobial resistance gene prevalence in a population of patients with advanced dementia is related to specific pathobionts
Authors: Rowan-Nash Aislinn D. , Araos Rafael , D’Agata Erika M.C. , Belenky Peter
Published: October 2019

Background

The issue of antimicrobial resistance continues to grow worldwide, and long-term care facilities are significant reservoirs of antimicrobial-resistant organisms, in part due to high frequency of antimicrobial use. Patients with advanced dementia are particularly vulnerable to multidrug-resistant organism acquisition and antimicrobial overuse, which has negative consequences for the gut microbiome and can contribute to the selection and propagation of antimicrobial resistance genes. In this study, we longitudinally examined a group of advanced dementia patients treated with the fluoroquinolone antimicrobial levofloxacin, finding a correlation between abundance of pathogens and antimicrobial resistance genes, which we confirmed in a larger cohort of subjects with advanced dementia.

Results

We observed significant inter- and intra-subject heterogeneity in the composition of the microbiota of the longitudinal levofloxacin cohort, suggesting temporal instability. Within this dataset, we did not find significant impacts of levofloxacin on the diversity, composition, function, or resistome of the gut microbiota of this population. However, we were able to link the antimicrobial resistance gene burden in a sample with the relative abundance of several pathobionts – particularlyEscherichia coli,Proteus mirabilis, andEnterococcus faecalis, as well as less-prevalent species includingProvidencia stuartiiandStaphylococcus haemolyticus. Furthermore, we used metagenomic assembly and binning to demonstrate that these species had higher genomic resistance gene levels than common gut commensals, and we were able to predict antimicrobial resistance gene burden from the relative abundances of these species in a separate, larger cohort from the same population.

Conclusions

We found that the relative abundances of several pathobionts were correlated with and were even predictive of the level of antimicrobial resistance genes in corresponding samples, and that these species carried high levels of resistances genes in their assembled genomes. In order to test this observation, we utilized a larger metagenomics dataset from a similar population and confirmed the association between pathobiont abundance and antimicrobial resistance genes. Given the high frequency with which these species were found at high levels in this population and the underlying vulnerability to infection with multidrug resistant organisms of advanced dementia patients, attention to microbial blooms of these species may be warranted. Additionally, in this study, we were able to utilize genomic assembly from metagenomic data to more definitively associate antimicrobial resistance gene levels with specific assembled species; as this technology continues to develop, assembly could prove to be a valuable method to monitor both specific resistance genes and blooms of multidrug-resistant organisms.
Serotonin depletion amplifies distinct human social emotions as a function of individual differences in personality
Authors: Kanen Jonathan W , Arntz Fréderique E , Yellowlees Robyn , Cardinal Rudolf N , Price Annabel , Christmas David M , Apergis-Schoute Annemieke M , Sahakian Barbara J , Robbins Trevor W
Published: October 2019

Serotonin is involved in a wide range of mental capacities essential for navigating the social world, including emotion and impulse control. Much recent work on serotonin and social functioning has focused on decision-making. Here we investigated the influence of serotonin on human emotional reactions to social conflict. We used a novel computerised task that required mentally simulating social situations involving unjust harm and found that depleting the serotonin precursor tryptophan – in a double-blind randomised placebo-controlled design – enhanced emotional responses to the scenarios in a large sample of healthy volunteers (n = 73), and interacted with individual differences in trait personality to produce distinctive human emotions. Whereas guilt was preferentially elevated in highly empathic participants, annoyance was potentiated in those high in trait psychopathy, with medium to large effect sizes. Our findings show how individual differences in personality, when combined with fluctuations of serotonin, may produce diverse emotional phenotypes. This has implications for understanding vulnerability to psychopathology, determining who may be more sensitive to serotonin-modulating treatments, and casts new light on the functions of serotonin in emotional processing.
In vivo Perturb-Seq reveals neuronal and glial abnormalities associated with Autism risk genes
Authors: Jin Xin , Simmons Sean K. , Guo Amy X. , Shetty Ashwin S. , Ko Michelle , Nguyen Lan , Robinson Elise , Oyler Paul , Curry Nathan , Deangeli Giulio , Lodato Simona , Levin Joshua Z. , Regev Aviv , Zhang Feng , Arlotta Paola
Published: October 2019

The thousands of disease risk genes and loci identified through human genetic studies far outstrip our current capacity to systematically study their functions. New experimental approaches are needed for functional investigations of large panels of genes in a biologically relevant context. Here, we developed a scalable genetic screen approach, in vivo Perturb-Seq, and applied this method to the functional evaluation of 35 autism spectrum disorder (ASD) de novo loss-of-function risk genes. Using CRISPR-Cas9, we introduced frameshift mutations in these risk genes in pools, within the developing brain in utero, and then performed single-cell RNA-Seq in the postnatal brain. We identified cell type-specific gene signatures from both neuronal and glial cell classes that are affected by genetic perturbations, and pointed at elements of both convergent and divergent cellular effects across this cohort of ASD risk genes. In vivo Perturb-Seq pioneers a systems genetics approach to investigate at scale how diverse mutations affect cell types and states in the biologically relevant context of the developing organism.
Differential protein metabolism and regeneration in hypertrophic diaphragm and atrophic gastrocnemius muscles in hibernating Daurian ground squirrels
Authors: Yan Xia , Gao Xuli , Peng Xin , Zhang Jie , Ma Xiufeng , Wei Yanhong , Wang Huiping , Gao Yunfang , Chang Hui
Published: October 2019

Whether differences in regulation of protein metabolism and regeneration are involved in the different phenotypic adaptation mechanisms of muscle hypertrophy and atrophy in hibernators? Two fast-type muscles (diaphragm and gastrocnemius) in summer active and hibernating Daurian ground squirrels were selected to detect changes in cross-sectional area (CSA), fiber type distribution, and protein expression indicative of protein synthesis metabolism (protein expression of P-Akt, P-mTORC1, P-S6K1, and P-4E-BP1), protein degradation metabolism (MuRF1, atrogin-1, calpain-1, calpain-2, calpastatin, desmin, troponin T, Beclin1, and LC3-II), and muscle regeneration (MyoD, myogenin, and myostatin). Results showed the CSA of the diaphragm muscle increased significantly by 26.1%, whereas the CSA of the gastrocnemius muscle decreased significantly by 20.4% in the hibernation group compared with the summer active group. Both muscles displayed a significant fast-to-slow fiber-type transition in hibernation. Our study further indicated that increased protein synthesis, decreased protein degradation, and increased muscle regeneration potential contributed to diaphragm muscle hypertrophy, whereas decreased protein synthesis, increased protein degradation, and decreased muscle regeneration potential contributed to gastrocnemius muscle atrophy. In conclusion, the differences in muscle regeneration and regulatory pattern of protein metabolism may contribute to the different adaptive changes observed in the diaphragm and gastrocnemius muscles of ground squirrels.
Discordant bioinformatic predictions of antimicrobial resistance from whole-genome sequencing data of bacterial isolates: An inter-laboratory study
Authors: Doyle Ronan M. , O’Sullivan Denise M. , Aller Sean D. , Bruchmann Sebastian , Clark Taane , Pelegrin Andreu Coello , Cormican Martin , Benavente Ernest Diez , Ellington Matthew J. , McGrath Elaine , Motro Yair , Thuy Nguyen Thi Phuong , Phelan Jody , Shaw Liam P. , Stabler Richard A. , van Belkum Alex , van Dorp Lucy , Woodford Neil , Moran-Gilad Jacob , Huggett Jim F. , Harris Kathryn A.
Published: October 2019

Background

Antimicrobial resistance (AMR) poses a threat to public health. Clinical microbiology laboratories typically rely on culturing bacteria for antimicrobial susceptibility testing (AST). As the implementation costs and technical barriers fall, whole-genome sequencing (WGS) has emerged as a ‘one-stop’ test for epidemiological and predictive AST results. Few published comparisons exist for the myriad analytical pipelines used for predicting AMR. To address this, we performed an inter-laboratory study providing sets of participating researchers with identical short-read WGS data sequenced from clinical isolates, allowing us to assess the reproducibility of the bioinformatic prediction of AMR between participants and identify problem cases and factors that lead to discordant results.

Methods

We produced ten WGS datasets of varying quality from cultured carbapenem-resistant organisms obtained from clinical samples sequenced on either an Illumina NextSeq or HiSeq instrument. Nine participating teams (‘participants’) were provided these sequence data without any other contextual information. Each participant used their own pipeline to determine the species, the presence of resistance-associated genes, and to predict susceptibility or resistance to amikacin, gentamicin, ciprofloxacin and cefotaxime.

Results

Individual participants predicted different numbers of AMR-associated genes and different gene variants from the same clinical samples. The quality of the sequence data, choice of bioinformatic pipeline and interpretation of the results all contributed to discordance between participants. Although much of the inaccurate gene variant annotation did not affect genotypic resistance predictions, we observed low specificity when compared to phenotypic AST results but this improved in samples with higher read depths. Had the results been used to predict AST and guide treatment a different antibiotic would have been recommended for each isolate by at least one participant.

Conclusions

We found that participants produced discordant predictions from identical WGS data. These challenges, at the final analytical stage of using WGS to predict AMR, suggest the need for refinements when using this technology in clinical settings. Comprehensive public resistance sequence databases and standardisation in the comparisons between genotype and resistance phenotypes will be fundamental before AST prediction using WGS can be successfully implemented in standard clinical microbiology laboratories.