bluuebunny/crossref_metadata_2025 huggingface dataset:
Regulation of innate immunity within the bovine endometrium during infection.
Authors: Oguejiofor C. F. , Cheng ZhangRui Cheng ZhangRui , Wathes D. C.
Published: January 2018

The innate immune response of the endometrium is crucial to achieve early and quick defence against pathogenic organisms that invade the reproductive tract and the uterus, before the adaptive immune response which develops much later. This early innate response is important to avoid the development of uterine disease that impacts negatively on fertility. This review is focused on the regulation of innate immunity within the bovine endometrium during infection. Although a phagocytic barrier to infection is provided by leucocytes, many recent studies have increasingly recognized the important roles of endometrial epithelial and stromal cells in early microbial detection, cellular and inter-cellular signalling, and secretion of immune/inflammatory mediators that can promote leucocyte recruitment and migration to the uterus and endometrium. Components of the endometrial innate immune response involve an increase in the expression of inflammatory products and innate immune mediators including antimicrobial peptides, mucins, pro-inflammatory cytokines including chemokines, acute phase proteins, type I interferons and prostaglandins. However, endometrial innate immunity can be influenced by many factors including infection with a number of pathogenic bacteria, viruses such as bovine viral diarrhoea virus and bovine herpes virus-4; fluctuating levels of the ovarian steroid hormones oestradiol and progesterone; and periparturient changes in body metabolism involving energy substrates and metabolites, metabolic hormones and protein metabolites. This review highlights the recent understandings on how these factors may regulate the endometrial innate immunity, although some of the underlying mechanisms are not yet clearly defined.
Characterization of tetrathionate hydrolase from the marine acidophilic sulfur-oxidizing bacterium, Acidithiobacillus thiooxidans strain SH
Authors: Kanao Tadayoshi , Onishi Moe , Kajitani Yasuyuki , Hashimoto Yuki , Toge Tatsuya , Kikukawa Hiroshi , Kamimura Kazuo
Published: January 2018

Tetrathionate hydrolase (4THase), a key enzyme of the S4-intermediate (S4I) pathway, was partially purified from marine acidophilic bacterium, Acidithiobacillus thiooxidans strain SH, and the gene encoding this enzyme (SH-tth) was identified. SH-Tth is a homodimer with a molecular mass of 97 ± 3 kDa, and contains a subunit 52 kDa in size. Enzyme activity was stimulated in the presence of 1 M NaCl, and showed the maximum at pH 3.0. Although 4THases from A. thiooxidans and the closely related Acidithiobacillus caldus strain have been reported to be periplasmic enzymes, SH-Tth seems to be localized on the outer membrane of the cell, and acts as a peripheral protein. Furthermore, both 4THase activity and SH-Tth proteins were detected in sulfur-grown cells of strain SH. These results suggested that SH-Tth is involved in elemental sulfur-oxidation, which is distinct from sulfur-oxidation in other sulfur-oxidizing strains such as A. thiooxidans and A. caldus.
Understanding the factors controlling the interfacial failure strength of advanced high-strength steel resistance spot welds: hardness vs. fracture toughness
Authors: Pouranvari Majid
Published: January 2018

The failure of advanced high-strength steels’ spot welds is a critical issue for automotive crashworthiness. This paper deals with understanding the underlying factors of the tensile-shear strength of automotive steels’ resistance spot welds during interfacial failure. It was found that the ratio of the fracture toughness to the hardness of the fusion zone is the critical factor governing the interfacial failure mechanism: ductile shear failure (controlled by the fusion zone hardness) vs. cleavage crack propagation (controlled by the fracture toughness). This clarification could pave the way for more accurate modelling of interfacial failure of advanced steel resistance spot welds and shed light on the design of proper post-weld heat treatment for improving the weld mechanical performance.
Preparation and Adsorption Property of Imido-acetic Acid Type Chelating Nano-fibers by Electro-spinning Technique
Authors: Yang Jiali , Lu Lansi , Zhang Zhu , Liao Minhui , He Huirong , Li Lingxing , Chen Jida , Chen Shijin
Published: January 2018

A novel nano-fibrous adsorbent from imino-acetic acid (IDA) and polyvinyl alcohol (PVA) mixture solution was prepared by electro-spinning technique. The nano-fibrous adsorbents with imino-acetic acid functional groups were characterized and demonstrated by fourier transform infrared spectrometry (FT-IR) and the scanning electron microscopy (SEM). The effect of the adsorbents to remove heavy metals such as lead (Pb) and copper (Cu) ions from the aqueous solution was studied. The maximum adsorption percentage (SP) of the metal ions can reach 93.08% for Cu (II) and 96.69% for Pb(II), respectively. Furthermore, it shows that the adsorption procedure of the adsorbents is spontaneous and endothermic, and adsorption rate fits well with pseudo-second-order kinetic model. Most importantly, the reusability of the nanofibers for removal of metal ions was also demonstrated to be used at least five times.
Artificial intelligence in drug combination therapy
Authors: Tsigelny Igor F
Published: January 2018

Currently, the development of medicines for complex diseases requires the development of combination drug therapies. It is necessary because in many cases, one drug cannot target all necessary points of intervention. For example, in cancer therapy, a physician often meets a patient having a genomic profile including more than five molecular aberrations. Drug combination therapy has been an area of interest for a while, for example the classical work of Loewe devoted to the synergism of drugs was published in 1928—and it is still used in calculations for optimal drug combinations. More recently, over the past several years, there has been an explosion in the available information related to the properties of drugs and the biomedical parameters of patients. For the drugs, hundreds of 2D and 3D molecular descriptors for medicines are now available, while for patients, large data sets related to genetic/proteomic and metabolomics profiles of the patients are now available, as well as the more traditional data relating to the histology, history of treatments, pretreatment state of the organism, etc. Moreover, during disease progression, the genetic profile can change. Thus, the ability to optimize drug combinations for each patient is rapidly moving beyond the comprehension and capabilities of an individual physician. This is the reason, that biomedical informatics methods have been developed and one of the more promising directions in this field is the application of artificial intelligence (AI). In this review, we discuss several AI methods that have been successfully implemented in several instances of combination drug therapy from HIV, hypertension, infectious diseases to cancer. The data clearly show that the combination of rule-based expert systems with machine learning algorithms may be promising direction in this field.
CGManalyzer: an R package for analyzing continuous glucose monitoring studies
Authors: Zhang Xiaohua Douglas , Zhang Zhaozhi , Wang Dandan
Published: January 2018

The R package CGManalyzer contains functions for analyzing data from a continuous glucose monitoring (CGM) study. It covers a wide and comprehensive range of data analysis methods including reading a series of datasets, obtaining summary statistics of glucose levels, plotting data, transforming the time stamp format, fixing missing values, evaluating the mean of daily difference and continuous overlapping net glycemic action, calculating multiscale sample entropy, conducting pairwise comparison, displaying results using various plots including a new type of plot called an antenna plot, etc. This package has been developed from our work in directly analyzing data from various CGM devices such as the FreeStyle Libre, Glutalor, Dexcom and Medtronic CGM. Thus, this package should greatly facilitate the analysis of various CGM studies.

Availability and implementation

The package for Windows is available from CRAN: http://cran.r-project.org/mirrors.html. The source file CGManalyzer_1.0.tar.gz is available in the Supplementary Material and at the website of Zhang’s lab https://quantitativelab.fhs.umac.mo/analytic-tool/.

Supplementary information

Supplementary data are available at Bioinformatics online.
Characteristics of Primary Care Physicians Associated With High Outpatient Antibiotic Prescribing Volume
Authors: Fleming-Dutra Katherine E , Bartoces Monina , Roberts Rebecca M , Hicks Lauri A
Published: January 2018

Our objective was to identify characteristics associated with high-volume antibiotic prescribing among office-based primary care physicians to target antibiotic stewardship efforts. Physicians aged 40 years and older who were male, located in the South, and in solo or 2-physician practices prescribed higher volumes of antibiotics than their peers by specialty.
Who Gets Ahead and Who Falls Behind During the Transition to High School? Academic Performance at the Intersection of Race/Ethnicity and Gender
Authors: Sutton April , Langenkamp Amy G , Muller Chandra , Schiller Kathryn S
Published: January 2018

Academic stratification during educational transitions may be maintained, disrupted, or exacerbated. This study marks the first to use national data to investigate how the transition to high school (re)shapes academic status at the intersection of race/ethnicity and gender. We seek to identify the role of the high school transition in shaping racial/ethnic and gender stratification by contextualizing students’ academic declines during the high school transition within the longer window of their educational careers. Using Add Health, we find that white and black boys experience the greatest drops in their grade point averages (GPAs). We also find that the maintenance of high academic grades between the eighth and ninth grades varies across racial/ethnic and gender subgroups; higher-achieving middle school black boys experience the greatest academic declines. Importantly, we find that white and black boys also faced academic declines before the high school transition, whereas their female student peers experienced academic declines only during the transition to high school. We advance current knowledge on educational stratification by identifying the transition to high school as a juncture in which boys’ academic disadvantage widens and high-achieving black boys lose their academic status at the high school starting gate. Our study also underscores the importance of adopting an intersectional framework that considers both race/ethnicity and gender. Given the salience of high school grades for students’ long-term success, we discuss the implications of this study for racial/ethnic and gender stratification during and beyond high school.
Autism spectrum disorder in primary care
Authors: Weill Victoria A. , Zavodny Stefanie , Souders Margaret C.
Published: January 2018

Nurse practitioners working in the primary care setting will commonly see children with autism spectrum disorder. It is important for clinicians to be vigilant for subtle developmental signs that can lead to early identification and diagnosis. This article presents information on assessment, screening, the responsibilities of coordinating services, and ways to support families.
Relaxation before Debriefing during High-fidelity Simulation Improves Memory Retention of Residents at Three Months
Authors: Lilot Marc , Evain Jean-Noel , Bauer Christian , Cejka Jean-Christophe , Faure Alexandre , Balança Baptiste , Vassal Olivia , Payet Cécile , Bui Xuan Bernard , Duclos Antoine , Lehot Jean-Jacques , Rimmelé Thomas
Published: January 2018

Background

High-fidelity simulation is known to improve participant learning and behavioral performance. Simulation scenarios generate stress that affects memory retention and may impact future performance. The authors hypothesized that more participants would recall three or more critical key messages at three months when a relaxation break was performed before debriefing of critical event scenarios.

Methods

Each resident actively participated in one scenario and observed another. Residents were randomized in two parallel-arms. The intervention was a 5-min standardized relaxation break immediately before debriefing; controls had no break before debriefing. Five scenario-specific messages were read aloud by instructors during debriefings. Residents were asked by telephone three months later to recall the five messages from their two scenarios, and were scored for each scenario by blinded investigators. The primary endpoint was the number of residents participating actively who recalled three or more messages. Secondary endpoints included: number of residents observing who recalled three or more messages, anxiety level, and debriefing quality.

Results

In total, 149 residents were randomized and included. There were 52 of 73 (71%) residents participating actively who recalled three or more messages at three months in the intervention group versus 35 of 76 (46%) among controls (difference: 25% [95% CI, 10 to 40%], P = 0.004). No significant difference was found between groups for observers, anxiety or debriefing quality.

Conclusions

There was an additional 25% of active participants who recalled the critical messages at three months when a relaxation break was performed before debriefing of scenarios. Benefits of relaxation to enhance learning should be considered for medical education.
Anesthesia for Same Day Discharge After Craniotomy: Review of a Single Center Experience
Authors: Sheshadri Veena , Venkatraghavan Lashmi , Manninen Pirjo , Bernstein Mark
Published: January 2018

Same day discharge or outpatient surgery for intracranial procedures has become possible with the advent of image-guided minimally invasive approaches to surgery and availability of short-acting anesthetic agents. In addition, patient satisfaction and the benefits of avoiding hospital stay have resulted in the evolution of neurosurgical day surgery. We reviewed our experience and the available literature to determine the perioperative factors involved which have promoted and will improve this concept in the future. Craniotomy and biopsy for supratentorial brain tumors and surgical clipping of intact cerebral aneurysms have been successfully performed as day surgeries. Patient perceptions and satisfaction surveys have helped in better understanding and delivery of care and successful outcomes. There are major differences in health care across the globe along with socioeconomic, medicolegal, and ethical disparities, which must be considered before widespread application of this approach. Nevertheless, collaborative effort by surgeons, anesthesiologists, and nurses can help in same day discharge of patients after cranial neurosurgery.
Lack of Early Improvement Predicts Poor Outcome Following Acute Intracerebral Hemorrhage
Authors: Yogendrakumar Vignan , Smith Eric E. , Demchuk Andrew M. , Aviv Richard I. , Rodriguez-Luna David , Molina Carlos A. , Silva Blas Yolanda , Dzialowski Imanuel , Kobayashi Adam , Boulanger Jean-Martin , Lum Cheemun , Gubitz Gord , Padma Vasantha , Roy Jayanta , Kase Carlos S. , Bhatia Rohit , Ali Myzoon , Lyden Patrick , Hill Michael D. , Dowlatshahi Dar
Published: January 2018

Objectives:

There are limited data as to what degree of early neurologic change best relates to outcome in acute intracerebral hemorrhage. We aimed to derive and validate a threshold for early postintracerebral hemorrhage change that best predicts 90-day outcomes.

Design:

Derivation: retrospective analysis of collated clinical stroke trial data (Virtual International Stroke Trials Archive). Validation: retrospective analysis of a prospective multicenter cohort study (Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign [PREDICT]).

Setting:

Neurocritical and ICUs.

Patients:

Patients with acute intracerebral hemorrhage presenting less than 6 hours. Derivation: 552 patients; validation: 275 patients.

Interventions:

None.

Measurements and Main Results:

We generated a receiver operating characteristic curve for the association between 24-hour National Institutes of Health Stroke Scale change and clinical outcome. The primary outcome was a modified Rankin Scale score of 4–6 at 90 days; secondary outcomes were other modified Rankin Scale score ranges (modified Rankin Scale, 2–6, 3–6, 5–6, 6). We employed Youden’s J Index to select optimal cut points and calculated sensitivity, specificity, and predictive values. We determined independent predictors via multivariable logistic regression. The derived definitions were validated in the PREDICT cohort. Twenty-four–hour National Institutes of Health Stroke Scale change was strongly associated with 90-day outcome with an area under the receiver operating characteristic curve of 0.75. Youden’s method showed an optimum cut point at –0.5, corresponding to National Institutes of Health Stroke Scale change of greater than or equal to 0 (a lack of clinical improvement), which was seen in 46%. Early neurologic change accurately predicted poor outcome when defined as greater than or equal to 0 (sensitivity, 65%; specificity, 73%; positive predictive value, 70%; adjusted odds ratio, 5.05 [CI, 3.25–7.85]) or greater than or equal to 4 (sensitivity, 19%; specificity, 98%; positive predictive value, 91%; adjusted odds ratio, 12.24 [CI, 4.08–36.66]). All definitions reproduced well in the validation cohort.

Conclusions:

Lack of clinical improvement at 24 hours robustly predicted poor outcome and showed good discrimination for individual patients who would do poorly. These findings are useful for prognostication and may also present as a potential early surrogate outcome for future intracerebral hemorrhage treatment trials.
Preliminary Evaluation of a Brief Autism Screener for Young Children
Authors: Zahorodny Walter , Shenouda Josephine , Mehta Uday , Yee Emily , Garcia Patricia , Rajan Mangala , Goldfarb Madeleine
Published: January 2018

Objective:

Our objective was to assess the operating characteristics of the Psychological Development Questionnaire-1 (PDQ-1), an autism screener for use with young children.

Methods:

In Phase 1, we evaluated the concordance of the PDQ-1 with established autism scales, determined test-retest reliability, and identified a risk threshold score. In Phase 2, a population of 1959 toddler-age children was prospectively screened through multiple pediatric practices in a diverse metropolitan region, using the new instrument. Screen-positive children were referred for diagnostic evaluation. Screened children received follow-up at age 4 years to identify autism cases missed by screening and to specify the scale's psychometric properties.

Results:

By screening a diverse population of low risk children, age 18 to 36 months, with the PDQ-1, we detected individuals with autism who had not come to professional attention. Overall, the PDQ-1 showed a positive predictive value (PPV) of 88%, with a sensitivity of 85% and specificity of 99% in a low risk population. High specificity, good sensitivity, and PPV were observed across the 18 to 36 month age-range.

Conclusion:

The findings provide preliminary empirical support for this parent report–based indicator of toddler psychological development and suggest that the PDQ-1 may be a useful supplement to developmental surveillance of autism. Additional research is needed with high risk samples and large, unselected populations under real-world conditions.
Genomics of Cardiovascular Measures of Autonomic Tone
Authors: Sigurdsson Martin I. , Waldron Nathan H. , Bortsov Andrey V. , Smith Shad B. , Maixner William
Published: January 2018

The autonomic nervous system exerts broad control over the involuntary functions of the human body through complex equilibrium between sympathetic and parasympathetic tone. Imbalance in this equilibrium is associated with a multitude of cardiovascular outcomes, including mortality. The cardiovascular static state of this equilibrium can be quantified using physiological parameters such as heart rate (HR), blood pressure, and by spectral analysis of HR variability. Here, we review the current state of knowledge of the genetic background of cardiovascular measurements of autonomic tone. For most parameters of autonomic tone, a large portion of variability is explained by genetic heritability. Many of the static parameters of autonomic tone have also been studied through candidate-gene approach, yielding some insight into how genotypes of adrenergic receptors affect variables such as HR. Genome-wide approaches in large cohorts similarly exist for static variables such as HR and blood pressure but less is known about the genetic background of the dynamic and more specific measurements, such as HR variability. Furthermore, because most autonomic measures are likely polygenic, pathway analyses and modeling of polygenic effects are critical. Future work will hopefully explain the control of autonomic tone and guide individualized therapeutic interventions.
Clinical and Environmental Risk Factors for Bipolar Disorder: Review of Prospective Studies
Authors: Marangoni Ciro , Faedda Gianni L. , Baldessarini Ross J.
Published: January 2018

Learning objectives

After participating in this activity, learners should be better able to:

• Evaluate factors that have been identified in prospective studies as predicting the onset of bipolar disorder

The prodromal phase of bipolar disorder (BD) remains incompletely characterized, limiting early detection of BD and delaying interventions that might limit future morbidity and disability. Retrospective and family-risk studies have consistently found evidence of prodromal psychopathology in subjects later diagnosed with BD. Here, we review prospective studies of clinical risk factors and exposures identified before diagnosis of BD: our findings are consistent with those from retrospective and family-risk studies. Affective psychopathology often precedes diagnosis to suggest a homotypic trajectory in developing BD. Early non-affective (heterotypic) psychopathological disturbances, including anxiety and disruptive behavior disorders, as well as environmental factors and exposures, have been found in prospective studies to increase the risk of BD, but tend to lack specificity in predicting BD. Findings from prospective studies are encouragingly similar to those of retrospective and family-risk studies.
MACULAR HOLE HYDRODISSECTION
Authors: Felfeli Tina , Mandelcorn Efrem D.
Published: January 2018

Purpose:

To present a new technique, macular hole hydrodissection, that increases the likelihood of closure for challenging macular holes (MHs) with multiple risk factors.

Methods:

A retrospective review of all consecutive eyes with idiopathic Stage 3 and 4 MHs that were either persistent (failed previous vitrectomy surgery), chronic (symptoms of central vision loss of ≥2 years or a clinical diagnosis for ≥1 year), and/or large (aperture diameter of ≥400μm), having undergone the macular hole hydrodissection surgical technique between January 1, 2014, and May 1, 2017, from an institutional practice setting was conducted. This technique lyses retina-retinal pigment epithelium adhesions by injecting fluid into the MH and allows for successful closure as the mobile edges are then brought closer together.

Results:

Thirty-nine eyes of 39 patients with mean MH aperture and base diameters of 549.1 ± 159.47μm and 941.97 ± 344.14 were included. Complete anatomical closure was achieved in 87.2% (34/39) of MHs. Vision improvement was observed in 94.9% (37/39) and gain of ≥2 lines was achieved in 79.5% (31/39). Of the MHs that achieved anatomical success, 100% (34/34) had a Type 1 closure. The mean postoperative follow-up was 320.33 ± 269.04 days.

Conclusion:

The macular hole hydrodissection surgical technique improves anatomical and functional outcomes of persistent, chronic, and/or large MHs.
Systemic Absorption of Mitomycin-C When Used in Pterygium Surgery
Authors: Yulish Michael , Khatib Ahmed , Pikkel Joseph
Published: January 2018

Purpose:

To determine whether scleral topical application of mitomycin-C (MMC) results in measurable plasma levels of systemic absorption.

Methods:

The study comprised 27 patients who were treated with MMC 0.2 mg/mL (0.02%) for 60 seconds during pterygium surgery. Blood samples were taken 30 minutes after surgery and evaluated by the human plasma liquid chromatography tandem-mass spectrometry method to determine the presence of MMC.

Results:

The amount of MMC in 27 samples tested was determined as below 0.25 ppb (ng/mL).

Conclusions:

In this study of 27 patients treated with topical application of MMC for pterygium surgery, there was no measurable evidence of systemic drug absorption. Although systemic absorption has been found with the use of larger quantities of MMC, there is an extremely low likelihood of systemic absorption or toxicity of MMC after pterygium surgery.
Trypan Blue for the Assessment of Filtering Bleb Function During Cataract Surgery
Authors: Yung Edward S. , Moster Marlene R. , Sanvicente Carina , Pluta John , Rahmatnejad Kamran , Patel Arjun S. , Williams Alice , Abramowitz Ben , Katz L. Jay , Pro Michael
Published: January 2018

Purpose:

Phacoemulsification has been cited as a possible cause of bleb failure in eyes with prior trabeculectomy. No method has been developed to directly evaluate the risk of bleb failure after phacoemulsification. We investigate the use of trypan blue during cataract surgery in the setting of a preexisting trabeculectomy to evaluate the functional status of the bleb and predict postoperative bleb function.

Materials and Methods:

In total, 14 patients contributing 1 eye each with a history of prior trabeculectomy with mitomycin C undergoing phacoemulsification with intraocular lens implantation were enrolled in this prospective, nonrandomized clinical trial. At the time of phacoemulsification, trypan blue was instilled into the anterior chamber before capsulorhexis creation. Staining of the bleb was grouped as being mild or diffuse using intraoperative photographs. These eyes were followed for 1 year postoperatively and evaluated for intraocular pressure (IOP) control.

Results:

The change in IOP was not significantly different between the 2 groups (P=0.14). A trend towards greater need for IOP-lowering medications was noted (P<0.10) in eyes with mild bleb staining. No statistically significant difference in rates of decreased bleb function was noted at 1-year follow-up after phacoemulsification.

Conclusion:

The intensity of bleb staining with trypan blue during phacoemulsification is not associated with changes in IOP postoperatively. A trend towards decreased need for IOP-lowering medications was noted in eyes with diffuse bleb staining at 1 year after cataract surgery.
A New Device for Securing Sternal Wires after Median Sternotomy
Authors: Danter Matthew R. , Saari Amy , Gao Min , Cheung Anson , Lichtenstein Samuel V. , Abel James G.
Published: January 2018

Objective

Morbidity due to sternotomy continues to be a significant clinical problem. Poor approximation of the sternum may lead to complications such as sternal dehiscence, infection, and pain. A device to assist in tensioning and twisting standard steel wires during sternal closure has been developed (TORQTM sternal closure device). Manually tightened interrupted wire closures were compared with those tightened and secured with the aid of the device. Performance of the device was assessed clinically.

Methods

Four cardiovascular surgeons performed manual and device-assisted closures on a biofidelic model. Closure force was measured to determine the residual force and its intraoperator variation. A retrospective review of patients treated before and after the introduction of the device was conducted. Predicted and actual outcomes were compared for the two groups (manual closure and deviceassisted closure).

Results

Biomechanical testing measured a 75% increase in residual closure force ( P < 0.001) and a significant reduction in the variability of the closure force ( P = 0.045) for device-assisted closures compared with manual closures. In the retrospective study, 3 of 173 manually closed patients had sterile sternal dehiscence and 1 of 173 had a deep sternal wound infection. In the device closure group, 2 of 127 had a sterile sternal dehiscence and no deep sternal wound infections were reported. No other device-related serious adverse events were reported.

Conclusions

Biomechanical data showed stronger, more consistent closure forces with the device. The retrospective data attest to the performance of the device.
Streamlining the Process for Intravenous Tissue Plasminogen Activator
Authors: Lawrence Erin , Merbach Dawn , Thorpe Sherry , Llinas Rafael H. , Marsh Elisabeth B.
Published: January 2018

Background: For ischemic stroke, the chance of improved recovery is directly impacted by length of time from symptom onset to administration of intravenous tissue plasminogen activator (IV tPA). Despite the importance of rapid treatment, stroke centers struggle with achieving consistent door-to-needle times of less than 60 minutes. Methods: We implemented a change in our response to the acute stroke patient by adding a dedicated stroke nurse and a nursing flow sheet focused on critical benchmarks before treatment. We collected data on patients treated with IV tPA preintervention and postintervention to determine whether our process increased the number of patients receiving tPA in less than 60 minutes. One hundred thirty-eight patients (n = 78 pre and 60 post) treated between 2009 and 2013 were included. Student t tests and χ2 tests were used to compare door-to-needle times preintervention and postintervention. Results: By implementing this new approach, the mean time to treatment decreased from 82 to 78 minutes (P = .583). The percentage of patients successfully treated within 60 minutes of arrival improved from 28% to 52% (P = .005). Stroke severity and need for additional imaging were associated with increased time to treatment. Conclusion: The use of a stroke nurse and a nursing flow sheet as part of the acute stroke assessment significantly increases the proportion of patients treated with IV tPA within 60 minutes from hospital arrival.
Involvement of Nucleotide-Binding and Oligomerization Domain-Like Receptors in the Intestinal Injury of Severe Acute Pancreatitis in Rats
Authors: Xu Shan , Wei Shuqing , Guo Yu , Cui Donglai , Yao Jinfeng
Published: January 2018

Objectives

The aim of the study was to observe the role of nucleotide-binding and oligomerization domain (NOD)-like receptors (NLR) in intestinal injury of severe acute pancreatitis (SAP) in rats.

Methods

Severe acute pancreatitis was induced by retrograde infusion of sodium taurocholate into the biliopancreatic duct. Rats were divided into the following 6 groups: sham operation, SAP treated with saline, and SAP treated with interleukin 1β (IL-1β)-converting enzyme inhibitor, killed at 6 or 12 hours after operation. Serum IL-18 and IL-1β concentrations were measured. mRNA expression and protein levels of NOD1, NOD2, and NLRP3 in the intestine were measured.

Results

Severe acute pancreatitis resulted in significantly higher serum IL-18 and IL-1β concentration, higher mRNA expression, and protein levels of NOD1, NOD2, and NLRP3 in intestine in SAP treated with saline groups compared with sham operation groups. This effect was attenuated by administration of IL-1β–converting enzyme inhibitor.

Conclusions

The NLRs, including NOD1, NOD2, and NLRP3, were involved in the intestinal injury in SAP through a caspase-1 pathway.
Transforming Growth Factor-β and Bone Morphogenetic Protein 2 Regulation of MicroRNA-200 Family in Chronic Pancreatitis
Authors: Yu Peter , Liu Ka , Gao Xuxia , Karmouty-Quintana Harry , Bailey Jennifer M. , Cao Yanna , Ko Tien C.
Published: January 2018

Objectives

To investigate regulation of microRNA (miR)-200 family (a, b, c, 141, and 429) in chronic pancreatitis (CP). This was accomplished by examining miR-200 family levels in a mouse model in vivo and their regulation in pancreatic cells in vitro.

Methods

Chronic pancreatitis was induced by cerulein for 4 weeks (50 μg/kg, 5 hourly intraperitoneal injections/day, and 3 days/week). Control mice received normal saline. The pancreata were harvested for fibrosis assessment by Sirius red staining and for miRNA, collagen, and fibronectin levels by quantitative PCR. In vitro, human primary pancreatic stellate cells and human primary pancreatic fibroblast (hPFBs), and rat pancreatic epithelial AR42J cells were treated with vehicle, transforming growth factor (TGF)-β (1 ng/mL), or BMP2 (50 ng/mL) for 24 hours and then harvested for miRNA analysis.

Results

In CP, miR-200s were decreased by 56% to 70% and inversely correlated with pancreatic fibrosis, miR-21, and miR-31 (P < 0.05). In vitro, TGF-β inhibited miR-200b in AR42J cells by 62%, whereas BMP2 increased miR-200b in all 3 cell types in a range of 1.5- to 3.4-fold and inhibited miR-21 in hPFBs by 21% (P < 0.05).

Conclusions

Both in vivo and in vitro studies suggest an antifibrogenic function of miR-200s in CP. The TGF-β and BMP2 may function through inverse regulation of miR-200b levels.
Histone Deacetylase Inhibition Restores Expression of Hypoxia-Inducible Protein NDRG1 in Pancreatic Cancer
Authors: Tiffon Céline
Published: January 2018

Objectives

N-myc downstream-regulated gene-1 (NDRG1) is a hypoxia-inducible and differentiation-related protein and candidate biomarker in pancreatic cancer. As NDRG1 expression is lost in high-grade tumors, the effects of the differentiating histone deacetylase inhibitor trichostatin A (TSA) were examined in human pancreatic cancer cell lines representing different tumor grades.

Methods

PANC-1 (poorly differentiated) and Capan-1 (moderately to well-differentiated) cells were treated with TSA. Effects were assessed in vitro by microscopic analysis, colorimetric assays, cell counts, real-time polymerase chain reaction, and Western blotting.

Results

Treatment of PANC-1 cells over 4 days with 0.5 μM TSA restored cellular differentiation, inhibited proliferation, and enhanced p21Cip1 protein expression. Trichostatin A upregulated NDRG1 mRNA and protein levels under normoxia from day 1 and by 6-fold by day 4 (P < 0.01 at all time points). After 24 hours under hypoxia, NDRG1 expression was further increased in differentiated cells (P < 0.01). Favorable changes were identified in the expression of other hypoxia-regulated genes.

Conclusions

Histone deacetylase inhibitors offer a potential novel epidrug approach for pancreatic cancer by reversing the undifferentiated phenotype and allowing patients to overcome resistance and better respond to conventional cytotoxic treatments.
Efficacy and Safety of Adalimumab in Pediatric Ulcerative Colitis
Authors: Aloi Marina , Bramuzzo Matteo , Arrigo Serena , Romano Claudio , D'Arcangelo Giulia , Lacorte Doriana , Gatti Simona , Illiceto Maria T. , Zucconi Francesca , Dilillo Dario , Zuin Giovanna , Knafelz Daniela , Ravelli Alberto , Cucchiara Salvatore , Alvisi Patrizia ,   SIGENP IBD Working Group
Published: January 2018

Objectives:

The aim of this study was to evaluate the effectiveness and safety of adalimumab (ADA) in children with ulcerative colitis (UC) previously treated with infliximab (IFX).

Methods:

Retrospective study including children with UC from a national registry who received ADA therapy. The primary endpoint was the rate of corticosteroid‐free remission at week 52. Secondary outcomes were the rate of sustained clinical remission, primary nonresponse, and loss of response at weeks 12, 30, and 52 and rate of mucosal healing and side effects at week 52.

Results:

Thirty‐two children received ADA (median age 10 ± 4 years). Median disease duration before ADA therapy was 27 months. All patients received previous IFX (43% intolerant, 50% nonresponders [37.5% primary, 42.5% secondary nonresponders], 6.7% positive anti‐IFX antibodies). Fifty‐two weeks after ADA initiation, 13 patients (41%) were in corticosteroid‐free remission. Mucosal healing occurred in 9 patients (28%) at 52 weeks. The cumulative probability of a clinical relapse‐free course was 69%, 59%, and 53% at 12, 30, and 52 weeks, respectively. Ten patients (31%) had a primary failure and 5 (15%) a loss of response to ADA. No significant differences in efficacy were reported between not‐responders and intolerant to IFX (P = 1.0). Overall, 19 patient (59%) maintained ADA during 52‐week follow‐up. Seven patients (22%) experienced an adverse event, no serious side effects were observed and none resulted in ADA discontinuation.

Conclusions:

Based on our data, ADA seems to be effective in children with UC, allowing to recover a significant percentage of patients intolerant or not‐responding to IFX. The safety profile was good.
Assessment of Humoral Immunity to Hepatitis B, Measles, Rubella, and Mumps in Children After Chemotherapy
Authors: Keskin Yildirim Zuhal , Buyukavci Mustafa
Published: January 2018

Background:

Cancer survival rates and longevity of patients after therapy have significantly improved during the last few decades. Therefore, lasting protection against infections should be provided.

Procedure:

A total of 162 children diagnosed with acute lymphoblastic leukemia, acute myelogenous leukemia, solid tumors, non-Hodgkin lymphoma, and Hodgkin lymphoma were enrolled in the study. Antibody levels against hepatitis B virus was assessed both at the time of diagnosis and within 6 months after completion of chemotherapy. However, measles, mumps, and rubella (MMR) antibodies levels were measured just within 6 months after completion of chemotherapy.

Results:

Anti-HBs antibody titers had decreased below the protective level after treatment in 25 of 96 patients having protective antibody levels for hepatitis B virus before therapy. In 66 patients without pretreatment protective levels of antibody, in spite of the immunization during chemotherapy, only 6 of them were found to be anti-HBS positive after treatment. In 153 patients previously vaccinated with MMR, 19 had protective antibody titers after treatment. MMR seropositivities were negatively correlated to age as expected.

Conclusions:

Our data demonstrate that a significant number of children lose preexisting humoral immunity against MMR and hepatitis B after completion of chemotherapy.
Development of an RN Champion Model to Improve the Outcomes of Ventilator-Associated Pneumonia Patients in the Intensive Care Unit
Authors: Robinson Carol , Hoze Marci , Hevener Stacy , Nichols Amy A.
Published: January 2018

Healthcare-associated infections are costly. Methods to prevent infections must be effective and provide a return on investment to be sustainable. A funded project supported the design and implementation of a unique quality and safety model, using unit-based quality and safety RN champions. The goal was to create and sustain a hospital-wide safety culture focused on preventing ventilator-associated pneumonia (VAP) by adopting the Institute for Healthcare Improvement’s VAP bundle. The program began with a pilot in 7 ICUs. Using the RN champion model resulted in the reduction of the incidence of VAP, cost avoidance, and decreased length of stay. Six years later, each adult ICU reached “zero zone.”
Complications in Orthognathic Surgery
Authors: Olate Sergio , Sigua Eder , Asprino Luciana , de Moraes Márcio
Published: January 2018

The aim of this study was to analyze the presence of complications related to orthognathic surgery performed by surgeons in train. A retrospective study was conducted between 2005 and 2014, analyzing the clinical records of patients treated in the authors’ Department. Patients who underwent orthognathic surgery were included, under a bidimensional analysis and with the conventional orthosurgical sequence; intraoperative complications were identified, such as the occurrence of a bad split, bleeding, tissue injury, among others and postoperative variables such as impaired sensation, infection, and alterations in the osteosynthesis systems. A statistical analysis was done using χ
2 and Student t tests, considering a statistical significance when P < 0.05. Two hundred fifty patients were included with an average follow-up of 13 months; 62.8% were women and 37.2% were men; 18.8% of the subjects presented some type of intraoperative or postoperative complication; excluding relapse and complications due to loss of bonding of the orthodontic device, a 12.4% complication rate was observed; intraoperative complications were 8% and postoperative complications 10.4%. Only the sensorineural alterations were associated with the mandibular surgery (P < 0.05). Finally, orthognathic surgery is relatively safe and produces a low number of complications when it is performed by surgeons in train.
Interpositional Arthroplasty by Temporalis Fascia Flap and Galea Aponeurotica Combined With Distraction Osteogenesis: a Modified Method in Treatment of Adult Patients With Temporomandibular Joint Ankylosis and Mandibular Dysplasia
Authors: Qiao Jia , Yu Bing , Gui Lai , Fu Xi , Yen Chung-Kwan , Niu Feng , Zhang Huijun , Wang Cai , Chen Ying , Wang Meng , Liu Jianfeng
Published: January 2018

Background:

Interpositional arthroplasty (IPA) with temporalis fascia flap has been one of the most frequently performed procedures to treat temporomandibular joint (TMJ) ankylosis. However, recurrence often occurs when the flap lacks bulk or atrophies. Whether to perform IPA or distraction osteogenesis (DO) first has long been a controversial issue when patients presented mandibular dysplasia (MD). This study provided IPA a new graft material sufficient to prevent recurrence, combined the modified protocol of performing DO 6 months after IPA, and evaluated its efficacy in treating TMJ ankylosis patients with MD.

Methods:

Six patients with unilateral TMJ ankylosis and MD were treated in the authors’ study. The temporalis fascia flap and part of adjacent galea aponeurotica were filled the space after surgical release. Mouth-opening exercises started immediately post-IPA. Distraction osteogenesis was performed 6 months after IPA and had a 4-month consolidation. The maximum interincisal distance at preoperative, immediately post-IPA and the latest follow-up were recorded, as was the distraction length. The body mass index was measured at each patient's postoperative visit.

Result:

All patients had significant improvements in facial aesthetic, mouth-opening, and occlusion. No major complication or recurrence was observed at 3 to 4 years’ follow-up. The mean maximum interincisal distance was 4.83 ± 2.79 mm preoperative and 35.67 ± 3.39 mm at the latest follow-up. The mean distraction distance was 16.17 ± 5.98 mm. The body mass index improved from 17.33 ± 0.64 kg/m2 preoperative to 18.75 ± 0.60 kg/m2 before DO.

Conclusions:

Temporalis fascia flap and adjacent galea aponeurotica as new graft materials are recommended for IPA. The modified staged treatment proved to be reliable and effective to prevent recurrence, improve mandibular length and final occlusion.
Maxillary Sagittal Position in Relation to the Forehead: A Target for Orthognathic Surgery
Authors: Resnick Cory M. , Calabrese Carly E. , Resnick Anthea S.
Published: January 2018

The relationship of the maxillary incisor to forehead position and angulation may be a predictor for the esthetic antero-posterior maxillary position in orthognathic surgery, but this has not been fully explored in the existing literature. Additionally, this analysis requires a lateral smiling photograph, which is not typically included in orthodontic/orthognathic records. This is a bidirectional study of Caucasian orthodontic patients with malocclusions correctable with nonsurgical and nonextraction treatment. Subjects for Group 1 were enrolled prospectively and records included a lateral smiling photograph. Group 2 patients were collected retrospectively with standard records. The analysis described in Andrews’ Element II of The Six Elements of Orofacial Harmony was applied to the smiling photographs for Group 1, resulting in “Incisor- goal anterior limit line (GALL)” measurements. A modified analysis utilizing cephalometric tracings was applied for both the groups, and the results were compared. Forty-nine subjects with mean age 11.8 ± 1.2 years were included (n = 14 for Group 1, n = 35 for Group 2). Mean Incisor-GALL distances were 3.71 ± 5.39 mm for females and 4.47 ± 5.06 mm for males. Correlation between analyses was excellent (intraclass correlation coefficient = 0.872). In conclusion, a modified approach to measuring the Incisor-GALL distance using standard orthodontic records correlated closely with the analysis described by Andrews. Normal values for this measurement are presented for Caucasian patients.
Postoperative ERAS Interventions Have the Greatest Impact on Optimal Recovery
Authors: Aarts Mary-Anne , Rotstein Ori D. , Pearsall Emily A. , Victor J. Charles , Okrainec Allan , McKenzie Marg , McCluskey Stuart A. , Conn Lesley Gotlib , McLeod Robin S.
Published: January 2018

Background:

Enhanced recovery after surgery (ERAS) programs incorporate evidence-based practices to minimize perioperative stress, gut dysfunction, and promote early recovery. However, it is unknown which components have the greatest impact.

Objective:

This study aims to determine which components of ERAS programs have the largest impact on recovery for patients undergoing colorectal surgery.

Methods:

An iERAS program was implemented in 15 academic hospitals. Data were collected prospectively. Patients were considered compliant if >75% of the preoperative, intraoperative, and postoperative predefined interventions were adhered to. Optimal recovery was defined as discharge within 5 days of surgery with no major complications, no readmission to hospital, and no mortality. Multivariable analysis was used to model the impact of compliance and technique on optimal recovery.

Results:

Overall, 2876 patients were enrolled. Colon resections were performed in 64.7% of patients and 52.9% had a laparoscopic procedure. Only 20.1% of patients were compliant with all phases of the pathway. The poorest compliance rate was for postoperative interventions (40.3%) which was independently associated with an increase in optimal recovery (RR = 2.12, 95% CI 1.81–2.47). Compliance with ERAS interventions remained associated with improved outcomes whether surgery was performed laparoscopically (RR = 1.55, 95% CI 1.23–1.96) or open (RR = 2.29, 95% CI 1.68–3.13). However, the impact of ERAS compliance was significantly greater in the open group (P < 0.001).

Conclusions:

Postoperative compliance is the most difficult to achieve but is most strongly associated with optimal recovery. Although our data support that ERAS has more effect in patients undergoing open surgery, it also showed a significant impact on patients treated with a laparoscopic approach.