bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in Gender-affirming Surgery in Insured Patients in the United States
Authors: Lane Megan , Ives Graham C. , Sluiter Emily C. , Waljee Jennifer F. , Yao Tsung-Hung , Hu Hsou Mei , Kuzon William M.
Published: April 2018

Background:

An estimated 0.6% of the U.S. population identifies as transgender and an increasing number of patients are presenting for gender-related medical and surgical services. Utilization of health care services, especially surgical services, by transgender patients is poorly understood beyond survey-based studies. In this article, our aim is 2-fold; first, we intend to demonstrate the utilization of datasets generated by insurance claims data as a means of analyzing gender-related health services, and second, we use this modality to provide basic demographic, utilization, and outcomes data about the insured transgender population.

Methods:

The Truven MarketScan Database, containing data from 2009 to 2015, was utilized, and a sample set was created using the Gender Identity Disorder diagnosis code. Basic demographic information and utilization of gender-affirming procedures was tabulated.

Results:

We identified 7,905 transgender patients, 1,047 of which underwent surgical procedures from 2009 to 2015. Our demographic results were consistent with previous survey-based studies, suggesting transgender patients are on average young adults (average age = 29.8), and geographically diverse. The most common procedure from 2009 to 2015 was mastectomy. Complications of all gender-affirming procedures was 5.8%, with the highest rate of complications occurring with phalloplasty. There was a marked year-by-year increase in utilization of surgical services.

Conclusion:

Transgender care and gender confirming surgery are an increasing component of health care in the United States. The data contained in existing databases can provide demographic, utilization, and outcomes data relevant to providers caring for the transgender patient population.
Optical Coherence Tomography Angiography Macular Vascular Density Measurements and the Central 10-2 Visual Field in Glaucoma
Authors: Penteado Rafaella C. , Zangwill Linda M. , Daga Fábio B. , Saunders Luke J. , Manalastas Patricia I.C. , Shoji Takuhei , Akagi Tadamichi , Christopher Mark , Yarmohammadi Adeleh , Moghimi Sasan , Weinreb Robert N.
Published: April 2018

Purpose:

To evaluate the association between macula vascular density assessed by optical coherence tomography angiography (OCT-A) and central visual field (VF) threshold sensitivities in healthy, glaucoma suspect, and glaucoma patients.

Methods:

A total of 185 eyes from 38 healthy participants, 31 glaucoma suspects, 72 mild glaucoma patients, and 44 moderate/severe glaucoma patients from the Diagnostic Innovations in Glaucoma Study who underwent OCT-A images of the macula and 10-2 VF testing were enrolled in this observational cross-sectional study. The relationship between central VF mean sensitivity (MS) and superficial macula whole-image vessel density (wiVD), and the relationship between the MS of the 4 central points of the 10-2 VF (MS4) and parafoveal vessel density (pfVD), were assessed using linear regression models.

Results:

Mean wiVD (52.5%, 49.8%, 49.4% and 45.2%, respectively) and mean pfVD (54.9%, 52.1%, 51.8% and 47.7%, respectively) were found to be significantly higher in healthy eyes and glaucoma suspect eyes compared with glaucoma eyes with mild and moderate/severe disease [analysis of covariance (ANCOVA) P<0.001]. The univariate associations between 10-2 MS and wiVD (R
2=26.9%) and between 10-2 MS4 and pfVD (R
2=16.8%) were statistically significant (P<0.001 for both). After adjusting for scan quality, age, sex and intraocular pressure, superficial macula wiVD and pfVD were still independently associated with central VF loss. Macula wiVD performed better [area under the receiver operator characteristic (AUROC)=0.70] than ganglion cell complex thickness (AUROC=0.50) for differentiating between glaucoma suspect and healthy eyes (P=0.010).

Conclusions:

Loss of OCT-A macula vessel density is associated with central 10-2 VF defects. Macula vessel density is a clinically relevant parameter that may enhance monitoring of glaucoma suspects and patients.
Azelaic Acid in Acne Vulgaris
Authors: Young Mary Caroline , Zito Patrick M.
Published: April 2018

By definition, a drug is a medicine or substance that exerts a physiologic effect on an organism. In dermatology, various medications and substances are utilized on a daily basis, ranging from topical treatments to anesthetics in micrographic surgery. The purpose of this section was to focus on some of the more common substances, specifically how they work, how they are utilized, and routine alternatives (if available). The mechanism of action, usage, and alternative options of the medication azelaic acid are discussed.
Effect of Routine Clopidogrel Use on Bleeding Complications After Endobronchial Ultrasound-guided Fine Needle Aspiration
Authors: Webb Tracey N. , Flenaugh Eric , Martin Ralitza , Parks Christopher , Bechara Rabih I.
Published: April 2018

Background:

Endobronchial ultrasonography has proven to be highly sensitive and specific in the diagnoses of patients with mediastinal and hilar adenopathy. Many of these patients are on a combination of clopidogrel (a compound that inhibits adenosine diphosphate–induced platelet aggregation) and aspirin due to neurological and/or cardiac-related comorbidities, and stopping anticoagulation may place these patients at high risk for potential complications. Our group has previously showed that thoracentesis with an 8-french catheter is safe in patients receiving clopidogrel and aspirin with low risk of complications. In this manuscript, we report the outcomes of the largest prospective multicenter series of patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) while receiving clopidogrel.

Methods:

Patients presenting to our institutions with mediastinal/hilar adenopathy, requiring EBUS-TBNA, and actively taking clopidogrel and aspirin were included in the study. If the medication could be held for 5 to 7 days before the procedure, the patient was excluded. EBUS-TBNA was performed by an interventional pulmonology faculty on a total of 42 patients. All patients received total intravenous anesthesia, and a total of 92 nodes were sampled. First, 3 passes were performed with a 22-G needle. If no complications were encountered, we followed with additional 3 passes with a 21 G. Rapid onsite evaluation was performed in all patients. Bleeding at the puncture site was considered significant if it required cold saline, topical sympathomimetic, or balloon tamponade for hemostasis. Bleeding was considered nonsignificant if no interventions were required to achieve hemostasis.

Results:

We were able to perform all procedures successfully using both the 21 and 22-G needles. One patient required 30 mL cold saline installation to accomplish hemostasis with the 21 and 22-G needles. Our yield was comparable with the current literature. No statistically significant complications occurred during the procedure. All patients were contacted within 24 hours, and none reported bloody sputum.

Conclusion:

We suggest that EBUS-TBNA, using 22 and 21-G needles, is safe with high yields in patients with mediastinal/hilar adenopathy, actively taking clopidogrel and aspirin, and are at high risk for thrombotic complications if the medication is discontinued.
Gabapentin Improves Symptoms of Functional Dyspepsia in a Retrospective, Open-label Cohort Study
Authors: Staller Kyle , Thurler Andrea H. , Reynolds Justin S. , Dimisko Laurie R. , McGovern Ryan , Skarbinski Kristina F. , Kuo Braden
Published: April 2018

Goals:

We sought to determine the efficacy of gabapentin in the treatment of functional dyspepsia among an observational cohort of patients.

Background:

Gabapentin has an established role in the treatment of neuropathic pain, with evidence supporting a benefit in visceral hypersensitivity. There is currently no data on the use of gabapentin for the treatment of functional dyspepsia.

Study:

Consecutive patients presenting to a tertiary motility clinic for the evaluation of functional dyspepsia without concurrent gastric emptying delay completed a baseline Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) before evaluation and were started on gabapentin for functional dyspepsia by their providers. The primary endpoint was change in total PAGI-SYM score between initial and subsequent visits.

Results:

Of 110 patients enrolled, 62 patients with functional dyspepsia completed pregabapentin and postgabapentin surveys. Subjects’ mean PAGI-SYM score decreased by 0.44 (P<0.0001) with significant changes in all subscales (including upper abdominal pain, lower abdominal pain, postprandial fullness) except for bloating. Multivariable analysis showed that worsening pretreatment symptom severity was independently associated with improvement. Seven (11.3%) patients discontinued gabapentin with 5 (71.4%) discontinuing due to side effects. Using the minimum significant PAGI-SYM score change threshold, ≥50% of the cohort had significant improvement in their overall, postprandial fullness, and upper abdominal pain subscores.

Conclusions:

In a retrospective, open-label cohort of patients treated with gabapentin for functional dyspepsia, there were significant improvements in dyspeptic symptoms interpreted within the limitations of an open-label study design. Further studies are needed to place gabapentin in the functional dyspepsia treatment algorithm.
Anemia in Pediatric Inflammatory Bowel Disease
Authors: Aljomah Ghanim , Baker Susan S. , Schmidt Kenneth , Alkhouri Razan , Kozielski Rafal , Zhu Lixin , Baker Robert D.
Published: April 2018

Objectives:

Anemia is the most frequent extra‐intestinal finding in inflammatory bowel disease (IBD). The aim of this study is to determine the prevalence and types of anemia in pediatric patients with IBD at diagnosis and at approximately 1 year follow‐up.

Methods:

This is a retrospective chart review of patients diagnosed with IBD from 2005 to 2012, ages 1 to 18 years. Patients who had hemoglobin, hematocrit, mean corpuscular volume, and iron indices obtained at the time of diagnosis and at approximately 1 year follow‐up were included in the study. The prevalence of anemia at the beginning and the end of the study was recorded. Using the soluble transferrin receptor index the type of anemia was determined.

Results:

At diagnosis, 67.31% of patients were anemic. Overall, 28.85% of patients had either iron deficiency anemia (IDA) or a combination of IDA and anemia of chronic disease (ACD), whereas 38.46% had ACD alone. At follow‐up, 20.51% were anemic. 15.38% had either IDA or a combination of IDA and ACD; 5.13% had ACD alone. The pattern of anemia and response to therapy differed among the IBD phenotypes

Conclusions:

Anemia is frequent in inflammatory bowel disease. The prevalence was higher in Crohn disease (CD). At 1 year, the prevalence of anemia decreased significantly, but persisted. Anemia of chronic disease predominated in CD. Iron deficiency anemia continued to be present in CD and ulcerative colitis.
Transjugular Intrahepatic Portosystemic Shunt Insertion for the Management of Portal Hypertension in Children
Authors: Johansen Lauren C. , McKiernan Patrick J. , Sharif Khalid , McGuirk Simon P.
Published: April 2018

Objectives:

the aim of the study was to describe our 20‐year experience with transjugular intrahepatic portosystemic shunt (TIPSS) procedures for children with resistant portal hypertension (PHTN).

Methods:

Retrospective review of all children that had a TIPSS performed at Birmingham Children's Hospital from January 1, 1995 to January 1, 2015.

Results:

Forty children underwent 42 attempted TIPSS for resistant PHTN with recurrent variceal bleeding (n = 35), refractory ascites (n = 4), and hypersplenism (n = 1). Median age at operation was 12 years (range 7 months–17 years). Thirty‐four procedures were elective and 8 were emergency cases. TIPSS was established in 33 cases (79%). Median portal venous pressure reduction was 10 mmHg. Variceal bleeding ceased in 27 (96%) and ascites improved in all. Clinical improvement following TIPSS enabled 7 children to be bridged to transplantation and 7 others to become suitable for transplantation. The 1‐year and 5‐year survival with TIPSS was 57% and 35%, respectively. Child‐Pugh score C was an independent risk factor for adverse outcome (Likelihood ratio (LR) = 8.0; 95% confidence interval (CI) 2.7 to 23.5; P = 0.001). There were 6 major complications: hepatic artery thrombosis and infarction (n = 1), hepatic artery pseudoaneurysm (n = 1), bile leak (n = 1), and hepatic encephalopathy (n = 3). Encephalopathy was resistant to medical treatment in 2 cases, necessitating staged closure in 1. Ten patients (30%) required intervention to maintain TIPSS patency. The 1‐year and 5‐year freedom from reintervention was 71% and 55%, respectively.

Conclusions:

A TIPSS is highly successful in controlling symptoms in children with resistant PHTN and facilitating liver transplantation. It is technically demanding and not without risk. Patients must be appropriately selected and counselled.
Value of Serum Zinc in Diagnosing and Assessing Severity of Liver Disease in Children With Wilson Disease
Authors: Sintusek Palittiya , Kyrana Eirini , Dhawan Anil
Published: April 2018

Objectives:

Wilson disease (WD) is a rare inborn error of copper metabolism with diverse manifestations. There has been no study of zinc (Zn), the copper's antagonist, in WD diagnosis and severity so far. Our aims were to evaluate serum Zn in WD and its correlation with the disease severity score (revised WD index). Although the ATP7B mutation analysis is highly accurate for WD diagnosis, it may not be readily available in a resource‐limiting setting. We proposed a disease diagnostic score (Proposed WD diagnostic score) which incorporates serum Zn.

Methods:

Medical records of WD and non‐WD children seen at King's College Hospital from 2005 to 2015 were reviewed for the selected parameters using the Proposed WD diagnostic score. Available serum Zn data in WD children before disease diagnosis and the calculated severity score were statistically analyzed. Diagnostic values of the Proposed WD diagnostic score were evaluated.

Results:

Serum Zn level was significantly lower in 8 WD‐acute liver failure (ALF) (5.8 [4.1–8.3] μmol/L) compared to 18 WD‐non‐ALF (13.5 [6.1–22.2] μmol/L) and 9 ALF from indeterminate cause (9.8 [7.0–12.1] μmol/L) (P < 0.001). Serum Zn significantly correlated with the revised WD index (r = −0.554, P = 0.004). The Proposed WD diagnostic score that included serum Zn level as 1 of the parameters had sensitivity and specificity of 87% and 99.2%, respectively.

Conclusions:

Serum Zn is a novel parameter for diagnosis and correlates with severity of WD. The Proposed WD diagnostic score is useful while awaiting ATP7B mutation analysis.
Induction Dosage of Propofol for Repeated Sedations in Children With Hematological Disorders
Authors: Moretto Alessandra , Zanella Alberto , Ciceri Valentina , Rota Matteo , Scaravilli Vittorio , Beltrama Virginia , Bosatra Mariagrazia , Pesenti Antonio
Published: April 2018

Pediatric patients with hematologic malignancies require several procedural sedations by means of propofol infusion. We retrospectively analyzed the medical records of leukemic pediatric patients who had undergone procedural sedations at an Italian tertiary referral center (San Gerardo Hospital, Monza) from January 2011 to November 2013. We retrieved the following: demographics; diagnosis; chemotherapy phase; use of corticosteroids; induction dosage of propofol, fentanyl and/or ketamine; and the type of procedure. We used a multivariate linear mixed model to evaluate the factors affecting induction propofol dose. We analyzed 1459 procedures (59% lumbar punctures, 31% bone marrow aspirations) performed on 96 children (7 [4-10] y old, 24 [16-34] kg, 37% female) admitted for acute lymphoblastic leukemia (80%), lymphoma (11%), and acute myeloid leukemia (7%). The induction propofol dose increased by 0.03 mg/kg per each procedure (P<0.05), from 2.6 (2.0-3.2) to 3.5 (2.6-4.3) mg/kg at the first and the last procedure, respectively. Higher age, weight, and use of ketamine were associated to lower propofol dosage (P<0.01), while combined procedures increased propofol dosage (P<0.01). In a large cohort of leukemic pediatric patients undergoing procedural sedation, the induction dose of propofol was increased over time, regardless of weight, age, use of corticosteroids, diagnosis, and treatment phase.
Pediatric Chronic Myeloid Leukemia Presenting With Extreme Thrombocytosis Simulating Essential Thrombocythemia
Authors: Boklan Jessica L. , Walsh Alexandra M. , de la Maza Michelina C. , Su Leon L. , Nizzi Francisco A. , Schafernak Kristian T.
Published: April 2018

A 10-year-old boy presented with spontaneous bruising and was found to have extreme thrombocytosis without neutrophilia/shift to immaturity, basophilia or eosinophilia. While the peripheral blood and bone marrow findings initially suggested essential thrombocythemia, BCR-ABL1 translocation was detected and chronic myeloid leukemia, chronic phase, was diagnosed. Apheresis for platelet depletion was performed as a bridge given the delayed effects of medical therapy.
Central Nervous System Involvement of Rhabdomyosarcoma: A Single Institution Experience
Authors: Moreira Daniel C. , Macy Margaret E. , Cost Carrye R. , Greffe Brian S. , Garrington Timothy P.
Published: April 2018

The incidence of central nervous system (CNS) involvement in patients with rhabdomyosarcoma (RMS) is low, and the outcome is dismal. We present a single institution analysis of CNS involvement of pediatric RMS. In 59 patients, the prevalence of CNS involvement was 11.9% (7 patients), higher than prior reports. Of the 6 deaths from disease, all had rapid progression, with a median survival of 14 days. The higher incidence could be secondary to treatment modifications or more sensitive detection. These findings are useful for decisions at the time of CNS involvement and could lead to modifications for future RMS clinical trials.
Myeloproliferative Neoplasms in Children and Adolescents and Thrombosis at Unusual Sites: The Role of Driver Mutations
Authors: Tafesh Laith , Musgrave Kathryn , Roberts Wing , Plews Dianne , Carey Peter , Biss Tina
Published: April 2018

Myeloproliferative neoplasms (MPNs) in childhood and adolescence are rare and seldom complicated by thrombosis. We describe 3 cases of thrombosis at unusual sites in young patients with MPNs. In the pediatric MPN population, unlike in adult MPNs, a clonal mutation is identifiable in only a minority of cases (22% to 26%). All 3 of these individuals had JAK2 mutations driving the disease process. A literature search identified 19 cases of MPN-associated thrombosis in children. Seventeen of the 19 children (89.5%) had a driver mutation. These cases suggest that identifiable driver mutations may confer an increased thrombotic risk in children with MPNs.
Effects of a PICU Status Asthmaticus De-Escalation Pathway on Length of Stay and Albuterol Use*
Authors: Brennan Steven , Lowrie Lia , Wooldridge Jamie
Published: April 2018

Objectives:

Evaluate the effects of an asthma de-escalation clinical pathway on selected outcomes for patients admitted to a PICU with status asthmaticus.

Design:

Time series quality improvement trial.

Setting:

PICU in a tertiary care children’s hospital.

Patients:

Children age 2–18 years old with a known diagnosis of asthma presenting with status asthmaticus.

Intervention:

One-hundred five admissions to a PICU for status asthmaticus were treated according to a new de-escalation pathway between August 15, 2015, and August 30, 2016. This group was compared with a prepathway group of 141.

Measurements and Main Results:

Primary outcome was variability in PICU length of stay. Secondary outcomes were median PICU length of stay, median hospital length of stay, and median duration a patient received continuous nebulized albuterol. The effectiveness of the intervention was tracked using control charts. The postpathway group demonstrated decreased variability of PICU length of stay and time receiving continuous albuterol. Statistically significant decreases were seen in median PICU length of stay (16 vs 13 hr;p= 0.0009), median duration a child spent receiving continuous nebulized albuterol (10.8 vs 7.3 hr;p= 0.0008), and median hospital length of stay (37 vs 31 hr;p= 0.02). Total number of asthma assessments completed by respiratory therapists increased from 741 to 1,087.

Conclusions:

Implementation of a PICU asthma de-escalation pathway demonstrated statistical decrease in the reported measures for children with status asthmaticus. Although the clinical significance of these changes may be debatable, the results demonstrate that efforts to standardize asthma care in the PICU setting is an area in need of further study.
Initiation of Disease-Modifying Therapies in Rheumatoid Arthritis Is Associated With Changes in Blood Pressure
Authors: Baker Joshua F. , Sauer Brian , Teng Chia-Chen , George Michael , Cannon Grant W. , Ibrahim Said , Cannella Amy , England Bryant R. , Michaud Kaleb , Caplan Liron , Davis Lisa A. , O'Dell James , Mikuls Ted R.
Published: April 2018

Purpose

This study reports the effect of disease-modifying therapies for rheumatoid arthritis (RA) on systolic and diastolic blood pressure (SBP, DBP) over 6 months and incident hypertension over 3 years in a large administrative database.

Methods

We used administrative Veterans Affairs databases to define unique dispensing episodes of methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, tumor necrosis factor inhibitors, and prednisone among patients with RA. Changes in SBP and DBP in the 6 months before disease-modifying antirheumatic drug initiation were compared with changes observed in the 6 months after initiation. The risk of incident hypertension within 3 years (new diagnosis code for hypertension and prescription for antihypertensive) was also assessed. Multivariable models and propensity analyses assessed the impact of confounding by indication.

Results

A total of 37,900 treatment courses in 21,216 unique patients contributed data. Overall, there were no changes in SBP or DBP in 6 months prior to disease-modifying antirheumatic drug initiation (all P > 0.62). In contrast, there was a decline in SBP (β = −1.08 [−1.32 to −0.85]; P < 0.0001) and DBP (β = −0.48 [−0.62 to −0.33]; P < 0.0001) over the 6 months following initiation. The greatest decline was observed among methotrexate and hydroxychloroquine users. Methotrexate users were 9% more likely to have optimal blood pressure (BP) after 6 months of treatment. Patients treated with leflunomide had increases in BP and a greater risk of incident hypertension compared with patients treated with methotrexate (hazard ratio, 1.53 [1.21–1.91]; P < 0.001).

Conclusions

Blood pressure may improve with treatment of RA, particularly with methotrexate or hydroxychloroquine. Leflunomide use, in contrast, is associated with increases in BP and a greater risk of incident hypertension.
Role of Interleukin 37 as a Novel Proangiogenic Factor in Juvenile Idiopathic Arthritis
Authors: El-Barbary Amal Mohamad , Hussein Manal Shawky , Almedany Samah Hamdy , Rageh Elsayed Mohamad , Alsalawy Alaa Mohamed , Aboelhawa Marwa Ahmed , Elkholy Radwa Mostafa , Shafik Noha Mohamed , Elharoun Ahmed Shukry
Published: April 2018

Objective

The aim of this study was to investigate interleukin 37 (IL-37) levels in the serum and synovial fluid of patients with juvenile idiopathic arthritis (JIA), its expression in peripheral blood mononuclear cells, and correlation with disease activity and angiogenesis.

Methods

Seventy JIA patients and 50 control subjects were examined. The Juvenile Arthritis Disease Activity Score in 27 joints (JADAS-27) was calculated. Immunoassays were used to measure the serum and synovial fluid levels of IL-37, vascular endothelial growth factor (VEGF), soluble VEGF receptor 1 (sVEGF-R1), and sVEGF-R2. Relative expression of IL-37 mRNA in peripheral blood mononuclear cells and the power Doppler ultrasound score of the affected joint were measured.

Results

Patients with JIA were subdivided as 20 systemic-onset, 20 polyarticular, and 30 oligoarticular (10 persistent, 20 extended) cases. Serum levels of IL-37, VEGF, VEGF-R1, and VEGF-R2 and relative IL-37 mRNA expression were significantly higher in JIA patients when compared with the control subjects (p < 0.001). These concentrations were significantly higher in systemic-onset JIA compared with those in polyarticular and oligoarticular JIA, and in polyarticular JIA when compared with oligoarticular JIA (p < 0.001). Serum, synovial, and mRNA expression levels of IL-37 were positively correlated with C-reactive protein, erythrocyte sedimentation rate, Juvenile Arthritis Disease Activity Score in 27 joints, power Doppler ultrasound score (p < 0.001), and the serum and synovial VEGF and VEGF-RI and -R2 levels (p < 0.05).

Conclusions

Our results demonstrate that IL-37 levels and mRNA expression were significantly increased in JIA patients, and their levels were positively correlated with disease activity and markers of angiogenesis (VEGF and VEGF receptors), suggesting that IL-37 may be correlated with angiogenesis.
Obesity Impacts Swelling of Ankle and Foot Joints in Early Rheumatoid Arthritis Patients
Authors: Ranganath Veena K. , Duffy Erin L. , Garg Vikram K. , Woodworth Thasia , Taylor Mihaela , Paulus Harold E. , Altman Roy D. , Elashoff David A.
Published: April 2018

Objective

The evaluation of disease activity in obese rheumatoid arthritis (RA) patients presents challenges particularly in the clinical assessment of swollen joints. This study examines the effect of obesity on the American College of Rheumatology (ACR) core set measures used in assessing RA disease activity with specific focus on the swollen joint count (SJC).

Methods

We examined a cross-sectional cohort of 323 early seropositive RA patients (symptom duration ≤15 months). Patients were biologic-naive with equal to or more than 6/44 SJC and equal to or more than 9/44 tender joint count. The ACR core set measures, components of Disease Activity Score (DAS) 44/erythrocyte sedimentation rate (ESR), DAS28/ESR4 item, Clinical Disease Activity Index (CDAI), and body mass index (BMI) were collected. Disease activity measures were compared between BMI categories. Multivariable linear regression models assessed the relationship between high BMI (≥30 kg/m2) and lower-extremity (LE) SJC and SJC44 while accounting for other ACR measures.

Results

Disease Activity Score 44/ESR4 item, Health Assessment Questionnaire Disability Index, physician global, and SJC44 differed across BMI categories (p < 0.05). Of the SJC44, metacarpophalangeal joints and LE joints (knees, ankles, metatarsophalangeal joints) were associated with increased swelling in all BMI groups (P < 0.05). Obesity was significantly associated with LE SJC after adjusting for ACR core set measures.

Conclusions

There is a direct association between increased BMI and increased swelling of LE joints in RA patients. Increases in DAS44–measured disease activity are higher in obese RA patients because of increased LE swollen joints. Disease Activity Score 28 and Clinical Disease Activity Index, which emphasize upper-extremity joint assessment, are not significantly influenced by obesity.
Subacute Infarct Volume With Edema Correction in Computed Tomography Is Equivalent to Final Infarct Volume After Ischemic Stroke
Authors: Broocks Gabriel , Faizy Tobias Djamsched , Flottmann Fabian , Schön Gerhard , Langner Sönke , Fiehler Jens , Kemmling Andre , Gellissen Susanne
Published: April 2018

Objectives

Final infarct volume is regularly used as an end point of tissue outcome in stroke trials; however, the reported volumes are most commonly derived from early follow-up imaging. Those volumes are significantly impaired by ischemic edema, which causes an overestimation of the true final lesion volume. As net water uptake within ischemic brain can be quantified densitometrically in computed tomography (CT) as recently described, we hypothesized that the final lesion volume can be better estimated by correcting the lesion volume in early follow-up for the corresponding proportion of edema.

Materials and Methods

After retrospective consecutive screening of the local registry, 20 patients with acute middle cerebral artery large vessel occlusion met the inclusion criteria with early and late follow-up CT; the latter acquired at least 4 weeks after admission. In early follow-up imaging 24 hours after onset, the proportion of edema contributing to the infarct lesion was calculated by quantifying the total volume of ischemic net water uptake. Edema volume was then subtracted from the total lesion volume to obtain edema-corrected lesion volumes. Finally, these corrected lesion volumes were compared with the final lesion volume on late follow-up serving as ground truth.

Results

The median lesion volume in the early follow-up was 115.1 mL (range, 21.9–539.9 mL) and significantly exceeded the median final lesion volume in the late follow-up CT, which was 86.6 mL (range, 11.2–399.0 mL; p < 0.001). The calculated mean proportion of edema within the early lesion volume was 25.8% (±5.9%; range, 11.1%–35.9%. The median edema-corrected lesion volume measured after 24 hours was 87.1 mL (range, 18.2–376.3 mL). The estimation of final lesion volume in the early follow-up CT was therefore improved by a mean of 31.4% (±2.1%) when correcting for the proportion of edema and did not differ significantly from the true final infarct volume (p = 0.2).

Conclusions

Edema-corrected volumes of early follow-up infarct lesion in CT were in close agreement with the actual final infarct volumes. Computed tomography–based edema correction of subacute infarct lesions improves the estimation of final tissue outcome. This could especially improve the comparability of imaging end points and facilitate patient recruitment in clinical trials.
Effects and Results of Omentopexy During Laparoscopic Sleeve Gastrectomy
Authors: Arslan Ergin , Banli Oktay , Sipahi Mesut , Yagci Gokhan
Published: April 2018

Purpose:

The aim of this study was to demonstrate that gastric volvulus can be prevented by omentopexy and sleeve gastrectomy without increasing other complication rates.

Materials and Methods:

A total of 1385 patients who underwent omentopexy and sleeve gastrectomy between April 2013 and September 2017 were included this study. Body mass index, age, sex, comorbidities, and postoperative complications of the patients were recorded as data.

Results:

A total of 1385 patients underwent sleeve gastrectomy and omentopexy. There were 999 female and 386 male patients. The mean age of the patients was 36 years (14 to 71 y). The mean body mass index was 42.74 kg/m2 (35 to 73 kg/m2). Twenty-one patients had previously undergone gastric banding and the other 80 patients had previous abdominal operation. The number of patients undergoing simultaneous cholecystectomy was 98. Three patients had hemorrhage due to hypertension and anticoagulant treatment in the postoperative period and the patients were treated medically. One staple-line leakage was observed. Twist, and stricture were not observed and no mortalities were noted.

Conclusions:

Sleeve gastrectomy and omentopexy can prevent the gastric twist, which is a functional cause of gastric stenosis, by stabilizing the posterior stomach wall.
The role of four-factor prothrombin complex concentrate in coagulopathy of trauma: A propensity matched analysis
Authors: Jehan Faisal , Aziz Hassan , O'Keeffe Terence , Khan Muhammad , Zakaria El Rasheid , Hamidi Mohammad , Zeeshan Muhammad , Kulvatunyou Narong , Joseph Bellal
Published: April 2018

BACKGROUND

Coagulopathy is a common complication after severe trauma. The efficacy of 4-factor prothrombin complex concentrate (4-PCC) as an adjunct to fresh frozen plasma (FFP) in reversal of coagulopathy of trauma (COT) has not been studied. The aim of our study is to compare 4-PCC + FFP versus FFP alone for the treatment of COT.

METHODS

We reviewed all trauma patients older than 18 years who received PCC + FFP or FFP alone at our Level I trauma center from 2015 to 2016. We excluded patients on preinjury oral anticoagulants. Patients were divided into two groups (4-PCC + FFP: FFP alone) and were matched in a 1:2 ratio using propensity score matching for demographics, vital and injury parameters, and initial international normalized ratio (INR). COT was defined as admission INR > 1.5. Corrected INR was defined as an INR of 1.5 or less. Outcome measures were time to correction of INR, packed red blood cells units transfused, thromboembolic complications, and mortality.

RESULTS

We analyzed 516 trauma patients, of which 120 patients (4-PCC + FFP: 40, FFP: 80) were matched. Mean age was 58 ± 20 years; 60% were male, median Injury Severity Score was 29 (14–38). Mechanism of injury was blunt in 87% patients. 4-PCC + FFP was associated with an accelerated correction of INR (373 minutes vs. 955 minutes; p = 0.001), a decrease in packed red blood cells units (7 units vs. 9 units; p = 0.04), and FFP units (5 units vs. 7 units; p = 0.03) transfused compared to FFP alone. 4-PCC + FFP was associated with a lower mortality (25% vs. 33% p = 0.04) compared with FFP alone; however, there was no difference in the thromboembolic complications (2.5% vs. 1.2%, p = 0.5) between the two groups. Administration of PCC + FFP led to an earlier correction of the INR compared with FFP alone.

CONCLUSION

Results of our study demonstrated that the use of 4-PCC in conjunction with FFP is associated with the rapid reversal of INR and reduction in transfusion requirements as compared with FFP alone. Four-factor PCC as a component therapy along with FFP is superior to FFP alone for the reversal of COT.

LEVEL OF EVIDENCE

Therapeutic studies, level IV.
Transfer status: A significant risk factor for mortality in emergency general surgery patients requiring colon resection
Authors: DeWane Michael P. , Davis Kimberly A. , Schuster Kevin M. , Erwin Scott P. , Maung Adrian A. , Becher Robert D.
Published: April 2018

BACKGROUND

Patients requiring emergency surgery have increased rates of morbidity and mortality. Transfer from outside institution delays effective control of ongoing infection and has been linked with worse outcomes. Previous research suggests transfer status negatively impacts survival but has not examined the effect of location and type of institution prior to transfer. This study aims to characterize the effect of type of transferring institution on postoperative outcomes after emergency colon surgery.

METHODS

Data originated from the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2012. Patients undergoing emergent colectomy were stratified based on location: not transferred, transferred from outside emergency department (ED), transferred from outside hospital inpatient unit, or transferred from a nursing home. Patient variables were stratified and compared via χ2 and analysis of variance. A backward-multivariable logistic regression and adjusted multivariate Cox regression analysis were performed to determine factors predicting 30-day mortality.

RESULTS

A total of 14,245 patients were identified, of whom 22% (3,203) were transfer patients. Among transfers, 48% (1,531) came from outside hospital inpatient units. Thirty-day mortality varied significantly (p < 0.001) among transfer location: 12.8% when not transferred, 19.4% from outside EDs, 25.7% from outside hospital inpatient units, and 34.2% from nursing homes. Hazard ratios were 1.30 (p < 0.001) after transfer from outside hospital inpatient ward and 1.50 (p < 0.001) after transfer from nursing home. Patients transferred from nursing homes were more likely to have septic shock (26.9% vs. 11.6%, p < 0.001) and longer hospitalizations (13 days vs. 10 days, p < 0.001) versus those not transferred.

CONCLUSION

Transfer status is an independent contributor to death in emergency general surgery patients undergoing colectomy. Patients transferred from an outside hospital ED, nursing home or chronic care facility have the poorest outcomes. These results reinforce the importance of rapid triage and transfer of patients with early physiologic decompensation to ensure timely surgical evaluation and intervention.

LEVEL OF EVIDENCE

Prognostic, level III; Therapeutic, level IV.
Developing and Implementing a Quality Assurance Strategy for Electroconvulsive Therapy
Authors: Hollingsworth Jessa , Baliko Beverly , McKinney Selina , Rosenquist Peter
Published: April 2018

Background

The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care; however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT.

Objective

The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy.

Methods

An audit tool was developed utilizing quality criteria derived from a systematic review of ECT practice guidelines, peer review, and facility policy. All ECT procedures occurring over a 2-month period of May to June 2017 were retrospectively audited and compared against target compliance rates set for the facility’s ECT program. Facility policy was adapted to reflect quality standards, and audit findings were used to inform possible practice change initiatives, were used to create benchmarks for continuous quality monitoring, and were integrated into regular hospital quality meetings.

Results

Clarification on standards of care and the use of clinical auditing in ECT was an effective starting point in the development of a quality assurance strategy. Audit findings were successfully integrated into the hospital’s overall quality program, and recognition of practice compliance informed areas for future quality development and policy revision in this small community-based hospital in the southeastern United States.

Conclusions

This project sets the foundation for a quality assurance strategy that can be used to help monitor procedural safety and guide future improvement efforts in delivering ECT. Although it is just the first step in creating meaningful quality improvement, setting clear standards and identifying areas of greatest clinical need were crucial beginning for this hospital’s growing program.
A method for RNA structure prediction shows evidence for structure in lncRNAs
Authors: ponti Riccardo Delli , Armaos Alexandros , Marti Stefanie , Tartaglia Gian Gaetano
Published: April 2018

To compare the secondary structures of RNA molecules we developed the CROSSalign method. CROSSalign is based on the combination of the Computational Recognition Of Secondary Structure (CROSS) algorithm to predict the RNA secondary structure at single-nucleotide resolution using sequence information, and the Dynamic Time Warping (DTW) method to align profiles of different lengths. We applied CROSSalign to investigate the structural conservation of long non-coding RNAs such as XIST and HOTAIR as well as ssRNA viruses including HIV. In a pool of sequences with the same secondary structure CROSSalign accurately recognizes repeat A of XIST and domain D2 of HOTAIR and outperforms other methods based on covariance modelling. CROSSalign can be applied to perform pair-wise comparisons and is able to find homologues between thousands of matches identifying the exact regions of similarity between profiles of different lengths. The algorithm is freely available at the webpage http://service.tartaglialab.com//new_submission/CROSSalign.
Multimodal evidence on shape and surface information in individual face processing
Authors: Nemrodov Dan , Behrmann Marlene , Niemeier Matthias , Drobotenko Natalia , Nestor Adrian
Published: April 2018

The significance of shape and surface information for face perception is well established, yet their relative contribution to recognition and their neural underpinnings await clarification. Here, we employ image reconstruction to retrieve, assess and visualize such information using behavioral, electroencephalography and functional magnetic resonance imaging data.

Our results indicate that both shape and surface information can be successfully recovered from each modality but that the latter is better recovered than the former, consistent with its key role for face representations. Further, shape and surface information exhibit similar spatiotemporal profiles, rely on the extraction of specific visual features, such as eye shape or skin tone, and reveal a systematic representational structure, albeit with more cross-modal consistency for shape than surface.

Thus, the present results help elucidate the representational basis of individual face recognition while, methodologically, they showcase the utility of image reconstruction and clarify its reliance on diagnostic visual information.
Early Exposure to Polycyclic Aromatic Hydrocarbons (PAHs) and Cardiac Toxicity in a Species (Xenopus laevis) with Low Aryl Hydrocarbon Receptor (AHR) Responsiveness
Authors: Sestak Madison C. , Pinette Julia A. , Lamoureux Caithlin M. , Whittemore Susan L.
Published: April 2018

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous, persistent environmental contaminants, of which 16 are EPA-designated priority pollutants. Cardiotoxicity is observed in fish with developmental exposures to certain PAHs; however, the mechanism of toxicity can differ. Phenanthrene (PHE) and benzo(a)pyrene (BaP) are both cardiotoxic to fish, but PHE acts independently of aryl hydrocarbon receptor (AHR) activation while BaP-associated cardiotoxicity is AHR-dependent. To further understanding of mechanisms of toxicity, we compared the effects of early exposure to the priority PAHs pyrene (PYR), fluoranthene (FLA), PHE and BaP on cardiac function andcytochrome P450 type 1A(cyp1a) mRNA expression, an indicator of AHR activation, in a model system with lower AHR sensitivity than that of fish, the embryos and larvae ofXenopus laevis.Exposure to PYR, PHE, and FLA (0.25 – 25 μM) caused ventricular tachycardia early in heart development, but bradycardia and atrioventricular (AV) block in later stages. Elevatedcyp1amRNA levels indicate that FLA and BaP, but not PHE or PYR, are AHR agonists. The finding of FLA-induced cardiotoxicity andcyp1aexpression (35-fold) is particularly surprising as FLA inhibits CYP1A activity in fish and, as a single compound, is not cardiotoxic. Our results suggest that early exposure to PHE, PYR, and FLA, but not to BaP, compromises cardiac function by altering normal pacemaker activity and conduction inXenopus, effects associated with increased mortality. Our findings also reveal a considerable degree of species specificity between fish and frog regarding cardiac sensitivity to developmental PAH exposures and have implications for the cardiovascular health of PAH-exposed humans and wild amphibians.
Retracing the Hawaiian silversword radiation despite phylogenetic, biogeographic, and paleogeographic uncertainty
Authors: Landis Michael J. , Freyman William A. , Baldwin Bruce. G.
Published: April 2018

The Hawaiian silversword alliance (Asteraceae) is an iconic adaptive radiation of 33 species. However, like many island plant lineages, no fossils have been assigned to the clade. As a result, the clade’s age and diversification rate are not known precisely, making it difficult to test biogeographic hypotheses about the radiation. In lieu of fossils, paleo-geographically structured biogeographic processes may inform species divergence times; for example, an island must first exist for a clade to radiate upon it. We date the silversword clade and test biogeographic hypotheses about its radiation across the Hawaiian Archipelago by modeling interactions between species relationships, molecular evolution, biogeographic scenarios, divergence times, and island origination times using the Bayesian phylogenetic framework, RevBayes. The ancestor of living silverswords most likely colonized the modern Hawaiian Islands once from the mainland approximately 5.1 Ma, with early surviving silversword lineages first appearing approximately 3.5 Ma. In testing the progression rule of island biogeography, we found strong positive evidence of the dispersal process preferring old-to-young directionality, but strong negative evidence for speciation occurring on islands during their young growth phase. This work serves as a general example for how diversification studies benefit from incorporating biogeographic and paleogeographic components.
Structural variants and selective sweep foci contribute to insecticide resistance in theDrosophila melanogastergenetic reference panel
Authors: Battlay Paul , Green Llewellyn , Leblanc Pontus B. , Schmidt Joshua M. , Fournier-Level Alexandre , Robin Charles
Published: April 2018

Patterns of nucleotide polymorphism within populations ofDrosophila melanogastersuggest that insecticides have been the selective agents driving the strongest recent bouts of positive selection. However, there is a need to explicitly link selective sweep loci to the particular insecticide phenotypes that could plausibly account for the drastic selective responses that are observed in these non-target insects. Here, we screen the Drosophila Genetic Reference Panel with two common insecticides; malathion (an organophosphate) and permethrin (a pyrethroid). Genome wide association studies map ‘survival-on-malathion’ to two of the largest sweeps in theD. melanogastergenome;AceandCyp6g1. Malathion survivorship also correlates with lines which have high levels ofCyp12d1andJheh1andJheh2transcript abundance. Permethrin phenotypes map to the largest cluster of P450 genes in the Drosophila genome, however in contrast to a selective sweep driven by insecticide use, the derived state seems to be associated with susceptibility. These results underscore previous findings that highlight the importance of structural variation to insecticide phenotypes:Cyp6g1exhibits copy number variation and transposable element insertions,Cyp12d1is tandemly duplicated, theJhehloci are associated with aBari1transposable element insertion, and aCyp6a17deletion is associated with susceptibility.
NAD(P)HX repair deficiency causes central metabolic perturbations in yeast and human cells
Authors: Becker-Kettern Julia , Paczia Nicole , Conrotte Jean-François , Zhu Chenchen , Fiehn Oliver , Jung Paul P. , Steinmetz Lars M. , Linster Carole L.
Published: April 2018

NADHX and NADPHX are hydrated and redox inactive forms of the NADH and NADPH cofactors, known to inhibit several dehydrogenasesin vitro. A metabolite repair system that is conserved in all domains of life and that comprises the two enzymes NAD(P)HX dehydratase and NAD(P)HX epimerase, allows reconversion of both theS- andR-epimers of NADHX and NADPHX to the normal cofactors. An inherited deficiency in this system has recently been shown to cause severe neurometabolic disease in children. Although evidence for the presence of NAD(P)HX has been obtained in plant and human cells, little is known about the mechanism of formation of these derivativesin vivoand their potential effects on cell metabolism. Here, we show that NAD(P)HX dehydratase deficiency in yeast leads to an important, temperature-dependent NADHX accumulation in quiescent cells with a concomitant depletion of intracellular NAD+and serine pools. We demonstrate that NADHX potently inhibits the first step of the serine synthesis pathway in yeast. Human cells deficient in the NAD(P)HX dehydratase also accumulated NADHX and showed decreased viability. In addition, those cells consumed more glucose and produced more lactate, potentially indicating impaired mitochondrial function. Our results provide first insights into how NADHX accumulation affects cellular functions and pave the way for a better understanding of the mechanism(s) underlying the rapid and severe neurodegeneration leading to early death in NADHX repair deficient children.