bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond health messaging: a behavioural economics approach to increasing self‐selected distance during an acute bout of cycling
Authors: Piepmeier Aaron T. , Etnier Jennifer L. , Fasczewski Kimberly S.
Published: August 2018

The purpose of this study was to explore the effects of the perceived purpose of exercising on the self‐selected distance peddled during an acute cycling task. Participants were randomly assigned to one of three groups (health, wealth, charity). All participants watched a video emphasizing the health benefits of performing at least 30 min of daily exercise. Those in the health group were not provided any additional information. Those in the wealth group were then informed that they would earn money for every two kilometres cycled. Those in the charity group were informed that they would earn money for a charity for every two kilometres cycled. Participants were not given a time/distance limit and were instructed to cycle until they chose to stop. Analyses revealed that participants in the wealth and charity group cycled significantly farther than those in the health group (approximately twice as far). Additionally, a significant sex by group interaction showed that women cycled farther for charity while men cycled farther for wealth. These results suggest that health messages used to increase exercise behaviour may benefit from exploring how paradigms from behavioural economics influence behaviors that have relevance to public health.
Separable reduction of local metric regularity
Authors: Fabian M. , Ioffe A. , Revalski J.
Published: August 2018

We prove that the property of a set-valued mapping

F
:
X
⇉
Y

F:X \rightrightarrows Y

to be locally metrically regular (and consequently, the properties of the mapping to be linearly open or pseudo-Lipschitz) is separably reducible by rich families of separable subspaces of

X
×
Y

X\times Y

. In fact, we prove that, moreover, this extends to computation of the functor

{reg}

F

\textrm {{reg}}\, F

that associates with

F
F

the rates of local metric regularity of

F
F

near points of its graph.
Inner functions and zero sets for ℓ^{𝑝}_{𝐴}
Authors: Cheng Raymond , Mashreghi Javad , Ross William
Published: August 2018

In this paper we characterize the zero sets of functions from

ℓ

A

p

\ell ^{p}_{A}

(the analytic functions on the open unit disk

D

\mathbb {D}

whose Taylor coefficients form an

ℓ
p

\ell ^p

sequence) by developing a concept of an “inner function” modeled by Beurling’s discussion of the Hilbert space

ℓ

A

2

\ell ^{2}_{A}

, the classical Hardy space. The zero set criterion is used to construct families of zero sets which are not covered by classical results. In particular, we give an alternative proof of a result of Vinogradov [Dokl. Akad. Nauk SSSR 160 (1965), pp. 263–266] which says that when

p
>
2

p > 2

, there are zero sets for

ℓ

A

p

\ell ^{p}_{A}

which are not Blaschke sequences.
Cell membrane proteins with high N-glycosylation, high expression and multiple interaction partners are preferred by mammalian viruses as receptors
Authors: Zhang Zheng , Zhu Zhaozhong , Chen Wenjun , Cai Zena , Xu Beibei , Tan Zhiying , Wu Aiping , Ge Xingyi , Guo Xinhong , Tan Zhongyang , Xia Zanxian , Zhu Haizhen , Jiang Taijiao , Peng Yousong
Published: August 2018

Motivation

Receptor mediated entry is the first step for viral infection. However, the question of how viruses select receptors remains unanswered.

Results

Here, by manually curating a high-quality database of 268 pairs of mammalian virus–host receptor interaction, which included 128 unique viral species or sub-species and 119 virus receptors, we found the viral receptors are structurally and functionally diverse, yet they had several common features when compared to other cell membrane proteins: more protein domains, higher level of N-glycosylation, higher ratio of self-interaction and more interaction partners, and higher expression in most tissues of the host. This study could deepen our understanding of virus–receptor interaction.

Availability and implementation

The database of mammalian virus–host receptor interaction is available at http://www.computationalbiology.cn: 5000/viralReceptor.

Supplementary information

Supplementary data are available at Bioinformatics online.
A quantitative map of protein sequence space for the cis-defensin superfamily
Authors: Shafee Thomas , Anderson Marilyn A
Published: August 2018

Motivation

The cis-defensins are a superfamily of small, cationic, cysteine-rich proteins, sharing a common scaffold, but highly divergent sequences and varied functions from host-defence to signalling. Superfamily members are most abundant in plants (with some genomes containing hundreds of members), but are also found across fungi and invertebrates. However, of the thousands of cis-defensin sequences in databases, only have a handful have solved structures or assigned activities. Non-phylogenetic sequence-analysis methods are therefore necessary to use the relationships within the superfamily to classify members, and to predict and engineer functions.

Results

We show that the generation of a quantitative map of sequence space allows these highly divergent sequences to be usefully analyzed. This information-rich technique can identify natural groupings of sequences with similar biophysical properties, detect interpretable covarying properties, and provide information on typical or intermediate sequences for each cluster. The cis-defensin superfamily contains clearly-defined groups, identifiable based on their biophysical properties and motifs. The organization of sequences within this space also provides a foundation of understanding the ancient evolution of the superfamily.

Availability and implementation

A webtool for exploring and querying the space is hosted at TS404.shinyapps.io/DefSpace.

Supplementary information

Supplementary data are available at Bioinformatics online.
DCARS: differential correlation across ranked samples
Authors: Ghazanfar Shila , Strbenac Dario , Ormerod John T , Yang Jean Y H , Patrick Ellis
Published: August 2018

Motivation

Genes act as a system and not in isolation. Thus, it is important to consider coordinated changes of gene expression rather than single genes when investigating biological phenomena such as the aetiology of cancer. We have developed an approach for quantifying how changes in the association between pairs of genes may inform the outcome of interest called Differential Correlation across Ranked Samples (DCARS). Modelling gene correlation across a continuous sample ranking does not require the dichotomisation of samples into two distinct classes and can identify differences in gene correlation across early, mid or late stages of the outcome of interest.

Results

When we evaluated DCARS against the typical Fisher Z-transformation test for differential correlation, as well as a typical approach testing for interaction within a linear model, on real TCGA data, DCARS significantly ranked gene pairs containing known cancer genes more highly across several cancers. Similar results are found with our simulation study. DCARS was applied to 13 cancers datasets in TCGA, revealing several distinct relationships for which survival ranking was found to be associated with a change in correlation between genes. Furthermore, we demonstrated that DCARS can be used in conjunction with network analysis techniques to extract biological meaning from multi-layered and complex data.

Availability and implementation

DCARS R package and sample data are available at https://github.com/shazanfar/DCARS. Publicly available data from The Cancer Genome Atlas (TCGA) was used using the TCGABiolinks R package. Supplementary Files and DCARS R package is available at https://github.com/shazanfar/DCARS.

Supplementary information

Supplementary data are available at Bioinformatics online.
Framing and Foreign Policy—Israel's Response to the Arab Uprisings
Authors: Aran Amnon , Fleischmann Leonie
Published: August 2018

The eruption of the 2010 Arab uprisings has generated a great deal of academic scholarship. However, the foreign policy of Israel, a key power in the Middle East, amid the Arab uprisings, has received limited attention. Furthermore, as we demonstrate, the conventional wisdom purported by the current debate, which is that Israel adopted a “defensive, non-idealist” realist foreign policy posture (Magen 2015, 114) in the wake of the Arab uprisings, is wrong. Rather, utilizing an innovative approach linking foreign policy analysis (FPA) and the literature on framing, we demonstrate that Israel adopted a foreign policy stance of entrenchment. This posture is predicated on peace for peace not territory, reinforcing Israel's military capabilities, and granting limited autonomy to the Palestinians under Israeli occupation. Thus, the article demonstrates how framing can usefully be operationalized to uncover how binary discourse does not merely reflect foreign policy but is, in fact, constitutive of it. We demonstrate that diagnostic and prognostic frames helped to create a direct connection between the images held by a leader, his/her worldview, ideas, perceptions and misperceptions, and foreign policy actions. These frames constituted action-oriented sets of beliefs and meaning that inspired and legitimated certain foreign policy options and instruments while restricting others.
Effectiveness of Boric Acid by Ingestion, But Not by Contact, Against the Common Bed Bug (Hemiptera: Cimicidae)
Authors: Sierras Angela , Wada-Katsumata Ayako , Schal Coby
Published: August 2018

Boric acid has been used as an insecticide in the successful control of agricultural, public health and urban pests long before the advent of synthetic organic pesticides. Boric acid products, formulated as dusts, sprays, granular baits, pastes, gels, and liquids, are widely available to consumers and pest management professionals, especially to control pest infestations within homes. Boric acid dust is commonly used against bed bugs (Cimex lectularius L. [Hemiptera: Cimicidae]), but its efficacy has not been demonstrated. We evaluated the efficacy of boric acid as an ingestible and residual contact insecticide on bed bugs, and compared its efficacy on the German cockroach (Blattella germanica L. [Blattodea: Ectobiidae]) which is known to be susceptible to boric acid by both routes. Dose–response studies of 0–5% boric acid in blood demonstrated that ingested boric acid caused rapid mortality at concentrations of ≥2%, and even 0.5% and 1% boric acid caused 100% mortality, albeit at a slower time course. In contrast, bed bugs survived contact with high concentrations of boric acid dust. Smaller boric acid particles did not increase mortality of either unfed or recently fed bed bugs. The same boric acid products were effective at causing mortality of German cockroaches by both contact and ingestion. We thus conclude that although boric acid is an excellent candidate active ingredient for an ingestible bait formulation, residual applications of dust or spray would be ineffective in bed bug interventions.
All-cause mortality in relation to changes in relative blood volume during hemodialysis
Authors: Preciado Priscila , Zhang Hanjie , Thijssen Stephan , Kooman Jeroen P , van der Sande Frank M , Kotanko Peter
Published: August 2018

Background

Relative blood volume (RBV) monitoring is widely used in hemodialysis (HD) patients, yet the association between intradialytic RBV and mortality is unknown.

Methods

Intradialytic RBV was recorded once/min during a 6-month baseline period; all-cause mortality was noted during follow-up. RBV at 1, 2 and 3 h into HD served as a predictor of all-cause mortality during follow-up. We employed Kaplan–Meier analysis, univariate and adjusted Cox proportional hazards models for survival analysis.

Results

We studied 842 patients. During follow-up (median 30.8 months), 249 patients (29.6%) died. The following hourly RBV ranges were associated with improved survival: first hour, 93–96% [hazard ratio (HR) 0.58 (95% confidence interval (CI) 0.42–0.79)]; second hour, 89–94% [HR 0.54 (95% CI 0.39–0.75)]; third hour, 86–92% [HR 0.46 (95% CI 0.33–0.65)]. In about one-third of patients the RBV was within these ranges and in two-thirds it was above. Subgroup analysis by median age (≤/> 61 years), sex, race (white/nonwhite), predialysis systolic blood pressure (SBP; ≤/> 130 mmHg) and median interdialytic weight gain (≤/> 2.3 kg) showed comparable favorable RBV ranges. Patients with a 3-h RBV between 86 and 92% were younger, had higher ultrafiltration volumes and rates, similar intradialytic average and nadir SBPs and hypotension rates, lower postdialysis SBP and a lower prevalence of congestive heart failure when compared with patients with an RBV >92%. In the multivariate Cox analysis, RBV ranges remained independent and significant outcome predictors.

Conclusion

Specific hourly intradialytic RBV ranges are associated with lower all-cause mortality in chronic HD patients.
Effect of Environmental Temperature on Serum Sodium Level in Hospitalized Non-critically Ill Children
Authors: Sakornyutthadej Natee , Poomthavorn Preamrudee , Mahachoklertwattana Pat
Published: August 2018

Background

Intravenous hypotonic fluid administered in children is associated with an increased risk of developing hyponatremia. This finding has been reported from temperate countries where climate is relatively cold. But whether this risk also occurs in tropical countries has not been elucidated.

Objective

The objective of this study was to determine the relationship between environmental temperature and serum sodium in non-critically ill children.

Methods

A retrospective study.

Results

A total of 1061 hospitalized children were enrolled. Incidences of hyponatremia were not different between patients who received isotonic and hypotonic fluids (29% vs. 31%). Subgroup analysis showed a trend of higher incidence of hyponatremia in patients who received hypotonic fluid than isotonic fluid only in patients admitted to the air-conditioned wards (29% vs. 21%, p = 0.08).

Conclusion

Children admitted to the air-conditioned wards who received hypotonic fluid seemed to carry a higher risk of developing hyponatremia than those admitted to the non-air-conditioned ward.
Genetic Diversity of Potato virus Y in Potato Production Areas in Northeast China
Authors: Bai Yanju , Han Shuxin , Gao Yanling , Zhang Wei , Fan Guoquan , Qiu Cailing , Nie Xianzhou , Wen Jingzhi
Published: August 2018

In 2011–2014, ELISA or nucleic acid spot hybridization (NASH) testing for common potato viruses or Potato spindle tuber viroid (PSTVd) was performed on 500 leaf samples collected in potato fields in the northeast provinces Heilongjiang and Inner Mongolia, China. The results revealed that 38.4% (Heilongjiang) and 27.7% (Inner Mongolia) were positive for Potato virus Y (PVY). To unveil the strain composition and population structure of PVY in the region, the multiplex RT-PCR described by Chikh-Ali et al. was performed on all of the ELISA-PVY-positive samples. Of the 158 samples whose PVY strain scenarios could be determined, PVYNTN-NW-SYR-II and PVYN-Wi were the most abundant strains, occurring in 58.9 and 47.5% samples, followed by PVYNTN-NW-SYR-I (31.0%), PVYN:O (19.6%), Eu-PVYNTN (7.6%), NA-PVYN (1.3%), and PVYO (0.6%). In the 84 single-strain-infected samples, PVYN-Wi accounted for 41.7%, PVYNTN-NW-SYR-II for 40.5%, PVYNTN-NW-SYR-I for 14.3%, and PVYN:O and Eu-PVYNTN for 3.6% each. Seven isolates representing PVYNTN-NW-SYR-I (HLJ-6-1 and HLJ-9-4), PVYNTN-NW-SYR-II (INM-W-369-12 and SC-1-1-2), PVYN:O (HLJ-30-2), and PVYN-Wi (HLJ-BDH-2 and HLJ-C-429) were sequenced and analyzed molecularly. Whereas the sequence identities for isolates belonging to the same strain group were >98.5%, they fell for isolates belonging to different strain groups to 92.7–98.1% at the genome level and 96.1–98.4% at the polyprotein level. Interestingly, the exact location of the recombination events varied among isolates within a strain group. Phylogenetic analysis of all 42 full length PVY sequences from China indicated that most clustered to various recombinant groups, despite the fact that the PVY isolates were isolated from at least five host species. Pathological analysis of four isolates representing PVYN:O, PVYN-Wi, PVYNTN-NW-SYR-I, and PVYNTN-NW-SYR-II revealed that the PVYNTN-NW-SYR-II isolate incited the most severe symptoms on potato cultivar Kexin 13, followed by PVYNTN-NW-SYR-I, PVYN:O and PVYN-Wi. The PVYNTN-NW-SYR-I and PVYNTN-NW-SYR-II isolates also caused necrotic ringspots on the tubers of Kexin 13, indicating their ability to induce the potato tuber necrotic ringspot disease in potato.
FOXO1 and ETV6 genes may represent novel regulators of splicing factor expression in cellular senescence
Authors: Latorre Eva , Ostler Elizabeth L. , Faragher Richard G. A. , Harries Lorna W.
Published: August 2018

Cellular plasticity is a key facet of cellular homeostasis requiring correct temporal and spatial patterns of alternative splicing. Splicing factors, which orchestrate this process, demonstrate age‐related dysregulation of expression; they are emerging as potential influences on aging and longevity. The upstream drivers of these alterations are still unclear but may involve aberrant cellular signaling. We compared the phosphorylation status of proteins in multiple signaling pathways in early and late passage human primary fibroblasts. We then assessed the impact of chemical inhibition or targeted knockdown of direct downstream targets of the ERK and AKT pathways on splicing factor expression, cellular senescence, and proliferation kinetics in senescent primary human fibroblasts. Components of the ERK and AKT signaling pathways demonstrated altered activation during cellular aging. Inhibition of AKT and ERK pathways led to up‐regulation of splicing factor expression, reduction in senescent cell load, and partial reversal of multiple cellular senescence phenotypes in a dose‐dependent manner. Furthermore, targeted knockdown of the genes encoding the downstream targets FOXO1 or ETV6 was sufficient to mimic these observations. Our results suggest that age‐associated dysregulation of splicing factor expression and cellular senescence may derive in part from altered activity of ERK and AKT signaling and may act in part through the ETV6 and FOXO1 transcription factors. Targeting the activity of downstream effectors of ERK and AKT may therefore represent promising targets for future therapeutic intervention.—Latorre, E., Ostler, E. L., Faragher, R. G. A., Harries, L. W. FOXO1 and ETV6 genes may represent novel regulators of splicing factor expression in cellular senescence. FASEB J. 33, 1086–1097 (2019). www.fasebj.org
Novel systemic drugs in treatment of atopic dermatitis: results from phase II and phase III studies published in 2017/2018
Authors: Werfel Thomas
Published: August 2018

Purpose of review

The present review will give an update of recently published clinical studies on novel systemic treatment approaches in atopic dermatitis.

Recent findings

Until 2017 immunosuppressive drugs such as cyclosporine had to be used in atopic dermatitis when the disease could not sufficiently be treated with topical drugs. Several new substances specifically targeting inflammation in atopic dermatitis are currently studied. In 2017, dupilumab was approved in the United States and in Europe for first-line biologic treatment of moderate to severe atopic dermatitis in adults. The antibody blocks a subunit of the interleukin (IL)-4 and IL-13 receptor, thus inhibiting effects of two key cytokines in type 2 polarized inflammation. In addition to the studies on dupilumab recent clinical investigations on the effects on anti-IL-13 (lebrikizumab, tralokinumab), anti-IL-31 receptor (nemolizumab), anti-IL-22 (fezakinumab), and on small molecules targeting the histamine-4-receptor (ZPL389) and the Janus kinase inhibitor baricitinib have been published as full papers in the last 2 years.

A couple of promising novel therapeutical targets have recently been investigated and published in clinical trials on atopic dermatitis.
Remooring: A Qualitative Focus Group Exploration of How Educators Maintain Identity in a Sea of Competing Demands
Authors: Jauregui Joshua , O’Sullivan Patricia , Kalishman Summers , Nishimura Holly , Robins Lynne
Published: August 2018

Purpose

Longitudinal faculty development programs (LFDPs) are communities of practice (CoPs) that support development of participants’ educator identity (EID). This study explored how program graduates negotiated their newly formed EIDs among competing identities and demands in academic medicine.

Method

In this multicenter, cross-sectional, qualitative study, graduates of two LFDP cohorts (one and five years post graduation) were invited in 2015 to participate in a one-hour, cohort-specific focus group. The focus group included questions about views of themselves as educators, experiences of transition out of the LFDP, and sustainability of their EID following program participation. Researchers analyzed transcripts using Wenger’s CoP and Tajfel’s social identity theories to guide interpretation of findings.

Results

Thirty-seven graduates, 17 from one year and 20 from five years post graduation, participated in eight focus groups. They described developing a new EID in their LFDP CoPs. Three major themes emerged: context, agency, and identity. A push–pull relationship among these themes influenced faculty members’ EID trajectory over time. Graduates described feeling unmoored from their LFDP community after graduation and relied on individual agency to remoor their new identities to supports in the larger institutional context.

Conclusions

LFDP graduation represented a transition point. Graduates found it challenging to lose supports from their time-limited CoP and remoor their EIDs to workplace supports. Remooring required individual agency and external support and affirmation. Faculty development programs must be designed with transition periods and sustainability in mind to ensure that participants and institutions can benefit from their transformative effects over time.
Commentary on “The More Things Change: Buprenorphine/Naloxone Diversion Continues While Treatment is Inaccessible”
Authors: Mitchell Shannon Gwin , Gryczynski Jan , Schwartz Robert P.
Published: August 2018

This commentary puts the recent findings by Carroll et al into historical perspective, noting both the long-held problem of medication diversion when pharmacotherapy access is limited, and the ways in which medication diversion concerns and regulations help create those treatment access barriers. Recent efforts to bridge the treatment gap, including increases in Federal funding through the 21st Century Cures Act and expanding the buprenorphine patient cap and scope of eligible providers under the Comprehensive Addiction Recovery Act (CARA) will likely help; however, important structural barriers remain. Health insurance barriers, including limited Medicaid coverage, combined with stigma against pharmacotherapy persist, which likely means that people in need of treatment will continue to self-treat their symptoms with diverted medications, such as the buprenorphine/naloxone use noted by Carroll and colleagues.
The Risk Factors of Low Back Pain in Female High School Students
Authors: Noormohammadpour Pardis , Borghei Alireza , Mirzaei Shadi , Mansournia Mohammad Ali , Ghayour-Najafabadi Mahboubeh , Kordi Mahla , Kordi Ramin
Published: August 2018

Study Design.

A prospective cross-sectional study.

Objective.

The aim of this study was to evaluate the prevalence and associated factors with low back pain (LBP) in female adolescents of high school age.

Summary of Background Data.

The prevalence of LBP in Tehran is high, and the majority of previous studies on LBP in adolescent and its risk factors have been performed in the developed countries. Therefore, identification of risk factors and planning appropriate protocols for prevention of LBP in adolescents may substantially decrease the prevalence of LBP and its burden in developing countries in future.

Methods.

In a prospective cross-sectional study, demographic characteristics, including age, body mass index (BMI), weight and mode of using backpack, family history of LBP in first degree relatives, and passive smoking status of the participants along with a history of LBP were recorded. Joint hypermobility was assessed using Beighton scale. Also, anthropometric measurements, spinal flexion, and hip joint range of motion were measured for each participant.

Results.

In total, 372 students participated in the study. The mean (SD) age of the participants was 15.8 (0.9) years. The lifetime, more than 3 months, and last month history of LBP was 46.2%, 11.6%, and 31.2%, respectively. Positive history of LBP in the first-degree relatives was significantly associated with LBP in the participants (P < 0.01). The prevalence of passive smoking was significantly higher in the participants with last month history of LBP (P = 0.03). The prevalence of joint hypermobility was 15.9% and was significantly higher in those with the lifetime and last month history of LBP (P < 0.01).

Conclusion.

LBP is a common complaint among adolescent and high school girl students. The results of this study identified the prevalence and associated factors with LBP in high school students and will help develop strategies for prevention and treatment of LBP in the adolescent population.

Level of Evidence: 3
The Impact of Vancomycin and Cefazolin as Standard Preoperative Antibiotic Prophylaxis on Surgical Site Infections Following Instrumented Spinal Fusion
Authors: Lopez Wylie Y. , Rider Sean M. , Nwosu Kenneth , Kazarian Erick R. , Blucher Justin A. , Schoenfeld Erin M. , Simpson Andrew K. , Kang James D. , Schoenfeld Andrew J.
Published: August 2018

Study Design.

Retrospective cohort study.

Objective.

To assess whether administration of prophylactic vancomycin, in addition to cefazolin decreased revision surgeries for postoperative infection (SSI) as well as the need for revisions overall.

Summary of Background Data.

In 2010 our institution implemented an antibiotic prophylaxis regimen consisting of intravenous vancomycin and cefazolin that applied to all patients receiving surgical implants. The impact of this change in prophylactic antibiotic regimen on SSIs following instrumented spinal fusions remains unknown.

Methods.

We conducted a prepost analysis evaluating the effect of the change in antibiotic prophylaxis on SSIs following instrumented spinal fusions. We collected data on all eligible patients over the course of 2005 to 2009 and 2011 to 2015. We used logistic regression techniques to evaluate unadjusted results for the prophylactic antibiotic protocol on all revision surgeries, as well as those for SSI, followed by sequential adjustments for sociodemographic factors and surgical characteristics.

Results.

Revision surgeries performed for a diagnosis of infection were reduced from a rate of 4% (n = 57) in the period 2005 to 2009 to 2% (n = 44) over 2011 to 2015 (P < 0.001). At the same time, the incidence of revision surgeries for any cause was also reduced (14% in 2005–2009vs. 9% in 2011–2015;P < 0.001). In adjusted analysis, the odds of a revision procedure for SSI were reduced by 50% following introduction of the protocol (OR 0.50; 95% CI 0.33, 0.76). No significant difference in the organisms responsible for SSI was identified between 2005 and 2009 and 2011 and 2015 (P = 0.22).

Conclusion.

This natural experiment has shown some utility for a preoperative prophylactic antibiotic regimen of vancomycin and cefazolin, including meaningful reductions in revision procedures performed for SSI. This is the first effort we are aware of to consider a uniform institutional protocol that employs the use of intravenous vancomycin and cefazolin as prophylactic agents.

Level of Evidence:2
Can Elective Spine Surgery Be Performed Safely Among Nonagenarians?
Authors: Oichi Takeshi , Oshima Yasushi , Matsui Hiroki , Fushimi Kiyohide , Tanaka Sakae , Yasunaga Hideo
Published: August 2018

Study Design.

Retrospective cohort study.

Objective.

To compare morbidity and mortality between nonagenarians and other older adult patients who underwent elective spine surgery.

Summary of Background Data.

There is a lack of information of the perioperative risks of nonagenarians undergoing spine surgery.

Methods.

Data of patients aged ≥65 years who underwent elective spine surgery from July 2010 to March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide administrative inpatient database in Japan. Clinical outcomes included mortality, occurrence of major complications (cardiac events, respiratory complications, pulmonary embolism, stroke, and acute renal failure), urinary tract infection, and postoperative delirium. These clinical outcomes in nonagenarians were compared with those in patients aged 65 to 79 years and octogenarians. A multivariate logistic regression model fitted with a generalized estimation equation was used to evaluate the influence of advanced age on 90-day mortality and postoperative major complications.

Results.

Of 88,370 patients identified in the database, 418 were nonagenarians. Compared with patients aged 65 to 79 years and octogenarians, nonagenarians had the highest rates of 90-day mortality (0.2%, 0.3%, and 1.7%, respectively; P < 0.001) and at least one major complication (3.7%, 5.0%, and 7.4%, respectively; P < 0.001). Nonagenarians had the highest proportions of cardiac events, respiratory complications, urinary tract infections, and delirium. The multivariable logistic regression analyses revealed that nonagenarians had increased risks of both 90-day mortality (odds ratio, 8.65; 95% confidence interval, 3.62–20.6) and postoperative major complications (odds ratio, 2.32; 95% confidence interval, 1.61–3.36) compared with patients aged 65 to 79 years.

Conclusion.

Nonagenarians had increased morbidity and mortality following elective spine surgery compared with other older adult patients. Among the complications, cardiac events, respiratory complications, urinary tract infection, and delirium were more likely to occur in nonagenarians.

Level of Evidence: 3
The Impact of Closed Incision Negative Pressure Therapy on Postoperative Breast Reconstruction Outcomes
Authors: Gabriel Allen , Sigalove Steven , Sigalove Noemi , Storm-Dickerson Toni , Rice Jami , Maxwell Patrick , Griffin Leah
Published: August 2018

Background:

Studies report that incision management with closed incision negative pressure therapy (ciNPT) may provide clinical benefits, including protecting surgical incisions, for postsurgical closed incisions (eg, orthopedic, sternotomy, and colorectal). This retrospective analysis compared postoperative outcomes in patients who received ciNPT versus standard of care (SOC) for incision management after breast reconstruction postmastectomy.

Methods:

Patient demographics, chemotherapy exposure, surgical technique, ciNPT use, number of drains, time to drain removal, and 90-day postoperative complication rates were analyzed from records of 356 patients (ciNPT = 177, SOC = 179) with 665 closed breast incisions (ciNPT = 331, SOC = 334).

Results:

Overall complication rate was 8.5% (28/331) in ciNPT group compared with 15.9% (53/334) in SOC group (P = 0.0092). Compared with the SOC group, the ciNPT group had significantly lower infection rates [7/331 (2.1%) versus 15/334 (4.5%), respectively; P = 0.0225], dehiscence rates [8/331 (2.4%) versus 18/334 (5.4%), respectively; P = 0.0178], necrosis rates [17/331 (5.1%) versus 31/334 (9.3%), respectively; P = 0.0070], and seroma rates [6/331 (1.8%) versus 19/334 (5.7%), respectively; P = 0.0106]. The ciNPT group required significantly fewer returns to operating room compared with the SOC group [8/331 (2.4%) versus 18/334 (5.4%), respectively; P = 0.0496]. Time to complete drain removal per breast for ciNPT versus SOC groups was 9.9 versus 13.1 days (P < 0.0001), respectively.

Conclusions:

Patients who received ciNPT over closed incisions following postmastectomy breast reconstruction experienced a shorter time to drain removal and significantly lower rates of infection, dehiscence, necrosis, and seromas, compared with the SOC group. Randomized controlled studies are needed to corroborate the findings in our study.
Lipoaugmentation following Implant Removal Preferred by Plastic Surgeons and the General Public
Authors: Mess Sarah A.
Published: August 2018

Background:

Breast implant removal followed by fat transfer to the breast (lipoaugmentation) is a newer procedure and as such there is a need for empirical aesthetic comparisons between breast augmentation with implants versus fat transfer. Fat transfer to the breast is becoming an important option for women seeking reoperation of breast augmentation.

Methods:

A survey was created using standardized before and after photographs of 12 patients who underwent implant removal and lipoaugmentation. Four photographs of breasts that had no surgery were used as controls, with identical before/after photographs. The survey was administered to 96 respondents from the general population and 10 plastic surgeons. Respondents were asked to rate the breasts using a 5-point Likert scale without procedural knowledge. The responses were evaluated using parametric statistical t tests to compare responses to implants versus fat transfer in terms of their respective attractiveness, naturalness, size, symmetry, and femininity.

Results:

Fat transfer was significantly preferred to implants on all 5 measures; attractiveness, naturalness, size, symmetry, and femininity. Fat transfer was significantly preferred to implants by a margin of +0.36 average on 1–5 scale, which is approximately 1/3 of a Likert interval on all measures. Plastic surgeons took significantly longer than the general population to complete the survey and preferred fat transfer over implants to a higher degree.

Conclusions:

Lipoaugmentation can provide a favorable aesthetic outcome in women seeking implant removal. The general public can be conveniently surveyed via crowd sourcing, and their aesthetic judgments largely mirror those of trained and experienced plastic surgeons. Patients weighing breast implant removal or breast implant revision could consider this study in their decision making.
An Algorithm Using Botox Injections for Facial Scar Improvement in Fitzpatrick Type IV–VI Skin
Authors: Shome Debraj , Khare Stuti , Kapoor Rinky
Published: August 2018

Background:

Wounds of the face are known to heal poorly with conspicuous scarring. Hence, it is crucial to address the distracting effect of muscle pull on immature collagen, which often leads to worsening of scars.

Study Design:

Prospective clinical study.

Methods:

One hundred patients with a minimum of 6 months follow-up were recruited. All patients with depressed scars underwent surgery for scar revision. Two weeks before surgical intervention, intramuscular Botulinum toxin was injected around the scar, to prevent movement of the facial muscles. From the second week postsurgery, Cicatrix (Formulation containing activated Centella Asiatica & Pinus Sylvestris, Catalysis, Spain) was routinely used, 3 times a day, for 6 months post the scar revision surgery. Six weeks postsurgery, Fractional C02laser treatment was started and performed every 4 weeks.

Results:

Using the Objective Assessment Score and the Subjective Assessment Score, the mean of the scores were taken. All patients had satisfactory results, as measured by a patient satisfaction survey and objectively by the physician assessment.

Discussion:

Botulinum toxin injected before scar revision surgery resulted in the wound being stabilized, better wound healing, and prevention of wound widening during healing.

Conclusion:

In view of the results of this study, it is considered worthwhile to offer patients with facial scars, Botulinum toxin injections before scar revision surgery, followed by Fractional C02laser, along with the routine use of Cicatrix Cream.
BREAST-Q Measurement of the Patient Perspective in Oncoplastic Breast Surgery: A Systematic Review
Authors: Liu Liang Q. , Branford Olivier A. , Mehigan Sinead
Published: August 2018

Background:

Since BREAST-Q was developed in 2009, it has been widely used by clinicians and researchers to capture information regarding health-related quality of life (HRQoL) and patient satisfaction related to breast surgery. Yet clinical guidelines regarding the use of BREAST-Q for assessment of success of surgery in women with breast cancer remain limited. To maximize the benefits of using BREAST-Q to inform clinical decision making, this systematic review aimed to identify and appraise current evidence on patient-reported outcomes (PROs) assessed by BREAST-Q associated with breast oncoplastic surgery.

Methods:

A detailed search strategy was implemented and electronic databases searched include PubMed, MEDLINE, CINAHL, and PsycINFO. Review was limited to peer-reviewed studies published in English from 2009 to January 2018. Any interventional and observational studies that used BREAST-Q to assess PROs in the assessment of breast oncoplastic surgery were included.

Results:

Fifty-four peer-reviewed articles met inclusion criteria. Fifty-three studies were observational, 1 study was interventional. Current comparative studies using BREAST-Q indicated that abdominal flap, buttock flap, or thigh flap reconstruction offered highest satisfaction with breast; contralateral prophylactic mastectomy with immediate reconstruction offered higher levels of satisfaction with breast, but poor postsurgical physical well-being. Silicone implant and no radiation therapy offered higher level satisfaction and HRQoL.

Conclusions:

Current evidence showed that BREAST-Q can effectively measure patient’s satisfaction and HRQoL in relation to different type of breast oncoplastic surgeries. BREAST-Q captured meaningful and reliable information from the patients’ perspective and may be useful for clinical decision making.
Spectral Domain Anterior Segment Optical Coherence Tomography in Fungal Keratitis
Authors: Sharma Namrata , Singhal Deepali , Maharana Prafulla Kumar , Agarwal Tushar , Sinha Rajesh , Satpathy Gita , Singh Bageshwar Lalit Mohan , Titiyal Jeewan S.
Published: August 2018

Purpose:

To evaluate the use of spectral domain anterior segment optical coherence tomography (SD-ASOCT) in fungal keratitis.

Methods:

Fifty eyes of 50 patients with fungal keratitis were recruited. Serial ASOCT was performed on days 0, 7, 14, 21, 28, 42, and 56. Corneal thickness (CT) in the infiltrate area, infiltrate thickness (IT), and infiltrate width were measured at each follow-up. The presence of any specific feature on ASOCT was evaluated.

Results:

Mean CT and IT at presentation were 650.5 ± 108 μm and 401.1 ± 91 μm, which reduced significantly at each follow-up [on days 7, 14, 28, and 42; 626.8 ± 113 μm (P < 0.001) and 367.3 ± 94 μm (P = 0.002), 601.4 ± 109 μm and 344.7 ± 94 μm (P < 0.001), 544.8 ± 103 μm and 305.1 ± 80 μm (P < 0.001), and 522.8 ± 97 μm and 291.4 ± 79 μm (P < 0.001), respectively]. The mean CT and scar depth at complete healing were 496.3 ± 101 μm and 283.2 ± 77 μm, respectively. In 10/50 (20%) eyes, the posterior border of the cornea was not clearly visible because of posterior shadowing; therefore, IT was measured along the maximum visible area of hyperreflectivity, whereas CT was measured just adjacent to the area of shadowing. The infiltrate width was measured in 35 eyes, and the mean values at days 0, 7, 14, 28, 42, and 56 were 5.5 ± 0.8 mm, 4.6 ± 0.7 mm, 4.4 ± 0.6 mm, 4.2 ± 0.6 mm, 4.1 ± 0.6 mm, and 4.1 ± 0.6 mm, respectively. A satellite lesion and endothelial plaque were seen in 30% (15/50) and 44% (22/50) eyes, respectively.

Conclusions:

ASOCT is a useful adjunct in monitoring fungal keratitis especially in cases with deep stromal involvement and endothelial plaques. In addition, it also provides insight into the activity of keratitis.
Increasing Vitamin D Serum Levels Is Associated With Reduced Pulmonary Exacerbations in Patients With Cystic Fibrosis
Authors: Abu‐Fraiha Yasmeen , Elyashar‐Earon Hila , Shoseyov David , Cohen‐Cymberknoh Malena , Armoni Shoshana , Kerem Eitan , Wilschanski Michael
Published: August 2018

Context:

In 2012, The North American Cystic Fibrosis Foundation (NACFF) published new guidelines for the treatment of vitamin D deficiency in individuals with cystic fibrosis (CF).

Objective:

The objectives of our study were to assess the efficacy of these guidelines, and to test the effect of increasing vitamin D dosage on pulmonary function and exacerbations.

Design:

Pulmonary function tests and serum concentrations of 25‐hydroxyvitamin D [25(OH)D] were measured 1 year before increasing vitamin D dosage according to the guidelines and at least 1 year later. In addition, days of hospitalization and pulmonary exacerbations were counted and an average per year (average number of days of hospitalization and average number of pulmonary exacerbations [PEA], respectively) was calculated.

Setting and Participants:

A total of 90 patients from The Cystic Fibrosis Clinic at Hadassah Mount‐Scopus Hospital, Jerusalem, Israel.

Results:

The mean serum concentration of vitamin D increased significantly from 20.97 ng/mL (52.34 nmol/L) at baseline to 25.41 ng/mL (63.42 nmol/L) at the end of follow‐up (P < 0.001). The number of PEA decreased significantly from 2.79 ± 3.96 to 2.15 ± 2.91 (P = 0.007). The change in vitamin D levels was correlated with a decrease in PEA (correlation coefficient = −0.318, P = 0.002).

Conclusions:

The NACFF guidelines for management of vitamin D deficiency improve vitamin D levels in patients with CF but did not reach the normal values in most patients. The increase in vitamin D serum levels was, however, associated with a decrease in number of pulmonary exacerbations.
Detection of mRNA of Telomerase Protein in Benign Naevi and Melanomas Using RNAscope
Authors: Baltzarsen Pii B. , Georgsen Jeanette B. , Nielsen Patricia S. , Steiniche Torben , Stougaard Magnus
Published: August 2018

Telomerase is reactivated in most cancers and is possibly an early driver event in melanoma. Our aim was to test a novel in situ hybridization technique, RNAscope, for the detection of human telomerase reverse transcriptase (hTERT) mRNA in archival formalin-fixed, paraffin-embedded (FFPE) tissue and to compare the mRNA expression of melanomas and benign naevi. Furthermore, we wanted to see if hTERT mRNA could be a diagnostic or prognostic marker of melanoma. In situ hybridization for the detection of hTERT mRNA was performed on FFPE tissue of 17 melanomas and 13 benign naevi. We found a significant difference in the expression of hTERT mRNA between melanomas and benign naevi (P<0.001) and the expression of hTERT mRNA correlated with Breslow thickness (ρ=0.56, P=0.0205) and the Ki67 proliferation index (ρ=0.72, P=0.001). This study showed that RNAscope was a reliable in situ hybridization method for the detection of hTERT mRNA in FFPE tissue of melanomas and benign naevi. hTERT mRNA was more abundantly expressed in melanomas compared with benign naevi, but cannot be used solely as a diagnostic marker due to an overlap in expression. The hTERT mRNA expression in melanomas correlated with the prognostic markers Breslow thickness and the Ki67 index indicating a prognostic potential of hTERT mRNA.
Providers' Ability to Identify Sentinel Injuries Concerning for Physical Abuse in Infants
Authors: Eismann Emily A. , Shapiro Robert A. , Thackeray Jonathan , Makoroff Kathi , Bressler Colleen J. , Kim Grace J. , Vavul-Roediger Lori , McPherson Paul , Izsak Eugene , Spencer Sandra P.
Published: August 2018

Objectives

The objectives of this study were to assess the ability of pediatric health care providers and social workers to recognize sentinel injuries in infants under 6 months of age and to determine what factors influence their decision to evaluate for physical abuse.

Methods

A statewide collaborative focused on sentinel injuries administered a survey to pediatric health care providers and social workers in the emergency department, urgent care, and primary care. The survey contained 8 case scenarios of infants under 6 months of age with an injury, and respondents were asked if they would consider the injury to be a sentinel injury requiring a physical abuse evaluation. Respondents were then presented with several factors and asked how much each influences the decision to perform a physical abuse evaluation.

Results

A total of 565 providers completed the survey. Providers had moderate interrater reliability on their classification of the cases as sentinel injuries or not (κ = 0.57). Nearly all respondents (97%) recognized genital bruising as a sentinel injury, whereas 77% of respondents recognized intraoral injuries. Agreement was highest among social workers (κ = 0.76) and physicians with categorical pediatrics training and pediatric emergency medicine fellowship (κ = 0.63) and lowest among nurse practitioners (κ = 0.48) and residents (κ = 0.51). Concern over missing the diagnosis of abuse had the greatest influence on the decision to perform a physical abuse evaluation.

Conclusions

Sentinel injuries are not uniformly recognized as potential signs of child abuse requiring further evaluation by pediatric health care providers. Additional evidence and education are needed regarding sentinel injuries.
Craniofacial Flash: Minimizing Radiation Dose in Pediatric Craniofacial Computed Tomography
Authors: Stewart Neil M. , Hallac Rami R. , Chou Pang-Yun , Koral Korgun , Blackburn Tim , Kane Alex A. , Seaward James R.
Published: August 2018

Background and Purpose:

The routine use of computed tomography (CT) in evaluation of pediatric craniofacial abnormalities is controversial. While there are benefits to preoperative imaging, there are risks related to ionizing radiation and sedation/anesthesia. In this study, the authors describe their experience with a new craniofacial CT protocol (Craniofacial-Flash) that provides bone detail equivalent to conventional CT, while delivering a substantially lower radiation dose and reducing the scan time to obviate the requirement of sedation/anesthesia.

Methods:

Following IRB approval, dose identification and image analysis were conducted retrospectively on all patients who underwent craniofacial CT using either the conventional protocol or Craniofacial-Flash protocol between November 2013 and September 2015. Image analysis consisted of automated segmentation of bone and soft tissue, followed by noise interpretation of each study segment.

Results:

The conventional CT group included 175 patients (mean age 6.38 years) with a median dose length product of 243.00 mGy·cm. The Craniofacial-Flash CT group included 208 patients (mean age 3.31 years) with median dose length product of 27.60 mGy·cm. Image quality was equivalent for bone, with coefficient of variation values of 0.20 for the conventional CT group and 0.21 for the Craniofacial-Flash group. Soft tissues coefficients of variation were disparate at 0.07 for conventional CT and 0.14 for Craniofacial-Flash protocol.

Conclusion:

The Craniofacial-Flash protocol reliably generates craniofacial bone images adequate for routine use in craniofacial practice, while reducing the radiation dose by 88.87% compared with a conventional craniofacial CT scan, and eliminating the need for sedation.