bluuebunny/crossref_metadata_2025 huggingface dataset:
Lumbar Arthroplasty: Past, Present, and Future
Authors: Sandhu Faheem A , Dowlati Ehsan , Garica Rolando
Published: October 2019

Lumbar degenerative disc disease is a pathologic process that affects a large portion of our aging population. In the recent past, surgical treatment has involved fusion procedures. However, lumbar disc arthroplasty and replacement provides an alternative for carefully selected patients. It provides the major advantage of motion preservation and thus keeps adjacent segments from significantly progressive degeneration. The history of lumbar disc replacement has roots that start in the 1960s with the implantation of stainless-steel balls. Decades later, multiple implants with different material design and biomechanical properties were introduced to the market. New third-generation implants have made great strides in improved biomechanics and clinical outcomes. Although there is room for further advancement and studies are warranted to assess the long-term durability and sustainability of lumbar disc arthroplasty, it has certainly proven to be a very acceptable alternative within the surgical armamentarium that should be offered to patients who meet indications. In this review we present an overview of lumbar disc arthroplasty including its history, indications, biomechanics, challenges, and future directions.
Networks in economic development
Authors: Breza Emily , Chandrasekhar Arun , Golub Benjamin , Parvathaneni Aneesha
Published: October 2019

This chapter surveys the implications of some studies in network economics research for economic development. We focus on information flow and risk-sharing—two topics where work in theory, empirics, and policy analysis have been especially intensive and complementary. In analysing information, we distinguish models of information diffusion and aggregation, highlight how different models imply very different guidance regarding the right way to seed information. In discussing risk-sharing, we look at the key frictions that impede efficient informal insurance, and some potential unintended consequences when policymakers intervene to help. Throughout, we stress practical insights that can be used with limited measurement of the details of networks.
Oxygenic Phototrophs Need ζ-Carotene Isomerase (Z-ISO) for Carotene Synthesis: Functional Analysis in Arthrospira and Euglena
Authors: Sugiyama Kenjiro , Takahashi Koh , Nakazawa Keisuke , Yamada Masaharu , Kato Shota , Shinomura Tomoko , Nagashima Yoshiki , Suzuki Hideyuki , Ara Takeshi , Harada Jiro , Takaichi Shinichi
Published: October 2019

For carotenogenesis, two biosynthetic pathways from phytoene to lycopene are known. Most bacteria and fungi require only phytoene desaturase (PDS, CrtI), whereas land plants require four enzymes: PDS (CrtP), ζ-carotene desaturase (ZDS, CrtQ), ζ-carotene isomerase (Z-ISO) and cis-carotene isomerase (CrtISO, CrtH). The gene encoding Z-ISO has been functionally identified in only two species, Arabidopsis thaliana and Zea mays, and has been little studied in other organisms. In this study, we found that the deduced amino acid sequences of Arthrospira Z-ISO and Euglena Z-ISO have 58% and 62% identity, respectively, with functional Z-ISO from Arabidopsis. We studied the function of Z-ISO genes from the cyanobacterium Arthrospira platensis and eukaryotic microalga Euglena gracilis. The Z-ISO genes of Arthrospira and Euglena were transformed into Escherichia coli strains that produced mainly 9,15,9′-tri-cis-ζ-carotene in darkness. In the resulting E. coli transformants cultured under darkness, 9,9′-di-cis-ζ-carotene was accumulated predominantly as Z-ISO in Arabidopsis. This indicates that the Z-ISO genes were involved in the isomerization of 9,15,9′-tri-cis-ζ-carotene to 9,9′-di-cis-ζ-carotene in darkness. This is the first functional analysis of Z-ISO as a ζ-carotene isomerase in cyanobacteria and eukaryotic microalgae. Green sulfur bacteria and Chloracidobacterium also use CrtP, CrtQ and CrtH for lycopene synthesis as cyanobacteria, but their genomes did not comprise Z-ISO genes. Consequently, Z-ISO is needed in oxygenic phototrophs, whereas it is not found in anoxygenic species.
Do Individual Differences Matter in the Way People View Police Legitimacy? A Partial Replication and Extension of Invariance Thesis
Authors: Zahnow Renee , Mazerolle Lorraine , Pang Alicia
Published: October 2019

The invariance thesis of police legitimacy argues that, regardless of individual differences, the more citizens perceive police as procedurally just and effective, the more they will see the police as a legitimate authority. Research primarily undertaken in the USA shows support for the invariance thesis with some nuanced findings for victims and those with prior police contact. This study conducts a partial replication and extension of the Wolfe et al.’s study (Wolfe, S., Nix, J., Kaminski, R., and Rojek, J. (2016). ‘Is the Effect of Procedural Justice on Police Legitimacy Invariant? Testing the Generality of Procedural Justice and Competing Antecedents of Legitimacy.’ Journal of Quantitative Criminology 32(2): 253–282) testing the invariance thesis, comparing the effects of citizen perceptions of procedural justice (PJ) and police effectiveness (PE) on perceptions of police legitimacy across individual characteristics in Australia. Using a survey of 4,167 residents across 148 communities, we find the effects of PJ perceptions on police legitimacy are largely invariant across individual differences. Yet contrary to previous research, our study finds that the impact of PE perceptions is not invariant and particularly matter for people with visible minority status.
‘What sport do you prefer to do?’ Improving knowledge of adolescents’ preferred sports within the sport participation decline framework
Authors: Gatouillat C , Luiggi M , Griffet J , Travert M
Published: October 2019

Background

Sport participation is declining in some European countries. Previous findings recommended considering territorial specificities to adapt local sports promotion programs. However, in France, little is known about adolescents’ preferences and their changes across time. This study aimed to measure preferred sports and their changes among a representative sample of adolescents of the third biggest French département.

Methods

Data were extracted from a previous cross-sectional study that used a quota sampling design to respect the proportions of advantaged and disadvantaged schools. The present study involved 744 and 938 participants, in 2001 and 2015, respectively. Adolescent preferences were calculated by sex and socioeconomic status (SES). Multiple binary logistic regressions were performed to measure changes between 2001 and 2015 by sex and SES.

Results

Sports preferences and their evolution differed by sex and SES. Three cases were observed: no significant change in sports preferences (low-SES boys), a sharp loss of interest for some sports (low-SES girls and high-SES boys) and a sharp loss of interest for some sports whilst others gained significant interest (high-SES girls).

Conclusions

This knowledge may help the development of sport promotion programs. Future sport policies could choose to develop sports that are preferred and increasingly appreciated by adolescents.
Incorporating non-stomatal limitation improves the performance of leaf and canopy models at high vapour pressure deficit
Authors: Yang J , Duursma R A , De Kauwe M G , Kumarathunge D , Jiang M , Mahmud K , Gimeno T E , Crous K Y , Ellsworth D S , Peters J , Choat B , Eamus D , Medlyn B E
Published: October 2019

Vapour pressure deficit (D) is projected to increase in the future as temperatures rise. In response to increased D, stomatal conductance (gs) and photosynthesis (A) are reduced, which may result in significant reductions in terrestrial carbon, water, and energy fluxes. It is thus important for gas exchange models to capture the observed responses of gs and A with increasing D.

We tested a series of coupled A-gs models against leaf gas exchange measurements from the Cumberland Plain Woodland (Australia), where D regularly exceeds 2 kPa and can reach 8 kPa in summer. Two commonly used A-gs models (Leuning 1995 and Medlyn et al. 2011) were not able to capture the observed decrease in A and gs with increasing D at the leaf scale. To explain this decrease in A and gs, two alternative hypotheses were tested: hydraulic limitation (i.e., plants reduce gs and/or A due to insufficient water supply) and non-stomatal limitation (i.e., downregulation of photosynthetic capacity). We found that the model that incorporated a non-stomatal limitation captured the observations with high fidelity and required the fewest number of parameters. While the model incorporating hydraulic limitation captured the observed A and gs, it did so via a physical mechanism that is incorrect.

We then incorporated a non-stomatal limitation into the stand model, MAESPA, to examine its impact on canopy transpiration and gross primary production. Accounting for a non-stomatal limitation reduced the predicted transpiration by ~19%, improving the correspondence with sap flow measurements, and gross primary production by ~14%. Given the projected global increases in D associated with future warming, these findings suggest that models may need to incorporate non-stomatal limitation to accurately simulate A and gs in the future with high D. Further data on non-stomatal limitation at high D should be a priority, in order to determine the generality of our results and develop a widely applicable model.
Mechanism of pulmonary immunosuppression: extrapulmonary burn injury suppresses bacterial endotoxin‐induced pulmonary neutrophil recruitment and neutrophil extracellular trap (NET) formation
Authors: Sakuma Miyuki , Khan Mohammed A. S. , Yasuhara Shingo , Martyn Jeevendra A. , Palaniyar Nades
Published: October 2019

Pulmonary immunosuppression often occurs after burn injury (BI). However, the reasons for BI‐induced pulmonary immunosuppression are not clearly understood. Neutrophil recruitment and neutrophil extracellular trap (NET) formation (NETosis) are important components of a robust pulmonary immune response, and we hypothesized that pulmonary inflammation and NETosis are defective after BI. To test this hypothesis, we established a mouse model with intranasal LPS instillation in the presence or absence of BI (15% of body surface burn) and determined the degree of immune cell infiltration, NETosis, and the cytokine levels in the airways and blood on d 2. Presence of LPS recruited monocytes and large numbers of neutrophils to the airways and induced NETosis (citrullinated histone H3, DNA, myeloperoxidase). By contrast, BI significantly reduced LPS‐mediated leukocyte recruitment and NETosis. This BI‐induced immunosuppression is attributable to the reduction of chemokine (C‐C motif) ligand (CCL) 2 (monocyte chemoattractant protein 1) and CCL3 (macrophage inflammatory protein 1a). BI also suppressed LPS‐induced increase in IL‐17A, IL‐17C, and IL‐17E/IL‐25 levels in the airways. Therefore, BI‐mediated reduction in leukocyte recruitment and NETosis in the lungs are attributable to these cytokines. Regulating the levels of some of these key cytokines represents a potential therapeutic option for mitigating BI‐mediated pulmonary immunosuppression.—Sakuma, M., Khan, M. A. S., Yasuhara, S., Martyn, J. A., Palaniyar, N. Mechanism of pulmonary immunosuppression: extrapulmonary burn injury suppresses bacterial endotoxin‐induced pulmonary neutrophil recruitment and neutrophil extracellular trap (NET) formation. FASEB J. 33, 13602‐13616 (2019). www.fasebj.org
A Signal Through the Noise: Do Professionalism Concerns Impact the Decision Making of Competence Committees?
Authors: Odorizzi Scott , Cheung Warren J. , Sherbino Jonathan , Lee A.C. , Thurgur Lisa , Frank Jason R.
Published: October 2019

Purpose

To characterize how professionalism concerns influence individual reviewers’ decisions about resident progression using simulated competence committee (CC) reviews.

Method

In April 2017, the authors conducted a survey of 25 Royal College of Physicians and Surgeons of Canada emergency medicine residency program directors and senior faculty who were likely to function as members of a CC (or equivalent) at their institution. Participants took a survey with 12 resident portfolios, each containing hypothetical formative and summative assessments. Six portfolios represented residents progressing as expected (PAE) and 6 represented residents not progressing as expected (NPAE). A professionalism variable (PV) was developed for each portfolio. Two counterbalanced surveys were developed in which 6 portfolios contained a PV and 6 portfolios did not (for each PV condition, 3 portfolios represented residents PAE and 3 represented residents NPAE). Participants were asked to make progression decisions based on each portfolio.

Results

Without PVs, the consistency of participants giving scores of 1 or 2 (i.e., little or no need for educational intervention) to residents PAE and to those NPAE was 92% and 10%, respectively. When a PV was added, the consistency decreased by 34% for residents PAE and increased by 4% for those NPAE (P = .01).

Conclusions

When reviewing a simulated resident portfolio, individual reviewer scores for residents PAE were responsive to the addition of professionalism concerns. Considering this, educators using a CC should have a system to report, collect, and document professionalism issues.
Validity Evidence for a Knowledge Assessment Tool for a Mastery Learning Scrub Training Curriculum
Authors: Hasty Brittany N. , Lau James N. , Tekian Ara , Miller Sarah E. , Shipper Edward S. , Bereknyei Merrell Sylvia , Lee Edmund W. , Park Yoon Soo
Published: October 2019

Purpose

To examine the validity evidence for a scrub training knowledge assessment tool to demonstrate the utility and robustness of a multimodal, entrustable professional activity (EPA)-aligned, mastery learning scrub training curriculum.

Method

Validity evidence was collected for the knowledge assessment used in the scrub training curriculum at Stanford University School of Medicine from April 2017 to June 2018. The knowledge assessment had 25 selected response items that mapped to curricular objectives, EPAs, and operating room policies. A mastery passing standard was established using the Mastery Angoff and Patient-Safety approaches. Learners were assessed pre curriculum, post curriculum, and 6 months after the curriculum.

Results

From April 2017 to June 2018, 220 medical and physician assistant students participated in the scrub training curriculum. The mean pre- and postcurriculum knowledge scores were 74.4% (standard deviation [SD] = 15.6) and 90.1% (SD = 8.3), respectively, yielding a Cohen’s d = 1.10, P < .001. The internal reliability of the assessment was 0.71. Students with previous scrub training performed significantly better on the precurriculum knowledge assessment than those without previous training (81.9% [SD = 12.6] vs 67.0% [SD = 14.9]; P < .001). The mean item difficulty was 0.74, and the mean item discrimination index was 0.35. The Mastery Angoff overall cut score was 92.0%.

Conclusions

This study describes the administration of and provides validity evidence for a knowledge assessment tool for a multimodal, EPA-aligned, mastery-based curriculum for scrub training. The authors support the use of scores derived from this test for assessing scrub training knowledge among medical and physician assistant students.
Teaching Motivational Interviewing to Medical Students: A Systematic Review
Authors: Kaltman Stacey , Tankersley Amelia
Published: October 2019

Purpose

Medical students must be prepared to work with patients with maladaptive health behaviors and chronic health conditions. Motivational interviewing (MI) is an evidence-based, patient-centered, directive communication style designed to help patients address behaviors that are detrimental to their health (e.g., substance abuse, poor diet). In this study, the authors systematically reviewed the evidence pertaining to MI curricula in medical schools. Their aims were to describe the pedagogical and content-related features of MI curricular interventions and to assess the effectiveness of the interventions and the quality of the research evidence.

Method

In March 2019, the authors searched databases, seeking studies on MI in medical schools. They manually extracted descriptive information, used the Medical Education Research Study Quality Instrument to assess the quality of the included studies, and synthesized the included studies’ results.

Results

Sixteen studies met inclusion criteria. The majority of included studies were pre-post evaluation designs; the most rigorous were randomized controlled trials. MI curricula were heterogeneous, varying in timing, content, pedagogical approaches, and outcomes measured.

Conclusions

The results of this review suggest that the implementation of MI curricula in medical schools can be feasible and effective and that students can achieve beginning levels of proficiency. The results support the inclusion of MI in undergraduate medical education curricula and highlight next steps to advance this area of medical education research: achieving consensus around essential early MI skills that should be taught in medical schools and identifying the most effective scaffolding strategies to teach this complex mode of communication.
Clinical Reasoning as a Core Competency
Authors: Connor Denise M. , Durning Steven J. , Rencic Joseph J.
Published: October 2019

Diagnostic error is a challenging problem; addressing it effectively will require innovation across multiple domains of health care, including medical education. Diagnostic errors often relate to problems with clinical reasoning, which involves the cognitive and relational steps up to and including establishing a diagnostic and therapeutic plan with a patient. However, despite a call from the National Academies of Sciences for medical educators to improve the teaching and assessment of clinical reasoning, the creation of explicit, theory-informed clinical reasoning curricula, faculty development resources, and assessment tools has proceeded slowly in both undergraduate and graduate medical education. To accelerate the development of this critical element of health professions education and to promote needed research and innovation in clinical reasoning education, the Accreditation Council for Graduate Medical Education (ACGME) should revise its core competencies to include clinical reasoning. The core competencies have proven to be an effective means of expanding educational innovation across the United States and ensuring buy-in across a diverse array of institutions and disciplines. Reformulating the ACGME core competencies to include clinical reasoning would spark much-needed educational innovation and scholarship in graduate medical education, as well as collaboration across institutions in this vital aspect of physicianship, and ultimately, could contribute to a reduction of patient suffering by better preparing trainees to build individual, team-based, and system-based tools to monitor for and avoid diagnostic error.
Variation in Prescribing and Factors Associated With the Use of Prophylactic Antibiotics for Mohs Surgery: A Single-Institution Retrospective Study
Authors: Barbieri John S. , Fix William C. , Miller Christopher J. , Sobanko Joseph F. , Shin Thuzar M. , Howe Nicole , Margolis David J. , Etzkorn Jeremy R.
Published: October 2019

BACKGROUND

Antibiotic use associated with Mohs surgery is increasing.

OBJECTIVE

To understand variation in practice patterns and factors associated with antibiotic use.

MATERIALS AND METHODS

The authors conducted a retrospective cohort study of antibiotic use among patients treated with Mohs micrographic surgery between July 1, 2013, and June 30, 2017, at an academic medical center. Multivariate logistic regression was used to evaluate for associations between antibiotic prescribing and the surgeon, site, reconstruction, and patient characteristics.

RESULTS

The odds of prescribing antibiotics differed significantly between each surgeon evaluated; 3.35-fold variation in postoperative antibiotic use was observed. Increasing number of surgical sites (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.09–1.41), number of Mohs stages required (OR 1.18; 95% CI 1.08–1.28), and defect area (OR 1.31; 95% CI 1.25–1.37), as well as patient female sex (OR 1.14; 95% CI 1.03–1.27), were associated with increased postoperative antibiotic use, whereas age >80 was associated with decreased use (OR 0.75; 95% CI 0.64–0.87) compared with age <60.

CONCLUSION

Antibiotics are more commonly prescribed for repairs that are considered higher risk for infection. However, significant variation exists between surgeons, even within a single institution, suggesting a need for prospective trials and consensus guideline development.
Impact of order of fixed-ratio presentation on demand for self-administered remifentanil in male rats
Authors: Maguire David R. , Minervini Vanessa , Dodda Vikas , France Charles P.
Published: October 2019

The behavioral economics framework has been used extensively to study factors that control operant behavior, including quantification of reinforcing effectiveness of drugs of abuse. Generally, consumption of a commodity decreases with increasing price, and the rate of decrease reflects demand elasticity, which is inversely related to reinforcing effectiveness. Drugs with low elasticity have greater effectiveness than those with greater elasticity. Price is often manipulated by varying the number of responses required to obtain an infusion (e.g. fixed ratio schedule); however, many studies present the fixed ratio in only one order (usually ascending), which could introduce sequence effects that influence estimates of demand. This study examined the impact of the order of fixed ratio presentation on demand for the mu opioid receptor agonist remifentanil (0.0032 mg/kg/infusion) using an ascending and a mixed order of fixed ratio presentation. Seven male rats lever pressed for intravenous infusions. The fixed ratio varied across 3-session blocks, yielding a demand curve. During the first and third phases, the fixed ratio increased, and, during the second phase, fixed ratio values were presented in a mixed order. On average, rats obtained more than 60 infusions per session under baseline (fixed ratio 1) during the each of the three phases, with the number of infusions received decreasing progressively with increasing fixed ratio values. Estimates of elasticity across the three phases were not statistically different indicating that the order of fixed ratio presentation did not markedly alter estimates of demand and further demonstrating the robustness of price as a source of control over operant behavior, including behavior maintained by drug reinforcers.
Effect of Orthokeratology Lens on Contrast Sensitivity Function and High-Order Aberrations in Children and Adults
Authors: Chang Chiung-Fang , Cheng Huey-Chuan
Published: October 2019

Objectives:

Overnight orthokeratology (OOK) lenses are used to temporarily decrease myopic refractive error and improve uncorrected vision. Overnight orthokeratology lenses significantly increase ocular and corneal high-order aberrations (HOAs) and compromise contrast sensitivity function (CSF) to a degree correlated with myopic correction achieved. In Taiwan, OOK lenses are mainly used in children for myopia control. However, information regarding its effects in this population remains limited. This study discusses the change in HOAs and CSF after 28 nights of OOK lens use in children compared with that in adults.

Methods:

In total, 46 children (9–18 years) and 26 adults (>18 years) who visited Ophthalmology Department of Mackay Memorial Hospital from October to December 2013 were enrolled. Contrast sensitivity and ocular/corneal total high-order, coma, and spherical aberrations (SA) were tested before OOK treatment. After 28 days of overnight use, CSF and topography were reexamined, and data were collected and analyzed using t test and Pearson correlation coefficients.

Results:

In total, 23 eyes of 23 children and 14 eyes of 14 adults were evaluated. The treatment resulted in a significant increase in ocular total HOA, coma, and SA in both groups. However, CSF declined more in adults than children.

Conclusion:

Our study revealed that OOK lenses decrease CSF to a greater extent in adults than that in children despite no significant differences in the change of ocular HOAs between both subject groups. We proposed children may have better neural adaptation to compensate for optical aberrations induced by OOK lens use.
Clinical Outcomes of an Asymmetric Model of Intrastromal Corneal Ring Segments for the Correction of Keratoconus
Authors: Prisant Olivier , Pottier Elodie , Guedj Tony , Hoang Xuan Thanh
Published: October 2019

Purpose:

To evaluate the clinical outcomes of a new model of intrastromal corneal ring segments (ICRSs) (Keraring AS) in patients with keratoconus and quantify subsequent changes in refraction and corneal topography.

Methods:

This nonrandomized, single-center, retrospective observational study explores the effect of progressive thickness ICRS implantation in patients with keratoconus with a 3-month follow-up. After creating an intrastromal tunnel using a femtosecond laser, 1 or 2 ICRSs of progressive thicknesses (150/250 μm or 200/300 μm) and 160-degree arc length were implanted. Changes in uncorrected distance visual acuity, best-corrected distance visual acuity, refractive outcomes, corneal astigmatism, and maximum keratometry readings were recorded before and after surgery.

Results:

The study cohort consisted of 82 patients (104 eyes) with a mean age of 31.2 ± 10 years. At 3 months, ICRS implantation significantly improved uncorrected and corrected visual acuities from 0.82 to 0.46 (logarithm of the minimum angle of resolution [LogMAR]) and from 0.31 to 0.21 (LogMAR), respectively (P < 0.001). The mean spherical error reduced from −1.74 diopters (D) to −0.90 D (P < 0.001), and the mean cylindrical error reduced from −4.22 D to −2.01 D (P < 0.001). The manifest refraction spherical equivalent reduced from −3.85 D to −1.91 D (P < 0.001). All topographic parameters were reduced, including maximum keratometry (53.6 D vs. 50.3 D) and keratometric astigmatism (−4.6 D vs. −2.2 D) (P < 0.001).

Conclusions:

The Keraring AS provides a new, apparently safe, and effective means of improving visual acuity and reducing the refractive error and mean keratometry in eyes with asymmetric keratoconus.
Clinicopathological Features and Outcomes in Lymphoma of Extraocular Muscles
Authors: Eade Edwina L. , Hardy Thomas G. , McKelvie Penelope A. , McNab Alan A.
Published: October 2019

A retrospective review of 25 patients with lymphoma of the extraocular muscles demonstrates excellent prognosis with a high rate of local remission (96%), 2 treatment-related complications, one recurrence, and no disease-related deaths.

Purpose:

To describe the clinicopathological features and report the outcomes of treatment in lymphoma involving the extraocular muscles (EOM), the largest reported case-series.

Methods:

A retrospective case series of patients with lymphoma involving the EOM from a single tertiary referral orbital center, between March 1992 and March 2018. Patients with other histopathologic diagnoses or who did not have an EOM biopsy were excluded. The main outcome measures were histologic evaluation and clinical follow-up including tumor response, recurrence, and survival.

Results:

Twenty-five patients were included, 16 female; 9 male; median age 64.7 years (range 33.8–92.6 years). Unilateral involvement was present in 23 cases (92%). Lymphoma was found to be primary in 15 patients (60%), and any EOM could be affected by disease. Fourteen patients (56%) displayed impaired duction in the direction of the affected muscle. The commonest histologic type was extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in 16 cases (64%) followed by follicular lymphoma in 3 cases (12%), diffuse large B-cell lymphoma in 2 cases (8%), gamma delta T-cell lymphoma in 2 cases (8%), small lymphocytic lymphom and lymphoplasmacytic lymphoma in 1 case each (4%). All 4 patients with high-grade lymphomas (diffuse large B-cell or T cell lymphoma) were found to have systemic disease. Patients were treated with combinations of radiotherapy, chemotherapy, or immunotherapy, with low toxicity. Two patients developed treatment-related complications. With a median follow-up of 26 months (range 3–108 months), there was only 1 recurrence, which was successfully salvaged with Rituximab, and no deaths due to lymphoma.

Conclusions:

Lymphoma of the EOM is a rare tumor with good response to treatment, few treatment-related complications and low risk of recurrence or mortality.
Selective-cold output through a distinct subset of lamina I spinoparabrachial neurons
Authors: Hachisuka Junichi , Koerber H. Richard , Ross Sarah E.
Published: October 2019

Spinal projection neurons are a major pathway through which somatic stimuli are conveyed to the brain. However, the manner in which this information is coded is poorly understood. Here, we report the identification of a modality-selective spinoparabrachial (SPB) neuron subtype with unique properties. Specifically, we find that cold-selective SPB neurons are differentiated by selective afferent input, reduced sensitivity to substance P, distinct physiological properties, small soma size, and low basal drive. In addition, optogenetic experiments reveal that cold-selective SPB neurons do not receive input from Nos1 inhibitory interneurons and, compared with other SPB neurons, show significantly smaller inhibitory postsynaptic currents upon activation of Pdyn inhibitory interneurons. Together, these data suggest that cold output from the spinal cord to the parabrachial nucleus is mediated by a specific cell type with distinct properties.
A whole-food plant-based experiential education program for health care providers results in personal and professional changes
Authors: Lessem Alexandra , Gould Susan Martin , Evans Joanne , Dunemn Kathleen
Published: October 2019

Diet-related diseases are the primary contributor to morbidity and mortality. The risk for these diseases can be reduced with a whole-food plant-based (WFPB) diet, but most people are never counseled on this dietary pattern. An experiential education program was designed and conducted in which sample of 30 nurse practitioners, registered nurses, and physicians learned about and followed a WFPB diet for 3 weeks. The objective was for the health care providers to increase their knowledge and acceptance of WFPB diets and increase their likelihood of counseling patients on this dietary pattern. Participants completed preintervention and postintervention questionnaires assessing dietary intake, knowledge, weight, mood, energy, benefits, barriers, self-efficacy, and likelihood of continuing to follow, or counsel patients about a WFPB diet. Participants decreased intake of animal-derived foods, increased intake of WFPB foods, had improvements in mood and energy, and lost weight. Perceived barriers to following and counseling about a WFPB diet declined and self-efficacy improved. Participants were likely to continue a WFPB diet and discuss the diet with their patients. The three-week intervention changed providers' knowledge, skills, and attitudes about WFPB diets. If nurse practitioners and other providers accept WFPB diets, more patients may be educated on this dietary pattern, helping to reduce the burden of diet-related chronic diseases.
Effect of Blood Group on Heart Transplant Waitlist Mortality in the Ventricular Assist Device Era
Authors: Vaidya Gaurang Nandkishor , Trivedi Jaimin , Vijayakrishnan Rajakrishnan , Fraser Gary E. , Slaughter Mark S. , Birks Emma , Abramov Dmitry
Published: October 2019

The effect of blood group on heart transplant list mortality in the era of continuous flow left ventricular assist devices (VADs) is unknown. We sought to examine mortality from the United Network for Organ Sharing (UNOS) database, with focus on mortality among VAD versus non-VAD recipients according to blood group. The UNOS database from 2007 to 2015 was evaluated to compare the rates of waitlist mortality or delisting for clinical worsening at 1-year postlisting among various blood types based on the presence or absence of durable continuous VAD. Patients with pulsatile VAD, temporary VAD, or with incomplete data were excluded. A total of 16,803 patients met the inclusion criteria. Of these, 2,663 had a HeartMate II or HeartWare VAD implanted before listing or by 365th day of listing. The rate of adverse events on the waitlist, irrespective of VAD, was highest among group O patients (odds ratio [OR] 1.54, p < 0.001). The use of VAD was associated with significant relative risk reduction (OR 0.43, p < 0.001) in waitlist adverse events among all patients, with relative risk reduction that overall did not vary by blood group. Among VAD recipients, waitlist adverse events were similar across all blood types. Among listed patients, there is a significantly higher adverse event rate in group O patients compared with others, irrespective of VAD use. With implantation of continuous flow HeartMate II or HeartWare VAD, all blood groups experience similar relative benefit and similar rates of adverse events. All patients, but particularly those with blood group O, eligible for VAD as a bridge to transplant should be considered for VAD placement.
Prognostic impact of lipoprotein(a) levels during lipid management with statins after ST-elevation acute myocardial infarction
Authors: Mitsuda Takayuki , Uemura Yusuke , Ishii Hideki , Tanaka Akihito , Takemoto Kenji , Koyasu Masayoshi , Ishikawa Shinji , Shibata Rei , Watarai Masato , Murohara Toyoaki
Published: October 2019

The causal relationship of lipoprotein(a) with cardiovascular disease has been established. However, clinical impacts of lipoprotein(a) levels on adverse vascular events in patients with established coronary artery disease who are undergoing statin treatment have not been fully elucidated. We measured lipoprotein(a) levels of 668 consecutive patients with ST-elevated myocardial infarction upon admission and reevaluated lipoprotein(a) of 189 of these patients during statin treatment at least 6 months later than the date of index ST-elevated myocardial infarction. Changes in lipoprotein(a) and associations between lipoprotein(a) levels and the incidence of major adverse cardiac and cerebrovascular event for 3 years were examined. Lipoprotein(a) at baseline was an independent predictor of 3-year major adverse cardiac and cerebrovascular event after ST-elevated myocardial infarction. Levels of lipoprotein(a) at follow-up were slightly but significantly elevated despite improvements in other lipid parameters due to statin treatment. Furthermore, higher levels of lipoprotein(a) achieved with statin treatment were also associated with the subsequent incidence of major adverse cardiac and cerebrovascular event over 3 years, regardless of whether or not the LDL-cholesterol levels were below 100 mg/dl. In conclusion, lipoprotein(a) levels during lipid management by statin are also predictive of adverse vascular events in Japanese patients with ST-elevated myocardial infarction.
Peripheral osteoma of the nasal bone after laser treatment
Authors: Hwang Jae ha , Lee Dong gyu , Kim Kwang seog , Lee Sam yong
Published: October 2019

Introduction:

Peripheral osteoma, which arises from the periosteum, commonly develops in the head and neck region and is found frequently in the mandible, maxilla, and paranasal sinuses. However, osteoma of the face, especially from the nasal bone, is quite rare.

Patient concerns:

A 34-year-old female visited our outpatient department with a small mass on the nose. She had n laser treatment of nevus at the same spot 14 years before, and it had enlarged slowly since 10 years before.

Diagosis:

Computed tomography scan revealed a 0.7 × 0.5 cm sized radio-opaque tumor of the nasal bone.

Interventions:

Under general anesthesia, surgical excision was performed through a transcolumellar and infracartilaginous incision. The excised tumor was a 0.7 × 0.5 cm sized hard mass.

Outcomes:

Biopsy confirmed it as a peripheral osteoma. After tumor removal, structural stability of nasal framework including bone and cartilage was maintained, and symmetry of the nasal dorsum was acquired.

Conclusion:

Chronic osteoma can compress the abutting structures. In the case of the nose, either structural instability or asymmetry can occur. By applying open rhinoplasty techniques, postoperative scars could be hidden and additional correction of the affected structure could be carried out if necessary. As a result, the surgeon can achieve the functional and esthetic outcomes simultaneously.
Association between the IL-10 rs1800872 polymorphisms and periodontitis susceptibility
Authors: Wang Zao , Li Yafang , Zhou Yanheng , Qiao Yiqiang
Published: October 2019

Background:

Periodontitis is a common disease with an unclear pathological mechanism. No precise consensus has been reached to evaluate the association between the IL-10 rs1800872 (- 592, -590, -597 C>A) polymorphism and periodontal disease. Thus, we performed this meta-analysis to collect more evidence-based information.

Methods:

Four online databases, PubMed, Embase, Web of Science, and China Biology Medicine disc (CBM), were searched in August 2018. An odds ratio (OR) with a 95% confidence interval (CI) was applied to evaluate the association of the rs1800872 with periodontitis susceptibility.

Results:

Twenty three case–control studies with 2714 patients and 2373 healthy controls were evaluated. The overall analyses verified that the IL-10 rs1800872 polymorphism was significantly associated with an increased risk of periodontitis in the allelic model, homozygote model, dominant model, and recessive model (A vs C: OR = 1.28, 95%CI = 1.11–1.49,P = .00,I2 = 56.87%; AA vs CC: OR = 2.06, 95%CI = 1.32–3.23,P = .00,I2 = 73.3%; AA + AC vs CC: OR = 1.42, 95%CI = 1.03–1.96,P = .03,I2 = 76.2%; AA vs AC + CC: OR = 1.78, 95%CI = 1.26–2.56,P = .00,I2 = 76.7%). Moreover, the subgroup analysis based on ethnicity, periodontitis type, and smoking status showed significant differences.

Conclusions:

The results of our meta-analysis demonstrate that rs1800872 is associated with periodontitis susceptibility in Caucasians and Asians. Moreover, A allele, AA genotype, CC genotype may be closely associated with chronic periodontitis (CP), while A allele, AA genotype may be closely associated with aggressive periodontitis (AgP).
Tai Chi for patients with mild cognitive impairment
Authors: Yang Juan , Chon Tony Y. , Li Guangxi , Mallory Molly J. , Bublitz Sara E. , Do Alexander , Xiao Lizu , Xiong Donglin , Bauer Brent A.
Published: October 2019

Background:

Mild cognitive impairment (MCI) is an intermediate stage between the cognitive changes of normal aging and early dementia. Tai Chi (TC) may be particularly beneficial to patients with MCI due to its whole-body coordination characteristics. This systematic review protocol aims to outline the methods that will be used to assess the comparative effectiveness and safety of TC for MCI through a systematic review and meta-analysis.

Methods:

A systematic review will identify and evaluate randomized controlled trials (RCTs) that examined the effects and safety of TC compared to a placebo, conventional treatment, and no treatment on cognitive function in individuals with MCI. Studies from databases of MEDLINE, PubMed, Embase, Global Health, Cochrane Library, and Scopus from January 1990 to March 2019 reported in English will be searched. Two independent reviewers will screen the studies for inclusion with the eligibility criteria and extract data. Risk of bias of individual studies will be assessed in line with Cochrane risk of bias tool. The overall quality of cumulative evidence will be assessed using selected Grading of Recommendations, Assessment, Development, and Evaluations criteria. Statistics will be used for heterogeneity assessment, sensitivity analysis, data synthesis, generating funnel plots, and subgroup analysis. Meta-analysis will be performed, if sufficiently homogeneous studies are found. A narrative synthesis will be conducted, grouping studies by exposure and outcome definitions, and describing any differences by subgroups.

Results:

This study will provide practical and targeted evidence in investigating the impact of TC exercise for individuals with MCI.

Conclusion:

The findings of our study will provide updated evidence to determine whether TC is an effective intervention to patients with MCI.

Trial registration number:

International Prospective Register for Systematic Reviews (PROSPERO) number CRD42019125104.
Quality assessment of kidney cancer clinical practice guidelines using AGREE II instrument
Authors: Hou XiaoFeng , Li Meixuan , He Wenbo , Wang Meng , Yan Peijing , Han Caiwen , Li Huijuan , Cao Liujiao , Zhou Biao , Lu Zhenxing , Jia Bibo , Li Jing , Hui Xu , Li Yunxia
Published: October 2019

Background:

Evidence-based guidelines are expected to provide clinicians with explicit recommendations on how to manage health conditions and bridge the gap between research and clinical practice. However, the existing practice guidelines(CPGs) vary in quality. This study aimed to evaluate the quality of CPGs of kidney cancer.

Methods:

We systematically searched PubMed, Embase, China Biology Medicine disc, and relevant guideline websites from their inception to April, 2018. We identified CGPs that provided recommendations on kidney cancer; 4 independent reviewers assessed the eligible CGPs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. The consistency of evaluations was calculated using intraclass correlation coefficients (ICC).

Results:

A total of 13 kidney cancer CGPs were included. The mean scores for each AGREEII domain were as follows: scope and purpose—76.9%; clarity and presentation—76.4%; stakeholder involvement—62.8%; rigor of development—58.7%; editorial independence—53.7%; and applicability—49.4%. Two CPGs were rated as “recommended”; 8 as “recommended with modifications”; and 3 as “not recommended.” Seven grading systems were used by kidney cancer CGPs to rate the level of evidence and the strength of recommendation.

Conclusions:

Overall, the quality of CPGs of kidney cancer is suboptimal. AGREE II assessment results highlight the need to improve CPG development processes, editorial independence, and applicability in this field. It is necessary to develop a standardized grading system to provide clear information about the level of evidence and the strength of recommendation for future kidney cancer CGPs.
Appendectomy and rheumatoid arthritis
Authors: Choi Hyo Geun , Oh Dong Jun , Kim Miyoung , Kim Sunmi , Min Chanyang , Kong Il Gyu
Published: October 2019

The present study evaluated the association between appendectomy and rheumatoid arthritis (RA) using a national sample cohort of the Korean population. In this cohort study, the Korean National Health Insurance Service-National Sample Cohort of individuals ≥20 years old was collected from 2002 to 2013. A total of 14,995 appendectomy participants were 1:4 matched with 59,980 control subjects for age, group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed the occurrence of RA in both the appendectomy and control groups. Appendectomies were identified using operation codes for appendicitis only. RA was defined by International Classification of Disease-10 codes (M05 or M06) and medication histories. Crude and adjusted hazard ratios (HRs) were analyzed using a stratified Cox proportional hazard model. Subgroup analyses were performed on groups stratified by age and sex. The adjusted HR for RA was 1.02 (95% confidence interval = 0.76–1.38) in the appendectomy group (P = .883). In all of the subgroup analyses according to age and sex, the adjusted HRs for RA were not higher in the appendectomy group than those in the control group. We could not identify any significant relationship between appendectomy and RA.
A case report of immune checkpoint inhibitor nivolumab combined with anti-angiogenesis agent anlotinib for advanced esophageal squamous cell carcinoma
Authors: Tang Yong , Ou Zhu’an , Yao Zhifang , Qiao Guibin
Published: October 2019

Introduction:

The PD-1 inhibitors have shown good response in the treatment for many types of malignant tumors, but as monotherapy for advanced esophageal squamous carcinoma, the objective response rate is low. Here we report a case of the patient with advanced esophageal squamous cell carcinoma (ESCC) showing a completely response to nivolumab combined with a small molecule multi-target tyrosine kinase inhibitor (TKI) anlotinib.

Patient concerns:

A 61-year-old male was put under a surgery as the response to the diagnosis of ESCC in March 2014. The post-operative follow-up in March 2018 suggested a recurrence based on imagological findings, and symptoms such as shortness of breath and cough were also observed in October 2018.

Diagnosis:

The patient was diagnosed as advanced metastatic ESCC in October 2018.

Interventions:

Radical resection and esophagogastrostomy under aortic arch with left thoracotomy was performed in March 2014. As a treatment against the post-surgical recurrence, 4 courses of paclitaxel combined with nedaplatin was administered in April 2018 with an outcome of PR, followed by a combined administration of Nivolumab and anlotinib in November 2018.

Outcomes:

Chest CT during a 3-month follow-up revealed the disappearance of all the metastases, and no adverse effect was observed during the treatment.

Conclusion:

The combined treatment of nivolumab and anlotinib is likely to be considered as an optional management of advanced ESCC.
Study protocol for a prospective observational study to investigate the role of luminal pressure on arteriovenous fistula maturation
Authors: Cheng Ho-Shun , Chang Te-I , Chen Cheng-Hsien , Hsu Shih-Chang , Hsieh Hui-Ling , Chen Chun-You , Huang Wen-Cheng , Sue Yuh-Mou , Lin Feng-Yen , Shih Chun-Ming , Chen Jaw-Wen , Lin Shing-Jong , Huang Po-Hsun , Liu Chung-Te
Published: October 2019

Introduction:

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis due to its higher patency and lower infection rate. However, its suboptimal maturation rate is a major weakness. Although substantial risk factors for AVF maturation failure have been disclosed, modifiable risk factors remain unknown. During the AVF maturation process, an elevated luminal pressure is required for outward remodeling; however, excessively high luminal pressure may also be detrimental to AVF maturation, which remains to be defined. We hypothesized that higher AVF luminal pressure is harmful to its maturation, and investigate its potential as a modifiable factor to improve AVF maturation.

Methods and analysis:

This prospective study includes patients undergoing surgical creation for a native AVF. The exclusion criteria were as follows: age <20 years, inability to sign an informed consent, and failure to create a native AVF due to technical difficulties. Demographic and laboratory profiles will be collected before AVF surgery. Vascular sonography will be performed within 1 week of AVF creation to measure the diameters, flow rates, and flow volumes of AVF and its branched veins. The pressure gradient within AVF will be estimated from the blood flow rates using the modified Bernoulli equation. The primary outcome is spontaneous AVF maturation defined as provision of sufficient blood flow for hemodialysis within 2 months of its creation without any interventional procedures. The secondary outcome is assisted AVF maturation, which is defined as AVF maturation within 2 months from its creation aided by any interventional procedure before the successful use of AVF.

Discussion:

While contemporary theory for AVF maturation failure focuses on disturbed wall shear stress, complicate assumptions and measurement preclude its clinical applicability. AVF luminal pressure, which may be manipulated pharmaceutically and surgically, may be a target to improve the outcome of AVF maturation.

Trial registration:

This study has been registered at the protocol registration and results system. The Protocol ID: NCT04017806.