bluuebunny/crossref_metadata_2025 huggingface dataset:
Note: A simple detection method for helium droplet spectroscopy experiments
Authors: Thomas Brandon J. , Harruff-Miller Barbara A. , Lewis William K.
Published: January 2017

Helium droplet methods are currently established as a premier experimental technique for the production and spectroscopic study of novel clusters and complexes. Unfortunately, some of the essential equipment required to perform the experiments, such as the detector used to monitor photon-induced depletion of the helium droplet beam, can be relatively large, complex, and expensive. Most often this detector is a quadrupole mass spectrometer (QMS). In this report, we describe the development and evaluation of an extremely simple, straightforward, small, and inexpensive droplet beam detector for use in helium droplet spectroscopy experiments and compare its performance to that of a QMS by recording the infrared spectra of helium droplets doped with either 13CO2 or CD4.
Cellular context-dependent consequences of
Apc
mutations on gene regulation and cellular behavior
Authors: Hashimoto Kyoichi , Yamada Yosuke , Semi Katsunori , Yagi Masaki , Tanaka Akito , Itakura Fumiaki , Aoki Hitomi , Kunisada Takahiro , Woltjen Knut , Haga Hironori , Sakai Yoshiharu , Yamamoto Takuya , Yamada Yasuhiro
Published: January 2017

Significance

Genotype-linked disease phenotypes are often observed in a cell type-specific manner, implying a cellular context-dependent effect of the genetic aberrations. However, the extent to which cellular context affects the biological consequences of oncogenic mutations is unclear. Here, we reprogrammed colon tumor cells in an
Apc
Min/+
(adenomatous polyposis coli) mouse model and showed the divergent in vivo consequences of
Apc
mutation that arise in different cellular contexts. We also showed that the reprogrammed tumor cells remain in a pretumoral microadenoma stage after differentiation into colonic epithelium, suggesting that macroscopic colon tumor cells are reprogrammable into microadenoma cells. Our results underscore the significance of epigenetic regulation on gene expression, cellular plasticity, and cellular behavior in response to cancer-causing mutations.
Climate change effects on urban pest insects.
Authors: Comont R. F.
Published: January 2017

This chapter discusses the possible effects of climate change on the population dynamics of insect pests in urban areas, and describes several key traits that are likely to govern the sensitivity of insect pests to climate change. It also describes the different types of insect pests. To be known as a pest, a species (native or non-native) is generally a threat in at least one of 3 main ways: threats, or apparent threats, to health of humans or domestic animals; structural or aesthetic damage to property or amenity plantings; and nuisance impacts. Ongoing changes to climate are likely, at least in temperate areas, to increase the abundance and diversity of pest species. The impacts of the pest species are likely to scale with abundance and diversity, and new pests are likely to arise as a result of introductions or better adaptations to the new climate regime. With urban areas, changes to the built environment and to human behaviour (including adaptations to the changing climate) will affect the impacts of pest species in ways that are hard to predict.
Climate change and urban pest management.
Authors: Dhang P.
Published: January 2017

This chapter presents a general review on how climate change could affect the population dynamics, distribution, density and diversity of urban pests, as well as their management. Particular focus is given on mosquitoes, flies, termites, ants, ticks, and cockroaches. Temperature, the primary indicator commonly used to determine climate change, has a significant influence on pest biology and behaviour. Temperature also influences the efficacy of all pest-control activities. In addition to the direct impact of temperature on the efficacy of insecticides, temperature can also influence a number of tools and methodologies which make use of them, such as in insecticide-treated nets, long-lasting insecticidal nets, insecticide residual treatment, and odour-baited traps. It is concluded that climate change and resulting temperature regimens, in particular, will have a profound influence on urban pests and their management strategies.
Natural disasters, extreme events and vector-borne diseases: impact on urban systems.
Authors: Moore C. G.
Published: January 2017

Various host-vector-pathogen systems will be affected in different ways by particular aspects of climate. The likelihood of a particular class of climatic event causing or leading to an increase (or decrease) in vector-borne disease outbreaks will depend heavily on the ecology of the vectors (such as insects (e.g. mosquitoes), ticks, and mites) and vertebrate hosts, as well as the behaviour and other characteristics of the local human population. This chapter first examines several major environmental causes of disasters, and reviews evidence for impact, or lack of impact, on vector-borne disease. These natural disasters include hurricane, tornado, tsunami, storm, floods, drought, extreme cold or heat, and earthquake, volcanic eruption and subsequent landslide. A vector-borne disease equation is presented, and the impact of climate change-related extreme events on the components (namely vector density, transmission efficiency, biting rate, daily mortality (survival), extrinsic incubation, and host recovery rate) of this equation is discussed.
Survival of Formosan subterranean termite colonies during periods of flooding.
Authors: Cottone C. , Su NanYao Su NanYao
Published: January 2017

The Formosan subterranean termite, Coptotermes formosanus, is an invasive pest in USA and has become successfully established in areas of the south-eastern USA and Hawaii. Immediately after the Hurricane Katrina flooding in New Orleans, Louisiana in August 2005, the question of subterranean termite colony survivorship was raised. The determination of colony survival mechanisms is important for those that live in flood-prone areas in which C. formosanus has become established. Understanding the survival and behaviour of C. formosanus colonies during flooding will help pest management professionals convey the need of retreating flooded structures for termites and educate the public of the importance of vigilance in termite control practices after natural disasters. This chapter reviews the economic impact, biology, behaviour, geographical distribution, and potential colony survival mechanisms during flooding of C. formosanus.
Urbanization, climate change and malaria transmission in sub-Saharan Africa.
Authors: Kweka E. J. , Mazigo H. D. , Himeidan Y. E. , Morona D. , Munga S.
Published: January 2017

This chapter explores the factors leading to urban migration in Sub-Saharan Africa, the impact of climate on the behaviour of malaria vectors (Anopheles spp.) in Africa, and the effects of climate change, urbanization, urban agriculture, and human settlement, activities and lifestyle on vector ecology and malaria transmission in urban areas of Sub-Saharan Africa. The adaptation of malaria vectors to urban climate is also discussed.
Climate change and urban human health.
Authors: Barata M. M. de L.
Published: January 2017

This chapter focuses on how to use research to build a resilient city facing the hazards posed by climate change. It takes into account all the interrelationships between climate and pests in cities. It presents an overview of the scientific knowledge on urban health outcomes and their climate-related drivers, and discusses the challenges for implementing adaptation strategies in cities to reduce pests and climate change hazards. Several climate-sensitive vector-borne diseases (such as mosquito- and tick-borne diseases) are discussed, including the recommended strategies for their control.
Innovative formulations useful for area-wide application suitable for climate change.
Authors: Liszka D. , Swietoslawski P.
Published: January 2017

This chapter provides an overview of the impact of climate change on pest management strategies, and discusses a number of novel technologies, such as the use of 3D-IPNS (3-Dimensional Immobilizing Polymer Network Structure) acting through a physical mechanism, which is a completely new and promising approach for the management of ectoparasites (e.g. poultry mites), and plant insect pests. It also describes the use of a physical action adjuvant, Provecta, a unique mixture of polymeric compounds to be combined in the spray tank with insecticides (toxicants) for more effective treatment. It generates specific actions on contact resulting in dehydration and eventual suffocation. Product characteristics and modes of action of an attract-and-kill insecticide formulation and a controlled-release capsulated larvicide for mosquitoes are described.
Sustainability and tourism development in island territories.
Authors: Modica P. , Uysal M.
Published: January 2017

This chapter analyses the concept of sustainability and island tourism development, and includes a case study of a Sardinian island. The case study refers to the island of Sant'Antioco. A small group of entrepreneurs working within tourism and related sectors on the island was involved to test the feasibility of the limits of acceptable change (LAC) framework to positively debate sustainable island tourism.
Developing a sustainable Caribbean tourism product.
Authors: Wright A.
Published: January 2017

In this chapter, Caribbean tourist arrivals, receipts and the industry challenges are reviewed before exploring how to create and maintain a sustainable Caribbean tourism product. The basics of competitive strategy and how it relates to sustainability are reviewed, leading to a discussion of the concept of sustainable competitive advantage (SCA). Strategies that companies have employed to develop a sustainable product are reviewed.
Dive tourism and the entrepreneurial process in the Perhentian Islands, Malaysia.
Authors: Jeyacheya J. , Hampton M. P.
Published: January 2017

This chapter explores the question of how the dive tourism entrepreneurial process in the Perhentian islands transforms (or not) as the destination moves to a strategically competitive one. It takes a holistic approach by considering the personal (characteristics, traits and socio-economic factors), environmental (business opportunities, resources and threats) and sociological factors (cultural norms, social networks, family) to understand how they interact with each other, with each stage of the process, and what the practical implications are.
Microtubules are reversibly depolymerized in response to changing gaseous microenvironments within Aspergillus nidulans biofilms
Authors: Shukla Nandini , Osmani Aysha H. , Osmani Stephen A.
Published: January 2017

How microtubules (MTs) are regulated during fungal biofilm formation is unknown. By tracking MT +end–binding proteins (+TIPS) in Aspergillus nidulans, we find that MTs are regulated to depolymerize within forming fungal biofilms. During this process, EB1, dynein, and ClipA form transient fibrous and then bar-like structures, novel configurations for +TIPS. Cells also respond in an autonomous manner, with cells separated by a septum able to maintain different MT dynamics. Surprisingly, all cells with depolymerized MTs rapidly repolymerize their MTs after air exchange above the static culture medium of biofilms. Although the specific gasotransmitter for this biofilm response is not known, we find that addition of hydrogen sulfide gas to growing cells recapitulates all aspects of reversible MT depolymerization and transient formation of +TIPs bars. However, as biofilms mature, physical removal of part of the biofilm is required to promote MT repolymerization, which occurs at the new biofilm edge. We further show MT depolymerization within biofilms is regulated by the SrbA hypoxic transcription factor and that without SrbA, MTs are maintained as biofilms form. This reveals a new mode of MT regulation in response to changing gaseous biofilm microenvironments, which could contribute to the unique characteristics of fungal biofilms in medical and industrial settings.
A Density‐Ratio Model of Crop Yield Distributions
Authors: Yvette Zhang Yu
Published: January 2017

This paper proposes a density ratio estimator of crop yield distributions, wherein the number of observations for individual distributions is often quite small. The density ratio approach models individual densities as distortions from a common baseline density. We introduce a probability integral transformation to the density ratio method that simplifies the modeling of distortion functions. We further present an implementation approach based on the Poisson regression, which facilitates model estimation and diagnostics. Monte Carlo simulations demonstrate good finite sample performance of the proposed method. We apply this method to estimate the corn yield distributions of ninety‐nine Iowa counties, and to calculate crop insurance premiums. Lastly, we illustrate that we can employ the proposed method to effectively identify profitable insurance policies.
Does Aerobic Exercise Increase 24-Hour Ambulatory Blood Pressure Among Workers With High Occupational Physical Activity?—A RCT
Authors: Korshøj Mette , Krause Niklas , Clays Els , Søgaard Karen , Krustrup Peter , Holtermann Andreas
Published: January 2017

OBJECTIVE

High occupational physical activity (OPA) increases cardiovascular risk and aerobic exercise has been recommended for reducing this risk. This paper investigates the effects of an aerobic exercise intervention on 24-hour ambulatory blood pressure (ABP) among cleaners with high OPA.

METHODS

Hundred and sixteen cleaners between 18 and 65 years were randomized. During the 4-month intervention period, the aerobic exercise group (AE) (n = 57) performed worksite aerobic exercise (2 × 30 minutes/week), while the reference group (REF) (n = 59) attended lectures. Between-group differences in 4-month ABP changes were evaluated by intention-to-treat analysis using a repeated-measure 2 × 2 multiadjusted mixed-models design.

RESULTS

Relative to REF, 24-hour ABP significantly increased in AE: systolic 3.6 mm Hg (95% confidence interval (CI) 1.6–5.7) and diastolic 2.3 mm Hg (95% CI 0.9–3.8). Cleaners with high aerobic workload exhibited particularly high 24-hour ABP increases: systolic 6.0 mm Hg (95% CI 2.4–9.6), and diastolic 3.8 mm Hg (95% CI 1.3–6.4).

CONCLUSION

Aerobic exercise increased 24-hour ABP among cleaners. This adverse effect raises questions about the safety and intended benefits of aerobic exercise, especially among workers with high OPA and a demanding aerobic workload.

http://www.controlled-trials.com/ISRCTN86682076. Unique identifier ISRCTN86682076.

CLINICAL TRIAL REGISTRATION

Trial Number ISRCTN86682076.
Otosclerosis
Authors: Batson Lora , Rizzolo Denise
Published: January 2017

Otosclerosis is a complex and progressive disease of pathological bone remodeling that affects the otic capsule of the temporal bone, resulting in hearing loss. Although traditional diagnostic methods are still used, improvements in technology and research have paved the way for additional diagnostic techniques and advancements. The traditional treatment of otosclerosis, stapes surgery, is now being augmented or replaced by innovations in hearing aid technology and cochlear implants. Earlier diagnosis of otosclerosis can occur through understanding of the cause, risk factors, and current diagnostic testing.
A fresh look at memory loss
Authors: Zale Stephanie , Dickerson Lisa
Published: January 2017

Frontotemporal dementia is a neurodegenerative disease affecting cognition and behavior in multiple devastating ways. This article highlights diagnostic features helpful in differentiating frontotemporal dementia from other dementias, most commonly Alzheimer disease.
Bone Morphogenetic Proteins in Pediatric Spinal Arthrodesis: A Statewide Analysis of Trends and Outcome of Utilization
Authors: Nwachukwu Benedict U. , Schairer William W. , Pan Ting , Widmann Roger F. , Blanco John S. , Green Daniel W. , Lyman Stephen , Dodwell Emily R.
Published: January 2017

Introduction:

Bone morphogenetic protein (BMP) is considered off-label when used to augment spinal arthrodesis in children and adolescents. There is a paucity of longer-term information on BMP use in this population. The purpose of this study was to determine the rate of BMP utilization in pediatric spinal arthrodesis, assess factors associated with BMP use in this population, and evaluate long-term outcome.

Methods:

Spinal arthrodeses in patients 18 years and younger performed in New York State between 2004 and 2014 were identified through the Statewide Planning and Research Cooperative System database. All cases had a minimum 1-year follow-up. The primary outcome was revision arthrodesis. The primary outcome, as well as short-term and longer-term complications were identified using time-to-event analysis. Multivariable Cox proportional hazards models were used to assess the association between BMP and outcomes.

Results:

Of 7312 children and adolescents who underwent spinal arthrodesis, 462 (6.7%) received BMP. Utilization spiked between 2008 and 2010 when (8.6%) of cases received BMP, but subsequently BMP use returned to pre-2008 levels (2004 to 2007: 5.3%; 2011 to 2014: 5.5%). BMP was more likely to be used in children who were older (P=0.027), white and with higher mean family income (P<0.001 for race and income). BMP was more likely to be used for revision surgery, 2 to 3 level fusions, and spondylolisthesis (P<0.001 for all). Revision rates did not differ based on BMP utilization status. Patients receiving BMP did not have increased risk of short-term complications although at 5-year follow-up, BMP was associated with a statistically significant increased risk of mechanical complications (hazard ratio 1.48; 95% confidence interval, 1.02-2.14).

Conclusions:

Off-label use of BMP for pediatric spinal arthrodesis increased until 2008 and now appears to be decreasing. Racial/ethnic minorities and lower socioeconomic status patients are less likely to receive BMP. The rate of revision after spinal arthrodesis does not differ between those treated with and without BMP. Further long-term studies are required to delineate appropriate guidelines for BMP utilization in children.

Level of Evidence:

Level III.
New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara: A Comprehensive Approach
Authors: Abraham Edward , Toby David , Welborn Michelle C. , Helder Cory W. , Murphy Angela
Published: January 2017

Background:

Successful surgical treatment of late-presenting infantile tibia vara (ITV) patient requires the correction of oblique deformities. The purpose of this study was to report on a new comprehensive approach to correct and prevent recurrence of these deformities with a single procedure.

Methods:

Medical records of 23 consecutive children (7 to 18 y) with advanced ITV (29 knees) were retrospectively reviewed after a mean of 7.3 years postoperatively (range, 2 to 22 y). Indications for the corrective surgery were any child 7 year or older with a varus mechanical axis angle ≥10 degrees or a varus anatomic axis angle ≥11 degrees and a medial tibial angle (MTA) slope <60 degrees. The deformities were corrected with a dome-shaped osteotomy proximal to the tibial tubercle with a midline vertical extension to the subchondral region of the joint and a lateral hemi-epiphysiodesis.

Results:

At latest follow-up, means and medians of each tibial radiographic axis measurement improved significantly from preoperative values (P<0.001): mechanical axis angle from 23 degrees to 4 degrees varus, anatomic axis angle from 25 degrees varus to 1 degree valgus, MTA downward slope from 30 to 78 degrees, posterior MTA from 59 to 80 degrees. In total, 79% and 74% had good to excellent results based on radiographic criteria and clinical questionnaire for satisfaction, pain and function, respectively. Two abnormal medial tibial plateau types were described.

Conclusions:

This is the first study to use a single-stage double osteotomy performed proximal to the tibial tubercle for the late-presenting ITV for children 7 years of age or older. In addition to the effective correction of the 4 major tibial deformities, a lateral proximal tibial hemi-epiphysiodesis minimizes recurrence of tibia vara. A contralateral proximal tibial epiphysiodesis is recommended for treated skeletally immature patients with unilateral disease.

Level of Evidence:

Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
Uniplanar Versus Fixed Pedicle Screws in the Correction of Thoracic Kyphosis in the Treatment of Adolescent Idiopathic Scoliosis (AIS)
Authors: Badve Siddharth A. , Goodwin Ryan C. , Gurd David , Kuivila Thomas , Kurra Swamy , Lavelle William F.
Published: January 2017

Background:

The aim of surgical treatment of scoliosis is to obtain fusion of the spinal column, balanced in the coronal and sagittal planes. Great success has been attained with coronal correction; however, the sagittal profile has received less attention, resulting in little correction of sagittal plane alignment. The purpose of this study was to compare uniplanar and fixed pedicle screws in the correction of the thoracic sagittal alignment in the treatment of adolescent idiopathic scoliosis (AIS).

Methods:

The sagittal profile of 2 groups of patients undergoing posterior spinal fusion (PSF) for AIS was compared. One group had uniplanar screws (n=16) as bone anchors, and the second group had fixed screws (n=20). Consecutive patients with AIS treated by PSF during 2004 to 2006 with fixed screws; and those treated in 2008 with uniplanar screws were included in the study. Data included: patient demographics, medical conditions, curve type, Risser stage, coronal and sagittal curve magnitude, curve flexibility, osteotomies, fusion levels, type and location of instrumentation, curve magnitude at the initial postoperative visit and at final follow-up. ANOVA and χ2 testing was completed. A P<0.05 was considered significant.

Results:

Both groups were comparable demographically, medically, in relation to the curve characteristics and the surgical treatment. Immediate postcorrection sagittal curvature measurements were greater using the uniplanar than fixed screws, 36 versus 26 degrees and was also statistically significant at final follow-up (P=0.006). There was no difference between groups with respect to coronal thoracic deformity. In the Lenke 1 and Lenke 2 curve population, similar results were found.

Conclusions:

In patients undergoing PSF for AIS, uniplanar screws achieved superior correction of the sagittal thoracic alignment than fixed screws. This advantage was maintained in the postoperative follow-up period. The ability of the uniplanar screws to adapt to variable sagittal orientation appears to contribute to better radiographic outcomes.

Level of Evidence:

This is a level III respective review study conducted at a single center from a single, pediatric spine surgeon.
Influence of Insurance Type on the Access to Pediatric Care for Children With Distal Radius Torus Fractures
Authors: Potak Harrison , Iobst Christopher A.
Published: January 2017

Background:

Previous literature has demonstrated that pediatric orthopaedic patients with private insurance have less difficulty obtaining appointments than those with Medicaid. Not all injuries of an orthopaedic nature, however, require specialist care. This study evaluated the willingness of pediatricians to provide care for minor orthopaedic injuries and whether or not the patient’s insurance status influenced the decision to provide care.

Methods:

Ninety-nine pediatric primary care offices were randomly selected from 2 regions in Florida. Each office was contacted twice, 2 to 3 months apart, and presented with a fictionalized account of a patient that had sustained a torus (“buckle”) fracture of the distal radius. In the first call, the patient was presented as having private insurance, and in the second call as having Medicaid insurance. If the patient was denied an appointment, the reason was recorded.

Results:

Of the 99 offices, 100% were willing to treat the patient’s injury if the child had private insurance, compared with 76% if the child had Medicaid. All Medicaid patient refusals were based on the insurance status of the patient. No office refused to see the patient due to the nature of the injury. Ninety-four percent of offices in South Florida were willing to see the Medicaid patient, compared with 58% in Central Florida. These differences were statistically significant (P<0.0001).

Conclusions:

It was previously unknown whether pediatricians felt comfortable managing minor orthopaedic injuries. This study demonstrates that 100% of the pediatricians surveyed were willing to treat a child with a distal radius buckle fracture with proper insurance. This information potentially can provide additional avenues for patients to achieve timely access to care. However, as seen in previous studies, there was a statistically significant difference in access to care for the same child with Medicaid. Until reimbursement rates for Medicaid improve, these patients will continue to have difficulty obtaining access to care to both primary care providers and specialists.

Level of Evidence:

Prospective survey study.
Assessment of Splints Applied for Pediatric Fractures in an Emergency Department/Urgent Care Environment
Authors: Abzug Joshua M. , Schwartz Brandon S. , Johnson Aaron J.
Published: January 2017

Background:

Fractures are common in the pediatric population. The initial evaluation is rarely by an orthopaedic surgeon, but commonly an emergency room or urgent care center physician/extender. This typically involves splint application by a nonorthopaedist to immobilize the extremity and provide stabilization. Iatrogenic injuries from inappropriate splint placement are a potential public health and legal concern that can lead to complications. The primary purpose of this study was to prospectively evaluate the adequacy of all splints placed on patients who presented to a pediatric orthopaedic office; secondary outcomes included assessing prevalence and types of complications that were associated with inadequate splints.

Methods:

Patients aged 0 to 18 years who presented with a splint were prospectively enrolled. Information was obtained regarding demographics of the patient and splint placement. Splints were evaluated for functional position, appropriate length, and presence of elastic bandage on the skin. Photographs were taken of each splint, and the extremity was examined for any soft tissue complications. Splints were not removed in 31 patients who had undergone fracture reduction.

Results:

In total, 275 patients were prospectively enrolled. Splints were improperly placed in 93%, with application of elastic bandage directly to the skin accounting for 77%. Improper positioning was observed in 59%, and inappropriate splint length was present in 52%. Skin and soft tissue complications were observed in 40%. The most common iatrogenic splint-related complication was excessive edema, seen in 28%. Direct injury to the skin and soft tissue was seen in 6%.

Conclusions:

Many practitioners incorrectly apply splints, potentially leading to suboptimal results or causing injury. Complications of poor splint placement include excessive swelling, skin breakdown, and poor immobilization. Health care workers who treat pediatric fractures may benefit from more extensive education regarding proper splinting techniques.

Level of Evidence:

Level 2—therapeutic study.
Lack of correlation between X-ray repair cross-complementing group 1 gene polymorphisms and the susceptibility to colorectal cancer in a Malaysian cohort
Authors: Lau Tze-Pheng , Lian Lay-Hoong , Cheah Phaik-Leng , Looi Lai-Meng , Roslani April C. , Goh Khean-Lee , Lee Ping-Chin , Chua Kek-Heng
Published: January 2017

X-ray repair
cross-complementing group 1 (XRCC1) is one of the key components in the base excision repair pathway that repairs erroneous DNA lesions and removes nonbulky base adducts for the maintenance of genome integrity. Studies have revealed that differences in individual DNA repair capacity can impact the interindividual variation in cancer susceptibility, tumour aggressiveness and treatment response. The relationship between XRCC1 and sporadic colorectal cancer (CRC) susceptibility, which is hitherto inconclusive, has been explored in many association studies of different populations. In view of the conflicting findings generated, we aimed to investigate the association between XRCC1 and genetic predisposition to CRC among Malaysians. The present case–control association study was conducted on 130 CRC patients and 212 age-matched healthy controls. The genotyping of XRCC1 Arg194Trp, Arg280His and Arg399Gln single nucleotide polymorphisms was performed with allele-specific real-time PCR approach. This was followed by basic statistical analysis on the single nucleotide polymorphisms and haplotype data obtained. No significant difference in the allele and genotype frequencies was observed between CRC patients and healthy controls (P>0.05). There was also no association observed between XRCC1 haplotypes and CRC (P>0.05). In conclusion, a positive association between XRCC1 gene polymorphisms and CRC risk was not established in our Malaysian population.
Genetic counselling and high-penetrance susceptibility gene analysis reveal the novel CDKN2A p.D84V (c.251A>T) mutation in melanoma-prone families from Italy
Authors: Borroni Riccardo G. , Manganoni Ausilia M. , Grassi Sara , Grasso Maurizia , Diegoli Marta , Giorgianni Carmela , Favalli Valentina , Pavoni Laura , Cespa Maddalena , Arbustini Eloisa
Published: January 2017

Genetic susceptibility to primary cutaneous melanoma (PCM) may account for up to 12% of PCMs, presenting as the familial atypical mole/multiple melanoma syndrome (FAMMM), an autosomal dominant condition with incomplete penetrance and variable expressivity, characterized by PCM in at least two relatives and/or more than one PCMs in the same patient. To identify individuals at high genetic risk of PCM, from 1 January 2012 to 31 December 2015, we offered genetic counselling and molecular analysis of the two high-penetrance FAMMM susceptibility genes, cyclin-dependent kinase inhibitor 2A (CDKN2A) and cyclin-dependent kinase 4 (CDK4), to 92 consecutive, unrelated patients with FAMMM. Age at diagnosis and number of PCMs were obtained from medical records; the number of PCMs and affected relatives were recorded for each family. The diagnostic work-up consisted of genetic counselling and cascade genetic testing in patients and further extension to relatives of those identified as mutation carriers. All exons and exon/intron boundaries of CDKN2A and CDK4 genes were screened by direct bidirectional sequencing. We identified CDKN2A mutations in 19 of the 92 unrelated patients (20.6%) and in 14 additional, clinically healthy relatives. Eleven of these latter subsequently underwent excision of dysplastic nevi, but none developed PCM during a median follow-up of 37.3 months. In three patients from unrelated families, the novel CDKN2A p.D84V (c.251A>T) mutation was observed, associated with PCM in each pedigree. Genetic screening of FAMMM patients and their relatives can contribute towards specific primary and secondary prevention programmes for individuals at high genetic risk of PCM. The novel CDKN2A p.D84V (c.251A>T) mutation adds to the known mutations associated with FAMMM.
Characterization of Readmission by Day of Rehospitalization After Colorectal Surgery
Authors: Al-Mazrou Ahmed M. , Suradkar Kunal , Mauro Christine M. , Kiran Ravi P.
Published: January 2017

BACKGROUND:

Factors associated with readmission stratified by the day of postdischarge rehospitalization after colorectal surgery have not been characterized previously.

OBJECTIVE:

The purpose of this study was to identify factors leading to readmission on a day-to-day basis after discharge from colorectal surgery.

DESIGN:

This was a retrospective analysis of patients readmitted within 30-days after colorectal surgery. Reasons and factors associated with readmission each day after discharge were evaluated. Early readmitted patients (day 0–5 postdischarge) were compared with those readmitted later (day 6–29 postdischarge).

SETTINGS:

The study was conducted at a tertiary center.

PATIENTS:

Patients included those who had undergone primary colorectal resection from the American College of Surgeons National Surgical Quality Improvement Program (2012–2013).

MAIN OUTCOME MEASURES:

The study intended to identify factors associated with any early versus late hospital readmission and to evaluate diagnoses for unplanned readmissions on a day-to-day basis after discharge.

RESULTS:

For 69,222 elective colorectal procedures, 7476 patients (10.8%) were readmitted to the hospital within 30 days. Early (median, 3 days) and late (median, 11 days) readmissions were 3278 (43.8%) and 4198 (56.2%). Except for sex, patient demographics were similar between groups. Neurologic comorbidity; wound disruption; sepsis or septic shock; unplanned reintubation and reoperation; anastomotic leak and ileus; and neurological, cardiovascular, and pulmonary complications were significantly higher in the early readmission, whereas disseminated malignancy, stoma creation, and renal/urological complications were significantly higher in the late readmission group. On multivariable analysis, early readmission was significantly associated with male patients, wound disruption, sepsis or septic shock, reoperation, reintubation, and postoperative neurological complications. Disseminated malignancy, ostomy creation, and postoperative renal dysfunction/urological infection were associated with delayed readmission.

LIMITATIONS:

Thirty-day readmissions and reasons for unplanned rehospitalizations were evaluated.

CONCLUSIONS:

Differing factors are associated with early versus late readmission after colorectal resection. These data suggest that early readmission is intricately related to patient and operative complexity and hence may be inevitable, whereas delayed hospital presentation is associated with identifiable perioperative predictors at the time of discharge and hence more likely to be targetable.
Liposomal Bupivacaine Use in Transversus Abdominis Plane Blocks Reduces Pain and Postoperative Intravenous Opioid Requirement After Colorectal Surgery
Authors: Stokes Audrey L. , Adhikary Sanjib D. , Quintili Ashley , Puleo Frances J. , Choi Christine S. , Hollenbeak Christopher S. , Messaris Evangelos
Published: January 2017

BACKGROUND:

Enhanced recovery protocols frequently use multimodal postoperative analgesia to improve postoperative outcomes in patients undergoing colorectal surgery.

OBJECTIVE:

The purpose of this study was to evaluate liposomal bupivacaine use in transversus abdominis plane blocks on postoperative pain scores and opioid use after colorectal surgery.

DESIGN:

This was a retrospective cohort study comparing outcomes between patients receiving nonliposomal anesthetic (n = 104) and liposomal bupivacaine (n = 303) blocks.

SETTINGS:

The study was conducted at a single tertiary care center.

PATIENTS:

Patients included those identified within an institutional database as inpatients undergoing colorectal procedures between 2013 and 2015 who underwent transversus abdominis plane block for perioperative analgesia.

MAIN OUTCOME MEASURES:

The study measured postoperative pain scores and opioid requirements.

RESULTS:

Patients receiving liposomal bupivacaine had significantly lower pain scores for the first 24 to 36 postoperative hours. Pain scores were similar after 36 hours. The use of intravenous opioids among the liposomal bupivacaine group decreased by more than one third during the hospitalization (99.1 vs 64.5 mg;p= 0.040). The use of ketorolac was also decreased (49.0 vs 18.3 mg;p< 0.001). In subgroup analysis, the decrease in opioid use was observed between laparoscopic and robotic procedures but not with laparotomies. No significant differences were noted in the use of oral opioids, acetaminophen, or ibuprofen. Postoperative length of stay and total cost were decreased in the liposomal bupivacaine group but did not achieve statistical significance.

LIMITATIONS:

The study was limited by its retrospective, single-center design and heterogeneity of block administration.

CONCLUSIONS:

Attenuated pain scores observed with liposomal bupivacaine use were associated with significantly lower intravenous opioid and ketorolac use, suggesting that liposomal bupivacaine-containing transversus abdominis plane blocks are well aligned with the opioid-reducing goals of many enhanced recovery protocols.
Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience
Authors: O’Neill Conor H. , Platz Joseph , Moore Jesse S. , Callas Peter W. , Cataldo Peter A.
Published: January 2017

BACKGROUND:

There is debate regarding the appropriate use of transanal endoscopic microsurgery for rectal cancer.

OBJECTIVE:

This study analyzed our single-center experience with transanal endoscopic microsurgery for early rectal cancer.

DESIGN:

Medical charts of patients who underwent transanal endoscopic microsurgery were reviewed to determine lesion characteristics, as well as operative and treatment characteristics. Complications and recurrences were recorded.

SETTINGS:

The study was conducted at a single academic medical center.

PATIENTS:

Patients with early stage cancer (T1 or T2, N0, and M0) of the rectum were included.

MAIN OUTCOME MEASURES:

Local and overall recurrence and disease-specific survival were measured.

RESULTS:

A total of 92 patients were analyzed. Median follow-up was 4.6 years. Negative margins were obtained in 98.9%. Length of stay was 1 day for 95.4% of patients. The complication rate was 10.9% (n = 10), including urinary retention at 4.3% (n = 4) and postoperative bleeding at 4.3% (n = 4). Preoperative staging included 54 at T1 (58.7%) and 38 at T2 (41.3%). Adjuvant therapy was recommended for all of the T2 and select T1 lesions with adverse features on histology. The final pathologic stages of tumors were ypT0 at 8.7% (n = 8), pT1 at 58.7% (n = 54), pT2 at 23.9% (n = 22), and ypT2 at 8.7% (n = 8). The 3-year local recurrence risk was 2.4% (SE = 1.7), and overall recurrence was 6.7% (SE = 2.9). There were no recurrences among patients with complete pathologic response to neoadjuvant therapy. Mean time to recurrence was 2.5 years (SD = 1.43). A total of 89.2% of patients with very low tumors underwent curative resection without a permanent stoma (33/37). The 3-year disease-specific survival rate was 98.6% (95% CI, 90.4%–99.8%), and overall survival rate was 89.4% (95% CI, 79.9%–94.6%).

LIMITATIONS:

The study was limited by its single-center retrospective experience.

CONCLUSIONS:

Transanal endoscopic microsurgery provides comparable oncologic outcomes to radical resection in properly selected patients with early rectal cancer. Sphincter preservation rates approach 90% even in patients with very distal rectal cancer.
Does Hospital Transfer Impact Outcomes After Colorectal Surgery?
Authors: Chow Christopher J. , Gaertner Wolfgang B. , Jensen Christine C. , Sklow Bradford , Madoff Robert D. , Kwaan Mary R.
Published: January 2017

BACKGROUND:

With increasing public reporting of outcomes and bundled payments, hospitals and providers are scrutinized for morbidity and mortality. The impact of patient transfer before colorectal surgery has not been well characterized in a risk-adjusted fashion.

OBJECTIVE:

We hypothesized that hospital-to-hospital transfer would independently predict morbidity and mortality beyond traditional predictor variables.

DESIGN:

We constructed a retrospective cohort of 158,446 patients who underwent colorectal surgery using the 2009–2013 American College of Surgeons National Surgical Quality Improvement Program database.

SETTINGS:

The study was conducted at a tertiary care hospital.

PATIENTS:

All of the patients who underwent colorectal surgery during the study period were included. Patients were excluded for unknown transfer status or transfer from a chronic care facility.

MAIN OUTCOME MEASURES:

Baseline characteristics were compared by transfer status. Multivariate logistic regression was used to evaluate the impact of transfer on major complications and mortality.

RESULTS:

A total of 7259 operations (4.6%) were performed after transfer. Transferred patients had higher rates of complications (p < 0.0001) with significant differences in unplanned endotracheal reintubation, bleeding, organ-space surgical site infection, wound dehiscence, postoperative sepsis, cardiac arrest requiring cardiopulmonary resuscitation, deep venous thrombosis, and myocardial infarction. Transferred patients also had longer hospital stays (9 vs 6 days; p < 0.0001) and a higher risk of death (13.2% vs 2.6%; p < 0.0001). On multivariate analysis, transferred patients had higher mortality rates despite risk adjustment (OR = 1.13 (95% CI, 1.02–1.25); p = 0.019) and were also more likely to have serious complications (OR = 1.12 (95% CI, 1.06–1.19); p < 0.001).

LIMITATIONS:

We were unable to analyze outcomes beyond 30 days, and we did not have information on preoperative evaluation or the reason for patient transfer.

CONCLUSIONS:

Hospital-to-hospital transfer independently contributed to patient morbidity and mortality in patients undergoing colorectal surgery. The impact of hospital transfer must be considered when evaluating surgeon and hospital performance, because the increased risk of serious complications or death is not fully accounted for by traditional methods.
Activation of Gαq in Cardiomyocytes Increases Vps34 Activity and Stimulates Autophagy
Authors: Liu Shengnan , Jiang Ya-Ping , Ballou Lisa M. , Zong Wei-Xing , Lin Richard Z.
Published: January 2017

Receptors that activate the heterotrimeric G protein Gαq are thought to play a role in the development of heart failure. Dysregulation of autophagy occurs in some pathological cardiac conditions including heart failure, but whether Gαq is involved in this process is unknown. We used a cardiomyocyte-specific transgenic mouse model of inducible Gαq activation (termed GαqQ209L) to address this question. After 7 days of Gαq activation, GαqQ209L hearts contained more autophagic vacuoles than wild type hearts. Increased levels of proteins involved in autophagy, especially p62 and LC3-II, were also seen. LysoTracker staining and western blotting showed that the number and size of lysosomes and lysosomal protein levels were increased in GαqQ209L hearts, indicating enhanced lysosomal degradation activity. Importantly, an autophagic flux assay measuring LC3-II turnover in isolated adult cardiomyocytes indicated that autophagic activity is enhanced in GαqQ209L hearts. GαqQ209L hearts exhibited elevated levels of the autophagy initiation complex, which contains the Class III phosphoinositide 3-kinase Vps34. As a consequence, Vps34 activity and phosphatidylinositol 3-phosphate levels were higher in GαqQ209L hearts than wild type hearts, thus accounting for the higher abundance of autophagic vacuoles. These results indicate that an increase in autophagy is an early response to Gαq activation in the heart.
Differences in the Expression of Symptoms in Men Versus Women with Depression: A Systematic Review and Meta-analysis
Authors: Cavanagh Anna , Wilson Coralie J. , Kavanagh David J. , Caputi Peter
Published: January 2017

Objective

While some studies suggest that men and women report different symptoms associated with depression, no published systematic review or meta-analysis has analyzed the relevant research literature. This article aims to review the evidence of gender differences in symptoms associated with depression.

Methods

PubMed, Cochrane, and PsycINFO databases, along with further identified references lists, were searched. Thirty-two studies met the inclusion criteria. They included 108,260 participants from clinical and community samples with a primary presentation of unipolar depression. All 32 studies were rated for quality and were tested for publication bias. Meta-analyses were conducted on the 26 symptoms identified across the 32 studies to assess for the effect of gender.

Results

The studies indicate a small, significant association of gender with some symptoms. Depressed men reported alcohol/drug misuse (Hedges’s g = 0.26 [95% confidence interval (CI), 0.11–0.42]) and risk taking/poor impulse control (g = 0.58 [95% CI, 0.47–0.69]) at a greater frequency and intensity than depressed women. Depressed women reported symptoms at a higher frequency and intensity that are included as diagnostic criteria for depression such as depressed mood (g = −0.20 [95% CI, −0.33 to −0.08]), appetite disturbance/weight change (g = −0.20 [95% CI, −0.28 to −0.11]), and sleep disturbance (g = −0.11 [95% CI, −0.19 to −0.03]).

Conclusions

Results are consistent with existing research on gender differences in the prevalence of substance use and mood disorders, and of their co-occurrence. They highlight the potential utility of screening for substance misuse, risk taking, and poor impulse control when assessing depression in men. Future research is warranted to clarify gender-specific presentations of depression and co-occurring symptoms.
Early Fever As a Predictor of Paroxysmal Sympathetic Hyperactivity in Traumatic Brain Injury
Authors: Hinson Holly E. , Schreiber Martin A. , Laurie Amber L. , Baguley Ian J. , Bourdette Dennis , Ling Geoffrey S. F.
Published: January 2017

Objective:

Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodic, hyperadrenergic alterations in vital signs after traumatic brain injury (TBI). We sought to apply an objective scale to the vital sign alterations of PSH in order to determine whether 1 element might be predictive of developing PSH.

Setting/Participants/Design:

We conducted an observational study of consecutive TBI patients (Glasgow Coma Scale score ≤12) and monitored the cohort for clinical evidence of PSH. PSH was defined as a paroxysm of 3 or more of the following characteristics: (1) tachycardia, (2) tachypnea, (3) hypertension, (4) fever, (5) dystonia (rigidity or decerebrate posturing), and (6) diaphoresis, with no other obvious causation (ie, alcohol withdrawal, sepsis).

Main Measures:

The Modified Clinical Feature Severity Scale (mCFSS) was applied to each participant once daily for the first 5 days of hospitalization.

Results:

Nineteen (11%) of the 167 patients met criteria for PSH. Patients with PSH had a higher 5-day cumulative mCFSS score than those without PSH (median [interquartile range] = 36 [29-42] vs 29 [22-35], P = .01). Of the 4 components of the mCFSS, elevated temperature appeared to be most predictive of the development of PSH, especially during the first 24 hours (odds ratio = 1.95; 95% confidence interval, 1.12-3.40).

Conclusion:

Early fever after TBI may signal impending autonomic dysfunction.