bluuebunny/crossref_metadata_2025 huggingface dataset:
Broader Practice Indications for Mohs Surgical Defect Healing by Secondary Intention: A Survey Study
Authors: Vedvyas Chetan , Cummings Patricia L. , Geronemus Roy G. , Brauer Jeremy A.
Published: January 2017

BACKGROUND

Recent reports have indicated secondary intention (SI) healing utilization for Mohs surgical defects beyond conventionally accepted indications.

OBJECTIVE

To characterize potentially more expansive guidelines for when SI healing is indicated or appropriate in dermatologic surgery.

METHODS

A survey study was e-mailed to the American College of Mohs Surgery in 2015. A group of 293 respondents addressed factors influencing decisions to heal surgical defects secondarily.

RESULTS

The most experienced surgeons were significantly more likely to heal deep and larger wounds secondarily. Many surgeons elect SI healing in patients with current or previous wound dehiscence, flap necrosis, or infection; in patients who have undergone skin cancer excisions before, or who are elderly, and; if the lesion was sent for permanent section, or when treating high-risk, large, recurrent, or aggressive tumors.

CONCLUSION

Broader indications for SI healing of Mohs surgical defects may be appropriate than previously understood. In addition to concave, temporal, periocular, perinasal, and periauricular sites, SI healing may be appropriate for convex sites such as the scalp and anterior lower extremity, deep wounds, and large wounds, as well as wounds with dehiscence, flap necrosis, or infection. Certain patient-specific and lesional factors are also appropriate indications for SI healing.
SHORT-TERM SAFETY OF 2 MG INTRAVITREAL ZIV-AFLIBERCEPT
Authors: Chhablani Jay , Dedhia Chintan Jethalal , Peguda Hari K. , Stewart Michael ,   on behalf of Ziv-aflibercept study group
Published: January 2017

Purpose:

To evaluate the safety of single intravitreal 2 mg ziv-aflibercept (0.08 mL) injections for the treatment of choroidal neovascular membranes (CNVM).

Methods:

Eyes with choroidal neovascular membranes because of several conditions each received single intravitreal injections of 2 mg ziv-aflibercept (0.08 mL). Comprehensive ophthalmic examinations and detailed systemic evaluations were performed at baseline and Days 1, 7, and 30 after injections. Standard electroretinography was performed at baseline and Day 30. Primary outcome measures consisted of safety assessments (signs of clinical toxicity and electroretinographic abnormalities). Secondary outcome measures included changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) of the macula.

Results:

Twenty-one eyes of 20 patients (12 males) received injections. Etiologies responsible for the choroidal neovascular membranes included age-related macular degeneration (14), polypoidal choroidal vasculopathy (PCV) (3), myopia (2), and idiopathic juxtafoveal telangiectasia (2). None of the patients complained of worsening vision or pain after the intravitreal injections and no intraocular inflammation was seen. No significant changes in the electroretinographic b/a ratio from baseline to 1 month were measured (scotopic: P = 0.89; photopic: P = 0.13) and mean intraocular pressures were unchanged (14.2 ± 3.6 vs. 13.7 ± 3.0 mmHg; P = 0.62). Mean best-corrected visual acuity did not change significantly from baseline to 1 month (0.66 ± 0.37 logMAR [Snellen equivalent: 20/100] vs. 0.61 ± 0.35 logMAR [Snellen equivalent: 20/80]; P = 0.72) but significant improvements in central subfield thickness were seen (343 ± 177 vs. 210 ± 133 μm; P = 0.01).

Conclusion:

Single intravitreal injections of 2 mg ziv-aflibercept (0.08 mL) appear to be safe through 1 month.
INFANTS WITH CONGENITAL ZIKA SYNDROME AND OCULAR FINDINGS FROM SÃO PAULO, BRAZIL: SPREAD OF INFECTION
Authors: de Oliveira Dias João Rafael , Ventura Camila V. , Borba Paula Delegrego , de Paula Freitas Bruno , Pierroti Ligia Camera , do Nascimento Ana Patricia , de Moraes Nilva Simeren Bueno , Maia Maurício , Belfort Rubens
Published: January 2017

Background/Purpose:

To describe the ocular findings of two infants with congenital Zika syndrome born in São Paulo state, Brazil, outside the primary outbreak region.

Methods:

Two female infants with congenital Zika syndrome were submitted to a complete screening for infectious diseases, as well as ocular examination, fundus photography, and optical coherence tomography of the retina. One of the infants was submitted to ocular ultrasound.

Results:

Both children showed positive serology for Zika virus, and other infectious diseases were ruled out. On fundus examination, one newborn had extensive bilateral macular chorioretinal atrophy with hyperpigmented borders associated with gross pigment mottling, as well as atrophic well-limited roundish peripheral lesions in the right eye. Spectral domain optical coherence tomography of the right eye showed complete chorioretinal atrophy in the temporal quadrant. The other infant presented bilateral gross pigment mottling in a paramacular location and a normal optical coherence tomography.

Discussion:

In this report, the ophthalmologic findings of two infants with Zika syndrome and ocular findings born in São Paulo state, Brazil, are described. Optical coherence tomography findings demonstrate the broad range of retinal damage caused by congenital Zika virus infection.

Conclusion:

The autochthonous cases of infants with congenital Zika syndrome and ocular findings described in this report demonstrate that Zika virus infection is not limited to northeast Brazil, with the potential for even greater spread.
MELANOCYTOMA OR JUXTAPAPILLARY MELANOMA?
Authors: Baartman Brandon J. , Ahmad Baseer , Srivastava Sunil , Jones Stephen , Singh Arun D.
Published: January 2017

Purpose:

To report the case of a melanocytoma of the optic disc leading to severe vision loss, raising concern for possible malignant transformation and optic nerve infiltration.

Methods:

Case report.

Results:

A 36-year-old Arabic woman presented to an outside facility with severe vision loss and a clinical picture concerning for optic neuritis with central retinal vein occlusion. On referral to the authors' institution 1 month after initial presentation, the vision of the patient was no light perception in the affected eye, and examination revealed the presence of a pigmented lesion adjacent to the nerve. Although standard 3-T magnetic resonance imaging orbits suggested 15 mm of optic nerve involvement, ultrahigh resolution 7-T magnetic resonance imaging was able to detect only 2 mm of optic nerve involvement.

Conclusion:

Melanocytoma of the optic disc is most often benign and causes few visual symptoms. However, in rare cases it can lead to severe vision loss and raise concern for malignant transformation. A 7-T magnetic resonance imaging provides higher resolution optic nerve images.
Glaucoma Diagnostic Capability of Circumpapillary Retinal Nerve Fiber Layer Thickness in Circle Scans With Different Diameters
Authors: Ghassibi Mark P. , Chien Jason L. , Patthanathamrongkasem Thipnapa , Abumasmah Ramiz K. , Rosman Michael S. , Skaat Alon , Tello Celso , Liebmann Jeffrey M. , Ritch Robert , Park Sung Chul
Published: January 2017

Purpose:

To compare varying circumpapillary optical coherence tomographic (OCT) scan diameters for glaucoma diagnosis.

Materials and Methods:

Prospective, cross-sectional, observational study. Circumpapillary retinal nerve fiber layer thickness (RNFLT) was measured using spectral-domain OCT in 1 randomly selected eye. Scans with diameters of 3.5, 4.1, and 4.7 mm were obtained, each with 7 parameters: mean global (G) RNFLT and mean RNFLT for the temporal-inferior (TI), nasal-inferior (NI), temporal-superior (TS), nasal-superior (NS), nasal (N), and temporal (T) sectors. Areas under the receiver operating characteristic curve (AUCs) were calculated.

Results:

Mean age was 55±18 years in 68 healthy eyes and 59±15 years in 95 glaucomatous eyes (P=0.12). Visual field mean deviation was −7.55±6.61 dB in glaucomatous eyes. In all 3 circle scans, mean TI RNFLT had the greatest AUC (0.974 to 0.983), followed by mean G RNFLT (0.949 to 0.956). The AUC of mean TI RNFLT in the 4.1-mm scan (0.983) was greater than the AUCs of mean TI RNFLTs in the 4.7- (0.978; P=0.128) and 3.5-mm (0.974; P=0.049) scans. The AUC of mean TI RNFLT in the 4.1-mm scan (0.983) was greater than the AUCs of mean G RNFLTs in the 3.5- (0.954; P=0.011), 4.1- (0.956; P=0.016), and 4.7-mm (0.949; P=0.011) scans. In 2 eyes with large parapapillary atrophy, RNFL segmentation error was noted only in the 3.5-mm scan in the area of parapapillary atrophy.

Conclusions:

Further investigations to find the spectral-domain OCT circle scan diameter with the best diagnostic capability and the least artifacts are warranted, especially focusing on larger-than-conventional circle scans.
Eyepass Glaucoma Implant in Open-Angle Glaucoma After Failed Conventional Medical Therapy: Clinical Results of a 5-Year-Follow-up
Authors: Wittmann Barbara , Huchzermeyer Cord , Rejdak Robert , Reulbach Udo , Dietlein Thomas , Hohberger Bettina , Jünemann Anselm
Published: January 2017

Purpose of the Study:

The purpose of the study was to evaluate the long-term safety and intraocular pressure (IOP) lowering effect of the Eyepass glaucoma implant (GMP Vision Solutions, Inc.).

Patients and Methods:

The prospective study included 15 patients (16 eyes) with primary open-angle glaucoma who underwent an implantation of the Y-shaped Eyepass glaucoma implant. This shunt diverts aqueous from the anterior chamber directly into Schlemm’s canal to increase outflow and to lower the IOP. IOP, visual acuity, potential complications and the number of antiglaucomatous medications were monitored over a period of 5 years.

Results:

The implant was successfully inserted in 14 of 16 eyes. Mean IOP was reduced from 26.4±8.1 mm Hg (SD) to 16.4±5.3 mm Hg (P=0.032) at the end of the follow-up. Mean number of antiglaucomatous medications dropped from 2.1±1.2 (SD) to 0.9±1.2 (SD). In 5 cases, no pressure-lowering medications were necessary 5 years after surgery. Mean best-corrected visual acuity did not change significantly (P>0.05). In all cases, filtering blebs were observed and sustained using antimetabolites. The most common complication was temporary ocular hypotony. Two patients required a revision surgery due to implant malposition.

Conclusions:

The Eyepass glaucoma implant seems to be a safe and effective treatment option for patients with primary open-angle glaucoma. The use of this device resulted in a significant decrease of IOP.
Nonmedical Out-of-Pocket Patient and Companion Expenditures Associated With Glaucoma Care
Authors: Schehlein Emily M. , Im Lily T. , Robin Alan L. , Onukwugha Eberechukwu , Saeedi Osamah J.
Published: January 2017

Purpose:

Nonmedical out-of-pocket cost to both patients and their companions of office visits for routine glaucoma care has not been extensively studied in the United States. We evaluate potential key predictors of patient expenditures that are critical to assessing the cost-effectiveness of glaucoma health care delivery.

Materials and Methods:

In total, 300 patients responded to the survey in 3 clinics in 2 clinical practice settings. Main outcome measures included both average visit and yearly expenditures.

Results:

Of the 300 patients, the majority were female (n=187, 62.3%) and African American (n=171, 57.0%). The median age was 66 years. The median [range; mean (SD)] expenditure per patient visit was $22.10 ($11.1, $42.9; $44.1 (72.8)). Patients with companions paid $38.77 more in average visit expenditure (β: 0.87, P<0.001). The average visit expenditure for retired patients was $17.37 less when compared with nonretired patients (β: −0.4, P=0.004). Patients living in a rural or suburban area paid $43.91 and $14.13 more per visit, respectively (β: 0.73, P=0.0004; β: 0.31, P=0.03), compared with patients living in an urban area. Patients with noncommercial insurance paid $24.01 less in average visit expenditure (β: −0.66, P=0.0008). The median yearly patient expenditure was $96.70 [$44.6, $222.7; $210.4 (333.9)]. Patients with companions paid $192.37 more in yearly expenditure (β: 0.9, P<0.001) than those without companions, whereas retired patients paid $80.83 less in yearly expenditure (β: −0.39, P=0.03) than nonretirees. Patients with noncommercial insurance paid $109.34 less in yearly expenditure (β: −0.63, P=0.01).

Conclusions:

Although a small part of the total cost of glaucoma care, nonmedical out-of-pocket costs constitute a substantial noncovered medical expense to most patients in the United States. Patients who are employed, come with companions, live in nonurban areas, or are on Medicare have greater expenditures.
Long-term Clinical and Radiologic Outcome in 500 Children With Parenchymal Neurocysticercosis
Authors: Singhi Pratibha , Suthar Renu , Deo Brijendra , Malhi Prabhjot , Khandelwal Niranjan K.
Published: January 2017

Background:

Our aim was to study long-term clinical and radiologic outcome in children with parenchymal neurocysticercosis (NCC) and its predictors.

Method:

Five hundred children with NCC registered in the pediatric NCC clinic between January 1996 and December 2002 and followed till December 2009 were enrolled. Demographic details, clinical presentations and therapy received were recorded. Outcome was evaluated in terms of seizure recurrence and resolution of lesions on neuroimaging. Various factors that could influence outcome were studied.

Results:

Mean age at presentation was 8 ± 2.7 years, and the mean duration of follow-up was 8.8 ± 2.03 years; 79.6% (398) had single lesion, and 20.4% (102) had multiple lesions at presentation; 14.5% (58) of children with single lesion, and 28.4% (29) of children with multiple lesions had recurrent seizures (P < 0.001) during follow-up. At 6-month follow-up neuroimaging, resolution was seen in 52.7% (210) and 31.3% (32) of children with single and multiple lesions, respectively (P < 0.001). On prolonged follow-up, 94.6% (384) of single-lesion NCC and 88% (90) of multiple-lesion NCC (P < 0.001) had radiologic resolution. Single-lesion NCC, radiologic resolution and cysticidal therapy were associated with better seizure outcome (P < 0.05). Children with multiple lesions had significantly higher percentage of calcified lesions on long-term follow-up compared with those with a single lesion (11.7% vs. 3.6%, P < 0.05).

Conclusions:

Children with a single-lesion NCC have favorable outcome with resolution of most of the lesions and few seizure recurrences. Cysticidal therapy leads to better seizure control and increased resolution of lesions on short-term follow-up.
Early Antiretroviral Therapy Initiation and Mortality Among Infants Diagnosed With HIV in the First 12 Weeks of Life
Authors: Sheahan Anna , Feinstein Lydia , Dube Queen , Edmonds Andrew , Chirambo Chawanangwa Mahebere , Smith Emily , Behets Frieda , Heyderman Robert , Van Rie Annelies
Published: January 2017

Background:

Based on clinical trial results, the World Health Organization recommends infant HIV testing at age 4–6 weeks and immediate antiretroviral therapy (ART) initiation in all HIV-infected infants. Little is known about the outcomes of HIV-infected infants diagnosed with HIV in the first weeks of life in resource-limited settings. We assessed ART initiation and mortality in the first year of life among infants diagnosed with HIV by 12 weeks of age.

Methods:

Cohort of HIV-infected infants in Kinshasa and Blantyre diagnosed before 12 weeks to estimate 12-month cumulative incidences of ART initiation and mortality, accounting for competing risks. Multivariate models were used to estimate associations between infant characteristics and timing of ART initiation.

Results:

One hundred and twenty-one infants were diagnosed at a median age of 7 weeks (interquartile range, 6–8). The cumulative incidence of ART initiation was 46% [95% confidence interval (CI), 36%, 55%] at 6 months and 70% (95% CI 60%, 78%) at 12 months. Only age at HIV diagnosis was associated with ART initiation by age 6 months, with a subdistribution hazard ratio of 0.70 (95% CI 0.52, 0.91) for each week increase in age at DNA polymerase chain reaction test. The 12-month cumulative incidence of mortality was 20% (95% CI 13%, 28%).

Conclusions:

Despite early diagnosis of HIV, ART initiation was slow and mortality remained high, underscoring the complexity in translating clinical trial findings and World Health Organization’s guidance into real-life practice. Novel and creative health system interventions will be required to ensure that all HIV-infected infants achieve optimal treatment outcomes under routine care settings.
HIV-infected Children in Malawi Have Decreased Performance on the 6-minute Walk Test With Preserved Cardiac Mechanics Regardless of Antiretroviral Treatment Status
Authors: Sims Sanyahumbi Amy E. , Hosseinipour Mina C. , Guffey Danielle , Hoffman Irving , Kazembe Peter N. , McCrary Madeline , Minard Charles G. , van der Horst Charles , Sable Craig A.
Published: January 2017

Aim:

The aims of this study were to 1) determine if cardiac disease can be detected in HIV-infected children by strain imaging and 2) to evaluate differences in exercise performance between HIV-infected children on antiretroviral therapy (ART) and HIV-infected children not yet on ART and in HIV-uninfected children by 6-minute walk tests (6MWTs).

Methods:

This cross-sectional study evaluated cardiac function by echocardiogram and exercise performance by 6MWT in HIV-infected and HIV-uninfected children 4–18 years of age in Lilongwe, Malawi. Analyses compared HIV uninfected, HIV infected not yet on ART, and HIV infected on ART. Comparisons used χ2 test, t test, analysis of variance and multiple linear regression.

Results:

No differences were found in ejection fraction, shortening fraction or strain in 73 children not yet on ART, 149 on ART and 77 HIV-uninfected controls. As viral load increased, children had worse circumferential strain. In addition, children receiving ART had better circumferential strain than those not yet on ART. Increased CD4 percentage was associated with better longitudinal strain and farther 6MWT distance. As longitudinal strain worsened, the 6MWT distance decreased. HIV-infected children not yet on ART walked a mean of 25.8 m less than HIV-uninfected children, and HIV-infected children on ART walked 25.9 m less (P = 0.015 comparing 3 groups).

Conclusions:

HIV-uninfected children performed better on the 6MWT than HIV-infected children. Lower viral load, being on ART, and higher CD4 percentage were associated with better strain measures. Better longitudinal strain was associated with a farther 6MWT distance. Overall, ejection fraction, shortening fraction and strain measures between groups were similar, so cardiac strain did not detect cardiac dysfunction in this young population.
Epigenetic divergence in the TRPA1 promoter correlates with pressure pain thresholds in healthy individuals
Authors: Gombert Sara , Rhein Mathias , Eberhardt Mirjam , Münster Tino , Bleich Stefan , Leffler Andreas , Frieling Helge
Published: January 2017

The expression pattern of important transduction molecules in nociceptive sensory neurons is likely to dictate pain sensitivity. While this notion is well established for increased pain sensitivities under conditions like inflammation and neuropathy, less is known as to which molecules are defining interindividual differences in pain sensitivity in healthy subjects. A genome-wide methylation analysis on monozygotic twins found that methylation of a CpG dinucleotide in the promoter of transient receptor potential ankyrin 1 (TRPA1) is inversely associated with the threshold for heat-induced pain. Several in vitro studies also suggest that TRPA1 mediates mechanical sensitivity of sensory afferents, thus potentially mediating pressure-evoked pain. In the present study, we therefore investigated the epigenetic predisposition for pressure pain by analyzing the methylation status of 47 CpG sites in the promoter region of TRPA1. Using DNA from whole-blood samples of 75 healthy volunteers, we found that the same CpG site previously found to affect the threshold for heat-evoked pain is hypermethylated in subjects with a low threshold for pressure pain. We also found gender differences, with females displaying higher methylation rates combined with higher pressure pain sensitivities as compared with males. In conclusion, our findings support the notion that epigenetic regulation of TRPA1 seems to regulate thermal and mechanical pain sensitivities.
Intense pain influences the cortical processing of visual stimuli projected onto the sensitized skin
Authors: Torta Diana M.E. , Van Den Broeke Emanuel N. , Filbrich Lieve , Jacob Benvenuto , Lambert Julien , Mouraux André
Published: January 2017

Sensitization is a form of implicit learning produced by the exposure to a harmful stimulus. In humans and other mammals, sensitization after skin injury increases the responsiveness of peripheral nociceptors and enhances the synaptic transmission of nociceptive input in the central nervous system. Here, we show that sensitization-related changes in the central nervous system are not restricted to nociceptive pathways and, instead, also affect other sensory modalities, especially if that modality conveys information relevant for the sensitized body part. Specifically, we show that after sensitizing the forearm using high-frequency electrical stimulation (HFS) of the skin, visual stimuli projected onto the sensitized forearm elicit significantly enhanced brain responses. Whereas mechanical hyperalgesia was present both 20 and 45 minutes after HFS, the enhanced responsiveness to visual stimuli was present only 20 minutes after HFS. Taken together, our results indicate that sensitization involves both nociceptive-specific and multimodal mechanisms, having distinct time courses.
E-Prescribing and Adverse Drug Events
Authors: Gabriel Meghan Hufstader , Powers Christopher , Encinosa William , Bynum Julie P.W.
Published: January 2017

Background:

Although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes.

Objective:

To examine the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia.

Design:

This is a prospective, observational cohort study with patient fixed effects.

Setting:

2011–2013 fee for service Medicare.

Patients:

In total, 3.1 million Medicare fee for service, Part D enrolled beneficiaries over age 66 with diabetes mellitus and at least 90 days of antidiabetic medications.

Measurements:

E-prescribing was measured as the percentage of all prescriptions a person received transmitted to the pharmacy electronically. The outcome measure was the occurrence of an emergency department (ED) visit or hospitalization for hypoglycemia or diabetes-related ADE.

Results:

Unadjusted results show that there were 21 ADEs per 1000 beneficiaries that had ≥75% of their medications e-prescribed. Beneficiaries with lower e-prescribing levels had significantly higher numbers of ADEs. We found a robust association between the greater use of electronic prescriptions in the outpatient setting and the lower risk of an inpatient or ED visit for an ADE event among Medicare beneficiaries with diabetes in our adjusted analysis. At the e-prescribing threshold of 75% and above, significant reductions in ADE risk can be seen.

Limitations:

As an observational study, the results show an association but do not prove causation.

Conclusions:

Use of e-prescribing is associated with lower risk of an ED visit or hospitalization for diabetes-related ADE.
Evaluating the Effects of Pioneer Accountable Care Organizations on Medicare Part D Drug Spending and Utilization
Authors: Zhang Yuting , Caines Kadin J. , Powers Christopher A.
Published: January 2017

Background:

The improvement of medication use is a critical mechanism that accountable care organization (ACO) could use to save overall costs. Currently pharmaceutical spending is not part of the calculation for ACO-shared savings and risks. Thus, ACO providers may have strong incentives to prescribe more medications hoping to avoid expensive downstream medical costs.

Methods:

We designed a quasinatural experiment study to evaluate the effects of Pioneer ACOs on Medicare Part D spending and utilization. Medicare fee-for-service beneficiaries with Part D drug coverage who were aligned to a Pioneer ACO were compared with a random 5% sample of non-ACO beneficiaries. Outcomes included changes in Part D spending, number of prescription fills, percent of brand medications, and total Part A and B medical spending. We utilized a generalized linear model with a difference-in-differences approach to estimate 2011–2012 changes in these outcomes among beneficiaries aligned with Pioneer ACOs, adjusting for all beneficiary-level demographics, income and insurance status, clinical characteristics, and regional fixed effects.

Results:

Being in an ACO did not significantly affect Part D spending (−$23.52; P=0.19), total prescriptions filled (−0.12; P=0.27), and the percent of claims for brand-name drugs (0.06%; P=0.23). The ACO group was associated with savings in Parts A and B spending of $345 (P<0.0001) per person per year.

Conclusions:

We found that beneficiaries aligned to Pioneer ACOs were not associated with changes in pharmaceutical spending and use, but were associated with savings in Parts A and B spending in 2012.
Conservative surgery for laryngeal chondrosarcoma: a review of the most recently proposed approaches
Authors: Piazza Cesare , Paderno Alberto , Nicolai Piero
Published: January 2017

Purpose of review

The aim of this study was to describe the most recent technical nuances for resection and reconstruction of Grade 1 and 2 laryngeal chondrosarcomas, with a special emphasis on those located at the level of the cricoid plate, which is the site of origin of the vast majority of these rare tumours.

Recent findings

Even though inherently based on retrospective small clinical series or anecdotal case reports, a number of studies have been recently published focusing on conservative transoral and open-neck surgical procedures aimed at an oncologically sound removal of the tumour together with organ and function preservation. The open-neck conservative approaches herein reported can be roughly distinguished in those achieving a primary airway reconstruction by a tracheo-hyoido-epiglottopexy or an end-to-end crico-tracheal, thyro-crico-tracheal or thyro-tracheal anastomosis, and those requiring a single or double-staged transposition of different microvascular flaps, with or without cartilaginous graft insertion, to reconstruct a subtotal/total cricoidectomy and obtain a rigid and stable subglottic airway.

No meaningful comparison in terms of oncologic and functional outcomes is still possible among the currently available conservative surgical strategies, due to the rarity of laryngeal chondrosarcomas and the heterogeneity of treatments proposed in the literature. However, a reasonable algorithm to approach this difficult clinical entity according to its site of origin and extent of cricoid circumference involved is herein presented.
A Model for Meaningful Conversation in Serious Illness and the Patient Preferences About Serious Illness Instrument
Authors: Whitehead Phyllis B. , Carter Kimberly F.
Published: January 2017

End-of-life (EOL) conversations are difficult for patients, families, and health care providers. Strategies are needed to elicit seriously ill patients’ care preferences. Ongoing discussions between patients and health care providers, throughout the course of a serious disease, can increase patients’ self-efficacy in planning EOL decisions. Instruments that provide structured approaches to guide these challenging EOL conversations are needed. The Patient Preferences About Serious Illness Instrument (PASI) is a resource to normalize the conversation for practitioners and should be used in conjunction with existing advanced care planning directives such as Physician Orders for Life-Sustaining Treatments and The Five Wishes. This article introduces a new model of meaningful conversation in serious illness and provides information about how the PASI can be used to support the challenging conversations that are important for patients facing serious illness. Case examples are presented to illustrate the value of the PASI in eliciting preferences.
Familial Interaction Patterns During the Palliative Phase of a Family Member Living With Cancer
Authors: Möllerberg Marie-Louise , Sandgren Anna , Swahnberg Katarina , Benzein Eva
Published: January 2017

This study aimed to illuminate aspects of familial interactions when 1 member is in the palliative phase of his/her cancer course. An individual cancer diagnosis influences the entire family, often requiring daily life changes for all members. Current research has examined individual family member perspectives; family system nursing studies are warranted. Narrative family interviews were conducted on 13 families living with cancer. The interviews were transcribed and analyzed according to a hermeneutic method. Analyses revealed the following: Family interaction patterns were adjusted in response to changes in family life, which encompassed 3 different, but interrelated, patterns: (1) power dynamics in the family, (2) the “secret game” in the family, and (3) multifaceted closeness and distance in the family. It is crucial to adopt a family perspective during palliative care to meet each unique family's needs. Health care facilitators should be aware of the complex dynamics and challenges that these families encounter. This will help obtain a greater understanding of factors underlying effective palliative care.
Hospice Staff Perceptions of Information Needs Among Patients and Families During Hospice Admissions Visits
Authors: Noh Hyunjin , Guo Yuqi , Halli-Tierney Anne , Anderson Kimberly Granda
Published: January 2017

Lack of hospice knowledge is 1 of the major barriers to its utilization. Initial meetings between patients/families and hospice admissions staff occurring before hospice enrollment provide a great opportunity to clarify patients’ and families’ misunderstandings of hospice, address concerns, and share in-depth information, thus facilitating informed decision making. This qualitative study explored hospice admissions staff’s perceptions of patients’ and families’ informational needs identified during initial meetings. Interviews conducted with 16 admissions staff members from 4 hospice agencies were analyzed using thematic analysis. Five areas of informational needs emerged. Patients and families often lacked knowledge of patient condition and illness progression and awareness of changes in bodily needs for nutrition/hydration and medication near death. Misconceptions about pain medicine in hospice are another area identified. Patients and families did not always realize risks of life-sustaining treatments. Finally, the availability of interdisciplinary service was not often known. Insufficient patient-health care provider communication contributes to lack of information in these areas. Although admissions staff can fill information gaps, patient-health care provider conversations on end-of-life issues should occur earlier than waiting until the patient is referred to hospice. Future studies should examine strategies to address informational needs and assess patient/family satisfaction with provided information.
Strengths of Parents Caring for Their Children in Hospice/Palliative Care
Authors: Haley Janice M.
Published: January 2017

Little is known about the strengths of parents caring for their child who is receiving hospice/palliative care in Kenya. The purposes of this study were (1) to identify the sources of strength parent caregivers of Kenya turn to when their child is receiving palliative/hospice care in the home, (2) to assess if new strengths emerge with this population in comparison to previous studies, and (3) to assess if the Strengths Guide (SG) is an intervention that improves the parents’ awareness of their value and utilization of their strengths. This descriptive study explored how these parents define strength and specifically where they find strength to carry on. A constant comparative analysis was used to identify the sources of strength. Before and after administering the SG, a “pre and post” Personal Strengths Scale was utilized to rate any differences in the parent’s strength. Participants were located through a rural hospice in Western Kenya. No new themes were identified when compared with previous studies. The source of spirituality was unanimously identified as the most extremely important strength and overwhelmingly threaded throughout nearly the 10 other sources of strength identified. The SG was found to be a welcomed and effective intervention for nurses to use with this population.
A New Scoring System to Predict Recurrent Disease in Grade 1 and 2 Nonfunctional Pancreatic Neuroendocrine Tumors
Authors: Genç Cansu G. , Jilesen Anneke P. , Partelli Stefano , Falconi Massimo , Muffatti Francesca , van Kemenade Folkert J. , van Eeden Susanne , Verheij Joanne , van Dieren Susan , van Eijck Casper H. J. , Nieveen van Dijkum Elisabeth J. M.
Published: January 2017

Objective:

The aim of this study was to predict recurrence in patients with grade 1 or 2 nonfunctioning pancreatic neuroendocrine tumors (NF-pNET) after curative resection.

Background:

Surgical resection is the preferred treatment for NF-pNET; however, recurrence occurs frequently after curative surgery, worsening prognosis of patients.

Methods:

Retrospectively, patients with NF-pNET of 3 institutions were included. Patients with distant metastases, hereditary syndromes, or grade 3 tumors were excluded. Local or distant tumor recurrence was scored. Independent predictors for survival and recurrence were identified using Cox-regression analysis. The recurrence score was developed to predict recurrence within 5 years after curative resection of grade 1 to 2 NF-pNET.

Results:

With a median follow-up of 51 months, 211 patients with grade 1 to 2 NF-pNET were included. Thirty-five patients (17%) developed recurrence. The 5- and 10-year disease-specific/overall survival was 98%/91% and 84%/68%, respectively. Predictors for recurrence were tumor grade 2, lymph node metastasis, and perineural invasion. On the basis of these predictors, the recurrence score was made. Discrimination [c-statistic 0.81, 95% confidence interval (95% CI) 0.75–0.87] and calibration (Hosmer Lemeshow Chi-square 11.25, P = 0.258) indicated that the ability of the recurrence score to identify patients at risk for recurrence is good.

Conclusions:

This new scoring system could predict recurrence after curative resection of grade 1 and 2 NF-pNET. With the use of the recurrence score, less extensive follow-up could be proposed for patients with low recurrence risk. For high-risk patients, clinical trials should be initiated to investigate whether adjuvant therapy might be beneficial. External validation is ongoing due to limited availability of adequate cohorts.
Here and there, but not everywhere: repeated loss of
uncoupling protein 1
in amniotes
Authors: McGaugh Suzanne , Schwartz Tonia S.
Published: January 2017

Endothermy is an evolutionary innovation in eutherian mammals and birds. In eutherian mammals, UCP1 is a key protein in adaptive nonshivering thermogenesis (NST). Although
ucp1
arose early in the vertebrate lineage, the loss of
ucp1
was previously documented in several reptile species (including birds). Here we determine that
ucp1
was lost at the base of the reptile lineage, as we fail to find
ucp1
in every major reptile lineage. Furthermore, though UCP1 plays a key role in mammalian NST, we confirm that pig has lost several exons from
ucp1
and conclude that pig is not a sole outlier as the only eutherian mammal lineage to do so. Through similarity searches and synteny analysis, we show that
ucp1
has also been lost/pseudogenized in Delphinidae (dolphin, orca) and potentially Xenarthra (sloth, armadillo) and Afrotheria (hyrax). These lineages provide models for investigating alternate mechanisms of thermoregulation and energy metabolism in the absence of functional UCP1. Further, the repeated losses of a functional UCP1 suggest the pervasiveness of NST via UCP1 across the mammalian lineage needs re-evaluation.
Modelling and parameter inference of predator–prey dynamics in heterogeneous environments using the direct integral approach
Authors: Dattner Itai , Miller Ezer , Petrenko Margarita , Kadouri Daniel E. , Jurkevitch Edouard , Huppert Amit
Published: January 2017

Most bacterial habitats are topographically complex in the micro scale. Important examples include the gastrointestinal and tracheal tracts, and the soil. Although there are myriad theoretical studies that explore the role of spatial structures on antagonistic interactions (predation, competition) among animals, there are many fewer experimental studies that have explored, validated and quantified their predictions. In this study, we experimentally monitored the temporal dynamic of the predatory bacteriumBdellovibrio bacteriovorus, and its prey, the bacteriumBurkholderia stabilisin a structured habitat consisting of sand under various regimes of wetness. We constructed a dynamic model, and estimated its parameters by further developing the direct integral method, a novel estimation procedure that exploits the separability of the states and parameters in the model. We also verified that one of our parameter estimates was consistent with its known, directly measured value from the literature. The ability of the model to fit the data combined with realistic parameter estimates indicate that bacterial predation in the sand can be described by a relatively simple model, and stress the importance of prey refuge on predation dynamics in heterogeneous environments.
Thioflavin T as an amyloid dye: fibril quantification, optimal concentration and effect on aggregation
Authors: Xue Christine , Lin Tiffany Yuwen , Chang Dennis , Guo Zhefeng
Published: January 2017

Formation of amyloid fibrils underlies a wide range of human disorders, including Alzheimer's and prion diseases. The amyloid fibrils can be readily detected thanks to thioflavin T (ThT), a small molecule that gives strong fluorescence upon binding to amyloids. Using the amyloid fibrils of Aβ40 and Aβ42 involved in Alzheimer's disease, and of yeast prion protein Ure2, here we study three aspects of ThT binding to amyloids: quantification of amyloid fibrils using ThT, the optimal ThT concentration for monitoring amyloid formation and the effect of ThT on aggregation kinetics. We show that ThT fluorescence correlates linearly with amyloid concentration over ThT concentrations ranging from 0.2 to 500 µM. At a given amyloid concentration, the plot of ThT fluorescence versus ThT concentration exhibits a bell-shaped curve. The maximal fluorescence signal depends mostly on the total ThT concentration, rather than amyloid to ThT ratio. For the three proteins investigated, the maximal fluorescence is observed at ThT concentrations of 20–50 µM. Aggregation kinetics experiments in the presence of different ThT concentrations show that ThT has little effect on aggregation at concentrations of 20 µM or lower. ThT at concentrations of 50 µM or more could affect the shape of the aggregation curves, but this effect is protein-dependent and not universal.
Beyond linear fields: the Lie–Taylor expansion
Authors: Arter Wayne
Published: January 2017

The work extends the linear fields’ solution of compressible nonlinear magnetohydrodynamics (MHD) to the case where the magnetic field depends on superlinear powers of position vector, usually, but not always, expressed in Cartesian components. Implications of the resulting Lie–Taylor series expansion for physical applicability of the Dolzhansky–Kirchhoff (D–K) equations are found to be positive. It is demonstrated how resistivity may be included in the D–K model. Arguments are put forward that the D–K equations may be regarded as illustrating properties of nonlinear MHD in the same sense that the Lorenz equations inform about the onset of convective turbulence. It is suggested that the Lie–Taylor series approach may lead to valuable insights into other fluid models.
Finite-element modelling of elastic wave propagation and scattering within heterogeneous media
Authors: Van Pamel A. , Sha G. , Rokhlin S. I. , Lowe M. J. S.
Published: January 2017

The scattering treated here arises when elastic waves propagate within a heterogeneous medium defined by random spatial fluctuation of its elastic properties. Whereas classical analytical studies are based on lower-order scattering assumptions, numerical methods conversely present no such limitations by inherently incorporating multiple scattering. Until now, studies have typically been limited to two or one dimension, however, owing to computational constraints. This article seizes recent advances to realize a finite-element formulation that solves the three-dimensional elastodynamic scattering problem. The developed methodology enables the fundamental behaviour of scattering in terms of attenuation and dispersion to be studied. In particular, the example of elastic waves propagating within polycrystalline materials is adopted, using Voronoi tessellations to randomly generate representative models. The numerically observed scattering is compared against entirely independent but well-established analytical scattering theory. The quantitative agreement is found to be excellent across previously unvisited scattering regimes; it is believed that this is the first quantitative validation of its kind which provides significant support towards the existence of the transitional scattering regime and facilitates future deployment of numerical methods for these problems.
Noise Control In Gene Regulatory Networks With Negative Feedback
Authors: Hinczewski Michael , Thirumalai D.
Published: January 2017

Genes and proteins regulate cellular functions through complex circuits of biochemical reactions. Fluctuations in the components of these regulatory networks result in noise that invariably corrupts the signal, possibly compromising function. Here, we create a practical formalism based on ideas introduced by Wiener and Kolmogorov (WK) for filtering noise in engineered communications systems to quantitatively assess the extent to which noise can be controlled in biological processes involving negative feedback. Application of the theory, which reproduces the previously proven scaling of the lower bound for noise suppression in terms of the number of signaling events, shows that a tetracycline repressor-based negative-regulatory gene circuit behaves as a WK filter. For the class of Hill-like nonlinear regulatory functions, this type of filter provides the optimal reduction in noise. Our theoretical approach can be readily combined with experimental measurements of response functions in a wide variety of genetic circuits, to elucidate the general principles by which biological networks minimize noise.
Gravitropic Movement in Wheat Coleoptile is Regulated by Ultradian Growth Oscillations
Authors: Bastien Renaud , Guayasamin Olivia , Douady Stéphane , Moulia Bruno
Published: January 2017

To stand straight and upright along their growth, plants needs to regulate actively their posture. Gravitropic movement, which occurs when plants modify their growth and curvature to orient their aerial organ against the force of gravity, is a major feature of this postural control. A recent model has shown that graviception and proprioception are sufficient to account for the gravitropic movement and subsequent organ posture demonstrated by a range of species. However, some plants, including wheat coleoptiles, exhibit a stronger regulation of posture than predicted by the model. Here, we performed an extensive kinematics study on wheat coleoptiles during a gravitropic perturbation experiment in order to better understand this unexpectedly strong regulation. Close temporal observation of the data revealed that both perturbed and unperturbed coleoptiles showed oscillatory pulses of elongation and curvature variation that propagated from the apex to the base of their aerial organs. In perturbed (tilted) coleoptiles, we discovered a non-trivial coupling between the oscillatory dynamics of curvature and elongation. This relationship appears to be critical to the postural control of the organ, and indicates the presence of a mechanism that is capable of affecting the relationship between elongation rate, differential growth, and curvature.
Existence and construction of large stable food webs
Authors: Haerter Jan O. , Mitarai Namiko , Sneppen Kim
Published: January 2017

Ecological diversity is ubiquitous despite the restrictions imposed by competitive exclusion and apparent competition. To explain the observed richness of species in a given habitat, food web theory has explored nonlinear functional responses, self-interaction or spatial structure and dispersal — model ingredients that have proven to promote stability and diversity. We here instead return to classical Lotka-Volterra equations, where species-species interaction is characterized by a simple product and spatial restrictions are ignored. We quantify how this idealization imposes constraints on coexistence and diversity for many species. To this end, we introduce the concept offreeandcontrolledspecies and use this to demonstrate how stable food webs can be constructed by sequential addition of species. When we augment the resulting network by additional weak interactions we are able to show that it is possible to construct large food webs of arbitrary connectivity. Our model thus serves as a formal starting point for the study of sustainable interaction patterns between species.
Lateral geniculate neurons show robust ocular dominance plasticity
Authors: Jäpel Juliane , Hübener Mark , Bonhoeffer Tobias , Rose Tobias
Published: January 2017

Experience-dependent plasticity in the mature visual system is considered exclusively cortical. Using chronic two-photon Ca2+imaging, we found evidence against this tenet: dLGN cells showed robust ocular dominance shifts after monocular deprivation. Most, but not all responses of dLGN cell boutons in binocular visual cortex were monocular during baseline. Following deprivation, however, deprived-eye dominated boutons became responsive to the non-deprived eye. Thus, plasticity of dLGN neurons contributes to cortical ocular dominance shifts.