bluuebunny/crossref_metadata_2025 huggingface dataset:
“Islamic cafés” and “Sharia dating:” Muslim youth, spaces of sociability, and partner relationships in Bosnia-Herzegovina
Authors: Mesarič Andreja
Published: July 2017

The paper explores forms of sociability and partner relationships among pious young Muslims in Sarajevo with a focus on the emic concepts of Islamic cafés (hospitality establishments perceived to operate according to Islamic moral principles) and Sharia dating (premarital relationships perceived to be sanctioned by Sharia). It draws on 10 months of ethnographic fieldwork conducted in different spaces of Islamic worship, learning, and sociability. This paper places the renewed interest in Islam within the context of a post-Dayton Bosnia characterized by complex and impractical government structures, lingering post-war grievances, and a brutal transition to a neoliberal capitalist economy. Although it acknowledges the continuing relevance of Islam as a resource for Bosniak nation building, it suggests treating the Muslim faith community as overlapping but distinct from the Bosniak community. By focusing on gendered interaction and partner-seeking strategies, this paper explores how young members of this faith community contextually negotiate their Islamic beliefs with mainstream local expectations of conventional behavior. The paper argues that believers’ varying responses to this predicament can be observed as an example of the localization of Islam, but they do not constitute a return to local, traditional gender roles and marriage practices, nor are they an introduction of foreign cultural patterns.
Visual cortex activation predicts visual preference: Evidence from Britain and Egypt
Authors: Makin Alexis DJ , Helmy Mai , Bertamini Marco
Published: July 2017

The term “Perceptual goodness” refers to the strength, obviousness, or salience of a visual configuration. Recent work has found strong agreement between theoretical, neural, and behavioural measures of perceptual goodness across a wide range of different symmetrical visual patterns. We used these pattern types again to explore the relationship between perceptual goodness and aesthetic preference. A group of 50 U.K. participants rated the patterns on a 0 to 100 scale. Preference ratings positively correlated with four overlapping measures of perceptual goodness. We then replicated this finding in Egypt, suggesting that our results reflect universal aspects of human preference. The third experiment provided consistent results with a different stimulus set. We conclude that symmetry is an aesthetic primitive that is attractive because of the way it is processed by the visual system.
More than a mere supply of monomers: G-Actin pools regulate actin dynamics in dendritic spines
Authors: Schlett Katalin
Published: July 2017

Synaptic activity reshapes the morphology of dendritic spines via regulating F-actin arborization. In this issue, Lei et al. (2017. J. Cell Biol. https://doi.org/10.1083/jcb.201612042) reports a novel, G-actin–dependent regulation of actin polymerization within spine heads. They show that actin monomer levels are elevated in spines upon activity, with G-actin immobilized by the local enrichment of phosphatidylinositol (3,4,5)-triphosphate (PIP3) within the spine plasma membrane.
Synergistic cooperation and crosstalk between MYD88L265P and mutations that dysregulate CD79B and surface IgM
Authors: Wang James Q. , Jeelall Yogesh S. , Humburg Peter , Batchelor Emma L. , Kaya Sarp M. , Yoo Hee Min , Goodnow Christopher C. , Horikawa Keisuke
Published: July 2017

CD79B and MYD88 mutations are frequently and simultaneously detected in B cell malignancies. It is not known if these mutations cooperate or how crosstalk occurs. Here we analyze the consequences of CD79B and MYD88L265P mutations individually and combined in normal activated mouse B lymphocytes. CD79B mutations alone increased surface IgM but did not enhance B cell survival, proliferation, or altered NF-κB responsive markers. Conversely, B cells expressing MYD88L265P decreased surface IgM coupled with accumulation of endoglycosidase H–sensitive IgM intracellularly, resembling the trafficking block in anergic B cells repeatedly stimulated by self-antigen. Mutation or overexpression of CD79B counteracted the effect of MYD88L265P. In B cells chronically stimulated by self-antigen, CD79B and MYD88L265P mutations in combination, but not individually, blocked peripheral deletion and triggered differentiation into autoantibody secreting plasmablasts. These results reveal that CD79B and surface IgM constitute a rate-limiting checkpoint against B cell dysregulation by MYD88L265P and provide an explanation for the co-occurrence of MYD88 and CD79B mutations in lymphomas.
Visual Reference and Iconic Content
Authors: Echeverri Santiago
Published: July 2017

Evidence from cognitive science supports the claim that humans and other animals see the world as divided into objects. Although this claim is widely accepted, it remains unclear whether the mechanisms of visual reference have representational content or are directly instantiated in the functional architecture. I put forward a version of the former approach that construes object files as icons for objects. This view is consistent with the evidence that motivates the architectural account, can respond to the key arguments against representational accounts, and has explanatory advantages. I draw general lessons for the philosophy of perception and the naturalization of intentionality.
Maximal and minimal solutions of second order elliptic and parabolic equations in non-divergence form with measurable coefficients
Authors: Cerutti M. Cristina , Piro Grimaldi Anna
Published: July 2017

In this paper we will prove that the supremum and infimum of good solutions of the Dirichlet problem for elliptic and parabolic equations in non-divergence form with measurable coefficients, are good solutions to the same problem.
proFIA: a data preprocessing workflow for flow injection analysis coupled to high-resolution mass spectrometry
Authors: Delabrière Alexis , Hohenester Ulli M , Colsch Benoit , Junot Christophe , Fenaille François , Thévenot Etienne A
Published: July 2017

Motivation

Flow Injection Analysis coupled to High-Resolution Mass Spectrometry (FIA-HRMS) is a promising approach for high-throughput metabolomics. FIA-HRMS data, however, cannot be preprocessed with current software tools which rely on liquid chromatography separation, or handle low resolution data only.

Results

We thus developed the proFIA package, which implements a suite of innovative algorithms to preprocess FIA-HRMS raw files, and generates the table of peak intensities. The workflow consists of 3 steps: (i) noise estimation, peak detection and quantification, (ii) peak grouping across samples and (iii) missing value imputation. In addition, we have implemented a new indicator to quantify the potential alteration of the feature peak shape due to matrix effect. The preprocessing is fast (less than 15 s per file), and the value of the main parameters (ppm and dmz) can be easily inferred from the mass resolution of the instrument. Application to two metabolomics datasets (including spiked serum samples) showed high precision (96%) and recall (98%) compared with manual integration. These results demonstrate that proFIA achieves very efficient and robust detection and quantification of FIA-HRMS data, and opens new opportunities for high-throughput phenotyping.

Availability and implementation

The proFIA software (as well as the plasFIA dataset) is available as an R package on the Bioconductor repository (http://bioconductor.org/packages/proFIA), and as a Galaxy module on the Main Toolshed (https://toolshed.g2.bx.psu.edu), and on the Workflow4Metabolomics online infrastructure (http://workflow4metabolomics.org).

Supplementary information

Supplementary data are available at Bioinformatics online.
Relationship of American Spinal Injury Association Impairment Scale Grade to Post-injury Hospitalization and Costs in Thoracic Spinal Cord Injury
Authors: Dukes Ellen M , Kirshblum Steven , Aimetti Alex A , Qin Sarah S , Bornheimer Rebecca K , Oster Gerry
Published: July 2017

BACKGROUND

The lifetime economic burden of thoracic spinal cord injury (SCI) is known to be high, but evidence of variability of costs in relation to the American Spinal Injury Association Impairment Scale (AIS) grade is limited.

OBJECTIVE

To estimate lifetime economic costs of hospitalization by AIS grade in thoracic SCI.

METHODS

Using SCI Model Systems data from January 2000 to March 2016 from the National Spinal Cord Injury Statistical Center, we estimated mean total annual days of all-cause hospitalization by AIS grade among persons with thoracic SCI, based on assessments 1, 5, and 10 yr post-injury. We combined this information with secondary cost data and projections of life expectancy to estimate lifetime economic costs of hospitalization by AIS grade in persons aged 35 yr at time of thoracic SCI. Future costs were discounted to present value at 3% annually.

RESULTS

One year post-injury, mean total annual days of hospitalization ranged from 2.1 for persons with AIS-D injuries to 5.9 for those who were AIS-A. Similar differences were noted 5 and 10 yr post-SCI. The estimated net present value of expected lifetime costs of hospitalization following thoracic SCI at age 35 yr was $321 534, $249 514, $188 989, and $68 120 (2015 US$) for AIS-A, AIS-B, AIS-C, and AIS-D injuries, respectively.

CONCLUSION

Persons with less severe thoracic SCI, as reflected in AIS grade, spend fewer days in hospital over their lifetimes, leading to lower costs of inpatient care. Therapies improving AIS grade following thoracic SCI may provide cost savings in addition to addressing substantial unmet need.
Single-Fraction Radiosurgery Using Conservative Doses for Brain Metastases: Durable Responses in Select Primaries With Limited Toxicity
Authors: Cummings Michael , Youn Paul , Bergsma Derek P , Usuki Kenneth Y , Walter Kevin , Sharma Manju , Okunieff Paul , Schell Michael C , Milano Michael T
Published: July 2017

BACKGROUND

Optimal doses for single-fraction stereotactic radiosurgery (SRS) in the treatment of brain metastases are not well established. Our institution utilized conservative dosing compared to maximum-tolerated doses from the Radiation Therapy Oncology Group 90-05 Phase I study.

OBJECTIVE

To report individual lesion control (LC) from conservative single-fraction doses and determine factors affecting LC.

METHODS

From 2003 to 2015, patients who underwent linear accelerator-based single-fraction SRS for cerebral/cerebellar metastases and receiving at least 1 follow-up magnetic resonance imaging (MRI) were identified. Lesion response was assessed by a size-based rating system and modified “Response Assessment in Neuro-Oncology Brain Metastases” (RANO-BM) criteria.

RESULTS

Among 188 patients with 519 lesions, median survival was 13.1 mo; median follow-up time with MRI was 9.6 mo per course. Median tumor-periphery dose was 15 Gy (range: 7.5-20.7). Median lesion volume was 0.5 cc and diameter was 9 mm (range: 2-45). Concordance between RANO-BM and size-based system was 93%. Crude 1-yr LC was 80%, 73%, 56%, and 38% for lesions 1 to 10, 11 to 20, 21 to 30, >31 mm, respectively. On multivariate analysis, increased size, melanoma and colorectal histology, and progression after whole brain radiation therapy predicted worse LC. When excluding lesions treated as a boost, dose was a significant predictor of LC in multivariate models (hazard ratio 0.89, P = .01). Symptomatic radiation necrosis occurred in 10 lesions in 10 patients.

CONCLUSION

Histology predicts LC after conservative SRS doses with evidence of a dose–response relationship. Conservative single-fraction SRS doses confer minimal toxicity and acceptable control in certain subgroups (breast cancer, <5 mm), with suboptimal control in larger lesions and in combination with whole brain radiation therapy.
Validity of Level of Supervision Scales for Assessing Pediatric Fellows on the Common Pediatric Subspecialty Entrustable Professional Activities
Authors: Mink Richard B. , Schwartz Alan , Herman Bruce E. , Turner David A. , Curran Megan L. , Myers Angela , Hsu Deborah C. , Kesselheim Jennifer C. , Carraccio Carol L.
Published: July 2017

Purpose

Entrustable professional activities (EPAs) represent the routine and essential activities that physicians perform in practice. Although some level of supervision scales have been proposed, they have not been validated. In this study, the investigators created level of supervision scales for EPAs common to the pediatric subspecialties and then examined their validity in a study conducted by the Subspecialty Pediatrics Investigator Network (SPIN).

Method

SPIN Steering Committee members used a modified Delphi process to develop unique scales for six of the seven common EPAs. The investigators sought validity evidence in a multisubspecialty study in which pediatric fellowship program directors and Clinical Competency Committees used the scales to evaluate fellows in fall 2014 and spring 2015.

Results

Separate scales for the six EPAs, each with five levels of progressive entrustment, were created. In both fall and spring, more than 300 fellows in each year of training from over 200 programs were assessed. In both periods and for each EPA, there was a progressive increase in entrustment levels, with second-year fellows rated higher than first-year fellows (P < .001) and third-year fellows rated higher than second-year fellows (P < .001). For each EPA, spring ratings were higher (P < .001) than those in the fall. Interrater reliability was high (Janson and Olsson’s iota = 0.73).

Conclusions

The supervision scales developed for these six common pediatric subspecialty EPAs demonstrated strong validity evidence for use in EPA-based assessment of pediatric fellows. They may also inform the development of scales in other specialties.
Linguistic Context Versus Semantic Competition in Word Recognition by Younger and Older Adults With Cochlear Implants
Authors: Amichetti Nicole M. , Atagi Eriko , Kong Ying-Yee , Wingfield Arthur
Published: July 2017

Objectives:

The increasing numbers of older adults now receiving cochlear implants raises the question of how the novel signal produced by cochlear implants may interact with cognitive aging in the recognition of words heard spoken within a linguistic context. The objective of this study was to pit the facilitative effects of a constraining linguistic context against a potential age-sensitive negative effect of response competition on effectiveness of word recognition.

Design:

Younger (n = 8; mean age = 22.5 years) and older (n = 8; mean age = 67.5 years) adult implant recipients heard 20 target words as the final words in sentences that manipulated the target word’s probability of occurrence within the sentence context. Data from published norms were also used to measure response entropy, calculated as the total number of different responses and the probability distribution of the responses suggested by the sentence context. Sentence-final words were presented to participants using a word-onset gating paradigm, in which a target word was presented with increasing amounts of its onset duration in 50 msec increments until the word was correctly identified.

Results:

Results showed that for both younger and older adult implant users, the amount of word-onset information needed for correct recognition of sentence-final words was inversely proportional to their likelihood of occurrence within the sentence context, with older adults gaining differential advantage from the contextual constraints offered by a sentence context. On the negative side, older adults’ word recognition was differentially hampered by high response entropy, with this effect being driven primarily by the number of competing responses that might also fit the sentence context.

Conclusions:

Consistent with previous research with normal-hearing younger and older adults, the present results showed older adult implant users’ recognition of spoken words to be highly sensitive to linguistic context. This sensitivity, however, also resulted in a greater degree of interference from other words that might also be activated by the context, with negative effects on ease of word recognition. These results are consistent with an age-related inhibition deficit extending to the domain of semantic constraints on word recognition.
Osteotomy as a treatment option in dysplasia epiphyseal hemimelica of the distal radius: a case report
Authors: Dominguez-Amador Juan J. , Cordero-Arriaza Francisco J. , Casas-Ruiz Magdalena , Andrés-García José A.
Published: July 2017

Dysplasia epiphysialis hemimelica (DEH), also known as Trevor disease, is a very rare disease characterized by an overgrowth of the osteocartilaginous epiphyseal caused by unknown factors. The medial side of the epiphysis is affected twice as often as the lateral side and more than one epiphysis was affected in two-thirds of the cases. Only a few cases of DEH in the upper extremities have been published, as the lower limb is usually the most affected, especially in the bones of the ankle joint. The symptoms vary from little significant deformities to symptomatic cases, pain, and decreased function depending on the location and the size of the lesion. When surgery is indicated, the complete excision of the lesion is the procedure of choice. If this is not possible, because of the location or size of the lesion, a realignment osteotomy may be necessary. We report the case of a 12-year-old patient with a distal epiphysis DEH on the left radius, treated by wedge osteotomy realignment at the level of the lesion with Kirschner wires. The clinical outcome of realignment osteotomy of the radial epiphysis has been the correction of the deformity with a normal and painless function of the wrist and hand. The case reported was an extremely rare location in the distal radial epiphysis of DEH. We are aware of only one case published previously with involvement of the distal radius in children. The surgical treatment of realignment osteotomy without complete removal of the lesion has enabled anatomical and functional improvement of the joint as well as a reduction in lesion size. Level of Evidence: Level IV case report.
Anxiety does not contribute to social withdrawal in the subchronic phencyclidine rat model of schizophrenia
Authors: Seillier Alexandre , Giuffrida Andrea
Published: July 2017

Social withdrawal should not be considered a direct measure of the negative symptoms of schizophrenia as it may result not only from asociality (primary negative symptom) but also from other altered processes such as anxiety. To understand the contribution of these two factors to social deficit, we investigated whether the social withdrawal observed in the subchronic phencyclidine (PCP) rat model of schizophrenia could be attributed to increased anxiety. Compared to saline controls, PCP-treated rats (5 mg/kg, twice daily for 7 days, followed by a washout period) spent significantly less time in social interaction, but did not show anxiety-like behaviors in different relevant behavioral paradigms. In addition, their social deficit was not affected by a behavioral procedure known to reduce anxiety-like behavior (repeated exposure to the same partner) nor by systemic administration of the classical anxiolytic diazepam. In contrast, PCP-induced social withdrawal was reversed by the cannabinoid agonist CP55,940, a drug with known anxiogenic properties. Furthermore, when using the social approach task, PCP-treated animals performed similarly to control animals treated with diazepam, but not to those treated with the anxiogenic compound pentylenetetrazole. Taken together, our results indicate that PCP-induced social withdrawal cannot be attributed to increased anxiety. These data are discussed in the context of primary versus secondary negative symptoms and the deficit syndrome of schizophrenia.
Agonist E-6837 and antagonist SB-271046 of 5-HT6 receptors both reverse the depressive-like effect induced in mice by subchronic ketamine administration
Authors: Suárez-Santiago José E. , Briones-Aranda Alfredo , Espinosa-Raya Judith , Picazo Ofir
Published: July 2017

Major depression is one of the most common affective disorders caused by schizophrenia. The administration of N-methyl-d-aspartate receptor antagonists, such as ketamine, can reproduce the negative and affective symptoms of this disorder in animals. Preclinical studies have shown that 5-HT6 receptor (5-HT6R) agonists and antagonists have a considerable antipsychotic response. The aim of the present study was to evaluate the effect of an acute treatment with an agonist, E-6837, and an antagonist, SB-271046, of 5-HT6R on the immobility induced in mice by a subchronic ketamine regimen (5 days; 10 mg/kg/day, intraperitoneal). Repeated ketamine administration alone increased the immobility time in the forced-swimming test and the tail-suspension test. E-6837 at 10 and 20 mg/kg caused a significant reduction of immobility in the tail-suspension test and forced-swimming test, respectively. Interestingly, SB-271046 (10 mg/kg) also elicited an antidepressant-like effect in both tests. The current findings suggest an important role for these 5-HT6R ligands as mood modulators. However, it is necessary to explore the physiological mechanisms involved in this process in greater detail.
Trace amine-associated receptor 1 agonists RO5263397 and RO5166017 attenuate quinpirole-induced yawning but not hypothermia in rats
Authors: Siemian Justin N. , Zhang Yanan , Li Jun-Xu
Published: July 2017

Increasing evidence suggests that trace amine-associated receptor 1 (TAAR1) is an important modulator of the dopaminergic system. Existing molecular evidence indicates that TAAR1 regulates dopamine levels through interactions with dopamine transporters and D2 receptors. However, investigations to date have not been exhaustive and other pathways may be involved. In this study, we used a well-described set of behaviors, quinpirole-induced yawning and hypothermia, to explore the potential interaction of TAAR1 and D3 receptors, which are members of the ‘D2-like’ dopamine receptor subfamily. Previous studies have shown that for D2/D3 receptor agonists, the induction of yawning is a D3 receptor-mediated effect, whereas the inhibition of yawning and induction of hypothermia are D2 receptor-mediated effects. Quinpirole produced an inverted U-shaped dose-effect curve for yawning, which was shifted downward dose-dependently by each of the TAAR1 agonists RO5263397 and RO5166017. Quinpirole also produced dose-dependent hypothermia, which was not affected by either TAAR1 agonist. These results suggest that TAAR1 agonists may interact with D3 receptors and/or its downstream pathways, as opposed to D2 receptors. These findings may shed light on a previously unexplored possibility for the mechanism of TAAR1-mediated effects.
Risks Versus Benefits of Anticoagulation for Atrial Fibrillation in Cirrhotic Patients
Authors: Choi Jonggi , Kim Junhwan , Shim Ju Hyun , Kim Minsu , Nam Gi-Byoung
Published: July 2017

Background & Aims:

To evaluate the clinical benefits and risks of anticoagulation with warfarin in cirrhotic patients with atrial fibrillation (AF).

Methods:

A total of 465 cirrhotic patients diagnosed with nonvalvular AF were retrospectively analyzed. We compared incidences of ischemic stroke and major bleeding events between the 2 groups and examined the factors predicting ischemic stroke or major bleeding events.

Results:

Of 465 patients with AF, 113 (24.3%) received warfarin. Warfarin users had a lower mean Child–Pugh score (6.1 ± 1.5 vs. 7.6 ± 2.6) and a higher mean CHA2DS2VASc score (2.0 ± 2.5 vs. 1.7 ± 1.3) than nonusers (P's < 0.05). Overall, the incidence of ischemic stroke was low in cirrhotic patients with AF. It was not dependent on the CHA2DS2VASc score (hazard ratio, 1.40; 95% confidence interval, 0.96–2.05; P = 0.081), and was comparable in warfarin users (0.9%/person-year) and nonusers (1.2%/person-year). However, the incidence of major bleeding events was significantly higher in warfarin users (5.9% vs. 2.6%; P < 0.05). A multivariate analysis identified warfarin use (2.60; 95% confidence interval, 1.32–5.12) and Child–Pugh score (1.25; 1.04–1.49) as independently associated with bleeding events in these cirrhotic patients (P's < 0.05). There was no correlation between HAS-BLED score and risk of major bleeding (1.20; 0.95–1.52; P = 0.123).

Conclusions:

Anticoagulation with warfarin in cirrhotic patients with AF may not significantly reduce the risk of ischemic stroke, whereas it increases hemorrhagic complications.
Diagnostic Accuracy of Lymphoscintigraphy for Lymphedema and Analysis of False-Negative Tests
Authors: Hassanein Aladdin H. , Maclellan Reid A. , Grant Frederick D. , Greene Arin K.
Published: July 2017

Background:

Lymphedema is the chronic enlargement of tissue due to inadequate lymphatic function. Diagnosis is made by history and physical examination and confirmed with lymphoscintigraphy. The purpose of this study was to assess the accuracy of lymphoscintigraphy for the diagnosis of lymphedema and to determine characteristics of patients with false-negative tests.

Methods:

Individuals referred to our lymphedema program with “lymphedema” between 2009 and 2016 were analyzed. Subjects were assessed by history, physical examination, and lymphoscintigraphy. Patient age at presentation, duration of lymphedema, location of disease, gender, previous infections, and lymphedema type were analyzed.

Results:

The study included 227 patients (454 limbs); lymphedema was diagnosed clinically in 169 subjects and confirmed by lymphoscintigraphy in 162 (117 primary, 45 secondary; 96% sensitivity). Fifty-eight patients were thought to have a condition other than lymphedema, and all had negative lymphoscintigrams (100% specificity). A subgroup analysis of the 7 individuals with lymphedema clinically, but normal lymphoscintigrams, showed that all had primary lymphedema; duration of disease and infection history were not different between true-positive and false-negative lymphoscintigram results (P = 0.5). Two patients with a false-negative test underwent repeat lymphoscintigraphy, which then showed lymphatic dysfunction consistent with lymphedema.

Conclusion:

Lymphoscintigraphy is very sensitive and specific for lymphedema. All patients with false-negative studies had primary lymphedema. A patient with a high clinical suspicion of lymphedema and a normal lymphoscintigram should be treated conservatively for the disease and undergo repeat lymphoscintigraphy.
EFFICACY AND SAFETY OF RANIBIZUMAB FOR THE TREATMENT OF CHOROIDAL NEOVASCULARIZATION DUE TO UNCOMMON CAUSE
Authors: Lai Timothy Y. Y. , Staurenghi Giovanni , Lanzetta Paolo , Holz Frank G. , Melissa Liew Shiao Hui , Desset-Brethes Sabine , Staines Harry , Hykin Philip G. ,   on behalf of the MINERVA study group
Published: July 2017

Purpose:

To evaluate the efficacy and safety of ranibizumab 0.5 mg in adult patients with choroidal neovascularization because of an uncommon cause enrolled in the 12-month MINERVA study.

Methods:

In this Phase III, double-masked study, adult (≥18 years) patients (N = 178) were randomized 2:1 to receive either ranibizumab (n = 119) or sham (n = 59) at baseline and, if needed, at Month 1 and open-label individualized ranibizumab from Month 2. Best-corrected visual acuity change from baseline to Month 2 (primary endpoint) and Month 12, treatment exposure, and safety over 12 months were reported. Subgroup analysis was conducted on five predefined choroidal neovascularization etiologies (angioid streak, postinflammatory, central serous chorioretinopathy, idiopathic, and miscellaneous).

Results:

Ranibizumab showed superior efficacy versus sham from baseline to Month 2 (adjusted least-squares mean best-corrected visual acuity: +9.5 vs. −0.4 letters;P< 0.001). At Month 12, the mean best-corrected visual acuity change was +11.0 letters (ranibizumab) and +9.3 letters (sham). Across the 5 subgroups, the treatment effect ranged from +5.0 to +14.6 letters. The mean number of ranibizumab injections was 5.8 (ranibizumab arm) with no new ocular or nonocular adverse events.

Conclusion:

Ranibizumab 0.5 mg resulted in clinically significant treatment effect versus sham at Month 2. Overall, ranibizumab was effective in treating choroidal neovascularization of various etiologies with no new safety findings.
CHOROIDAL VASCULAR HYPERPERMEABILITY AS A PREDICTOR OF TREATMENT RESPONSE FOR POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Yanagi Yasuo , Ting Daniel S. W. , Ng Wei Yan , Lee Shu Yen , Mathur Ranjana , Chan Choi Mun , Yeo Ian , Wong Tien Yin , Cheung Gemmy Chui Ming
Published: July 2017

Purpose:

To investigate the influence of choroidal vascular hyperpermeability (CVH) and choroidal thickness on treatment outcomes in eyes with polypoidal choroidal vasculopathy (PCV) undergoing anti–vascular endothelial growth factor monotherapy or combination therapy of photodynamic therapy and anti–vascular endothelial growth factor injections.

Methods:

The authors performed a prospective, observational cohort study involving 72 eyes of 72 patients with polypoidal choroidal vasculopathy (mean age 68.6 years, 51% men) treated with either monotherapy (n = 41) or combination therapy (n = 31). Each eye was imaged with color fundus photography, fluorescent angiography, indocyanine green angiography, and spectral domain optical coherence tomography. Indocyanine green angiography images were used to evaluate CVH, and spectral domain optical coherence tomography was used to measure central choroidal thickness. Changes in visual acuity over 12 months, and number of anti–vascular endothelial growth factor injections were investigated.

Results:

Choroidal vascular hyperpermeability was present in 31 eyes (43.1%). Visual acuity change over 12 months was numerically better in the CVH group compared with the CVH (−) group (−0.099 and −0.366 logarithm of the minimal angle of resolution unit in the CVH (−) and CVH (+) groups, respectively, multivariate P = 0.063) and significantly better in a matched pair analysis (P = 0.033). Furthermore, in the combination therapy group, the number of injection was significantly lower in the CVH (+) group compared with the CVH (−) group (4.68 vs. 2.58 injections/year in the CVH (−) and CVH (+) groups; P = 0.0044). There was no significant relationship between treatment response and choroidal thickening.

Conclusion:

The presence of CVH is associated with better visual outcome in eyes with polypoidal choroidal vasculopathy and lower injection number in combination therapy. Thus, CVH, but not choroidal thickness, should be further evaluated as a potential biomarker for selecting patients for combination therapy.
Recurrence Rate and Graft Stability With Fibrin Glue Compared With Suture and Autologous Blood Coagulum for Conjunctival Autograft Adherence in Pterygium Surgery: A Meta-Analysis
Authors: Maiti Rituparna , Mukherjee Somnath , Hota Debasish
Published: July 2017

Purpose:

To minimize recurrence and improve graft stability after pterygium surgery, conjunctival autograft adherence is done using fibrin glue (FG) or autologous blood coagulum (ABC). But there are studies that have reported conflicting or inconclusive results. This meta-analysis was conducted to evaluate the postoperative recurrence rate and graft stability after using FG, sutures, and ABC.

Methods:

MEDLINE, Cochrane databases, and ICTRP were searched and PRISMA guidelines as well as recommended meta-analysis practices were followed. The odds ratio was calculated to estimate the effect size to assess the difference in recurrence and graft stability between the groups. Heterogeneity across the studies was explored using subgroup analyses and quality assessment using the Cochrane risk of bias tool and sensitivity analysis.

Results:

After screening, 30 studies were included for meta-analysis. The random model analysis for recurrence revealed an effect size of 0.44 [95% confidence interval (CI), 0.32–0.60], and subgroup analysis for studies comparing FG and sutures showed an effect size of 0.38 (95% CI, 0.27–0.53). In case of studies comparing FG and ABC, the random model analysis revealed an effect size of 1.01 (95% CI, 0.45–2.26). The random model analysis for graft stability revealed an effect size of 0.87 (95% CI, 0.57–1.31). In subgroup analysis, the random model revealed an effect size of 0.39 (95% CI, 0.17–0.88) indicating significant better graft stability with FG over ABC.

Conclusions:

This meta-analysis reveals the superiority of FG over sutures as the use of FG can significantly reduce the recurrence rate, but no significant difference in graft stability was found between FG and sutures. No significant difference was found in the recurrence rate between FG and ABC, but graft stability was found to be better with FG compared with ABC.
Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria
Authors: Faghih Mahya , Garcia Gonzalez Francisco , Makary Martin A. , Singh Vikesh K.
Published: July 2017

Purpose of review

Critical review of the indications for total pancreatectomy and highlight limitations in current diagnostic criteria for chronic pancreatitis.

Recent findings

The diagnosis of noncalcific chronic pancreatitis remains controversial because of an overreliance on nonspecific imaging and laboratories findings. Endoscopic ultrasound, s-magnetic resonance cholangiopancreatography, and/or endoscopic pancreatic function testing are often used to diagnose noncalcific chronic pancreatitis despite the fact that there is no gold standard for this condition. Abdominal pain is not specific for chronic pancreatitis and is more likely to be encountered in patients with functional gastrointestinal disorders based on the high incidence of these conditions. The duration of pain and opioid analgesic use results in central sensitization that adversely affects pain outcomes after total pancreatectomy. An alcoholic cause is associated with poorer pain outcomes after total pancreatectomy.

The lack of a gold standard for noncalcific chronic pancreatitis limits the diagnostic accuracy of imaging and laboratory tests. The pain of chronic pancreatitis is nonspecific and is affected by duration, preoperative opioid use, and cause. These factors will need to be considered in the development of future selection criteria for this morbid surgery.
Mandatory influenza vaccination for all healthcare personnel: a review on justification, implementation and effectiveness
Authors: Wang Tiffany L. , Jing Ling , Bocchini Joseph A.
Published: July 2017

Purpose of review

As healthcare-associated influenza is a serious public health concern, this review examines legal and ethical arguments supporting mandatory influenza vaccination policies for healthcare personnel, implementation issues and evidence of effectiveness.

Recent findings

Spread of influenza from healthcare personnel to patients can result in severe harm or death. Although most healthcare personnel believe that they should be vaccinated against seasonal influenza, the Centers for Disease Control and Prevention (CDC) report that only 79% of personnel were vaccinated during the 2015–2016 season. Vaccination rates were as low as 44.9% in institutions that did not promote or offer the vaccine, compared with rates of more than 90% in institutions with mandatory vaccination policies. Policies that mandate influenza vaccination for healthcare personnel have legal and ethical justifications. Implementing such policies require multipronged approaches that include education efforts, easy access to vaccines, vaccine promotion, leadership support and consistent communication emphasizing patient safety.

Mandatory influenza vaccination for healthcare personnel is a necessary step in protecting patients. Patients who interact with healthcare personnel are often at an elevated risk of complications from influenza. Vaccination is the best available strategy for protecting against influenza and evidence shows that institutional policies and state laws can effectively increase healthcare personnel vaccination rates, decreasing the risk of transmission in healthcare settings. There are legal and ethical precedents for institutional mandatory influenza policies and state laws, although successful implementation requires addressing both administrative and attitudinal barriers.
HGNET-BCOR Tumors of the Cerebellum
Authors: Appay Romain , Macagno Nicolas , Padovani Laetitia , Korshunov Andrey , Kool Marcel , André Nicolas , Scavarda Didier , Pietsch Torsten , Figarella-Branger Dominique
Published: July 2017

The central nervous system (CNS) high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR) is a recently described molecular entity. We report 3 new CNS HGNET-BCOR cases sharing common clinical presentation and pathologic features. The 3 cases concerned children aged 3 to 7 years who presented with a voluminous mass of the cerebellum. Pathologic features included proliferation of uniform spindle to ovoid cells with fine chromatin associated with a rich arborizing capillary network. Methylation profiling classified these cases as CNS HGNET-BCOR tumors. Polymerase chain reaction analysis confirmed the presence of internal tandem duplications in the C-terminus of BCOR (BCOR-ITD), a characteristic of these tumors, in all 3 cases. Immunohistochemistry showed a strong nuclear BCOR expression. In 2 cases, local recurrence occurred within 6 months. The third case, a patient who received a craniospinal irradiation after total surgical removal followed by a metronomics maintenance with irinotecan, temozolomide, and itraconazole, is still free of disease 14 months after diagnosis. In summary, CNS HGNET-BCOR represents a rare tumor occurring in young patients with dismal prognosis. BCOR nuclear immunoreactivity is highly suggestive of a BCOR-ITD. Whether CNS HGNET-BCOR should be classified among the category of “embryonal tumors” or within the category of “mesenchymal, nonmeningothelial tumors” remains to be clarified. Because CNS HGNET-BCOR share pathologic features and characteristic BCOR-ITD with clear cell sarcoma of the kidney, these tumors may represent local variants of the same entity.
Estimated HIV Incidence, Prevalence, and Undiagnosed Infections in US States and Washington, DC, 2010–2014
Authors: Satcher Johnson Anna , Song Ruiguang , Hall H. Irene
Published: July 2017

Introduction:

The burden of HIV infection and health outcomes for people living with HIV varies across the United States. New methods allow for estimating national and state-level HIV incidence, prevalence, and undiagnosed infections using surveillance data and CD4 values.

Methods:

HIV surveillance data reported to the Centers for Disease Control and Prevention and the first CD4 value after diagnosis were used to estimate the distribution of delay from infection to diagnosis based on a well-characterized CD4 depletion model. This distribution was used to estimate HIV incidence, prevalence, and undiagnosed infections during 2010–2014. Estimated annual percentage changes (EAPCs) were calculated to assess trends.

Results:

During 2010–2014, HIV incidence decreased 10.3% (EAPC = −3.1%) and the percentage of undiagnosed infection decreased from 17.1% to 15.0% (EAPC = −3.3%) in the United States; HIV prevalence increased 9.1% (EAPC = 2.2%). Among 36 jurisdictions with sufficient data to produce stable estimates, HIV incidence decreased in 3 jurisdictions (Georgia, New York, and District of Columbia) and the percentage of undiagnosed HIV infections decreased in 2 states (Texas and Georgia). HIV prevalence increased in 4 states (California, Florida, Georgia, and Texas). In 2014, southern states accounted for 50% of both new HIV infections and undiagnosed infections.

Conclusion:

HIV incidence and undiagnosed infection decreased in the United States during 2010–2014; however, outcomes varied by state and region. Progress in national HIV prevention is encouraging but intensified efforts for testing and treatment are needed in the South and states with high percentages of undiagnosed infection.
Prospects for elimination of soil-transmitted helminths
Authors: Ásbjörnsdóttir Kristjana H. , Means Arianna R. , Werkman Marleen , Walson Judd L.
Published: July 2017

Purpose of review

Soil-transmitted helminths (STH) are endemic in 120 countries and are associated with substantial morbidity and loss of economic productivity. Although current WHO guidelines focus on morbidity control through mass drug administration (MDA), there is global interest in whether a strategy targeting disease elimination might be feasible in some settings. This review summarizes the prospects for switching from control to an elimination strategy.

Recent findings

STH control efforts have reduced the intensity of infections in targeted populations with associated reductions in morbidity. However, adults are not frequently targeted and remain important reservoirs for reinfection of treated children. Recent modeling suggests that transmission interruption may be possible through expanded community-wide delivery of MDA, the feasibility of which has been demonstrated by other programs. However, these models suggest that high levels of coverage and compliance must be achieved. Potential challenges include the risk of prematurely dismantling STH programs and the potential increased risk of antihelminthic resistance.

Elimination of STH may offer an opportunity to eliminate substantial STH-related morbidity while reducing resource needs of neglected tropical disease programs. Evidence from large community trials is needed to determine the feasibility of interrupting the transmission of STH in some geographic settings.
Retrospective Study of Patients on Etanercept Therapy for Rheumatic Diseases in Patients With Chronic Hepatitis C Virus
Authors: Gandhi Nisarg P. , Manadan Augustine M. , Block Joel A.
Published: July 2017

Objective

Treatment of rheumatic diseases with concurrent hepatitis C virus (HCV) infection is a therapeutic challenge. Etanercept has no known hepatotoxicity; however there is a concern for worsening of HCV infection–related liver disease due to immunosuppressive action of the drug. Here, we retrospectively assessed the safety of etanercept in rheumatologic disease in patients with chronic HCV.

Methods

A retrospective review was conducted in patients with chronic HCV infection who received etanercept for diagnosis of rheumatoid arthritis and psoriatic arthritis. The primary end point was a serum transaminase level of at least 3 times the upper limit of normal during etanercept therapy. We also recorded HCV RNA load.

Results

Fourteen patients met the inclusion criteria. Mean age was 52 (SD, 8) years. The median follow-up period after initiation of etanercept was 105 months (range, 13–132 months). During follow-up, 7 of 14 patients had elevation of aspartate aminotransferase and/or alanine aminotransferase 3 times the upper limit of normal. Two of 7 patients had concomitant elevation in transaminases and increase in HCV viral load during etanercept exposure, which could not be attributed to other hepatotoxic disease-modifying antirheumatic drugs. In both patients, transaminase levels normalized upon etanercept discontinuation.

Conclusions

In contrast to the majority of previous shorter-duration studies, 2 of 14 patients in our series had possible HCV-related worsening of liver disease while on etanercept therapy. Although no firm conclusion can be drawn, it appears that HCV infection can worsen while on etanercept therapy, and therefore, we propose these patients should be monitored serially.
Quantifying and exploring the recent national increase in surgical stabilization of rib fractures
Authors: Kane Erica D. , Jeremitsky Elan , Pieracci Fredric M. , Majercik Sarah , Doben Andrew R.
Published: July 2017

BACKGROUND

Surgical stabilization of rib fractures (SSRF) has become pivotal in the management of severe chest injuries. Recent literature supports improved outcomes and mortality in severe fracture and flail chest patients who undergo SSRF compared with nonoperative management (NOM). A 2014 National Trauma Data Bank review provided a point prevalence of 0.7% SSRF in flail patients. We hypothesize that this prevalence is increasing and that temporal, regional, and American College of Surgeons (ACS) trauma designation vary in SSRF utilization.

METHODS

Retrospective National Trauma Data Bank data were extracted for years 2007 to 2014 for patients with rib fractures. Cases were divided into SSRF versus NOM. SSRF frequencies were analyzed across year, region, and ACS level. Patient demographics, injury severity score, number of fractured ribs, and hospital characteristics were identified for multivariable analysis.

RESULTS

Between 2007 and 2014, 687,137 rib fracture patients were identified; 29,981 (4.36%) underwent SSRF. SSRF increased by 76% nationally during the review period (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.50–1.67; p < 0.001). Compared with the north, SSRF was used more in the west (OR, 1.6; 95% CI, 1.57–1.71), south (OR, 1.48; 95% CI, 1.43–1.54), then midwest (OR, 1.4; 95% CI, 1.34–1.46; p < 0.001). Although likelihood of SSRF is higher at ACS Level I (LI) centers compared with Level II (LII) centers (OR, 0.67; 95% CI, 0.65–0.69) or Level III (LIII) (OR, 0.24; 95% CI, 0.22–0.26); p < 0.001), frequency of SSRF increased dramatically at lower-level centers from 2007 to 2014 (LI, 41.4%; LII, 53.6%; LIII, 60.0%).

Overall SSRF mortality was 1.58% (NOM, 5.3%; p < 0.001), decreasing significantly between 2007 and 2014 (p < 0.0001). ACS LII had higher mortality than LI (OR, 1.82; 95% CI, 1.39–2.39; p < 0.0001), controlled by Injury Severity Score.

CONCLUSION

Utilization of SSRF has risen considerably nationwide. Prevalence varies by region and ACS level. Although greatest growth is occurring at LII hospitals, mortality is also the highest at these centers. Further research is needed to determine the need for regionalization of care and center of excellence designation.

LEVEL OF EVIDENCE

Epidemiological study, level III.
Impact of the Trough Level of Calcineurin Inhibitor on the Prevalence of Donor-Specific Human Leukocyte Antigen Antibodies During Long-Term Follow-Up After Pediatric Liver Transplantation: Antibody Strength and Complement-Binding Ability
Authors: Tokodai Kazuaki , Miyagi Shigehito , Nakanishi Chikashi , Hara Yasuyuki , Nakanishi Wataru , Goto Masafumi , Unno Michiaki , Kamei Takashi
Published: July 2017

Background

In pediatric patients, long-term immunosuppression after liver transplantation (LT) is typically minimal. However, posttransplant donor-specific HLA antibodies (DSAs) may be prevalent under these conditions. Here, we evaluated the effects of minimized calcineurin inhibitor (CNI) on DSA development to assess the validity of minimized/withdrawn immunosuppression.

Methods

We retrospectively examined 66 patients who underwent pediatric LT at our institution between July 1991 and October 2013. Patients were divided into 2 groups based on the CNI trough level. The cutoff trough levels were 3 and 30 ng/mL for tacrolimus and cyclosporine, respectively. Luminex single-antigen bead assays were performed, and the cutoff for a positive reaction was set at a mean fluorescence intensity (MFI) of at least 1000.

Results

The mean recipient ages at the time of LT were 29.1 and 77.2 months for the low and regular CNI groups, respectively (P = 0.0007). Univariate logistic regression analysis revealed that recipient age at LT younger than 3 years (P = 0.0099) and low CNI (P < 0.0001) were significantly associated with DSA development. In multivariate analysis, low CNI was an independent risk factor of DSA development (P = 0.0011). Of 15 high-MFI DSAs, 3 were anti-DR, and 12 were anti-DQ. Two of 3 anti-DR DSAs and 11 of 12 anti-DQ DSAs had complement-binding ability and high MFIs.

Conclusions

CNI minimization was an independent risk factor for posttransplant DSA during long-term follow-up after pediatric LT. Adjusting CNI to appropriate levels is a safe first step to prevent the immunological effects of DSA.