bluuebunny/crossref_metadata_2025 huggingface dataset:
Indigenous Rights to Development, Socio-Economic Rights, and Rights for Groups with Vulnerabilities
Authors: Pérez-Bustillo Camilo , Hohmann Jessie
Published: July 2018

This chapter looks at Articles 20, 21, 22, 21, and 44, considering rights to development, socio-economic rights, and rights for groups with particular vulnerabilities. These provisions are centred on: the economic, social, and cultural rights of indigenous peoples, with a particular focus on the right to health; their right to development; and the rights of those indigenous individuals and groups who are particularly vulnerable, including women and children, and again with a particular focus on women's rights to be free from violence. The provisions highlight the evolving place of indigenous rights within the overall framework of international law and international human rights. However, the negotiating history of the provisions demonstrates that some of the core issues addressed in these Articles remain contested. The right to development itself, let alone a vision of development in harmony with indigenous worldviews, remains controversial and resisted by states.
FinTech and Alternative Finance in the CMU
Authors: Ferrarini Guido , Macchiavello Eugenia
Published: July 2018

This chapter focuses on FinTech, which offers firms and individuals new ways for accessing alternative sources of finance. It first examines the main types of alternative finance which technology has helped to develop and could further complement the traditional markets, focusing on marketplace investing and its perspectives in Europe. It then analyzes financial return crowdfunding as an application of marketplace investing; its main business models, such as investment-based and loan-based crowdfunding; and the risks and benefits deriving from them. Next, it compares the different regulatory models applicable to crowdfunding at EU and member states' levels, distinguishing between the traditional approach, which extends existing banking or financial regulation to these new sectors, and the ‘innovative’ approach contemplating ad hoc regimes for crowdfunding. The final section suggests a tailored policy approach to marketplace investing in the Capital Markets Union.
National Databases in Pediatric Orthopaedic Surgery: A Comparison of Demographics, Procedures, and Outcomes
Authors: Gutman Ilya M. , Niemeier Thomas E. , Gilbert Shawn R.
Published: July 2018

Background:

Large national databases have been increasingly used in recent years to determine the rate of adverse events and identify factors associated with altered surgical outcomes. This can be especially useful to evaluate rare events such as 30-day mortality. Despite differences between national pediatric databases, there have been no comparison studies in the pediatric orthopaedic population.

Methods:

The Healthcare Cost and Utilization Project’s Kids’ Inpatient Database (KID) along with the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP Pediatric) databases were queried to identify common pediatric orthopaedic procedures for humeral fractures, scoliosis, slipped capital femoral epiphysis, and femoral fractures during a single year. Clinical characteristics and complications in the 2 databases were compared using Student t test, χ2, or Fisher’ exact test.

Results:

In total, 26,978 patients in the KID and 5186 patients in the NSQIP Pediatric databases were identified. Large differences were observed between the databases in identical procedure categories with respect to age, race, sex, and length of stay. Regardless of procedure, NSQIP Pediatric had statistically higher reported rates of cumulative complications. Surgical site infections and sepsis were consistently observed to be at least twice as common in the NSQIP Pediatric database in comparison to the KID. Overall, complication rates ranged from <1% in humeral fractures to >100% in neuromuscular scoliosis.

Conclusions:

Clinically and statistically significant differences exist between the KID and NSQIP Pediatric databases. Clinicians and researchers who utilize large databases must understand the differences in data import, quality control, and population sampling in order to provide adequate representation of the population as a whole.

Level of Evidence:

Level III, prognostic study.
How to Write Effective Discussion and Conclusion Sections
Authors: Makar Gabriel , Foltz Carol , Lendner Mayan , Vaccaro Alexander R.
Published: July 2018

With the exponential increase in research in the field of spine surgery, publishing peer-reviewed articles has become both more desirable and competitive in the past decade. Constructing an impactful manuscript has many important factors, one of which is a well-written Discussion section. A research study can ask a pressing question, have a meticulous methodology and report compelling results; however, without a thoughtful and well-informed analysis of the meaning of the study’s findings and their potential influence on the field, the paper will be uninteresting and weak. Thus, formulating an effective Discussion section is crucial to improving the likelihood of the study’s publication and its impact.
Clinical Outcomes After Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction
Authors: Delaloye Jean-Romain , Murar Jozef , Gonzalez Mauricio , Amaral Thiago , Kakatkar Vikram , Sonnery-Cottet Bertrand
Published: July 2018

Background:

Graft rupture rate, return to sport and persistent rotational instability remain a concern postoperatively following anterior cruciate ligament (ACL) reconstruction. The anterolateral ligament (ALL) has recently been shown to act as a lateral knee stabilizer that helps improve rotational stability. To improve functional and clinical outcomes, a combined ACL reconstruction with an associated ALL reconstruction has been proposed.

Purpose:

The main purpose of this study was to evaluate the clinical outcomes of the combined ACL and ALL reconstruction.

Methods:

A literature search in PubMed was performed and papers reporting on clinical outcomes after combined ACL and ALL reconstruction were identified. The inclusion criteria was a minimum 2-year follow-up.

Results:

Five studies were included in the review. The overall graft failure rate in patients with ACL and ALL reconstruction was <3% at 2 years minimum after surgery. Comparison analysis in a high-risk population demonstrated that the graft failure rate in combined ACL and ALL reconstruction was 2.5 times lower than with isolated bone-patella tendon-bone graft and 3.1 times lower than with isolated hamstring graft. The medial meniscal repair failure rate was also 2 times lower in the combined ACL and ALL reconstruction group compared with isolated ACL reconstruction. Return to sport and functional outcomes did not show any significant difference between the groups. The rate of reoperations was not increased in patients with combined ACL and ALL reconstruction.

Conclusions:

Overall, combined ACL and ALL reconstruction provides promising results that may improve graft rupture rates and meniscal repair failure rates, while maintaining excellent functional outcomes.
Corticosteroids in Sepsis: An Updated Systematic Review and Meta-Analysis
Authors: Rochwerg Bram , Oczkowski Simon J. , Siemieniuk Reed A. C. , Agoritsas Thomas , Belley-Cote Emilie , D’Aragon Frédérick , Duan Erick , English Shane , Gossack-Keenan Kira , Alghuroba Mashari , Szczeklik Wojciech , Menon Kusum , Alhazzani Waleed , Sevransky Jonathan , Vandvik Per Olav , Annane Djillali , Guyatt Gordon
Published: July 2018

Objective:

This systematic review and meta-analysis addresses the efficacy and safety of corticosteroids in critically ill patients with sepsis.

Data Sources:

We updated a comprehensive search of MEDLINE, EMBASE, CENTRAL, and LILACS, and unpublished sources for randomized controlled trials that compared any corticosteroid to placebo or no corticosteroid in critically ill children and adults with sepsis.

Study Selection:

Reviewers conducted duplicate screening of citations, data abstraction, and, using a modified Cochrane risk of bias tool, individual study risk of bias assessment.

Data Extraction:

A parallel guideline committee provided input on the design and interpretation of the systematic review, including the selection of outcomes important to patients. We assessed overall certainty in evidence using Grading of Recommendations Assessment, Development and Evaluation methodology and performed all analyses using random-effect models. For subgroup analyses, we performed metaregression and considered p value less than 0.05 as significant.

Data Synthesis:

Forty-two randomized controlled trials including 10,194 patients proved eligible. Based on low certainty, corticosteroids may achieve a small reduction or no reduction in the relative risk of dying in the short-term (28–31 d) (relative risk, 0.93; 95% CI, 0.84–1.03; 1.8% absolute risk reduction; 95% CI, 4.1% reduction to 0.8% increase), and possibly achieve a small effect on long-term mortality (60 d to 1 yr) based on moderate certainty (relative risk, 0.94; 95% CI, 0.89–1.00; 2.2% absolute risk reduction; 95% CI, 4.1% reduction to no effect). Corticosteroids probably result in small reductions in length of stay in ICU (mean difference, –0.73 d; 95% CI, –1.78 to 0.31) and hospital (mean difference, –0.73 d; 95% CI, –2.06 to 0.60) (moderate certainty). Corticosteroids result in higher rates of shock reversal at day 7 (relative risk, 1.26; 95% CI, 1.12–1.42) and lower Sequential Organ Failure Assessment scores at day 7 (mean difference, –1.39; 95% CI, –1.88 to –0.89) (high certainty). Corticosteroids likely increase the risk of hypernatremia (relative risk, 1.64; 95% CI, 1.32–2.03) and hyperglycemia (relative risk, 1.16; 95% CI, 1.08–1.24) (moderate certainty), may increase the risk of neuromuscular weakness (relative risk, 1.21; 95% CI, 1.01–1.52) (low certainty), and appear to have no other adverse effects (low or very low certainty). Subgroup analysis did not demonstrate a credible subgroup effect on any of the outcomes of interest (p > 0.05 for all).

Conclusions:

In critically ill patients with sepsis, corticosteroids possibly result in a small reduction in mortality while also possibly increasing the risk of neuromuscular weakness.
Early Differentiation of Shiga Toxin–Associated Hemolytic Uremic Syndrome in Critically Ill Adults With Thrombotic Microangiopathy Syndromes
Authors: Joseph Adrien , Rafat Cédric , Zafrani Lara , Mariani-Kurkdjian Patricia , Veyradier Agnès , Hertig Alexandre , Rondeau Eric , Mariotte Eric , Azoulay Elie
Published: July 2018

Objectives:

Thrombotic microangiopathy syndromes are a heterogeneous group of severe diseases that often require ICU admission. Prompt initiation of targeted therapies is required for atypical hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, whereas there is no specific consensus therapy for Shiga toxin–associated hemolytic uremic syndrome. We sought to compare the characteristics of Shiga toxin–associated hemolytic uremic syndrome, atypical hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura patients at admission in the ICU to allow early differentiation of Shiga toxin–associated hemolytic uremic syndrome from other thrombotic microangiopathy syndromes and help to tailor initial treatment.

Design:

Retrospective cohort study.

Setting:

Two ICUs part of the French reference center for thrombotic microangiopathy syndromes.

Patients:

Adult patients presenting with features of thrombotic microangiopathy syndromes. Other causes than Shiga toxin–associated hemolytic uremic syndrome, atypical hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura were excluded.

Interventions:

None.

Measurements and Main Results:

From September 2003 to January 2017, 236 thrombotic microangiopathy syndrome patients were admitted, including 12 Shiga toxin–associated hemolytic uremic syndrome, 21 atypical hemolytic uremic syndrome, and 91 thrombotic thrombocytopenic purpura. Shiga toxin–associated hemolytic uremic syndrome patients were older than other thrombotic microangiopathy syndromes patients (64 yr [interquartile range, 50–72 yr] vs 42 yr [31–54 yr]; p = 0.007) and presented with more frequent digestive symptoms (92% vs 42%; p < 0.001), especially nonbloody diarrhea and vomiting. Biologically, Shiga toxin–associated hemolytic uremic syndrome patients displayed higher fibrinogen (490 mg/dL [460–540 mg/dL] vs 320 mg/dL [240–410 mg/dL]; p = 0.003) and creatinine levels (2.59 mg/dL [2.12–3.42 mg/dL] vs 1.26 mg/dL [0.61–1.90 mg/dL]; p < 0.001), and less marked anemia (hemoglobin level, 9.7 g/dL [8.7–11.9 g/dL] vs 7.7 g/dL [6.3–9.1 g/dL]; p < 0.001). Forty-two percent (n = 5) required renal replacement therapy, and 83% (n = 10) were treated with plasma exchange before the distinction from other thrombotic microangiopathy syndromes could be made.

Conclusions:

Adult Shiga toxin–associated hemolytic uremic syndrome patients are older, present more frequently with digestive symptoms and display higher hemoglobin and fibrinogen levels than other thrombotic microangiopathy syndromes. However, overlap across the three thrombotic microangiopathy syndromes remains substantial, putting forward the need to implement early plasma therapy until thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome can be ruled out.
Histopathological Findings and Increased D-Dimer Are Predictive Factors of Systemic Thromboses in Eosinophilic Granulomatosis With Polyangiitis
Authors: Kanno Kyoko , Minami-Hori Masako , Honma Masaru , Ishida-Yamamoto Akemi
Published: July 2018

Eosinophilic granulomatosis with polyangiitis (EGPA; ie, Churg–Strauss syndrome) is one of the antineutrophil cytoplasmic antibody–associated vasculitis syndromes. Although extravascular granulomatoses are a well-known histopathological feature, the diverse histopathologic spectrum of cutaneous lesions has not been described in detail. Thus, this study sought to investigate the possible correlation between the clinical features and histopathology of cutaneous lesions in EGPA cases, focusing on systemic thrombogenic conditions, such as visceral infarction and deep vein thrombosis. Fourteen cases of EGPA diagnosed at the Department of Dermatology in Asahikawa Medical University from 1977 to 2017 were clinically and histopathologically reviewed. In 6 (43%) cases, skin lesions were the initial manifestation of EGPA. Among the cutaneous lesions, purpura and erythema were the most common. Persistent proteinuria and macrohematuria were observed in only 2 myeloperoxidase–antineutrophil cytoplasmic antibody–positive cases. Systemic thrombotic symptoms, such as cerebral infarction and deep vein thrombosis, were detected in 5 (36%) cases, and, in 3 of those cases, thromboses in dermal or subcutaneous vessels were observed histopathologically. Elevation of plasma D-dimer level (>2.5 μg/mL) was significantly correlated with concomitant systemic thrombotic symptoms (P = 0.0152, Fischer exact test). The histopathological finding of thrombotic features and increased plasma D-dimer were predictive factors of EGPA accompanied with systemic thromboses, such as deep vein thromboses and cerebral infarction.
The Translaminar Pressure Gradient: Papilledema After Trabeculectomy Treated With Optic Nerve Sheath Fenestration
Authors: Radke Phillip M. , Rubinstein Tal J. , Hamilton Steven R. , Jamil Annisa L. , Sires Bryan S.
Published: July 2018

Introduction:

Trans-lamina cribrosa pressure has been postulated to be a contributor in the development of a glaucomatous optic nerve versus optic nerve edema, depending on the pressure gradient. Uncertainty remains in the therapeutic outcome of adjusting this gradient.

Case Report:

We discuss a unique case of idiopathic intracranial hypertension presenting as asymmetric optic disc edema following trabeculectomy. It was treated via optic nerve fenestration due to the patient remaining symptomatic on maximum tolerated acetazolamide. Intraocular pressure stabilized into target range and the optic nerve edema resolved.

Conclusions:

Rarely, intraocular pressure reduction can unmask elevated intracranial pressure, leading to optic nerve edema. Optic nerve sheath fenestration is a practical therapeutic modality to consider when treating this occurrence.
Implementing a patient-centered walking program for residents in long-term care: A quality improvement project
Authors: Kazana Izabela , Pencak Murphy Marcia
Published: July 2018

Background and purpose:

This quality improvement (QI) project was designed to increase walking activity for eligible residents in long-term care (LTC). Walking programs have positive benefits; however, they are underused in LTC.

Methods:

The Model for Improvement and Plan-Do-Study-Act cycles were used to implement the key components including building a guiding coalition, environment and policy assessment, development of a patient-centered walking program protocol, staff education, mobility huddle to motivate and mentor staff, and ongoing evaluation and feedback.

Results:

Of the 78 residents screened for walking activity, 13 (17%) were eligible. Data were collected weekly. After 20 weeks, 69% (n = 9) of the enrolled residents were still in the program. The majority of residents were provided walking activity between 60% and 90% of the time. None of the residents experienced a fall during the activity. Average adherence to documenting the activity was 79%.

Conclusions:

The QI project provided the implementation and evaluation of a consistent walking program in a LTC setting.

Implications for Practice:

The project findings may assist nurse practitioners in implementing QI initiatives in LTC to increase walking activity of eligible residents and aid in evaluating those programs. However, leadership commitment and ongoing support are essential to sustain the effectiveness of a program.
Takotsubo cardiomyopathy: A discussion and case study
Authors: Swenson Sara , Bull Justin , Chen Iris B. , Joseph Dency , Joseph Jolly , Varghese Molly , Dellostritto Rita A.
Published: July 2018

Background and purpose:

Takotsubo cardiomyopathy (TCM), first reported by Japanese doctors, has gained an overall acknowledgment as an independent malady of international attention. It resembles the presentation of an acute myocardial infarction but lacks ischemic myocardial tissue. The objective of this article is to review the physiology, diagnostics, treatment, and complications of TCM and report a case study of a patient who developed TCM.

Methods:

Observation through direct patient care allowed for data collection of this unique medical phenomenon. Supporting information was obtained via investigation of scholarly articles on TCM over the past 10 years.

Conclusions:

Although TCM is usually transient, it is important to quickly differentiate TCM from other more serious medical conditions, such as myocardial infarction, pulmonary embolism, and pheochromocytoma. Typical diagnostic workup includes electrocardiography, cardiac biomarkers, and echocardiography or coronary angiography. Complications include cardiogenic shock, left ventricular wall rupture, and life-threatening arrhythmias.

Implications for practice:

The advanced practice nurse (APN) is instrumental in differentiating between TCM versus acute myocardial infarction, heart failure, pulmonary edema, dynamic outflow obstruction, and cardiogenic shock. Because of these possible acute and critical presentations, prompt recognition and intervention for patients with TCM are priorities for nurse practitioners.
Risk Factors for Mortality in Children Admitted for Suspected Malaria to a Pediatric Emergency Ward in a Low-Resource Setting: A Case-Control Study
Authors: Cavallin Francesco , Pisani Luigi , Stancari Lorenzo , Massaquoi Vandi , Sharif Allieu , Pisani Enzo , Putoto Giovanni , Trevisanuto Daniele
Published: July 2018

Objectives:

To identify the risk factors for mortality after admission for suspected malaria in a pediatric emergency ward in Sierra Leone.

Design:

Retrospective case-control.

Setting:

Pujehun Hospital Pediatric Ward in Pujehun, Sierra Leone.

Patients:

All cases were pediatric deaths after admission for suspected malaria at the Pujehun Hospital Pediatric Ward between January 1, 2015, and May 31, 2016. The case-control ratio was 1:1. The controls were infants admitted at Pujehun Hospital Pediatric Ward for malaria and discharged alive during the same period. Controls were selected as the next noncase infant admitted for malaria and discharged alive, as recorded in local medical records.

Interventions:

None.

Measurements and Main Results:

Children characteristics, vital variables on hospital access, comorbidity status at admission, antibiotic and antimalarial therapy at admission; presence of hematemesis, respiratory arrest or bradypnea, abrupt worsening, and emergency interventions during hospital stay; final diagnosis before discharge or death. In total, 320 subjects (160 cases and 160 controls) were included in the study. Multivariable analysis identified being referred from peripheral health units (odds ratio, 4.00; 95% CI, 1.98–8.43), cerebral malaria (odds ratio, 6.28; 95% CI, 2.19–21.47), malnutrition (odds ratio, 3.14; 95% CI, 1.45–7.15), dehydration (odds ratio, 3.94; 95% CI, 1.50–11.35), being unresponsive or responsive to pain (odds ratio, 2.17; 95% CI, 1.15–4.13), and hepatosplenomegaly (odds ratio, 3.20; 95% CI, 1.74–6.03) as independent risk factors for mortality.

Conclusions:

Risk factors for mortality in children with suspected malaria include cerebral malaria and severe clinical conditions at admission. Being referred from peripheral health units, as proxy of logistics issue, was also associated with increased risk of mortality. These findings suggest that appropriate interventions should focus on training and resources, including the increase of dedicated personnel and available equipment.
Insulin Promotes Adipose-Derived Stem Cell Differentiation after Fat Grafting
Authors: Kim Yang Woo , Min Hyung Jun , Choi Rak Jun , Lee Dong Hun , Cheon Young Woo
Published: July 2018

Background:

Adipose-derived stem cells are used to enhance fat graft survival. However, their mechanism of action when grafted is controversial. The grafted cells can be replaced by connective tissue or survive at the recipient site and differentiate. Insulin is a powerful agent used to induce their differentiation to adipocytes. The purpose of this study was to elucidate the fate of grafted adipose-derived stem cells in nonvascularized fat grafts with or without insulin.

Methods:

Fat was harvested from a female human donor who had undergone reduction mammaplasty. The authors also isolated and cultured adipose-derived stem cells expressing green fluorescent protein from transgenic Sprague-Dawley rats. Injection of free fat graft, the adipose-derived stem cells, phosphate-buffered saline, and insulin was performed on the four paravertebral points of the back of each mouse (n = 30) as follows: group A (control group) received adipose tissue and phosphate-buffered saline; group B received adipose tissue and adipose-derived stem cells; group C received adipose tissue, adipose-derived stem cells, and phosphate-buffered saline; and group D received adipose tissue, adipose-derived stem cells, and insulin. Green fluorescent protein expression was evaluated using an in vivo imaging system. The volume of transplanted fat was evaluated at 8 weeks after graft with six histologic parameters. The fat graft was immunostained with green fluorescent protein, 4′,6-diamidino-2-phenylindole, and perilipin. Statistical analysis was performed using a one-way analysis of variance test.

Results:

The fat graft volume was significantly higher in group D (p < 0.05). Histologic examination revealed reduced fibrosis and increased cysts, vacuoles, integrity, and vascularity in group D. The green fluorescent protein and perilipin co–positive area was more apparent in group D compared with groups B and C.

Conclusion:

Insulin could enhance the survival and differentiation of adipose-derived stem cells in nonvascularized fat grafts.
Single-phase Split-bolus Dual Energy Computed Tomography Angiography for Evaluation of Hemoptysis
Authors: Meena Pankaj , Bhalla Ashu S. , Goyal Ankur , Sharma Raju , Kumar Atin , Srivastva Deep N. , Sreenivas Vishnu , Guleria Randeep
Published: July 2018

Purpose:

The purpose of this study was to assess feasibility and overall utility of single-phase split-bolus dual energy computed tomography (DECT) angiography (DECTA) for evaluation of hemoptysis, and to establish an injection protocol for evaluation of hemoptysis, by comparing 2 contrast injection protocols.

Materials and Methods:

Using dual-source (80 and 140 kV), 2×128-slice equipment, DECTA was performed using 400 mg iodine/mL, 50 to 80 mL iodinated contrast in 257 patients (189 male individuals, 68 female individuals, age range: 15 to 76 y) presenting with hemoptysis. Initially, 50 patients were randomized into 2 groups for 2 different injection protocols (A and B). Images were assessed quantitative and qualitatively. Later, 207 patients were randomized using protocol B, which was technically simpler, and single-CT acquisition, for simultaneous opacification of systemic and pulmonary vessels.

Results:

Injection protocol A resulted in higher vessel attenuation, both in the aorta and in the pulmonary artery and its segmental branches; however, the difference was not statistically significant. No significant difference was noted in signal-to-noise ratio, contrast-to-noise ratio, as well as subjective image quality parameters. Overall optimal opacification of both systemic and pulmonary arteries was achieved in 247/257 patients. A total of 308 abnormal bronchial arteries were noted. A total of 392 nonbronchial systemic arteries were noted, the majority arising from posterior intercostals and subclavian artery branches. The pulmonary source of hemoptysis was identified in 9 patients (3 pulmonary thromboembolisms, 5 pulmonary artery pseudoaneurysms, and 1 pulmonary venous ectasia).

Conclusion:

Combined DECTA is a novel technique that enables simultaneous evaluation of both systemic and pulmonary vascular cause of hemoptysis in a single acquisition with small contrast dose. Both injection protocols “A” and “B” were equally efficacious in simultaneous opacification of both the aorta and pulmonary arteries. To the best of our knowledge, such a protocol has never been described for hemoptysis evaluation.
A Structured Compensation Plan Improves But Does Not Erase the Sex Pay Gap in Surgery
Authors: Morris Melanie , Chen Herb , Heslin Martin J. , Krontiras Helen
Published: July 2018

Objective:

The aim of this study is to examine the relationship between the sex pay gap in a large academic department of surgery and a recently instituted structured compensation plan.

Summary of Background Data:

A recent large study found that after controlling for measures of academic and clinical productivity, male physicians earned nearly $20,000 more annually than female physicians. Increased salary transparency has been proposed as a method to reduce this disparity.

Methods:

A new structured compensation plan was developed to improve transparency of compensation and financial viability of each division. The total compensations of each faculty member before and after the new compensation plan were calculated. Salaries were compared with the Association of Academic Medical Colleges (AAMC) median value based on specialty, region, academic rank, stratified by sex and compared. Work relative value units (wRVUs) were calculated for each faculty member during the entire study period, stratified by sex and compared.

Results:

Among 44 eligible surgeons (33 men and 11 women), a sex pay gap existed with male surgeon salaries significantly higher than female surgeon salaries [56% (8 to 213) vs 26% (1 to 64); P < 0.00001] despite similar RVU production (men 8725 ± 831 vs women 7818 ± 911, P = 0.454). The new compensation plan did not significantly change male surgeon salaries [56% (8 to 213) vs 58% (26 to 159); P = 0.552] but did significantly increase the salaries of female surgeons [26% (1 to 64) vs 42% (10 to 80); P = 0.026].

Conclusion:

A structured compensation plan can improve the sex pay gap in a short period of time. More transparency in surgical compensation plans is essential to understand the most equitable way to compensate all surgeons.
Relevance of poly (ADP-ribose) polymerase inhibitors in prostate cancer
Authors: Rescigno Pasquale , Chandler Robert , de Bono Johann
Published: July 2018

Purpose of review

Poly (ADP-ribose) polymerase inhibitors (PARPi) are approved drugs for the treatment of ovarian and breast cancer and currently under investigation for the treatment of prostate cancer and other malignancies with aberrations in homologous recombination DNA repair.

This review summarizes literature published during 2017 concerning the relevance of PARPi in prostate cancer and presents new evidence on mechanisms of resistance and biomarkers of response.

Recent findings

The approval of several PARPi (olaparib, rucaparib, and niraparib) has driven the focus of anticancer treatment on synthetic lethality in prostate cancer too. Despite anecdotal reports of long-term responders, most cancers become resistant to these therapies.

Different mechanisms of primary and acquired resistance to PARPi have been recently investigated including loss of PARP1 expression, BRCA mutations with partial function, and acquisition of reversion restoration of function mutations.

Here, we discuss the importance of PARPi in metastatic castration-resistant prostate cancer and discuss the possible mechanisms of resistance.
Clinical Utility of Routine Preoperative Laboratory Assessment in a Urogynecologic Population
Authors: Geynisman-Tan Julia , Bochenska Katarzyna , Gillingham Akira , Collins Sarah , Lewicky-Gaupp Christina , Mueller Margaret , Kenton Kimberly
Published: July 2018

Objective

The objective of this study was to determine the incidence of newly diagnosed, clinically meaningful laboratory abnormalities on routine preoperative laboratory testing in women undergoing urogynecologic surgery.

Methods

All urogynecologic cases performed at a single institution over a 3-year period were reviewed. Women undergoing major surgery routinely had a basic metabolic panel, complete blood count (CBC), and type and screen, whereas women undergoing minor surgery had testing at the surgeon's discretion. Demographics, surgical details, preoperative laboratory values, and instances of postoperative transfusion were abstracted. If testing revealed a clinically meaningful abnormality, physician notes were reviewed to determine whether the abnormality was previously known or led to surgical postponement.

Results

A total of 836 cases were identified: 411 major (49%) and 425 minor (51%). Patients had a mean ± SD age of 57 ± 13 years and body mass index of 27 ± 6 kg/m2. Medical comorbidities were hypertension, 38%; diabetes, 24%; chronic kidney disease, 3%; and congestive heart failure, 4%; 89% had an American Society of Anesthesiologists class of less than or equal to 2. A total of 453 (54%) had preoperative CBC, and 367 (44%) had preoperative basic metabolic panel. Six (1.3%) new abnormalities (hemoglobin between 8.0 and 10.0) were identified on CBC. Thirty-one women had elevated creatinine level (>1.0), and 28 (90%) of these had a history of hypertension. No surgeries were postponed or changed owing to anemia, thrombocytopenia, or renal dysfunction. No clinically significant electrolyte abnormalities were identified. Type and screen were collected on 394 patients; none were transfused intraoperatively.

Conclusions

Routine preoperative laboratory testing does not identify clinically meaningful abnormalities or alter surgical management in women undergoing urogynecologic surgery.
Donor-derived Viral Infections in Liver Transplantation
Authors: Nam Hannah , Nilles Kathy M. , Levitsky Josh , Ison Michael G.
Published: July 2018

Donor-derived infections are defined as any infection present in the donor that is transmitted to 1 or more recipients. Donor-derived infections can be categorized into 2 groups: “expected” and “unexpected” infections. Expected transmissions occur when the donor is known to have an infection, such as positive serology for cytomegalovirus, Epstein Barr virus, or hepatitis B core antibody, at the time of donation. Unexpected transmissions occur when a donor has no known infection before donation, but 1 or more transplant recipients develop an infection derived from the common donor. Unexpected infections are estimated to occur in far less than 1% of solid organ transplant recipients. We will review the epidemiology, risk factors, and approaches to prevention and management of donor-derived viral infectious disease transmission in liver transplantation.
Retinal Neuronal Loss in Visually Asymptomatic Patients With Myoclonic Epilepsy With Ragged-Red Fibers
Authors: Najjar Raymond P. , Reynier Pascal , Caignard Angélique , Procaccio Vincent , Amati-Bonneau Patrizia , Mack Heather , Milea Dan
Published: July 2018

Background:

Myoclonic epilepsy with ragged-red fibers (MERRF, OMIM, #545000) is a rare neurological condition mostly caused by the m.8344A>G mitochondrial DNA pathogenic variant, which can variably affect multiple tissues, including the retina and optic nerve. We report detection of visually asymptomatic neuroretinal loss in 3 patients with genetically confirmed MERRF, using spectral domain optical coherence tomography (SD-OCT).

Methods:

All patients underwent a complete ophthalmic examination including assessments of visual acuity, color vision, pupillary reactions, extraocular movements, applanation tonometry, slit-lamp, and dilated fundus examinations. Standard automated perimetry or Goldmann kinetic perimetry was performed, as well as fundus photographs and SD-OCT of the optic nerve head and macula.

Results:

Despite the absence of visual symptoms in all patients, and normal visual acuity and visual fields in 1 patient, the 3 genetically confirmed patients (point mutations m.8344A>G; age range: 18–62 years) with MERRF-related neurological manifestations, displayed thinning of the retinal nerve fiber layer and variable alterations of the macular ganglion cell complex.

Conclusions:

Visually asymptomatic patients with genetically confirmed MERRF can display features of structural neuroretinal loss, quantifiable with SD-OCT. Further investigations are needed to establish whether OCT can assess early neurodegeneration in MERRF.
Accelerated Magnetic Seizure Therapy for Treatment of Major Depressive Disorder
Authors: Wang Jian , Vila-Rodriguez Fidel , Jiang Wei , Ren Yian-Ping , Wang Chang-Ming , Ma Xin
Published: July 2018

Introduction

Major depressive disorder is a prevalent and debilitating condition that afflicts millions of people worldwide. Magnetic seizure therapy (MST) is a promising convulsive neurostimulation treatment for depression with fewer cognitive adverse effects than electroconvulsive therapy.

Methods

A small case series of patients recruited as part of an open-label clinical trial is presented. Patients with depression underwent an accelerated MST protocol (aMST) consisting of 1 treatment per day for 6 consecutive weekdays. The primary outcome was severity on the HDRS17 (Hamilton Depression Rating Scale 17-item). In addition, patients underwent neuropsychological assessment with the Repeatable Battery for the Assessment of Neuropsychological Status and Stroop test.

Results

After completing aMST, all patients experienced improvement. Two patients met response criterion, and the third experienced a 27% decrease on the HDRS17. All 3 patients experienced improvement in cognitive performance with a global 20% mean improvement and strongest improvement in immediate and delayed verbal memory indices (mean improvement of 40% and 27%, respectively). There were no cases of prolonged confusion or delirium after MST treatments. There were no severe adverse effects in any of the 3 patients.

Conclusions

Accelerated MST protocol was well tolerated and associated with positive outcomes in this small case series. Accelerated MST protocol was not associated with prolonged confusion or delirium and was associated with improvement in memory indices. Our results merit further research in large RCT to test whether accelerated MST protocol might be an efficacious treatment for major depressive disorder.
Process optimization of ultrasound-assisted treatment for soya bean protein isolate/polyacrylamide composite film
Authors: Cao Xinwei , Zhu Bo , Gao Yichuan , Liu Jianli , Gao Weidong , Gai Xiaoling , Bao Wei
Published: July 2018

In this paper, composite films composed of soya bean protein isolate (SPI) and polyacrylamide (PAM) were prepared under variations of ultrasonic power, treatment time and heating temperature. The effects of the major processing parameters related to ultrasonic-assisted treatment were evaluated and optimized through the single-factor analysis and Box–Behnken design (BBD), respectively, when the tensile strength of composite films was considered as the response value. The single-factor analysis was carried out to study the effects of ultrasonic power, treatment time and heating temperature on the viscosity and cohesion of the slurry and the tensile strength of SPI/PAM composite films, which also provided a reasonable data range of each factor for further optimization. Experiment results indicated that these three factors play a significant role in the tensile strength of films. Then BBD was applied to optimize the treatment conditions of these three factors, using the tensile strength of films as the response value. According to the interactive second-order polynomial model of three factors and the three-dimensional response surface, the maximum tensile strength of films was obtained under the optimal condition. To verify the reliability of the model, the experiment with the optimal condition was conducted, and results demonstrated that the observed tensile strength was in agreement with the predicated one. Also, the morphology and water solubility of the films showed that the film can be coated on the yarns evenly and removed clearly.
Cognitive self-regulation influences pain-related physiology
Authors: Matthewson Gordon , Woo Choong-Wan , Reddan Marianne C. , Wager Tor D.
Published: July 2018

Cognitive self-regulation can shape pain experience, but its effects on autonomic responses to painful events are unclear. In this study, participants (N = 41) deployed a cognitive strategy based on reappraisal and imagination to regulate pain up or down on different trials while skin conductance responses (SCR) and electrocardiogram (ECG) activity were recorded. Using a machine learning approach, we first developed stimulus-locked SCR and ECG physiological markers predictive of pain ratings. The physiological markers demonstrated high sensitivity and moderate specificity in predicting pain across two datasets, including an independent test dataset (N = 84). When we tested the markers on the cognitive self-regulation data, we found that cognitive self-regulation had significant impacts on both pain ratings and pain-related physiology in accordance with regulatory goals. These findings suggest that self-regulation can impact autonomic nervous system responses to painful stimuli and provide pain-related autonomic profiles for future studies.
On the Subspace Invariance of Population Responses
Authors: Tring Elaine , Ringach Dario L.
Published: July 2018

The response of a neural population in cat primary visual cortex to the linear combination of two sinusoidal gratings (a plaid) can be well approximated by a weighted sum of the population responses to the individual gratings – a property we refer to as subspace invariance. We tested subspace invariance in mouse primary visual cortex by measuring the angle between the population response to a plaid and the plane spanned by the population responses to its individual components. We found robust violations of subspace invariance, represented by a median angular deviation of ~55 deg. The cause of this departure is a strong, negative correlation between the mean responses a neuron to the individual gratings and its response to the plaid. We suggest that an early nonlinearity may distort the power distribution of grating and plaid stimuli such that plaids have a prominent power component at ±45 deg off the fundamental orientations. We conclude that subspace invariance does not hold in mouse V1. This finding rules out a large class of possible models of population coding, including vector averaging and gain control.
Disentangling bacterial invasiveness from lethality in an experimental host-pathogen system
Authors: Biancalani Tommaso , Gore Jeff
Published: July 2018

Quantifying virulence remains a central problem in human health, pest control, disease ecology, and evolutionary biology. Bacterial virulence is typically quantified by theLT50(i.e.the time taken to kill 50% of infected hosts), however, such an indicator cannot account for the full complexity of the infection process, such as distinguishing between the pathogen’s ability to colonize vs. kill the hosts. Indeed, the pathogen needs to breach the primary defenses in order to colonize, find a suitable environment to replicate, and finally express the virulence factors that cause disease. Here, we show that two virulence attributes, namely pathogen lethality and invasiveness, can be disentangled from the survival curves of a laboratory population ofCaenorhabditis elegansnematodes exposed to three bacterial pathogens:Pseudomonas aeruginosa,Serratia marcescensandSalmonella enterica. We first show that the host population eventually experiences a constant mortality rate, which quantifies the lethality of the pathogen. We then show that the time necessary to reach this constant-mortality rate regime depends on the pathogen growth rate and colonization rate, and thus determines the pathogen invasiveness. Our framework reveals thatSerratia marcescensis particularly good at the initial colonization of the host, whereasSalmonella entericais a poor colonizer yet just as lethal once established.Pseudomonas aeruginosa, on the other hand, is both a good colonizer and highly lethal after becoming established. The ability to quantitatively characterize the ability of different pathogens to perform each of these steps has implications for treatment and prevention of disease and for the evolution and ecology of pathogens.
Spatiotemporal Analysis of Category and Target-related Information Processing in the Brain during Object Detection
Authors: Karimi-Rouzbahani Hamid , Vahab Ehsan , Ebrahimpour Reza , Menhaj Mohammad Bagher
Published: July 2018

To recognize a target object, the brain implements strategies which involve a combination of externally sensory-driven and internally task-driven mechanisms. While several studies have suggested a role for frontal brain areas in enhancing task-related representations in visual cortices, especially the lateral-occipital cortex, they remained silent about the type of information transferred to visual areas. However, the recently developed method of representational causality analysis, allowed us to track the movement of different types of information in the brain. Accordingly, we designed an EEG object detection experiment and evaluated the spatiotemporal dynamics of category- and target-related information across the brain using. Results showed that the prefrontal area initiated the processing of target-related information. This information was then transferred to posterior brain areas during stimulus presentation to facilitate object detection and to direct the decision-making procedure. We also observed that, as compared to category-related information, the target-related information could predict the behavioral detection performance more accurately, suggesting the dominant representation of internal compared to external information in brain signals. These results provided new evidence about the role of prefrontal cortices in the processing of task-related information the brain during object detection.
Most sleep does not serve a vital function. Evidence from Drosophila melanogaster
Authors: Geissmann Quentin , Beckwith Esteban J. , Gilestro Giorgio F.
Published: July 2018

Sleep appears to be a universally conserved phenomenon among the animal kingdom but whether this striking evolutionary conservation underlies a basic vital function is still an open question. Using novel technologies, we conducted an unprecedentedly detailed high-throughput analysis of sleep in the fruit fly Drosophila melanogaster, coupled with a life-long chronic and specific sleep restriction. Our results show that some wild-type flies are virtually sleepless in baseline conditions and that complete, forced sleep restriction is not necessarily a lethal treatment in wild-type Drosophila melanogaster. We also show that circadian drive, and not homeostatic regulation, is the main contributor to sleep pressure in flies. We propose a three-partite model framework of sleep function, according to which, total sleep accounts for three components: a vital component, a useful component, and an accessory component.
Inference of Chromosome-length Haplotypes using Genomic Data of Three to Five Single Gametes
Authors: Li Ruidong , Qu Han , Chen Jinfeng , Wang Shibo , Chater John M. , Zhang Le , Wei Julong , Zhang Yuan-Ming , Xu Chenwu , Zhong Wei-De , Zhu Jianguo , Lu Jianming , Ma Renyuan , Ferrante Sergio Pietro , Roose Mikeal L. , Jia Zhenyu
Published: July 2018

Knowledge of chromosome-length haplotypes will not only advance our understanding of the relationship between DNA and phenotypes, but also promote a variety of genetic applications. Here we present Hapi, an innovative method for chromosomal haplotype inference using only 3 to 5 gametes. Hapi outperformed all existing haploid-based phasing methods in terms of accuracy, reliability, and cost efficiency in both simulated and real gamete datasets. This highly cost-effective phasing method will make large-scale haplotype studies feasible to facilitate human disease studies and plant/animal breeding. In addition, Hapi can detect meiotic crossovers in gametes, which has promise in the diagnosis of abnormal recombination activity in human reproductive cells.
Flux, toxicity and protein expression costs shape genetic interaction in a metabolic pathway
Authors: Kemble Harry , Eisenhauer Catherine , Couce Alejandro , Chapron Audrey , Magnan Mélanie , Gautier Gregory , Le Nagard Hervé , Nghe Philippe , Tenaillon Olivier
Published: July 2018

Our ability to predict the impact of mutations on traits relevant for disease and evolution remains severely limited by the dependence of their effects on the genetic background and environment. Even when molecular interactions between genes are known, it is unclear how these translate to organism-level interactions between alleles. We therefore characterized the interplay of genetic and environmental dependencies in determining fitness by quantifying ~4,000 fitness interactions between expression variants of two metabolic genes, in different environments. We detect a remarkable variety of environment-dependent interactions, and demonstrate they can be quantitatively explained by a mechanistic model accounting for catabolic flux, metabolite toxicity and expression costs. Complex fitness interactions between mutations can therefore be predicted simply from their simultaneous impact on a few connected molecular phenotypes.