bluuebunny/crossref_metadata_2025 huggingface dataset:
Mkt1 is required for RNAi-mediated silencing and establishment of heterochromatin in fission yeast
Authors: Taglini Francesca , Chapman Elliott , van Nues Rob , Theron Emmanuelle , Bayne Elizabeth H
Published: November 2019

Constitutive domains of repressive heterochromatin are maintained within the fission yeast genome through self-reinforcing mechanisms involving histone methylation and small RNAs. Non-coding RNAs generated from heterochromatic regions are processed into small RNAs by the RNA interference pathway, and are subject to silencing through both transcriptional and post-transcriptional mechanisms. While the pathways involved in maintenance of the repressive heterochromatin state are reasonably well understood, less is known about the requirements for its establishment. Here, we describe a novel role for the post-transcriptional regulatory factor Mkt1 in establishment of heterochromatin at pericentromeres in fission yeast. Loss of Mkt1 does not affect maintenance of existing heterochromatin, but does affect its recovery following depletion, as well as de novo establishment of heterochromatin on a mini-chromosome. Pathway dissection revealed that Mkt1 is required for RNAi-mediated post-transcriptional silencing, downstream of small RNA production. Mkt1 physically associates with pericentromeric transcripts, and is additionally required for maintenance of silencing and heterochromatin at centromeres when transcriptional silencing is impaired. Our findings provide new insight into the mechanism of RNAi-mediated post-transcriptional silencing in fission yeast, and unveil an important role for post-transcriptional silencing in establishment of heterochromatin that is dispensable when full transcriptional silencing is imposed.
Myrf guides target gene selection of transcription factor Sox10 during oligodendroglial development
Authors: Aprato Jessica , Sock Elisabeth , Weider Matthias , Elsesser Olga , Fröb Franziska , Wegner Michael
Published: November 2019

Oligodendrocytes generate myelin in the vertebrate central nervous system and thus ensure rapid propagation of neuronal activity. Their development is controlled by a network of transcription factors that function as determinants of cell identity or as temporally restricted stage-specific regulators. The continuously expressed Sox10 and Myrf, a factor induced during late development, are particularly important for terminal differentiation. How these factors function together mechanistically and influence each other, is not well understood. Here we show that Myrf not only cooperates with Sox10 during the induction of genes required for differentiation and myelin formation. Myrf also inhibits the activity of Sox10 on genes that are essential during earlier phases of oligodendroglial development. By characterization of the exact DNA-binding requirements of Myrf, we furthermore show that cooperative activation is a consequence of joint binding of Sox10 and Myrf to the same regulatory regions. In contrast, inhibition of Sox10-dependent gene activation occurs on genes that lack Myrf binding sites and likely involves physical interaction between Myrf and Sox10 followed by sequestration. These two opposite activities allow Myrf to redirect Sox10 from genes that it activates in oligodendrocyte precursor cells to genes that need to be induced during terminal differentiation.
B-cell treatment in ANCA-associated vasculitis
Authors: Karras Alexandre , Lazareth Hélène , Chauvet Sophie
Published: November 2019

The pivotal role of B-cells in ANCA-associated vasculitis has been suggested by experimental data that demonstrate the direct pathogenicity of ANCAs. Rituximab (RTX), an anti-CD20 monoclonal antibody that targets B-cells, has proven its efficacy for induction of remission in severe ANCA vasculitis. RTX is equivalent to CYC for induction of remission, and is probably superior in relapsing patients. Long-term B cell depletion by prolonged RTX treatment has been shown to significantly reduce the relapse rate, when compared with AZA maintenance therapy. Biomarkers, such as B-cell subpopulations or ANCA monitoring, may help the clinician to determine the optimal dose and duration of RTX therapy.
Disproportionality in Juvenile Justice Diversion: An Examination of Teen Court Peer-Derived Consequences
Authors: Stalker Katie Cotter
Published: November 2019

Juvenile justice diversion programs, such as Teen Court (TC), represent an alternative to traditional juvenile justice responses to youth misbehavior and delinquency. However, although TC represents a potential strategy to address disproportionate minority contact, there is a dearth of research examining the extent to which TC programs are racially equitable. To address this gap, the current study examines racial disproportionality in a TC program in Arizona. Results indicated that in a diverse sample of youths involved in a TC program in Arizona, youths who identified as Latinx or American Indian were more likely to receive a severe consequence from the peer jury compared with their non-Latinx, white counterparts. Multiracial youths were less likely to receive a severe consequence compared with white youths. A hierarchical regression model indicated that offense-related variables explained the largest proportion of variance in number of consequence hours assigned. However, disparities for Latinx and American Indian youths compared with non-Latinx, white youths persisted after controlling for other demographics, type of offense, prior offenses, and additional charges. The results of the current study are the first to document racial disparity in the TC process.
DNA sequence repeats identify numerous Type I restriction‐modification systems that are potential epigenetic regulators controlling phase‐variable regulons; phasevarions
Authors: Atack John M. , Guo Chengying , Yang Long , Zhou Yaoqi , Jennings Michael P.
Published: November 2019

Over recent years several examples of randomly switching methyltransferases, associated with Type III restriction‐modification (R‐M) systems, have been described in pathogenic bacteria. In every case examined, changes in simple DNA sequence repeats result in variable methyltransferase expression and result in global changes in gene expression, and differentiation of the bacterial cell into distinct phenotypes. These epigenetic regulatory systems are called phasevarions, phase‐variable regulons, and are widespread in bacteria, with 17.4% of Type III R‐M system containing simple DNA sequence repeats. A distinct, recombination‐driven random switching system has also been described in Streptococci in Type I R‐M systems that also regulate gene expression. Here, we interrogate the most extensive and well‐curated database of R‐M systems, REBASE, by searching for all possible simple DNA sequence repeats in the hsdRMS genes that encode Type I R‐M systems. We report that 7.9% of hsdS, 2% of hsdM, and of 4.3% of hsdR genes contain simple sequence repeats that are capable of mediating phase variation. Phase variation of both hsdM and hsdS genes will lead to differential methyltransferase expression or specificity, and thereby the potential to control phasevarions. These data suggest that in addition to well characterized phasevarions controlled by Type III mod genes, and the previously described Streptococcal Type I R‐M systems that switch via recombination, approximately 10% of all Type I R‐M systems surveyed herein have independently evolved the ability to randomly switch expression via simple DNA sequence repeats.
Transesophageal echocardiography in minimally invasive cardiac surgery
Authors: Prempeh Agya B.A. , Scherman Jacques , Swanevelder Justiaan L.
Published: November 2019

Purpose of review

Transesophageal echocardiography (TEE) has made its way into the cardiac surgery realm and spurred the development of many interventions. In the domain of minimally invasive cardiac surgery (MICS), TEE has become central to reducing cardiovascular complications.

Recent findings

Real-time three-dimensional TEE is a key contributor to the safe and precise deployment of the PASCAL mitral valve repair system, which is showing great potential in ongoing studies. The current data on outcomes of transcatheter aortic valve replacement show that preprocedural three-dimensional TEE and multidetector computed tomography (CT) perform similarly in aortic root assessment. Three-dimensional color Doppler TEE has been suggested to be more appropriate in quantifying residual mitral regurgitation and evaluating the success of surgical or percutaneous closure. A three-dimensional TEE-derived aortomitral angle may be valuable in predicting and detecting dynamic left ventricular outflow tract obstruction, thereby enhancing the safety of transcatheter mitral valve replacement.

Advanced imaging modalities are essential for the sustained growth of MICS, particularly with the evolution of novel transcatheter systems. These techniques rely on exceptional imaging quality at all stages of the perioperative period to modify surgical-risk and improve patient outcomes. TEE has the additional benefit of providing real-time information on intrathoracic structures to guide intraoperative management.
Individualizing Glycemic Control in the Critically Ill
Authors: Murphy Claire V. , Saliba Lina , MacDermott Jennifer , Soe Kyaw , Dungan Kathleen M.
Published: November 2019

Hyperglycemia is a common phenomenon in critically ill patients, even in those without diabetes. Two landmark studies established the benefits of tight glucose control (blood glucose target 80-110 mg/dL) in surgical and medical patients. Since then, literature has consistently demonstrated that both hyperglycemia and hypoglycemia are independently associated with increased morbidity and mortality in a variety of critically ill patients. However, tight glycemic control has subsequently come into question due to risks of hypoglycemia and increased mortality. More recently, strategies targeting euglycemia (blood glucose ≤180 mg/dL) have been associated with improved outcomes, although the risk of hypoglycemia remains. More complex targets (ie, glycemic variability and time within target glucose range) and the impact of individual patient characteristics (ie, diabetic status and prehospital glucose control) have more recently been shown to influence the relationship between glycemic control and outcomes in critically ill patients. Although our understanding has increased, the optimal glycemic target is still unclear and glucose management strategies may require adjustment for individual patient characteristics. As glucose management increases in complexity, we realize that traditional means of using meters and strips and paper insulin titration algorithms are potential limitations to our success. To achieve these complex goals for glycemic control, the use of continuous or near-continuous glucose monitoring combined with computerized insulin titration algorithms may be required. The purpose of this review is to discuss the evidence surrounding the various domains of glycemic control and the emerging data supporting the need for individualized glucose targets in critically ill patients.
Lifestyle Risk Factors in Esophageal Cancer
Authors: Zhao Xinyu , Lim Fidelindo
Published: November 2019

Esophageal cancer (EC) is a prevalent type of cancer, affecting more than 16 000 people annually in the United States. Being a high-burden disease, the comprehensive management of EC is challenging, particularly for older adults. In addition, Asian countries have some of the highest age-standardized incidence rates of EC in the world. Epidemiologic studies have revealed that cigarette and cigar smoking, alcohol drinking, obesity, being overweight, and areca chewing increase the risk of EC. This integrative review aims to elucidate the association between lifestyle factors such dietary habits, smoking, and alcohol consumption and EC among the Asian populations with Chinese, Japanese, and Taiwanese ethnicity. The synthesis of the literature found that environmental factors play an important role in the risk of EC occurrence. Although most of the risk factors showed a positive relationship in increasing the risk, studies included in this review reported inconclusive results on whether tea and coffee are risk factors. The consumption of very hot beverages and low intake of green vegetable are associated with EC. Smoking, alcohol intake, and their interaction with diets were found to be the biggest factor in the development of EC. Registered nurses can educate about esophageal thermal injury among persons who have preference for drinking burning-hot beverages and those with multiple risk factors, such as those who smoke and drink excess alcohol, as well as promoting health behaviors and serving as patient advocates.
Bridging the Communication Gap
Authors: Griffith Andy , Haverstick Stacy , Blissick Deb , Colaianne Teresa , Shields Heidi , Johnson Caty , Lucier Rená , Melong Mary Jane , Kasten Kristin , Knott Kevin
Published: November 2019

Background

As of December 31, 2016, in the United States, 22 866 patients received left ventricular assist devices (LVADs) (J Heart Lung Transplant. 2017;36(10):1080-1086). First responders are generally unfamiliar with LVAD equipment functionality (J Heart Lung Transplant. 2018;37(4):S275). When a patient has an emergency either clinically or with a controller alarm or failure, speaking with ventricle assist device (VAD)–trained personnel is imperative to the prevention of adverse events. Starting February 2017, an LVAD program totaling 181 patients at a large teaching hospital changed their afterhours process to reduce wait time between patient call and talking to VAD-trained personnel to increase patient safety and patient satisfaction.

Methods

The Plan-Do-Check-Act quality improvement method was used to evaluate this project from February 2017 to July 2018 by the program's clinical information analyst. An afterhours summary of telephone interactions between VAD program clinicians (VAD coordinators, physician assistants, and nurse practitioner) was used to analyze the use of the “VAD Emergency Line.” An annual patient satisfaction survey was completed to analyze patient satisfaction of the VAD Emergency Line.

Interventions

Review of the afterhours summary was conducted to determine the use of the VAD Emergency Line. The process of afterhours patient calls was changed so that calls are answered immediately by a 24-hour LVAD-trained medical ambulance service, called VAD Emergency Line. Patient use of the VAD Emergency Line was continuously assessed. In November 2017, it was recognized that only 57% of patient calls used the VAD Emergency Line, and further intervention was needed. In November 2017, patients were provided visual reminders to ensure compliance.

Results

Seventeen months after the implementation of the VAD Emergency Line, 92% of patient's afterhours calls were through the VAD Emergency Line. Although there was no statistical significance found, there was clinical significance. Since the implementation of the VAD Emergency Line, patient use of the VAD Emergency Line increased 56% from March 2017 to July 2018. There have been zero adverse safety events. Sixty-one percent of patients strongly agreed to the question “You are able to communicate emergent needs after hours (VAD Emergency Line)?

Conclusion

Implementation of the LVAD Emergency Line has improved communication between patients in the outpatient setting. This increased patient safety by allowing patients to speak to LVAD-trained first responders and VAD coordinator personnel immediately without ever being put on hold. This communication process can be applied to other clinical programs.
Neonatal Compartment Syndrome as a Result of Thromboembolic Event
Authors: Zajac Jocelyn C. , Mantilla-Rivas Esperanza , Tilt Alexandra , Bryant Justin R. , Oh Albert K. , Rogers Gary F.
Published: November 2019

Neonatal compartment syndrome is a rare condition characterized by progressive limb ischemia and tissue necrosis manifesting at birth or in the immediate postpartum period. Early recognition of clinical features and immediate surgical intervention offer the best prognosis, but unfamiliarity with this uncommon entity often results in delayed diagnosis and catastrophic consequences, including limb amputation. We present a case in a preterm neonate who developed a proximal arterial thrombus after sustaining limb ischemia in utero. This case demonstrated that even delayed treatment with appropriate therapy can result in salvage of the limb. Clinicians should be aware of the characteristic skin findings and institute appropriate measures to determine the presence or absence of compartment syndrome.
Left ventricular mass and incident out-of-office hypertension in a general population
Authors: Cuspidi Cesare , Facchetti Rita , Quarti-Trevano Fosca , Sala Carla , Tadic Marijana , Grassi Guido , Mancia Giuseppe
Published: November 2019

Aim:

Findings regarding the association of left ventricular mass (LVM) and new-onset hypertension are based on blood pressure measured in the office. We sought to assess the value of LVM in predicting in-office and out-of-office incident hypertension in members of the general population enrolled in the Pressioni Monitorate E Loro Associazioni study.

Methods:

The study included participants with normal office (n = 792), home (n = 714) and 24-h (n = 825) ambulatory blood pressure (ABP) at baseline evaluation who had a readable echocardiogram at entry and at the end of follow-up. Each normotensive group was divided into quartiles of LVM indexed (LVMI) to height2.7.

Results:

Over a follow-up of 148 months cumulative incidence of new office, home and 24-h ABP hypertension were 35.9, 30.7 and 36.1%, respectively. In fully adjusted models (including age, sex, BMI change during follow-up, baseline serum glucose, creatinine, total cholesterol office, home and 24-h SBP and DBP). higher LVMI values (i.e. the highest vs. the lowest quartile) were independently associated with an increased risk of home [odds ratio (OR) = 2.14, 95% confidence interval (CI) 1.21–3.77, P = 0.008] and 24-h ABP hypertension (OR = 1.70, 95% CI 1.05–2.76, P = 0.03). This was not the case for new-onset office hypertension (OR = 1.61, 95% CI 0.94–2.74, P = 0.07).

Conclusion:

Our study provides the first evidence that in normotensive individuals the magnitude of LVMI is independently associated with the risk of incident out-of-office hypertension.
Urinary tract infection in patients with spinal cord injury after urodynamics under fosfomycin prophylaxis: a retrospective analysis
Authors: Amaral Daniela M. , Pereira Ana Margarida V. C. , Rodrigues Margarida R. , Gandarez Maria de Fátima L. , Cunha Maria R. , Torres Marta S. R.
Published: November 2019

Background:

Urinary tract infection (UTI) is a common complication of spinal cord injury (SCI). Urodynamic testing is widely used for characterization of vesico-sphincteric dysfunction and for therapeutic orientation. As an invasive procedure, the risk of UTI is increased so, in some medical centers, antibiotic prophylaxis is instituted. Fosfomycin is one of the antibiotics used.

Objective:

The aim of this study was to evaluate the incidence of UTI after urodynamics in patients with SCI, under fosfomycin prophylaxis.

Methods:

Retrospective analysis was performed on patients with SCI, admitted to a rehabilitation center between January 2016 and June 2017, who underwent urodynamics studies under fosfomycin prophylaxis. Demographic data, risk factors for UTI—bacteriuria before urodynamics, high residual volume (>100 mL), bladder emptying method, vesico-sphincteric dyssynergia, and detrusor hyperactivity were analyzed. The incidence of UTI after urodynamics was evaluated.

Results:

The study included 84 patients, predominantly men 55 (65.5%). The mean age of the patients was 55.6 (18.9). Eleven (22.5%) had vesico-sphincteric dyssynergia, 32 (65.3%) detrusor hyperactivity and 22 (44.9%) had a high residual volume. Thirty-seven (44.1%) had asymptomatic bacteriuria before the urodynamics. Urinary complaints suggestive of UTI after urodynamics were observed in 2(2.4%) of patients, without significant bacteriuria and identification of bacterial agent.

Conclusions:

The incidence of UTI after invasive procedures is reported between 3% and 20% in the literature, so antibiotic prophylaxis has been instituted, although controversial. In the study, in none of the patients the diagnosis of UTI was confirmed. Fosfomycin prophylaxis may have been important in reducing the incidence of UTI.
Frailty and Neurocognitive Impairment: Impacts on Quality of Life in HIV
Authors: Rubtsova Anna A. , Sabbag Samir , Sundermann Erin , Nguyen Annie L. , Ellis Ronald J. , Moore David J. , Letendre Scott , Jeste Dilip V. , Marquine María J.
Published: November 2019

Little is known about the effects of aging-related conditions on health-related quality of life (HRQOL) among people living with HIV (PLWH). The purpose of our study was to examine the independent effects of neurocognitive impairment (NCI) and frailty and the interactive effects with HIV serostatus on HRQOL. Our sample consisted of 121 adults (63 PLWH and 58 HIV-uninfected) participating in the Multi-Dimensional Successful Aging among HIV-Infected Adults study at the University of California, San Diego. HRQOL was measured with the Medical Outcome Study 36-Item Short Form Health Survey scale. We found that frailty was significantly associated with HRQOL (p < .001) in the overall sample, and this effect was significantly stronger for PLWH than HIV-uninfected adults. NCI was not significantly associated with HRQOL in our sample. Frailty may be a particularly important factor in HRQOL for PLWH, highlighting the need for prevention and intervention strategies to mitigate the risks for frailty.
Professional Recognition at Work
Authors: Renger Daniela , Miché Marcel , Casini Annalisa
Published: November 2019

Objective:

The present research systematically investigates the role of recognition experiences at work as a protective factor for burnout.

Method:

In two cross-sectional studies (N = 328 andN = 220) with employees we measured via online questionnaires three forms of recognition (achievement-based social esteem, equality-based respect, and need-based care) from coworkers and supervisors as predictors and burnout among employees as outcome.

Results:

Using multiple regression analyses, Study 1 provided initial evidence that both supervisor and coworker recognition were negatively associated with employees’ burnout. Study 2 further demonstrated that whereas respect experiences were especially crucial for lowering emotional exhaustion, care was primarily linked to reduced depersonalization and esteem to heightened personal accomplishment.

Conclusion:

We discuss how positive recognition experiences can be fostered in organizations in order to buffer the negative effects burnout can cause.
Comparing the Suppression Head Impulse Paradigm and the Head Impulse Paradigm in Vestibular Neuritis
Authors: Park Jin Su , Lee Jung Yup , Nam Woojoo , Noh Seungho , Chang Sun O , Kim Min-Beom
Published: November 2019

Objective:

To compare the results of suppression head impulse paradigm (SHIMP) and head impulse paradigm (HIMP) in acute vestibular neuritis (AVN).

Study Design:

Retrospective study.

Setting:

Tertiary otology clinic.

Patients and Interventions:

We tested 21 patients with AVN with the HIMP, SHIMP, and caloric tests, and we analyzed the relationships between the tests’ results.

Main Outcome Measures:

For this study, we adopted vestibulo-ocular reflex (VOR) gains in the SHIMP and HIMP, peak saccade velocity (PSV) of SHIMP which is another indicator of residual vestibular function, and canal paresis of caloric test.

Results:

VOR gains showed significant correlation (R
2 = 0.926, p < 0.001) between the SHIMP and HIMP, but VOR gains were slightly lower in the SHIMP than in the HIMP (mean difference 0.07 ± 0.09, p < 0.001). The difference between the HIMP and SHIMP gains was slightly larger on the affected side (0.10 ± 0.09) than on the healthy side (0.03 ± 0.09). The PSV of SHIMP had significant correlation with HIMP gain and canal paresis. Sixteen of 21 patients showed 100% ipsilesional caloric canal paresis, and eight (50%) of them showed no anti-compensatory saccade (direction toward head rotation) in the SHIMP. However, they showed not extremely low VOR gain but variable VOR gain.

Conclusion:

The new parameters of SHIMP might be used as complement for evaluating vestibular function in AVN. However, the clinical impact of the saccades of SHIMP in AVN has not been revealed clearly yet. This question should be investigated in further studies.
Duration of Processor Use Per Day Is Significantly Correlated With Speech Recognition Abilities in Adults With Cochlear Implants
Authors: Holder Jourdan T. , Dwyer Nichole C. , Gifford René H.
Published: November 2019

Objective:

Quantify the relationship between average hours of processor use per day and measures of speech recognition in post-lingually deafened adults with cochlear implants.

Setting:

Cochlear implant (CI) program at a tertiary medical center.

Patients:

Three hundred adult (mean age = 64, 130 women) CI users were included.

Main Outcome Measures:

Correlation analyses were completed for CI-aided speech recognition (Consonant-Nucleus-Consonant [CNC] monosyllables and AzBio sentences) at approximately 12 months post-implantation and average hours of processor use per day, which was extracted from the CI programming software.

Results:

Average processor use was 10.2 hours per day (range, 0.1–22.7), and average speech recognition scores were 49.9 and 61.7% for CNC and AzBio sentence recognition, respectively. We found a strong, significant correlation between hours of processor use per day and consonant-nucleus-consonant (CNC) word recognition (r
s = 0.61, p < 0.0001) and AzBio sentence recognition (r
s = 0.56, p < 0.0001).

Conclusions:

Results suggest that highest speech recognition outcomes are correlated with greater than 10 hours of CI use per day. Further research is needed to assess the causal link between daily CI use and speech recognition abilities.
Update on methods to enhance growth
Authors: Hodax Juanita K. , DiVall Sara A.
Published: November 2019

Purpose of review

To discuss treatments used to enhance growth in pediatric patients with short stature.

Recent findings

New data confirm the known efficacy of recombinant human growth hormone (rhGH) in growth hormone deficiency (GHD) and idiopathic short stature. The latest data from the Safety and Appropriateness of Growth hormone Treatment in Europe cohort did not indicate a long-term risk of malignancy in those treated for isolated GHD, but possibly increased risk in those with other diagnoses. Recombinant human insulin-like growth factor 1 is effective in treating patients with pregnancy-associated plasma protein A2 deficiency. Gonadotropin-releasing hormone agonists or aromatase inhibitor treatment to delay puberty remains controversial. They are more likely to augment adult height if combined with rhGH treatment in children already receiving rhGH. Preliminary data indicate that recombinant C-type natriuretic peptide (CNP) is safe in children and increases growth velocity upon 42 months of treatment in achondroplasia.

Recent data confirms previous data on rhGH efficacy and safety. Therapies to delay growth plate closure have greatest efficacy to augment height if combined with GH in select diagnoses. Recombinant CNP holds promise as a medical treatment for short stature associated with achondroplasia.
Simple predictors of nonresponse to direct-acting antivirals in chronic hepatitis C patients
Authors: Shousha Hend Ibrahim , Saad Yasmin , Saleh Doa’a A. , Dabes Hosam , Alserafy Magdy , ElShazly Yehia , Said Mohamed
Published: November 2019

Objectives

The introduction of direct acting antivirals (DAAs) has resulted in very high sustained virological response rates (SVR) in patients with chronic hepatitis-C (CHC). There are still a minority who fails to achieve SVR. This study aims to identify simple factors associated with nonresponse to DAAs using routine pretreatment workup.

Methods

A retrospective study included 10 655 CHC patients who were candidates for anti-viral therapy. Pretreatment demographics, laboratory results, ultrasonography and FIB-4were obtained.

Results

At post-treatment week 4, 10 495 patients (98.5%) were responders and 160 (1.5%) were non-responders. About 50.6% of non-responders were males and 61.3% were cirrhotic. Non-responders had significantly higher baseline BMI, liver enzymes, AFP and a significantly lower albumin, platelet count by univariate analysis ((P < 0.001). Sex, previous treatment, BMI, liver cirrhosis, AST, Albumin and platelet counts were the independent predictors of non-response. At post-treatment week 12, HCV-PCR results were available only for 7259 patients and 210 (2.9%) were non-responders. 54.8% of non-responders were cirrhotic and 51.4% were males. Non-responders had significantly higher AST, AFP and INR and a significantly lower albumin level, platelet count by univariate analysis (P < 0.05). Sex, previous treatment, AST, Albumin, WBC and platelet counts were the independent predictors of non-response. SVR-4 among treatment naive patients was 98.6% while among treatment experienced was 96.8%. SVR-12 among treatment naive patients was 97.9% while among treatment experienced was 87.9%.Cirrhotics had SVR-4 rate 97.7% and SVR-12 rate 96.21%.

Conclusion

Routine pre-treatment work up for HCV G4 patients receiving DAAs can help in prediction of non-response.
Politics and Policymaking in Medicare Part C
Authors: Adrion Emily R.
Published: November 2019

Background:

Once just a small part of the Medicare program, private managed care plans now cover over one-third of all Medicare beneficiaries and cost the Federal government ~$210 billion each year. Importantly, the evolution of Medicare managed care policy has been far from linear; for several decades there have been dramatic shifts in the payment and regulatory policies facing private Medicare managed care plans.

Objectives:

This article presents a critical review of the history of Medicare managed care payment and regulatory policies and discusses the role of political ideology and stakeholder influence in shaping the direction of policy over time.

Conclusions:

As Medicare Advantage becomes an increasingly prominent area of focus for the health services, health policy, and medical research communities, it is important to bear in mind the highly political history of the program, the role of stakeholder influence in shaping the direction of policy, and to understand the historic barriers to evidence-based policymaking.
Understanding the impact of state vaccination laws on exemption rates
Authors: King Adrian R. , Salmon Kyle S. , Bednarczyk Robert A.
Published: November 2019

Purpose of review

This review summarizes the current state of school-entry vaccination requirements and related exemption policies in the United States and examines recent changes to these policies.

Recent findings

With recent infectious disease outbreaks in the United States, there has been heightened awareness on unvaccinated individuals, and the state-level policies that allow individuals to be exempted from school-entry vaccination requirements. Between 2015 and 2017, there have been eleven states that have altered their policies regarding school-entry vaccination requirements and related reporting for which no formal evaluations have been published. One policy change during that period, California SB 277, which became law in 2016, reduced the nonmedical exemption and increased the childhood vaccination coverage rate in that state, though with some evidence of exemption replacement through the use of medical exemptions. Through September 2019, five additional state law changes have been enacted.

The large number of heterogeneous changes to state-level policies for school-entry vaccination requirements in recent years need rigorous evaluation to identify best practices for balancing public health authority and parental autonomy while seeking to achieve the highest level of infectious disease prevention for children.
Advances in pediatric psychooncology
Authors: Wiener Lori , Devine Katie A. , Thompson Amanda L.
Published: November 2019

Purpose of review

This article reviews the current literature on psychosocial care of children with cancer with particular focus on evidence-based standards of care, including developments in systematic distress screening, utilization of patient-reported outcomes, evidence-based interventions, survivorship, palliative care and bereavement.

Recent findings

Although attention to the psychosocial needs of the child and family is increasingly recognized as an essential element of care for children with cancer, implementing evidence-based care remains suboptimal. Recent efforts have focused on utilizing technology to improve the reach of these interventions and to enhance engagement with special populations, such as adolescents and young adults. Increasing data elucidate the long-term psychological and physical late effects of childhood cancer survivorship and the impact of cancer on siblings and the family. Gaps in clinical care and important directions for future research include the needs of infants and toddlers, overlooked minorities, and patients with hereditary tumor predisposition syndromes, and attention to the psychosocial impact of exciting new treatments, such as autologous chimeric antigen receptor (CAR) T-cell therapy.

The evidence base for the psychosocial standards of care for children with cancer and their families continues to grow, but more work is needed to successfully implement these standards across pediatric cancer centers.
Prevention of recurrent urinary stone disease
Authors: Goka Selasie Q. , Copelovitch Lawrence
Published: November 2019

Purpose of review

Urinary stone disease (USD) is increasing in prevalence and recurrence is common. In pediatrics, most stones are composed primarily of calcium with the highest incidence observed in adolescents. Given the morbidity associated with USD, an in depth review of current management strategies is of paramount importance to highlight the data supporting the recommended treatments and the knowledge gaps which still exist.

Recent findings

Several interventions for the management of recurrent calcium USD in children have been recommended based on primarily adult studies. These interventions include modification of diet and fluid intake in addition to the utilization of medications such as thiazide diuretics and citrates when supportive care is inadequate. Overall there is conflicting data in the adult literature which is further complicated by our attempts to extrapolate these data to children.

Based on the currently available literature the management of USD in pediatrics should be individualized to each patient and focused on the particular metabolic risk factors that are identified during the course of their evaluation. Several interventions may be required or trialed in a particular patient to show an effect. Well designed trials to assess the efficacy of each intervention in the pediatric population are needed.
Knee orthopedic problems in newborns and infancy: a review
Authors: Kubat Ozren , Vlaić Josip , Antičević Darko
Published: November 2019

Purpose of review

We present the reader with insight on the most common disorders of the knee in newborns and infants. Knee issues in this population may confuse the first contact physicians due to certain peculiarities of the immature immune system, small size and underdevelopment of joint anatomy. Data presented here are recent and significant, and something to bear in mind when caring for children of this age.

Recent findings

With the advent of new diagnostic methods, a shift in the causative agent of pediatric knee infections has been noted. Minimally invasive methods such as arthrocentesis and arthroscopy are successfully employed in treatment of knee problems in newborns and infants. A trial of conservative therapy in congenital patellar instability can give good results, and obviate the need for surgery in some cases. Various syndromes that affect the knee have specific characteristics that need to be recognized early to avoid problems in the future.

Although rare, knee problems in infants can and do occur. Their cause varies significantly and good outcomes require a multidisciplinary approach. Early diagnosis, referral and initiation of treatment protocols can significantly influence the fate of the joint and with it the patients’ functional status for life.
A Case of Myelofibrosis and Myelodysplasia Identified Following Exposure to Isotretinoin
Authors: Mojica Ann M. , Wolfe Adam D.
Published: November 2019

A 15-year-old male individual treated with isotretinoin for acne vulgaris presented with persistent pancytopenia and circulating myeloblasts after discontinuation of the drug. Marrow assessment revealed myelofibrosis (MF) and myeloblasts exhibiting monosomy 7, diagnostic of myelodysplastic syndrome (MDS). Although a popular website seems to associate isotretinoin with MF, no published cases of MF or MDS attributable to this drug were identified. Although we expect that he would eventually have developed MDS and MF, this patient was perhaps identified sooner due to cytopenias accelerated by isotretinoin. This case illustrates that patients exhibiting cytopenias persisting following isotretinoin therapy merit evaluation for underlying hematopoietic disorders.
Dietary Sources of Sugars and Calories
Authors: Malek Angela M. , Newman Jill C. , Hunt Kelly J. , Jack Maia M. , Marriott Bernadette P.
Published: November 2019

Dietary sources of macronutrients include foods, beverages, accompaniments, and other items, all of which contribute to intake of energy, total sugar, and added sugar. We examined the relative contributions of food and beverage items, as well as subcategories of beverages, to calories, total sugar, and added sugar intakes among individuals 2 years or older using 24-hour dietary recall data (day 1) from the 2015–2016 National Health and Nutrition Examination Survey (NHANES). We compared these data to data discussed in the 2015 Dietary Guidelines Advisory Committee report based on the 2009–2010 NHANES. We found that the percentage energy from all foods has increased slightly from 81% to 84%, whereas percentage energy from beverages has declined (19% to 16%) from 2009/2010 to 2015/2016, mainly attributable to a decrease in percentage energy from sugar-sweetened beverage (SSB) intake. In 2015 to 2016, all foods including accompaniments and other items contributed 57% of total sugars intake, with beverages contributing 43%. Among beverages, the largest source of total sugar intake was SSBs, followed by dairy-based beverages. Comparing 2009-2010 with 2015–2016 NHANES data, we found that there has been a decrease in the percentage of added sugar in the US diet overall for beverages (as defined in the 2015 Dietary Guidelines Advisory Committee) from 47% to 43%, with this change primarily a result of a decrease in the percentage of added sugar from SSBs. The percentage of added sugar from coffees and teas remained relatively constant at roughly 7%, however, the percentage of added sugar from alcoholic beverages increased from 1% to 2%. Whereas percentage beverage energy from SSBs has declined among persons 2 years or older in the United States (7% in 2009–2010 to 5% in 2015–2016), SSBs remain the main beverage source of total and added sugar.
Nutritional Content and Ingredients of Commercial Infant and Toddler Food Pouches Compared With Other Packages Available in the United States
Authors: Moding Kameron J. , Ferrante Mackenzie J. , Bellows Laura L. , Bakke Alyssa J. , Hayes John E. , Johnson Susan L.
Published: November 2019

The ingredients and nutrients of infant and toddler foods (ITFs) sold in pouches were compared with products available in other packages, such as jars/packs and other containers. Company websites (n = 21) and in-store shelf inventory (n = 3) were used to create a database of commercial ITFs containing vegetables (n = 548) sold in the United States. Results indicated that ITFs containing vegetables were most commonly packaged in pouches (50%), followed by “other” packages (25%) and jars/packs (25%). Infant and toddler food pouches contained significantly more sugars per serving and per Reference Amount Customarily Consumed, as well as a greater percentage of calories from sugars, compared with both jars/packs and “other” packages. Pouches were also more likely to contain vegetable/fruit blends, whereas jars/packs were more likely to contain single-vegetable or multivegetable blends, and “other” packages were more likely to contain vegetable/other ingredient combinations (eg, grains and/or dairy). Pouches are popular, widely available, and convenient but may not represent the vegetable profiles and nutritional qualities that parents believe they are buying for their children.
The Effect of Training Given to Hemodialysis Patients According to the Comfort Theory
Authors: Kacaroğlu Vicdan Ayşe
Published: November 2019

Purpose

This study was conducted to determine the effect of training that is given in accordance with the Comfort Theory to hemodialysis patients.

Methods

This study was conducted as a randomized, controlled, and experimental trial between October 10, 2018, and February 27, 2019. The sample of the study consisted of 68 voluntary and literate individuals (34 in the experimental group and 34 in the control group).

Results

When the comfort conditions of patients in the experimental and control groups were compared, it was determined that there was no significant difference in the mean total score on the General Comfort Questionnaire, mean subdimension scores, and mean comfort level scores in the first interview. In the last interview, it was determined that the differences in the mean total score on the General Comfort Questionnaire; the mean scores on the physical, psychospiritual, and sociocultural comfort subdimension; and the mean score of the comfort levels between the experimental and control groups were statistically significant.

Conclusion

It was observed that the training that is given in accordance with the Comfort Theory of Kolcaba to the hemodialysis patients increased the mean scores of patients' comfort.
Malignant Sex Cord-Stromal Tumor, Not Otherwise Specified, Harboring FOXL2, p53, and TERT Promoter Mutations: Report of a Case
Authors: Mayer Romana , Dandulakis Mary , Richards Stephanie , Roque Dana M. , Staats Paul N.
Published: November 2019

Rare sex cord-stromal tumors of the ovary cannot be further subclassified and are therefore designated “sex cord-stromal tumor-not otherwise specified.” These tumors have highly varied morphology, and the literature describing them is limited. Herein, we report the pathology and clinical course of a 46-yr-old woman diagnosed with sex cord-stromal tumor-not otherwise specified. The tumor was composed predominantly of juvenile granulosa cell tumor histology, with elements of thecoma, adult granulosa, Sertoli, as well as poorly differentiated epithelioid and sarcomatoid components. Next-generation sequencing revealed a FOXL2 C134W mutation, seen most commonly in adult granulosa cell tumors, as well as mutations in TP53 (V172F) and TERT promoter (-124C>T). The patient exhibited an aggressive clinical course involving rapid recurrence with distant metastases that responded to 4 cycles of cisplatin, bleomycin, and etoposide.
Predicting Ischemic Complications in the Inframammary Approach to Nipple-Sparing Mastectomy: The Midclavicular-to–Inframammary Fold Measurement
Authors: Willey Shawna C. , Fan Kenneth L. , Luvisa Kyle , Graziano Francis D. , Lau Stephanie H. Y. , Black Cara K. , Song David H. , Pittman Troy
Published: November 2019

Background:

The authors refine their anatomical patient selection criteria with a novel midclavicular-to–inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach.

Methods:

Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included other mastectomy incisions, staged mastectomy, previous breast operation, and autologous reconstruction. Preoperative anatomical measurements for each breast, clinical course, and specimen weight were obtained.

Results:

One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch–to-nipple distance, was strongly correlated with midclavicular-to–inframammary fold measurement on linear regression (R
2 = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to–inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to–inframammary fold measurement was less than 30 cm.

Conclusions:

Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to–inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to–inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Chondrogenesis of Adipose-Derived Stem Cells on Irradiated Cartilage
Authors: Choi Soon Woo , Hong Ki Yong , Minn Kyung Won , Chang Hak
Published: November 2019

Background:

Irradiated allogeneic costal cartilage is an alternative option of cartilage graft in patients with insufficient autologous cartilage. However, complications can occur during long-term follow-up. This study investigated whether Tutoplast-processed cartilage, one of the irradiated allogeneic costal cartilages, acts as a scaffold for adipose-derived stem cells and chondrogenesis.

Methods:

In vitro setting, human adipose-derived stem cells seeded onto Tutoplast-processed cartilage were cultured in chondrogenic medium and observed using a scanning electron microscope. Next, 3 types of irradiated cartilage–including Tutoplast-processed cartilage, undifferentiated stem cells on Tutoplast-processed cartilage (undifferentiated group), and chondrogenic differentiated stem cells on Tutoplast-processed cartilage (chondrogenic group)–were implanted subcutaneously into nude mice. Gross, histologic, and gene expression analyses of Tutoplast-processed cartilages were performed at postoperative weeks 2 and 4.

Results:

Human adipose-derived stem cells subjected to in vitro three-dimensional culture differentiated into chondrocytes and expressed cartilage-specificgenes. Adipose-derived stem cells seeded onto Tutoplast-processed cartilage were differentiated into chondrocytes in chondrogenic medium. In the chondrogenic group, the chondrogenic-differentiated cells attached to the surface of the Tutoplast-processed cartilage were maintained during the follow-up and were distinct from the existing Tutoplast-processed cartilage. Moreover, the chondrogenic group had higher expression of cartilage-specific genes compared with the undifferentiated group.

Conclusions:

Adipose-derived stem cells seeded onto Tutoplast-processed cartilage underwent chondrogenic differentiation, generating new cartilage, which was maintained after implantation without critical complications. The findings are clinically valuable in terms of overcoming the limitations of irradiated allogeneic costal cartilage, and broaden the surgical options for treatments requiring cartilage.