bluuebunny/crossref_metadata_2025 huggingface dataset:
The features of compositional form in ordinary averaged architecture
Authors: Ibragimov I A
Published: June 2019

The article deals with the features of composition in architectural design for most of cases. On the basis of well known parameters of form there is conducted a comparison with different kinds of visual Arts. There is established that at present time ordinary averaged architecture has definite natural restrictions in form and placement. A value and colour are the elements which have more possibilities for the real architectural practice. They are relatively cheap in comparison to form and placement.
Application of the Glass-Metal Composite Made by Spin Casting Method for Pressure Hulls of Deep-Sea Submersibles
Authors: Goncharuk V , Bocharova A , Ratnikov A
Published: June 2019

In this work the manufacturing techniques of layered constructional material metal-glass-metal by method of centrifugal casting are considered. The scheme of installation for production of cylindrical shells from a glass-metal composite is provided, the research of the main technological modes providing reliable connection of aluminium coverings with the glass which is in a plastic state is conducted optimum values of temperature parameters are defined. Methods of electronic microscopy have investigated the diffusive layer which is formed on border glass-aluminium.
Worn Condition Ship Set Stability Estimation
Authors: Cherevko E , Vasilchenko N
Published: June 2019

The work studies the influence of wearing and corrosion of vessel bridging elements on the rigidity of the longitudinal framing reinforced plates. An assessment method of a potential plates stability loss between the reinforcing plates until the moment of reinforced plate general stability loss.
Flexible model selection for mechanistic network models
Authors: Chen Sixing , Mira Antonietta , Onnela Jukka-Pekka
Published: June 2019

Network models are applied across many domains where data can be represented as a network. Two prominent paradigms for modelling networks are statistical models (probabilistic models for the observed network) and mechanistic models (models for network growth and/or evolution). Mechanistic models are better suited for incorporating domain knowledge, to study effects of interventions (such as changes to specific mechanisms) and to forward simulate, but they typically have intractable likelihoods. As such, and in a stark contrast to statistical models, there is a relative dearth of research on model selection for such models despite the otherwise large body of extant work. In this article, we propose a simulator-based procedure for mechanistic network model selection that borrows aspects from Approximate Bayesian Computation along with a means to quantify the uncertainty in the selected model. To select the most suitable network model, we consider and assess the performance of several learning algorithms, most notably the so-called Super Learner, which makes our framework less sensitive to the choice of a particular learning algorithm. Our approach takes advantage of the ease to forward simulate from mechanistic network models to circumvent their intractable likelihoods. The overall process is flexible and widely applicable. Our simulation results demonstrate the approach’s ability to accurately discriminate between competing mechanistic models. Finally, we showcase our approach with a protein–protein interaction network model from the literature for yeast (Saccharomyces cerevisiae).
Fredholm Determinant Solutions of the Painlevé II Hierarchy and Gap Probabilities of Determinantal Point Processes
Authors: Cafasso Mattia , Claeys Tom , Girotti Manuela
Published: June 2019

We study Fredholm determinants of a class of integral operators, whose kernels can be expressed as double contour integrals of a special type. Such Fredholm determinants appear in various random matrix and statistical physics models. We show that the logarithmic derivatives of the Fredholm determinants are directly related to solutions of the Painlevé II hierarchy. This confirms and generalizes a recent conjecture by Le Doussal, Majumdar, and Schehr [20]. In addition, we obtain asymptotics at $\pm \infty $ for the Painlevé transcendents and large gap asymptotics for the corresponding point processes.
Combining gene network, metabolic and leaf-level models shows means to future-proof soybean photosynthesis under rising CO2
Authors: Kannan Kavya , Wang Yu , Lang Meagan , Challa Ghana S , Long Stephen P , Marshall-Colon Amy
Published: June 2019

Global population increase coupled with rising urbanization underlies the predicted need for 60% more food by 2050, but produced on the same amount of land as today. Improving photosynthetic efficiency is a largely untapped approach to addressing this problem. Here, we scale modelling processes from gene expression through photosynthetic metabolism to predict leaf physiology in evaluating acclimation of photosynthesis to rising atmospheric concentrations of CO2 ([CO2]). Model integration with the yggdrasil interface enabled asynchronous message passing between models. The multiscale model of soybean (Glycine max) photosynthesis calibrated to physiological measures at ambient [CO2] successfully predicted the acclimatory changes in the photosynthetic apparatus that were observed at 550 ppm [CO2] in the field. We hypothesized that genetic alteration is necessary to achieve optimal photosynthetic efficiency under global change. Flux control analysis in the metabolic system under elevated [CO2] identified enzymes requiring the greatest change to adapt optimally to the new conditions. This predicted that Rubisco was less limiting under elevated [CO2] and should be down-regulated allowing re-allocation of resource to enzymes controlling the rate of regeneration of ribulose-1,5-bisphosphate (RuBP). By linking the Gene Regulatory Network through protein concentration to the metabolic model, it was possible to identify transcription factors (TFs) that matched the up- and down-regulation of genes needed to improve photosynthesis. Most striking was TF Gm-GATA2, which down-regulated genes for Rubisco synthesis while up-regulating key genes controlling RuBP regeneration and starch synthesis. The changes predicted for this TF most closely matched the physiological ideotype that the modelling predicted as optimal for the future elevated [CO2] world.
p53 modifications: exquisite decorations of the powerful guardian
Authors: Liu Yanqing , Tavana Omid , Gu Wei
Published: June 2019

The last 40 years have witnessed how p53 rose from a viral binding protein to a central factor in both stress responses and tumor suppression. The exquisite regulation of p53 functions is of vital importance for cell fate decisions. Among the multiple layers of mechanisms controlling p53 function, posttranslational modifications (PTMs) represent an efficient and precise way. Major p53 PTMs include phosphorylation, ubiquitination, acetylation, and methylation. Meanwhile, other PTMs like sumoylation, neddylation, O-GlcNAcylation, adenosine diphosphate (ADP)-ribosylation, hydroxylation, and β-hydroxybutyrylation are also shown to play various roles in p53 regulation. By independent action or interaction, PTMs affect p53 stability, conformation, localization, and binding partners. Deregulation of the PTM-related pathway is among the major causes of p53-associated developmental disorders or diseases, especially in cancers. This review focuses on the roles of different p53 modification types and shows how these modifications are orchestrated to produce various outcomes by modulating p53 activities or targeted to treat different diseases caused by p53 dysregulation.
Increasing Number and Volume of Cavitary Lesions on Chest Computed Tomography Are Associated With Prolonged Time to Culture Conversion in Pulmonary Tuberculosis
Authors: Hernandez-Romieu Alfonso C , Little Brent P , Bernheim Adam , Schechter Marcos C , Ray Susan M , Bizune Destani , Kempker Russell
Published: June 2019

Background

Cavitary lesions (CLs) primarily identified by chest x-ray (CXR) have been associated with worse clinical outcomes among patients with pulmonary tuberculosis (PTB). Chest computed tomography (CT), which has better resolution and increased sensitivity to detect lung abnormalities, has been understudied in PTB patients. We compared detection of CLs by CT and CXR and assessed their association with time to sputum culture conversion (tSCC).

Methods

This was a retrospective cohort study of 141 PTB patients who underwent CT. We used multivariate Cox proportional hazards models to evaluate the association between CLs on CXR and the number and single largest volume of CLs on CT with tSCC.

Results

Thirty (21%) and 75 (53%) patients had CLs on CXR and CT, respectively. CT detected cavities in an additional 44 patients (31%) compared with CXR. After multivariable adjustment, we observed a negative association between CLs and tSCC, with an adjusted hazard ratio (aHR) of 0.56 (95% confidence interval [CI], 0.32 to 0.97) for single CLs and 0.31 (95% CI, 0.16 to 0.60) for multiple CLs present on CT. Patients with a CL volume ≥25 mL had a prolonged tSCC (aHR, 0.39; 95% CI, 0.21 to 0.72). CLs on CXR were not associated with increased tSCC after multivariable adjustment.

Conclusions

CT detected a larger number of cavities in patients with PTB relative to CXR. We observed an association between increasing number and volume of CLs on CT and delayed tSCC independent of sputum microscopy result. Our findings highlight a potential role for CT in the clinical and research setting as a tool to risk-stratify patients with PTB.
Impact of an Antiretroviral Stewardship Team on the Care of Patients With Human Immunodeficiency Virus Infection Admitted to an Academic Medical Center
Authors: DePuy Ashley M , Samuel Rafik , Mohrien Kerry M , Clayton Elijah B , Koren David E
Published: June 2019

Background

Interdisciplinary antiretroviral stewardship teams, comprising a human immunodeficiency virus pharmacist specialist, an infectious diseases physician, and associated learners, have the ability to assist in identification and correction of inpatient antiretroviral-related errors.

Methods

Electronic medical records of patients with antiretroviral orders admitted to our hospital were evaluated for the number of interventions made by the stewardship team, number of admissions with errors identified, risk factors for occurrence of errors, and cost savings. Risk factors were analyzed by means of multivariable logistic regression. Cost savings were estimated by the documentation system Clinical Measures.

Results

A total of 567 admissions were included for analysis in a 1-year study period. Forty-three percent of admissions (245 of 567) had ≥1 intervention, with 336 interventions in total. The following were identified as risk factors for error: multitablet inpatient regimen (odds ratio, 1.834; 95% confidence interval, 1.160–2.899; P = .009), admission to the intensive care unit (2.803; 1.280–6.136; P = .01), care provided by a surgery service (1.762; 1.082–2.868; P = .02), increased number of days reviewed (1.061; 1.008–1.117; P = .02), and noninstitutional outpatient provider (1.375; .972–1.946; P = .07). The 1-year cost savings were estimated to be $263 428.

Conclusions

Antiretroviral stewardship teams optimize patient care through identification and correction of antiretroviral-related errors. Errors may be more common in patients with multitablet inpatient regimens, admission to the intensive care unit, care provided by a surgery service, and increased number of hospital days reviewed. Once antiretroviral-related errors are identified, the ability to correct them provides cost savings.
Helicobacter pylori infection and the risk of colorectal cancer: a nationwide population-based cohort study
Authors: Liu I-L , Tsai C -H , Hsu C -H , Hu J -M , Chen Y -C , Tian Y -F , You S -L , Chen C -Y , Hsiao C -W , Lin C -Y , Chou Y -C , Sun C -A
Published: June 2019

Background

The role of Helicobacter pylori (H. pylori) infection in the development of colorectal neoplasia has been a matter of scientific debate with controversial findings.

Aims

This study examined the association between H. pylori infection and colorectal cancer (CRC) in a nationwide population-based Chinese cohort study.

Methods

A total of approximately 3936 individuals with newly diagnosed H. pylori infection (the H. pylori-infected cohort) and 15 744 age- and sex-matched patients with diagnoses absence of H. pylori infection (the comparison cohort) from 2000 to 2005 were identified from Taiwan’s National Health Insurance Research Database. The Kaplan–Meier method was used for measuring the cumulative incidence of CRC in each cohort. Cox proportional hazards models were used to compute hazard ratios (HRs) and accompanying 95% confidence intervals (CIs) for the estimation of the association between H. pylori infection and CRC.

Results

The cumulative incidence of CRC was higher in H. pylori-infected cohort than that in the comparison cohort (log-rank test, P < 0.001). After adjustment for potential confounders, H. pylori infection was associated with a significantly increased risk of CRC (adjusted HR 1.87; 95% CI 1.37–2.57). In addition, the HR of CRC appeared to increase with increasing frequency of clinical visits for H. pylori infection.

Conclusions

Our study demonstrated that H. pylori infection was associated with an increased risk of CRC, which warrants confirmation and exploration of the underlying biologic mechanisms by future studies.
Crowden v Aldridge—the correct approach to variations?
Authors: Saunders James
Published: June 2019

Deeds of variation are often utilised in practice but the manner in which they operate remains obscure. Jonathan Sumption QC’s 1993 decision in Crowden v Aldridge attempted to shed light on the topic but has remained largely untouched ever since. This article reanalyses testamentary variations in order to clarify their mode of operation, essential requirements and broad utility.
The Court of Appeal recasts fiduciary accountability
Authors: Flannigan Robert
Published: June 2019

Two decisions of the Court of Appeal appear to fracture our regulation of the opportunism of fiduciaries. However the reasoning is not robust, and that suggests caution in relying on the propositions advanced.
Society of Behavioral Medicine position statement: Support the updated hypertension guidelines and modify Medicare Part B to improve hypertension management
Authors: Kang Augustine W , Freedland Kenneth E , Janke Amy , Sumner Jennifer A , Hayman Laura L , Fitzgibbon Marian , Buscemi Joanna , Dulin Akilah
Published: June 2019

Hypertension contributes to significant global health and economic burdens. The American College of Cardiology/American Heart Association’s latest guideline lowers the blood pressure threshold for hypertension, and as a result, the number of adults with hypertension has increased. Hypertension is a major risk factor for cardiovascular morbidity, especially among older adults. Many individuals who are diagnosed with hypertension at the new, lower threshold may benefit from lifestyle counseling, but changes to existing Medicare policies are required to increase utilization of evidence-based lifestyle counseling approaches to hypertension management. We recommend appropriate funding for the reimbursement of evidence-based lifestyle counseling for hypertension management, the expansion of medical nutrition therapy counseling coverage as an option for Medicare beneficiaries with hypertension, the inclusion of home-based blood pressure monitoring devices in the list of Durable Medical Equipment Coverage, and modifications to the Medicare Benefit Policy Manual to prioritize evidence-based programs such as Dietary Approaches to Stop Hypertension, American Heart Association, and plant-predominant dietary programs.
Two New Drugs Approved for Multiple Sclerosis
Authors: Aschenbrenner Diane S.
Published: June 2019

The FDA has recently approved two new oral drugs, cladribine (Mavenclad) and siponimod (Mayzent), to treat multiple sclerosis.
Benefits Of Screening Ultrasonography For Breast Cancer May Not Outweigh Harms
Authors: Rosenberg Karen
Published: June 2019

According to this study:

Among young women who had varying levels of breast cancer risk, screening ultrasonography in addition to mammography offered modest benefits and high rates of screening harms.
Medication Safety of Patients With Parkinson’s Disease During Care Transitions: Educating Nursing Students
Authors: Ellis Diane M. , Hickey Shelley , Prieto Patricia , Doyle Adeline , Galvin Meghan , Vernon Gwyn , O'Connor Melissa
Published: June 2019

The purpose of this study was to increase awareness and educate undergraduate nursing students and clinical faculty regarding the importance of missed or omitted Parkinson’s disease medications during care transitions. To improve quality and safety among this vulnerable population, an innovative, simulated unfolding case study focusing on incomplete medication reconciliation and omission of time-sensitive medications was conducted. Second-degree BSN students (n = 94) and clinical faculty (n = 7) participated in the study. Pretest/posttest results were compared. Findings indicated increased understanding among students and faculty regarding the impact of medication reconciliation and the timely administration of Parkinson’s disease medication.
Current market trends in anterior ocular inflammatory disease landscape
Authors: Khan Rubba Shoukat , Rizvi Salman , Syed Basharut A. , Bielory Leonard
Published: June 2019

Purpose of review

In the US anterior ocular inflammatory disease (AOID) composed of the spectrum of ocular allergies, different forms of infectious conjunctivitis, and dry eye diseases, affects over 40% of the population. This review evaluates the current economic costs for AOID associated pharmacotherapies.

Recent findings

In recent years, with improved understanding in pathophysiology of the AOID, providing novel targets for pharmacotherapy, have led to considerable improvements in outcomes for patients. Despite these advances, there continues to be a need for interventions that inhibit key inflammatory mediators or pathways in the ophthalmic space. In 2018, AOID drugs market represents ∼40% of the costs for the total ophthalmic drugs: dry eye (43%), antiinfectives (15%), antiallergics (13%), and antiinflammatory agents (29%). With increasing treatment costs, the need for improved, cost-effective modalities persists along with treatment algorithms to derive optimal benefits for patients.

There has been a dramatic increase in the economic burden of AOID with the annual expenditure for the prescription drugs approaching close to $11 billion in 2018. With increasing prevalence of ocular disease, further investment is required to provide more effective treatment options and deliver improved public health and economic outcomes.
Are 15-Year Trajectories of Low Back Pain and Sciatica Associated With Cardiovascular Autonomic Function in the General Population?
Authors: Oura Petteri , Hautala Arto , Kiviniemi Antti , Auvinen Juha , Puukka Katri , Tulppo Mikko , Huikuri Heikki , Seppänen Tapio , Karppinen Jaro
Published: June 2019

Study Design.

A population-based cohort study.

Objective.

The aim of this study was to examine whether 15-year trajectories of low back pain (LBP) and sciatica are associated with cardiovascular autonomic function in a large general population sample.

Summary of Background Data.

Previous studies using mainly small patient samples have suggested that LBP and sciatica are associated with abnormal cardiovascular autonomic function, namely altered heart rate variability (HRV) and baroreflex sensitivity (BRS). We examined this association in a large general population sample.

Methods.

The data collections of the Northern Finland Birth Cohort 1966 consisted of pain questionnaires at 31 and 46 years (history of LBP, sciatica, and other musculoskeletal pains during the previous year; yes/no for each) and measurements of HRV and BRS at 46 years (heart rate, HR; root mean square of successive differences in beat-to-beat intervals, rMSSD; low-frequency systolic blood pressure variability, SBPV; cross-spectral BRS, BRS; each while seated and standing). The data collections also comprised several confounders. Trajectories for LBP, sciatica, and both together (“no pain,” “decreasing,” “increasing,” “long-term pain”) were constructed and general linear models were used to perform comparisons between trajectories (for HR/rMSSD, n = 3398; for SBPV/BRS, n = 1667).

Results.

In the crude models, LBP and sciatica were associated with higher HR, lower rMSSD, higher SBPV, and lower BRS, but these associations were mostly attenuated by adjustments. Regarding both LBP and sciatica, only the “increasing” trajectory was associated with two of the eight outcomes (standing SBPV, seated BRS) after adjustments. Regarding LBP, the “increasing” trajectory was associated with three (standing SBPV, seated BRS, standing BRS), the “long-term pain” trajectory with one (standing BRS), and the “decreasing” trajectory with one outcome (seated SBPV) after adjustments. Sciatica showed no association with the outcomes after adjustments.

Conclusion.

We conclude that the 15-year trajectories of LBP and sciatica do not have a consistent independent association with cardiovascular autonomic function among the general population.

Level of Evidence: 3
Postoperative Resolution of MR T2 Increased Signal Intensity in Cervical Spondylotic Myelopathy
Authors: Machino Masaaki , Ando Kei , Kobayashi Kazuyoshi , Ota Kyotaro , Morozumi Masayoshi , Tanaka Satoshi , Ito Keigo , Kato Fumihiko , Ishiguro Naoki , Imagama Shiro
Published: June 2019

Study Design.

A prospective comparative imaging study.

Objective.

This study investigated whether postoperative resolution of spinal cord increased signal intensity (ISI) reflected symptom improvement and surgical outcomes in cervical spondylotic myelopathy (CSM) patients.

Summary of Background Data.

Although some CSM patients exhibit magnetic resonance imaging (MRI) ISI, its alteration and resolution have not been investigated. The association between postoperative ISI resolution and surgical outcomes in CSM patients remains controversial.

Methods.

A total of 505 consecutive CSM patients (311 males; 194 females) aged a mean of 66.6 years (range, 41–91) were enrolled. All were treated with laminoplasty and underwent MRI scans preoperatively and after an average of 26.5 months postoperatively (range 12–66 months). ISI was classified pre- and postoperatively based on sagittal T2-weighted magnetic resonance images into Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). The patients’ pre- and postoperative neurological statuses were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy [Japanese Orthopedic Association (JOA) score] and other quantifiable tests, including the 10-s grip and release (10-s G&R) test and 10-s step test.

Results.

A total of 337 patients showed preoperative ISI. Among these, 42 (12.5%) showed postoperative ISI resolution, associated with better postoperative JOA score and recovery rate, 10-s G&R and 10-s step test scores than those who retained it. Patients with preoperative Grade 2 ISI had no postoperative ISI resolution. Patients with ISI improvement from Grade 1 to Grade 0 had better outcomes than those with ISI worsening from Grade 1 to Grade 2.

Conclusion.

Postoperative ISI resolution in CSM patients reflects postoperative symptoms and surgical outcomes. Patients who exhibit ISI resolution have better clinical outcomes.

Level of Evidence: 3
Follicular lymphomas in vulnerable/older patients
Authors: Tucci Alessandra , Rossi Giuseppe
Published: June 2019

Purpose of review

Unlike for diffuse large-cell lymphoma, both the management of elderly patients with follicular lymphoma and the role of comprehensive geriatric evaluation to optimize treatment choices have been rarely addressed. This review analyses available evidence on follicular lymphoma occurring in aged persons.

Recent findings

Most retrospective studies and expert recommendations agree that the diagnostic approach and the treatment algorithm in elderly follicular lymphoma should not differ from younger patients up to the age of 80. However, slowly progressing follicular lymphoma low-tumor burden should start treatment even though asymptomatic. Prospective identification of those unfit patients is needed where a treatment deintensification may not be detrimental. Octogenarians have more aggressive disease and do not benefit from chemoimmunotherapy more than from single-agent rituximab. An activity of daily living loss significantly impact on their outcome and specific prognostic scores may help in the better manage these oldest patients.

Given the lack of prospective studies there is an urgent need to investigate if geriatric assessment including comorbidities, geriatric parameters, patient's reported outcomes and quality of life issues, may help selecting those frail elderly follicular lymphoma patients less suitable for full-dose treatments. In addition, the potential usefulness of the new noncytotoxic agents of proven efficacy in follicular lymphoma warrants specific investigations in older patients.
Enhanced Recovery After Surgery and Acute Postoperative Pain Management
Authors: KALOGERA ELEFTHERIA , DOWDY SEAN C.
Published: June 2019

Enhanced recovery pathways were first developed in colorectal surgery and have since been adapted to other surgical subspecialties including gynecologic surgery. Mounting evidence has shown that the adoption of a standardized perioperative pathway based on evidence-based literature reduces length of hospital stay, reduces cost, reduces opioid requirements with stable to improved pain scores, and accelerates return to normal function as measured by validated patient reported outcomes measurements. The many elements of enhanced recovery may be distilled into 3 concepts: (1) optimizing nutrition before and after surgery, recognizing that nutritional status directly impacts healing; (2) opioid-sparing analgesia, considering the current American prescription opioid crisis and the importance of pain control to regaining functional recovery; and (3) maintenance of euvolemia before, during, and after surgery. Evidence supporting enhanced recovery is presented with reference to international guidelines which were formed based on systematic reviews. Change management and the use of auditing are discussed to assure that patients derive the greatest improvement in surgical outcomes from implementation of an enhanced recovery pathway.
miR-222 expression is correlated with the ATA risk stratifications in papillary thyroid carcinomas∗
Authors: Xiang Dapeng , Tian Bin , Yang Tianyao , Li Zhiyu
Published: June 2019

Background:

miR-222 is one of the most consistently overexpressed miRNAs in papillary thyroid carcinoma (PTC). Previous studies demonstrated that miR-222 overexpression conferred high-risk features in PTC patients, suggesting its value in risk-stratification. However, studies in term of miR-222's utility on stratifying PTCs are lacking.

Methods:

One hundred patients including 10 with multinodular goiter and 90 with PTC were enrolled. Formalin-fixed paraffin-embedded samples were exploited for miR-222 quantitative reverse transcriptase- polymerase chain reaction (RT-PCR) analysis. Correlations between miR-222 expression and different clinicopathological features, Tumor-node-metastasis (TNM) staging and ATA risk level were analyzed.

Results:

miR-222 expression of the PTC group was significantly higher than that of the goiter group (P < .001). Furthermore, miR-222 expression was significantly higher in PTCs with advanced features like larger tumor, capsular invasion, vascular invasion and lymph nodes metastasis. The majority of patients (61%) were in stage I group (similar to ATA low-risk) by TNM staging system. As to the ATA system, the majority (73%) were in intermediate-risk group (similar to TNM stage II and III roughly). Contrary to previous report, here we found that miR-222 expression was correlated with the ATA risk level (P < .001), but not with the TNM staging (P = .122).

Conclusion:

In the present study, we demonstrated that miR-222 overexpression was correlated with advanced features like capsular invasion, vascular invasion, larger tumor size and lymph node metastasis in PTCs. Most importantly, miR-222 expression was correlated with ATA risk levels, suggesting its potential value in PTC risk-stratification.
A 12-year review of patient-reported outcomes after reduction mammoplasty in patients with high body mass index
Authors: Ngaage Ledibabari M. , Bai Jennifer , Gebran Selim , Elegbede Adekunle , Ihenatu Chinezimuzo , Nam Arthur J. , Slezak Sheri , Rasko Yvonne M.
Published: June 2019

Patients with increased body mass index (BMI) are often denied reduction mammoplasty due to concern for high morbidity. There is a paucity of evidence identifying high BMI as a predictor of poor long-term outcomes in reduction mammoplasty. In this study, we investigated the influence of BMI on long-term patient satisfaction following reduction mammoplasty.

All patients undergoing reduction mammoplasty over a 12-year period at a single institution were included in the study. A retrospective chart review was conducted to extract demographics, operative data, and postoperative course including complications. Patients were classified into 4 categories based on BMI (normal (<25), overweight (25–29.9), obese (30–39.9), and morbidly obese (≥40)). Patient satisfaction was assessed using a customized survey which was administered over the phone. Only patients with complete medical records who participated in the survey were included.

The 70 patients met the inclusion criteria for the study. Median time from surgery to survey was 6 years. Overall satisfaction after reduction mammoplasty was high, 5 on a 5-point Likert scale. The amount of breast tissue resected correlated with patient BMI (P <.01). There was no statistical difference in satisfaction across BMI classes. Furthermore, high BMI (obese, and morbidly obese) was not associated with higher postoperative complications (P = .70). Those with a high overall satisfaction score had a significantly greater self-reported aesthetic score compared to those with low and mid satisfied scores (P <.01).

Following reduction mammoplasty, patients report high satisfaction which is sustained over several years. Obesity is not associated with a higher incidence of complications or lower satisfaction. Our data suggest that patients with a high BMI should not be denied reduction mammoplasty out of concern for higher complication rate or reduced patient satisfaction due to BMI alone, but reduction mammoplasty should be considered in the setting of overall health counseling.
Autologous whole-blood or autologous serum acupoint injection therapy for chronic urticaria
Authors: Zhang Leixiao , Xiao Xianjun , Hui Ruting , Shi Yunzhou , Deng Yanli , Zheng Hui , Zheng Qianhua , Zhou Siyuan , Yao Junpeng , Cao Wei , Liu Ying , Hao Pingsheng , Li Ying
Published: June 2019

Background:

Chronic urticaria (CU) is a common and easily recurring skin disease in the world. Many trials have shown that autologous whole-blood or autologous serum acupoint injection therapy is effective in treating CU. There is currently no systematic review of this therapy. The program aims to evaluate the effectiveness and safety of this therapy in patients with CU.

Methods:

Literature search will be conducted at Medline, PubMed, Excerpt Medica Database, Springer, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and other databases. The search date is until May 2019. We will search for popular terms including CU and this therapy. Import the literature electronically. Duplicate documents will be deleted. The primary outcome is the urticaria activity score or other validated scales. Secondary outcomes included response rate, quality of life scale, recurrence rate, and adverse events. A systematic review and search for a randomized controlled trial of this therapy for CU. Implement the Cochrane RevMan V5.3 bias assessment tool to assess bias assessment risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). The mean difference, standard MD, and binary data will be used to represent continuous results.

Results:

This study will provide a comprehensive review of the available evidence for the treatment of CU with this therapy.

Conclusion:

This study will provide new evidence for assessing the effectiveness and side effects of this therapy for CU. Since the data is not individualized, there is no need for formal ethical approval.

PROSPERO registration number:

CRD42019128364.
Comparison of internal fixation with Gamma3 Long nails and INTERTAN nails in the treatment of Seinsheimer type V subtrochanteric femoral fractures in elderly patients
Authors: Li Yan-Hui , Zhu Dong , Li Yuying , Zhao Tianhao , Cao Zongbing , Tan Lei
Published: June 2019

The aim of this study was to clinically compare the therapeutic effects of internal fixation using a third-generation Gamma Long Nail (TGLN) with that of INTERTAN in the treatment of Seinsheimer Type V subtrochanteric femoral fractures in elderly patients.

The therapeutic effect of internal fixation with TGLN, compared with that with INTERTAN, was retrospectively analyzed in elderly patients diagnosed with Seinsheimer Type V subtrochanteric fracture. Twenty-five cases were divided into 2 groups based on the fixation devices: the TGLN group (13 cases; 5 men and 8 women) and the INTERTAN group (12 cases; 5 men and 7 women). Patients were followed up postoperatively, and their clinical history, intraoperative blood loss, fracture healing, Harris Hip Scores, and postoperative complications were recorded and compared.

Patients in the TGLN group had shorter operation time and less intraoperative blood loss, compared with those in the INTERTAN group (P < .05). There were no significant between-group differences in postoperative complications, fracture healing time and Harris Hip Scores during the follow-up (P > .05).
Nonalcoholic fatty pancreas disease is related independently to the severity of acute pancreatitis
Authors: Xie Jiarong , Xu Lu , Pan Yuning , Li Peifei , Liu Yi , Pan Yue , Shan Keshu , Zhang Yu , Xu Lei
Published: June 2019

Background

This study aimed to investigate the association between nonalcoholic fatty pancreas disease and the severity of acute pancreatitis (AP).

Patients and methods

Among the 1662 AP patients admitted between August 2010 and August 2017, 82 eligible patients with moderately severe acute pancreatitis (SAP) and SAP were selected. Meanwhile, 164 mild AP patients were age-matched, sex-matched, and BMI-matched at a ratio of 1 : 2. Nonalcoholic fatty pancreas disease was estimated by mean pancreas attenuation by unenhanced computed tomography. Finally, 1662 patients were screened and 246 patients were analyzed.

Results

For the 246 patients, the mean pancreatic attenuation and pancreas-to-spleen attenuation ratio (P/S ratio) were significantly lower in the moderately SAP and SAP groups compared with those in the mild AP group (both, P<0.001). Pancreatic attenuation decreased with an increase in the rate of ICU transfer, AP severity, systemic complications, and prognostic factors of AP (Acute Physiology and Chronic Health Evaluation II score≥8; P<0.001). A decreased P/S ratio was correlated positively with the increased mortality of patients with AP (hazard ratio: 0.000; 95% confidence interval: 0.000–0.012; P<0.001), as determined by Cox proportional regression analysis adjusted for creatinine, calcium, and albumin levels.

Conclusion

The pancreatic attenuation level and P/S ratio are correlated independently to severity, mortality, and systemic complications in patients with AP.
Mental Health of a Large Group of Adults With Disorders of Sex Development in Six European Countries
Authors: de Vries Annelou L.C. , Roehle Robert , Marshall Louise , Frisén Louise , van de Grift Tim C. , Kreukels Baudewijntje P.C. , Bouvattier Claire , Köhler Birgit , Thyen Ute , Nordenström Anna , Rapp Marion , Cohen-Kettenis Peggy T.
Published: June 2019

Objective

The aim of the study was to evaluate psychiatric symptoms among 1022 persons with various disorders of sex development (DSDs).

Methods

The study was a European multicenter cross-sectional clinical evaluation in six countries. The mean (SD) age of participants was 32.1 (13.4) years. The cohort consisted of 325 individuals with Turner syndrome, 219 individuals with Klinefelter syndrome (KS), female individuals with various XY-DSD conditions (107 with and 67 without androgenization), 87 male individuals with XY-DSD conditions, and 221 female individuals with congenital adrenal hyperplasia. The Hospital Anxiety and Depression Scale, the Short Autism Spectrum Quotient, the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale, and self-reported mental health history were used to assess psychiatric symptoms.

Results

Across the six DSD diagnostic groups, clinical cutoff symptom scores were reached in 19.5% of participants for anxiety, in 7.1% for depression, in 4.1% for attention-deficit/hyperactivity disorder, and in 9.1% for autism. The mean depression and anxiety scores were higher compared with population norms in men with KS and men with XY-DSD. Compared with participants with other DSD conditions, men with KS reported significantly more mental health symptoms. Self-esteem, satisfaction with care, body dissatisfaction, and experiences of shame were associated with psychiatric symptoms in many DSD conditions.

Conclusions

A substantial minority of adults with DSD, with KS in particular, experience psychiatric morbidity. Across DSD conditions, adults may share feelings of shame. Developing a positive self-esteem and body image may be challenging. Multidisciplinary DSD care that involves specialized mental health support can be of important value.

Trial Registration

German Clinical Trials Register DRKS00006072.
Rembrandt's Aging Face in Plastic Surgical Perspective
Authors: Hage J. Joris , Lange Jan , Karim Refaat B.
Published: June 2019

Background and Aim

When the painter Rembrandt van Rijn (1607–1669) died 350 years ago, he left us some 90 self-portraits showing his aging face. Recognizing aging characteristics of the male face is fundamental to the planning of a surgical procedure and a prerequisite when communicating to the male patient. Rembrandt's recordings through the years might offer an optimal aid to train such recognition, provided that they are truthful. In this article, we present an inventory of age-related changes observed in these self-portraits to assess whether they are truthful.

Methods

High-quality photographs of 25 self-portraits that are generally accepted as works by Rembrandt were independently assessed in a standardized fashion for the presence of 25 aging characteristics, by 2 plastic surgeons and a physician-portraitist.

Results

The observed proportion of agreement between assessments reached 0.87 (κ = 0.68, indicating good agreement). We found Rembrandt's self-portraits to reflect his facial aging as a chronologically increasing process. Observed characteristics set in as of 1642, the year that he lost his beloved first wife, Saskia. His face appears to have particularly aged from 1652 to 1659, in which period Rembrandt's second great love Hendrickje was summoned because of her living in sin with Rembrandt, and Rembrandt himself faced financial problems. As of 1660, Rembrandt seems to have been less intended to depict his facial aging characteristics.

Conclusions

We conclude that Rembrandt truthfully reflected his ongoing age in the self-portraits, up to 1660. These self-portraits therefore may allow for training the art of observation of such characteristics.
Orbital Volume Increases With Age
Authors: Ugradar Shoaib , Lambros Val
Published: June 2019

Objective

The aim of the study was to determine whether the bony orbital volume (BOV) changes with age in males and females.

Methods

This case-control study reviewed high-resolution (<1-mm slices) computed tomography (CT) scans of consecutive patients seen for 4 years. The scans were requested as part of the patient's routine care for symptoms related to sinus symptoms. Eligible participants were adults aged between 18 and 30 years and 60 and 75 years. Exclusion criteria included previous surgery, any medical conditions that might affect the bone or soft tissue of the orbit, and any abnormalities seen on imaging. Male patients aged between 18 and 30 years were compared with males aged 60 to 75 years. The same was done for females. The main outcome measure was measurement of the BOV. Both orbits of each patient were included using the generalized estimating equation, to avoid any bias from correlation between 2 orbits of the same patient.

Results

A total of 240 orbits from 120 patients were used for this study. Each age group contained 30 patients. There were no significant differences in the ages between males and females in each age category (P = 0.88 for ages 20–30 years and P = 0.74 for ages 60–75 years). The mean (SD) BOV for females aged between 20 and 30 years was 19,153.69 mm3 (3776.21), whereas that for females aged between 60 and 75 years was 20,939.38 mm3 (2837.34). The difference between the groups was significant (Pr(>|W|) = 0.05). The mean (SD) BOV for males aged between 20 and 30 years was 22,2721 mm3 (2977.35), whereas that for males aged between 60 and 75 years was 22,892.92 mm3 (2389.46) (Fig. 1). The difference between these 2 groups was not significant (Pr(>|W|) = 0.40). The mean BOV was significantly greater for males than females (P ≤ 0.01) across both age groups.

Conclusions

This study found that female orbits expand with age, whereas male orbits showed no significant changes. Changes to the orbital volume in females may contribute to the appearance of aging.
Rigid External Le Fort I Distraction Followed by Secondary Bone Grafting for Maxillary Advancements in Patients With Cleft Lip and Palate
Authors: Tobolowsky William , Gupta Pranjal , Lopez Joseph , Cho Regina , Mundinger Gerhard S. , Yang Robin , Tufaro Anthony P.
Published: June 2019

Introduction:

Maxillary hypoplasia after cleft lip and palate (CLP) repair can result in significant functional and aesthetic impairments. Le Fort I osteotomy & advancement and Le Fort I distraction osteogenesis are standard treatment options for individuals with CLP-associated midface retrusion. However, both of these modalities continue to be associated with a high relapse rate. This study describes surgical outcomes of a 2-stage technique utilizing distraction osteogenesis combined with bone grafting and rigid fixation, which may optimize skeletal stability by reducing relapse.

Methods:

A retrospective review of CLP patients with severe maxillary hypoplasia evaluated by a single surgeon from 2003 to 2014 was performed. Twenty-one subjects were identified that underwent maxillary advancement via a 2-stage technique: (1) Le Fort I external rigid distraction using a HALO device, followed by (2) autologous iliac crest bone graft application and plate-fixation. Post-operative cephalograms were taken on average 1-year following surgery.

Results:

Twelve subjects met the inclusion/exclusion criteria. A distraction rate of 1 mm/day was achieved with an average of 14 mm of maxillary advancement. Average increase in SNA was +9.03°, with an increase from 71.84° to 80.88° (normal = 82.0°, P value <0.0001), with no significant change in SNB, and a +9.63° change in ANB from −7.76° to 1.88° (normal = 1.6°, P value <0.0001).

Conclusions:

The described 2-step procedure had similar cephalometric improvements as compared to distraction osteogenesis alone. However, successive bone grafting and rigid fixation as a second procedure may help ameliorate relapse risk and optimize the correction of maxillary hypoplasia in susceptible populations.
Visual Hallucinations Induced by Clarithromycin in a Child: A Case Report and Literature Review
Authors: Göktürk Bahar , Erden Semih
Published: June 2019

Objective

Our aim was to present a child with visual hallucinations possibly associated with oral clarithromycin administration.

Case report

A 4-year-old child was admitted to our hospital with an onset of visual hallucinations after taking the second dose of clarithromycin by mouth. The symptoms gradually disappeared in a week once the clarithromycin therapy had been discontinued. She was observed for a month without any symptoms or further treatment. She was suspected of having Hoigne syndrome (also called as antibiomania) induced by clarithromycin syndrome.

Conclusion

This report highlights neuropsychological adverse effects due to therapeutic doses of clarithromycin therapy as a possible adverse effect in children.
Recombinant Expression of Aldehyde Dehydrogenase 2 (ALDH2) inEscherichia coliNissle 1917 for Oral Delivery in ALDH2-Deficient Individuals
Authors: Ho Tim , Chang Catherine , Wu Justin , Huang Iris , Tsai Leona , Lin Justin , Tai Emily , Chou Caroline , Yang Justin , Wei Yvonne , Yeh Catherine , Chen William , Lu Dylan , Chou Charlotte , Su Longan , Chang Nicole , Huang Colin , Wang Chloe , Abrena Paul , Cheung Christy , Yeh Cassandra , Whiteford Shantih , Chen Phoebe , Huang Austin , Wu Aire , Wei Benjamin , Kao Eugene , Lin Nicholas , Chang Anna , Yang Jake , Lin Yasmin , Tsao Sean , Ward Nicholas , Chiang Teresa , Clapper Jude
Published: June 2019

Turning red after consuming alcohol may seem like a mere social inconvenience. Yet, this flushing response is caused by an accumulation of acetaldehyde, a carcinogenic intermediate of alcohol metabolism. Aldehyde dehydrogenase 2 (ALDH2) deficiency, the result of a point mutation, produces a less efficient ALDH2. The resulting accumulation of acetaldehyde greatly increases the risk of developing esophageal and head and neck cancers. In this study, we produced recombinant ALDH2 in the probioticE. coliNissle 1917, which successfully reduces acetaldehyde levels in simulated oral conditions. Packaged in a hard candy, the ALDH2-probiotic would remain in the mouth to specifically target salivary acetaldehyde. Using mathematical modeling, we also determined how much recombinant ALDH2 is needed to reduce elevated acetaldehyde levels.

Financial Disclosure

This work was funded by Taipei American School. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests

The authors have declared that no competing interests exist.

Ethics Statement

N/A

Data Availability

Yes – all data are fully available without restriction. Sequences for the plasmids used in this study are available through the Registry of Standard Biological Parts. Links to raw data are included in Supplementary Information.