bluuebunny/crossref_metadata_2025 huggingface dataset:
PB2401 GENETICS OF IRANIAN ALPHA THALASSEMIA PATIENTS; COMPREHENSIVE ORIGINAL STUDY
Authors: Paridar M. , Khosravi A. , Keikhaei B. , Shariati G.
Published: June 2019

Please indicate where the abstract has been published before: The full paper was published in Biochemical genetics journal

Background:

Alpha thalassemia is the most prevalent monogenic gene disorder in the world and especially in Mediterranean countries. In the current hematological phenotype of patients with different genotypes, and also the effect of missense mutations on the protein function and stability were evaluated in a large cohort study.

Aims:

To evaluate the genetics of large populations of Iranian alpha thalassemia patients

Methods:

One thousand five hundred and sixty subjects were participated in the study and divided into two groups; 259 normal subjects and 1301 alpha thalassemia carriers. Genomic DNA was extracted and analyzed using ARMS PCR, Multiplex Gap, and direct sequencing. The effects of single nucleotide change on the protein function and stability were predicted by free available databases of human polymorphisms.

Results:

Sixty‐three different genotypes were seen in the patients. The more prevalent was heterozygote form of ‐α3.7 (41.4%) followed by ‐α3.7 homozygote(11.6%) and ‐ ‐MED(3.8%). The significant differences were seen in mean hemoglobin level [F = 20.5, p < 0.001] between the Alpha globin genotypes when adjusted for gender. Moreover, 28 different mutations were found in our study. A significant relationship was seen between ethnicity and the alpha globin mutation frequency X2 (df;8) = 38.36, p <0.0001).

Summary/Conclusion:

Different genotypes could be displayed as different phenotypes. The mutation frequency distributions in our region are different from other parts of Iran. Significant differences are seen in the spectrum of mutation frequency between various ethnicity. Finally, some missense mutations maybe did not considerably effect on the proteins and could be a neutral mutation.

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PB2404 ARE DAA SAFE AND EFFECTIVE IN TREATMENT OF THALASSEMIA PATIENTS WITH CHRONIC HCV?
Authors: Ashwah S. El , Eisa N. , Ghoneem E. A. , El‐Etreby S.
Published: June 2019

Background:

Hepatitis C virus (HCV) infection is a major cause of liver‐related morbidity and mortality among thalassemic patients. Direct‐acting antivirals agents (DAAs) are highly effective and well‐tolerated by chronic HCV patients.

Aims:

This study was conducted to evaluate the safety and efficacy of DAAs in treatment of thalassemic patients with chronic HCV.

Methods:

This prospective study enrolled 22 thalassemic patients with chronic HCV infection proved by positive RT PCR HCV RNA from a total 40 patients who were positive for HCV ELISA test. Severity of liver disease was assessed in all patients. They received treatment of HCV according to guidelines of the National Committee for Control of Viral Hepatitis (NCCVH) in Egypt. About, 16 (72.72%) patients were treated with a sofosbuvir plus daclatasvir, and the other 6 (27.27 %) patients received sofosbuvir plus ledipasvir for 3 months. Primary end point was assessed by achievement of sustained virological response (SVR) at 12 weeks. Secondary end point was assessed by recording any side effects, transfusion requirements if need or stoppage of treatment.

Results:

The mean age of our patients was 29 years and 50% of them were male. Only 2 (9.09%) of them had compensated cirrhosis. SVR 12 was achieved in all patients (100%). Only one case required treatment discontinuation for one week due to acute kidney injury after prolonged use of NSAIDs then resumed DAAs after decline of creatinine to normal value. The most common side effects were fatigue (18%), progressive anemia (13.63%), requiring blood transfusion that occurred in three of the patients who received sofosbuvir plus daclatasvir, and lastly, headache (4.5%). There was no statistically significant difference in the level of hemoglobin before and after DAAs (8.5 ± 1.34 gm/dl vs 8.6 ± 1.38 gm/dl with p value = 0.484). There was significant improvement of mean ALT values after treatment compared to baseline one (42.45 ± 18.56 vs 57.29 ± 35.07 with p value < 0.0005).

Summary/Conclusion:

Direct acting antiviral drugs namely sofosbuvir plus daclatasvir or sofosbuvir plus ledipasvir are safe, effective, and well tolerated regimens in thalassemic patients with chronic HCV.
PB2414 AWARENESS AND KNOWLEDGE OF CARDIOVASCULAR DISEASE RISK AMONG THALASSEMIA PATIENTS
Authors: Meloni A. , Maffei S. , Pistoia L. , Traghella I. , Spiga A. , Massei F. , Serra M. , Guerrini G. , Giovangrossi P. , Fotzi I. , Marcheschi P. , Pepe A.
Published: June 2019

Background:

Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality for thalassemia major (TM) patients but also for the general population in industrialized countries. Different studies revealed broad misconceptions with regard to the leading cause of death and impact of heart disease among the general population.

Aims:

We evaluated for the first time knowledge and awareness of CVD among TM patients in Italy.

Methods:

An anonymous questionnaire was completed by 44 TM patients (25 females, 39.95 ± 6.89 years) consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) Network.

Results:

Table 1 shows the answers to the first part of the questionnaire.

The first two questions were multiple‐choice questions. The 74.4% of TM patients defined cancer (in general, breast/prostate or hepatic) as the greatest health problem for people of the same age. Out of the 13 patients with a CVD, only two defined CVD as the greatest health problem.

The 44,1% of patients indicated cancer as the greatest danger to their future health.

The other questions were yes/no questions. The 80.5% of TM patients thought that CVD was the leading cause of death in Italy. The percentage of patients who answered positively to this question was no significantly different among those with CVD than those without CVD. The 41.7% of patients who considered CVD to be the main cause of death named CVD as the greatest health problem.

Summary/Conclusion:

Although TM patients are aware that CVD is the leading cause of death, they seem to have a misperception of the impact of CVD on their personal current and future health status. Our data highlight the need to empower knowledge and perception of CVD in TM as a real health problem and not just as a potentially lethal threat.

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PB2417 SPECTRUM OF HAEMOGLOBINOPATHIES;A TERTIARY CARE HOSPITAL EXPERIENCE
Authors: Fareed N. , Fatima G. , Quraishy M.
Published: June 2019

Background:

Inherited abnormalities of hemoglobin synthesis include a myriad of disorders ranging from thalassemia syndromes to structurally abnormal hemoglobin variants.

Identification of these disorders is immensely important epidemiologically and aid in prevention of more serious hemoglobin disorders.

Aims:

This study presents the pattern of haemoglobinopathies amongst the referred patients of anaemia in a 1 year period, it helps to identify the cases of different hemoglobin disorders.

Methods:

Inherited abnormalities of hemoglobin synthesis include a myriad of disorders ranging from thalassemia syndromes to structurally abnormal hemoglobin variants. Identification of these disorders is immensely important epidemiologically and aid in prevention of more serious hemoglobin disorders.

Results:

Out of 747 cases, 558 (74.6%) were normal and 189 (25.3%) cases had abnormal haemoglobin pattern. 356 (47.6%) were males and 391 (52.3%) were females. Of all cases of Anaemia 278 (49.8%) were microcytic hypochromic, 22 (3.9%) macrocytic and the rest 258 (46.2%) had normocytic normochromic picture. Of the 189 abnormal cases, Spectrum of haemoglobinopathies prevalent were Beta Thalassemia trait 117 (61.9%), followed by Beta thalassaemia major 27 (14.2%). Other haemoglobinopathies in descending order of frequency were sickle cell disease 15 (7.9%), Hb D Disease 16 (8.4%), sickle cell trait 01 (0.5%), Sickle/beta thalassaemia in 02 (1.0%) and Hb E in 04 (2.1%).

Summary/Conclusion:

Our study showed higher frequency of Beta Thalassaemia trait. It is suggested that detection of HbA2 should be carried out in all the high‐risk groups with anaemia. Further larger studies are needed to screen our population to detect thalassaemia carrier state and Iron deficiency Anaemia.
PB2424 AUGMENTED AND SYNERGISTIC EFFECT OF FACTOR V LEIDEN (FVL) AND MTHFR GENES POLYMORPHISMS AND PLATELET ACTIVITY AND REACTIVITY AS RISK FACTORS FOR ISCHEMIC CEREBROVASCULAR STROKE (IS)
Authors: Abdelhamid A.E.S. , Nashaat H.‐A. Hassan , Ahmed A. Sayed , Hosny A. O. , Hassan A.M. , ELSamahy M.A.A. , Abdelhamid M.A.S.
Published: June 2019

Background:

Ischemic cerebrovascular stroke (IS) is a polygenic multifactorial disease; effect of thrombotic gene polymorphism, platelet activation and reactivation synergistic risk effect are plausible postulation.

Aims:

To assess synergistic effect of FVL and MTHFR genes polymorphisms and platelet activity and reactivity as risk factors for ischemic cerebrovascular stroke

Methods:

A hospital‐based case‐control study; approvered by Suez Canal University (SCU) ethical committee, after obtaining an informed consent. 120 individuals were included: 60 acute IS patients, subdivided into 2 subgroups regarding the vascular risk factors recruited from neurology department, SCU Hospital; and 60 matched healthy individuals. FVL G1691A, FVLA4070G, FVL A5279G, MTHFRC677T, and MTHFR A1298C were assessed using multiplex real‐time PCR assay (AnyplexTM II Thrombosis SNP Panel Assay, seegene); platelet ex vivo activity & reactivity (CD62P; after ADP provocation) were assessed by four‐colors flow cytometry, FACS Caliber, BD‐Biosciences).

Results:

Both FVLG1691A & FVL A4070G (OR 19.6; 95 % CI = 2.5 to 154.4; p = 0.0001), (OR 7.6; 95 % CI = 1.13 to 178; p = 0.012), and MTHFRC677T (OR 10; 95 % CI = 1.16to 85.8; p = 0.03) and MTHFRA1298C (OR 11.6; 95 % CI = 1.35to 100.7; p = 0.03) & the presence of >1 mutation (p < 0.0001) showed a statistically significant association with IS. Multivariate logistic regression models showed that studied SNPs add synergistic effect on the vascular risk factors. A statistically significant difference was detected in platelet CD62p % after adding ADP (IS patients: 72.95 ± 14.8 ‐ controls: 62.2 ± 11.39), MFI IS patients: 248 ± 101‐controls 215 ± 75.8). both FVLG1691A and MTHFRC677T were significantly associated with higher baseline platelet activation in the co‐dominant and recessive models for FVLG1691A and in the dominant model for MTHFRC677T

Summary/Conclusion:

FVLG1691A, FVL14070G, MTHFRC677T & MTHFRA1298C were independent risk factors for IS especially in younger patients & existence of >1 mutation significantly increased IS risk, platelet activity and reactivity and genetic polymorphism play a potential synergistic role increasing the risk of IS.

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PB2431 CAROTID INTIMA‐MEDIA THICKNESS PROGRESSION AND BLOOD COAGULATION FACTOR XIII LEVELS IN TYPE 2 DIABETES: 8 YEARS OF FOLLOW‐UP
Authors: Sadeghi F. , Cogoi B. , Káplár M. , Csiki Z. , Kovács S. , Katona É. , Muszbek L. , Shemirani A. H.
Published: June 2019

Background:

Blood coagulation factor XIII (FXIII) main function is to strengthen and consequently protect fibrin polymers from fibrinolysis. Associations of transglutaminases in general, FXIII in particular and atherogenesis are described in the literature. Carotid intima‐media thickness (CIMT) has been shown to be a proxy end point for future vascular events. CIMT is related to premature atherosclerosis in healthy young adults.

Aims:

In this prospective study, the objective was to assess the relation between FXIII antigen, activity, CIMT at follow‐up as well as for CIMT progression (ΔCIMT).

Methods:

This prospective study comprised of 118 patients (56 females, 62 males, mean age of 62 ± SD10 years). All participants in the study cohort offered clinical, biochemical and ultrasonography investigations at baseline and at follow‐up.

Results:

During the period of investigation, mean CIMT, FXIII cross‐linking activity and antigen levels, both non‐adjusted and adjusted for the respective independently associated parameters, were significantly higher (p < 0.001). We divided the patients in tertiles of FXIII activity and antigen. At baseline, number of patients decreased as FXIII cross‐linking activity increased. It was reversed at follow‐up and significantly higher number of patients were present at upper tertile compare with lower tertile (p = 0.023). We observed similar results in case of FXIII antigen (p < 0.001).

Summary/Conclusion:

In conclusion, FXIII antigen and activity are elevated in individuals with type 2 diabetes. Increased CIMT and its progression was observed in this group of patients.
PB2443 AUDIT ON NOACS (APIXABAN AND RIVAROXABAN) PRESCRIPTION IN A DISTRICT GENERAL HOSPITAL
Authors: Lovato S. , Kanakam T. , Vajia P. , Dosanjh J. , Harford D.
Published: June 2019

Background:

Oral anticoagulation therapy is the treatment of choice to prevent stroke in patients with non valvular atrial fibrillation. Non‐vitamin K antagonist oral anticoagulants (NOACs) are often used as alternative to vitamin K antagonists as they do not require INR level monitoring. Before initiating the anticoagulant therapy the risk of stroke should be evaluated using the CHA2DS2‐VASc score and the bleeding risk using the HAS‐BLED score. In our institution the most used NOACs are Apixaban and Rivaroxaban. The recommended dose for Apixaban is 5 mg bd, reduced to 2.5 mg twice bd in patients with age >80, weight < 61 kg or serum creatinine > 133 micromol/litre. The recommended dose for Rivaroxaban is 20 mg od.

Aims:

The aim of this study was to understand the appropriateness of NOACs use in our institution in terms of indication and dose compared to the national guidelines.

Methods:

We performed an audit including all new patients who attended our anticoagulation service in a period of six months and were started on either Apixaban or Rivaroxaban. To do this we evaluated if the indication for anticoagulation was appropriate, if CHA2DS2‐VASc score HAS‐BLED score were documented on the notes. We also evaluated the appropriateness of the dose adjusted for creatinine of Apixaban.

Results:

We included 57 patients, 29 of them were started on Apixaban and 28 on Rivaroxaban. All of the patients had a diagnosis of Non Valvular Atrial Fibrillation. CHA2DS2‐VASc score was documented in 31 patients (54%) and HAS‐BLED score in 32 patients (56%), only 22 patients (38%) had both score properly documented. Out of 31 patients 4 (13%) had a CHA2DS2‐VASc score of 0, and out of 32 patients 2 (6%) had a HAS‐BLED score >3. This mean that in 19% of the patients the anticoagulation therapy was not indicated or contraindicated, but also that in 62% of the patients the appropriateness could not be properly evaluated. Creatinine was documented only in 11 of the patients on Apixaban (38%), in all of them the dose was appropriate for renal function.

Summary/Conclusion:

We included 57 patients, 29 of them were started on Apixaban and 28 on Rivaroxaban. All of the patients had a diagnosis of Non Valvular Atrial Fibrillation. CHA2DS2‐VASc score was documented in 31 patients (54%) and HAS‐BLED score in 32 patients (56%), only 22 patients (38%) had both score properly documented. Out of 31 patients 4 (13%) had a CHA2DS2‐VASc score of 0, and out of 32 patients 2 (6%) had a HAS‐BLED score >3. This mean that in 19% of the patients the anticoagulation therapy was not indicated or contraindicated, but also that in 62% of the patients the appropriateness could not be properly evaluated. Creatinine was documented only in 11 of the patients on Apixaban (38%), in all of them the dose was appropriate for renal function.
Utilizing an SBAR Workshop With Baccalaureate Nursing Students to Improve Communication Skills
Authors: Stevens Natalie , McNiesh Susan , Goyal Deepika
Published: June 2019

This study evaluated the effectiveness of the Situation-Background-Assessment-Recommendation (SBAR) technique to reduce anxiety and increase self-confidence levels regarding health care communication among undergraduate nursing students. Baccalaureate nursing students (n = 35) completed anxiety and self-confidence questionnaires before and after an SBAR communication workshop and subsequent simulation. A statistically significant increase in postintervention self-confidence scores was noted with no significant difference in anxiety levels. The findings support the use of SBAR as an organizing tool to promote nursing students’ self-confidence during communication; however, further efforts are needed to qualitatively examine how this tool promotes these changes.
Congenital Forearm Pseudarthrosis, a Systematic Review for a Treatment Algorithm on a Rare Condition
Authors: Siebelt Michiel , de Vos-Jakobs Suzanne , Koenrades Nienke , van Nieuwenhoven Christianne A.V. , Oostenbrink Rianne , Bramer Wichor M. , Verhaar Jan A.N. , Bessems Gert J.H.J.M. , Kempink Dagmar R.J.
Published: June 2019

Background:

A congenital forearm pseudarthrosis is a rare condition and is strongly associated with neurofibromatosis type 1. Several surgical techniques are described in the literature, but the most optimal treatment strategy remains unclear. This systematic review aims to develop a treatment algorithm that may aid in clinical decision making.

Methods:

The PROSPERO registration number for this study was CRD42018099602 and adheres to the PRISMA guidelines for systematic reviews. Embase, MEDLINE, Cochrane Central, Web of Science, and Google Scholar databases were searched for published studies reporting on congenital forearm pseudarthrosis not related to other underlying pathologies like bacterial infection or fibrous dysplasia. Results were not restricted by date or study type, only English literature was allowed. Studies were assessed for quality using the critical appraisal checklist for case reports from the Joanna Briggs Institute. Patient characteristics, underlying disease, type of surgery, union rate, and functional outcome were extracted from included studies.

Results:

Of 829 studies identified, 47 were included in this review (17 case series and 30 case reports, a total of 84 cases). A one-bone forearm procedure showed highest union rates (92%), however, it results in loss of forearm rotation. Free vascularized fibula grafting showed high union rates (87%) and was related to good functional outcome of elbow flexion and forearm rotations. Other procedures showed disappointing outcomes.

Conclusions:

Congenital forearm pseudarthrosis is best treated with a free vascularized fibula grafting, a one-bone forearm procedure should be used as a salvage procedure. Evidence extracted from the case reports was sufficient to generate a treatment algorithm to be used in clinical pediatric practice.

Level of Evidence:

Level IV—therapeutic.
Causes of Death in Status Epilepticus
Authors: Hawkes Maximiliano A. , English Stephen W. , Mandrekar Jay N. , Rabinstein Alejandro A. , Hocker Sara
Published: June 2019

Objectives:

To determine the causes of death in patients with status epilepticus. To analyze the relative contributions of seizure etiology, seizure refractoriness, use of mechanical ventilation, anesthetic drugs for seizure control, and medical complications to in-hospital and 90-day mortality, hospital length of stay, and discharge disposition.

Design:

Retrospective cohort.

Setting:

Single-center neuroscience ICU.

Participants:

Patients with status epilepticus were identified by retrospective search of electronic database from January 1, 2011, to December 31, 2016.

Interventions:

Review of electronic medical records.

Measurements and Main Results:

Demographics, clinical characteristics, treatments, and outcomes were collected. Univariable and multivariable logistic regression analysis were used to determine whether the use of anesthetic drugs, mechanical ventilation, Status Epilepticus Severity Score, refractoriness of seizures, etiology of seizures, or medical complications were associated with in-hospital, 90-day mortality or discharge disposition. Among 244 patients with status epilepticus (mean age was 64 yr [interquartile range, 42–76], 55% male, median Status Epilepticus Severity Score 3 [interquartile range, 2–4]), 24 received anesthetic drug infusions for seizure control. In-hospital and 90-day mortality rates were 9.2% and 19.2%, respectively. Death was preceded by withdrawal of life-sustaining treatment in 19 patients (86.3%) and cardiac arrest in three (13.7%). Only Status Epilepticus Severity Score was associated with in-hospital and 90-day mortality, whereas the use of anesthetic drugs for seizure control, mechanical ventilation, medical complications, etiology, and refractoriness of seizures were not. Hospital length of stay was longer in patients with medical complications (p = 0.0091), refractory seizures (p = 0.0077), and in those who required anesthetic drugs for seizure control (p = 0.0035). Patients who had refractory seizures were less likely to be discharged home (odds ratio, 0.295; CI, 0.143–0.608; p = 0.0009).

Conclusions:

In this cohort, death primarily resulted from the underlying neurologic disease and withdrawal of life-sustaining treatment and not from our treatment choices. Use of anesthetic drugs, medical complications, and mechanical ventilation were not associated with in-hospital and 90-day mortality.
PT-31, a putative α2-adrenoceptor agonist, is effective in schizophrenia cognitive symptoms in mice
Authors: Betti Andresa Heemann , Antonio Camila Boque , Herzfeldt Vivian , Pitta Marina Galdino da Rocha , da Rocha Pitta Ivan , do Rego Jean-Luc , do Rego Jean-Claude , Vaudry David , Rates Stela Maris Kuze
Published: June 2019

Evidence of changes in central noradrenergic activity has been reported in schizophrenic patients and studies indicate that activation of the α2-adrenoceptor improves memory and neuroprotection. In this study, a new imidazolidine derivative 3-(2-chloro-6-fluorobenzyl)-imidazolidine-2,4-dione, PT-31, a putative α2A-adrenoceptor agonist, was evaluated in mouse models predictive of efficacy in the treatment of positive and cognitive symptoms of schizophrenia, as well as its ability to promote cerebellar granule cell survival in vitro, in the presence or absence of glutamate (100 µmol/l). PT-31 prevented apomorphine-induced climbing and the ketamine-induced hyperlocomotion, without inducing catalepsy or motor impairment. PT-31 protected against the impairment of prepulse inhibition induced by apomorphine, (±)-DOI, and ketamine. The molecule did not affect mouse short nor long-term memory per se, but it protected against ketamine-induced memory impairment when administered at different stages of the memory process (acquisition, consolidation, and retrieval) in the novel object recognition task. When added to cultured cerebellar granule neurons, PT-31 was not toxic per se and protected neurons from glutamate-induced apoptosis. In conclusion, PT-31 displayed a preclinical pharmacology predictive of neuroprotective effects and efficacy in relieving schizophrenia symptoms, without inducing motor side effects, suggesting that it could represent a molecular scaffold for antipsychotic drug development.
Oral Gabapentinoids and Nerve Blocks for the Treatment of Chronic Ocular Pain
Authors: Small Leslie R. , Galor Anat , Felix Elizabeth R. , Horn Danielle B. , Levitt Roy C. , Sarantopoulos Constantine D.
Published: June 2019

Purpose:

There is a recognition that nerve dysfunction can contribute to chronic ocular pain in some individuals. However, limited data are available on how to treat individuals with a presumed neuropathic component to their ocular pain. As such, the purpose of this study was to examine the efficacy of our treatment approaches to this entity.

Methods:

A retrospective review of treatments and outcomes in individuals with chronic ocular pain that failed traditional therapies.

Results:

We started eight patients on an oral gabapentinoid (gabapentin and/or pregabalin) as part of their pain regimen (mean age 46 years, 50% women). Two individuals reported complete ocular pain relief with a gabapentinoid, in conjunction with their topical and oral medication regimen. Three individuals noted significant improvements, one slight improvement, and two others no improvement in ocular pain with gabapentin or pregabalin. We performed periocular nerve blocks (4 mL of 0.5% bupivacaine mixed with 1 mL of 80 mg/mL methylprednisolone acetate) targeting the periocular nerves (supraorbital, supratrochlear, infratrochlear, and infraorbital) in 11 individuals (mean age 54 years, 36% women), 10 of whom had previously used a gabapentinoid without ocular pain improvement. Seven individuals experienced pain relief after nerve blocks that lasted from hours to months and four failed to benefit. Five of the individuals who experienced pain relief underwent repeat nerve blocks, weeks to months later.

Conclusions:

Approaches used to treat chronic pain outside the eye can be applied to ocular pain that is not responsive to traditional therapies.
Complex Stenoses and CT Features of the Nasolacrimal Canal in Congenital Nasolacrimal Duct Obstruction
Authors: Fayet Bruno , Racy Emmanuel , Bordonné Corinne , Katowitz James A. , Katowitz William R. , Brémond-Gignac Dominique
Published: June 2019

The authors describe hard contact palpation during probing for CLNDO and its relationship to anatomic location and etiologies of obstruction in the nasolacrimal canal by CT imaging.

Purpose:

To study the CT appearance of the nasolacrimal canal (NLC) in cases of congenital nasolacrimal duct obstruction (CNLDO) where there is a tactile sensation of a hard contact (HC) stop in the duct preventing stent intubation.

Methods:

The authors retrospectively reviewed all consecutive cases of chronic CNLDO observed between 2003 and 2018 in which an apparent HC obstruction prevented nasolacrimal intubation. CT scans were reviewed to determine the cause of probing failure: distal stenosis, loss of parallelism of the NLC walls, abnormal angulations or an adjacent obstacle blocking tear outflow.

Results:

Nine patients (12 sides) met the following criteria: CNLDO + HC + probing failure. The mean age at the time of the first HC was 3.9 years (range: 0.8–8.1 years) and at the time of a second confirmation of HC with subsequent dacryocystorhinostomy was 7.8 years (range: 4.1–9.2 years). Nasolacrimal duct opacification was noted in 33% of cases (4/12). Abnormalities of the NLC occurred in 8 of the 12 cases of CNLDO (8/12 = 66.6%) and on the asymptomatic side in 1 case (1/6 = 16.6%). A canine tooth bud situated in the same plane as the NLC was observed in 9 cases of CNLDO (9/12 = 75%) and on the asymptomatic side in 2 cases (2/6 = 33.3%).

Conclusions:

HC noted during probing is a sensitive but relatively nonspecific sign which, nevertheless, does indicate either a complex obstruction or at least potential intubation difficulties. As confirmed by CT imaging, a significant anatomical variant is not necessarily predictive of epiphora, but nevertheless may complicate the intubation procedure.
Subconjunctival Dirofilariasis Presenting as Orbital Cellulitis
Authors: Shambhu Smitha K. , Murthy Praveen R. , D’souza Placid E. , Hanumappa Dhanalakshmi , Vikram Holenarasipur R. , Janardhana Geethanjali C. , Matada Roopashri
Published: June 2019

Human ocular Dirofilariasis is a relatively rare, zoonotic disease, caused by a filarial nematode, Dirofilaria repens. This parasitic infestation usually presents as a subconjunctival nodule with hyperemia. The authors present a case of subconjunctival dirofilariasis in a 91-year-old gentleman, who presented with manifestations of orbital cellulitis. The live worm was surgically removed and identified to be D. repens.
Diagnostic Utility and Safety of Endobronchial Ultrasound–guided Transbronchial Needle Aspiration in the Elderly
Authors: Dhooria Sahajal , Sehgal Inderpaul S. , Gupta Nalini , Prasad Kuruswamy T. , Aggarwal Ashutosh N. , Agarwal Ritesh
Published: June 2019

Background:

There is limited evidence regarding the effect of age on the specimen adequacy, positivity rate of specimen on cytology (PR), and safety of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA). The aim of this study was to investigate the utility of EBUS-TBNA in the elderly.

Methods:

This was a retrospective study of subjects who underwent EBUS-TBNA. We compare the specimen adequacy, PR, and the incidence of complications in the elderly (age 65 y and above) versus the younger subjects (age younger than 65 y). A multivariate logistic regression analysis was performed to identify the factors affecting the diagnostic yield.

Results:

Of the 1816 subjects, 258 (14.2%) were elderly. The specimen adequacy was similar between the old and the young (93.5% vs. 96.3%, P=0.053). The PR in the elderly (48.8%) was lower (P<0.001) than the younger subjects (66.7%). Among those with a definite diagnosis made on EBUS-TBNA, 55.4% of the older subjects had malignancy, while 82.4% of the young had granulomatous disorders. The incidence of complications was similar in the 2 groups (3.9% vs. 4.4%, P=0.87). The specimen adequacy, PR and complications were also similar among the different age groups within the older population (65 to 69, 70 to 74, 75 to 79, and 80 y and above). On multivariate logistic regression analysis, older age, the number of lymph nodes sampled, the lymph node size, and needle reuse influenced the PR.

Conclusion:

EBUS-TBNA appears to have a similar specimen adequacy and safety but a lower PR in the elderly as compared with the younger individuals.
When a Child Dies in the PICU: Practice Recommendations From a Qualitative Study of Bereaved Parents*
Authors: Butler Ashleigh E. , Copnell Beverley , Hall Helen
Published: June 2019

Objectives:

Around the world, the PICU is one of the most common sites for hospitalized children to die. Although ensuring the best possible care experience for these children and their families is important, clear recommendations for end-of-life and bereavement care, arising from the parents themselves, remain limited within current literature. This report aims to describe bereaved parents’ recommendations for improvements in end-of-life care and bereavement follow-up when a child dies in intensive care.

Design:

Thematic analysis of incidental data from a larger grounded theory study.

Setting:

Four Australian PICUs.

Subjects:

Twenty-six bereaved parents participated in audio-recorded, semi-structured interviews in 2015–2016. Interviews explored their experiences of having a child die in intensive care and their experiences of end-of-life care and bereavement follow-up. Data pertaining to this report were analyzed via thematic analysis.

Interventions:

None.

Measurements and Main Results:

Bereaved parents identified several areas for care delivery and improvement across three time periods: during hospitalization; during the dying phase; and during bereavement. During hospitalization, parents’ recommendations focused on improved communication, changes to the physical environment, better self-care resources, and provision of family support. During the dying phase, parents suggested private, de-medicalized rooms, familiar staff members, and support to leave the hospital. Recommendations for care after death focused mainly on the provision of ongoing support from the hospital or local bereavement services, as well as improved information delivery.

Conclusions:

Findings from this study offer many concrete recommendations for improvements in care both during and after a child’s death. These recommendations range from simple practice changes to larger organizational modifications, offering many potential avenues for change and improvement both on an individual healthcare provider level and within individual PICUs.
Long-Term Follow-Up of Longevity and Diffusion Pattern of Hyaluronic Acid in Nasolabial Fold Correction through High-Frequency Ultrasound
Authors: Qiao Ju , Jia Qian-Nan , Jin Hong-Zhong , Li Feng , He Chun-Xia , Yang Jun , Zuo Ya-Gang , Fu Lan-Qin
Published: June 2019

Background:

Injectable hyaluronic acid fillers have been widely applied in the clinical treatment of facial wrinkles. However, further information and clinical evidence concerning dermal changes and hyaluronic acid filler longevity after injection and diffusion pattern are limited.

Methods:

The authors evaluated the longevity and diffusion pattern of two hyaluronic acid fillers generated by different cross-linking technologies used in the treatment of nasolabial folds using high-frequency ultrasound. Forty-one subjects were treated with Restylane 2 and the remaining 41 were treated with Dermalax DEEP. Wrinkle severity rating scale score and high-frequency ultrasound evaluation of nasolabial folds were performed before and after the injection of hyaluronic acid filler. The ultrasound images were acquired and analyzed to determine dermal thickness and the shape and distribution of hyaluronic acid filler.

Results:

At 2 and 24 weeks from baseline, increased dermal thickness induced by hyaluronic acid filler treatment was not significantly different between groups. At 48 weeks after injection, increased dermal thicknesses of the Restylane 2 group (0.14 ± 0.12 mm) were much lower than those of the Dermalax DEEP group (0.20 ± 0.13 mm). Ultrasound examination revealed that hyaluronic acid materials form well-demarcated and hypoechogenic areas. Restylane 2 tended to form a more diffuse pattern, with multiple smaller bubbles, whereas Dermalax DEEP developed into a more localized configuration, with larger clumps.

Conclusions:

This study is the first long-term assessment of nasolabial fold correction that reveals the performance of different hyaluronic acid materials in vivo and validates high-frequency ultrasound as a simple and rapid modality. Hyaluronic acid fillers generated by different cross-linking technologies display differential diffusion patterns in skin tissues.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Role of Fresh Frozen Cartilage in Revision Rhinoplasty
Authors: Mohan Raja , Shanmuga Krishnan R. Raja , Rohrich Rod J.
Published: June 2019

Background:

Correction of secondary nasal deformities frequently requires cartilage to build the framework of the nose. Traditionally, autologous costal cartilage has been used because of the paucity of the septal cartilage. Because of associated donor-site complications and increased operating time, irradiated allografts have been used. These grafts have a higher rate of resorption and infection. Thus, the authors have used fresh frozen, nonirradiated, cadaveric rib cartilage as donor cartilage to avoid these shortcomings, and they present their early experience.

Methods:

The operative data of 50 patients who underwent secondary rhinoplasty performed by the senior author between 2014 and 2017 were analyzed. The outcomes of the rhinoplasty were evaluated by preoperative and postoperative photographs by four blinded plastic surgeons, and the results were tabulated using the Independent Rhinoplasty Outcome Score.

Results:

Fifty patients were followed up over an average period of 3.35 months (range, 1 to 18 months). There was only one complication (infection, 2 percent), which did not need revision surgery. There was no warping or extrusion in this cohort.

Conclusions:

The authors believe that fresh frozen, nonirradiated cartilage allografts are an evolving source of donor cartilage grafts for revision rhinoplasty because they are associated with lower complication rates. However, further long-term studies with an increased sample size are necessary to prove that fresh frozen cartilage grafts are better than other sources.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Assessment of Hepatic Perfusion Using GRASP MRI
Authors: Weiss Jakob , Ruff Christer , Grosse Ulrich , Grözinger Gerd , Horger Marius , Nikolaou Konstantin , Gatidis Sergios
Published: June 2019

Purpose

The aim of this study was to demonstrate the feasibility of hepatic perfusion imaging using dynamic contrast-enhanced (DCE) golden-angle radial sparse parallel (GRASP) magnetic resonance imaging (MRI) for characterizing liver parenchyma and hepatocellular carcinoma (HCC) before and after transarterial chemoembolization (TACE) as a potential alternative to volume perfusion computed tomography (VPCT).

Methods and Materials

Between November 2017 and September 2018, 10 patients (male = 8; mean age, 66.5 ± 8.6 years) with HCC were included in this prospective, institutional review board–approved study. All patients underwent DCE GRASP MRI with high spatiotemporal resolution after injection of liver-specific MR contrast agent before and after TACE. In addition, VPCT was acquired before TACE serving as standard of reference. From the dynamic imaging data of DCE MRI and VPCT, perfusion maps (arterial liver perfusion [mL/100 mL/min], portal liver perfusion [mL/100 mL/min], hepatic perfusion index [%]) were calculated using a dual-input maximum slope model and compared with assess perfusion measures, lesion characteristics, and treatment response using Wilcoxon signed-rank test. To evaluate interreader agreement for measurement repeatability, the interclass correlation coefficient (ICC) was calculated.

Results

Perfusion maps could be successfully generated from all DCE MRI and VPCT data. The ICC was excellent for all perfusion maps (ICC ≥ 0.88; P ≤ 0.001). Image analyses revealed perfusion parameters for DCE MRI and VPCT within the same absolute range for tumor and liver tissue. Dynamic contrast-enhanced MRI further enabled quantitative assessment of treatment response showing a significant decrease (P ≤ 0.01) of arterial liver perfusion and hepatic perfusion index in the target lesion after TACE.

Conclusions

Dynamic contrast-enhanced GRASP MRI allows for a reliable and robust assessment of hepatic perfusion parameters providing quantitative results comparable to VPCT and enables characterization of HCC before and after TACE, thus posing the potential to serve as an alternative to VPCT.
Endoscopic Transpapillary Pancreatic Duct Stent Placement for Symptomatic Peripancreatic Fluid Collection Caused by Clinically Relevant Postoperative Pancreatic Fistula After Distal Pancreatectomy
Authors: Watanabe Yusuke , Ueda Keijiro , Nakamura So , Endo Sho , Kozono Shingo , Nishihara Kazuyoshi , Nakano Toru
Published: June 2019

This study aimed to evaluate the safety and efficacy of endoscopic transpapillary pancreatic duct stent placement (ETPS) for symptomatic peripancreatic fluid collection caused by postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP). ETPS was also compared with percutaneous drainage (PTD). Retrospectively 38 patients were studied who developed clinically relevant POPF. Of 38 patients, 4 underwent PTD and 11 underwent ETPS. Technical and clinical success rates of ETPS (100% and 91%, respectively) were comparable with PTD (100% and 75%, respectively). The tip of a pancreatic stent was placed over the pancreatic stump in 4 patients and draining of pus through the pancreatic stent was observed. The hospital stay after DP and the interval from intervention to discharge were significantly shorter in the ETPS group than in the PTD group. ETPS is safe and successful for managing peripancreatic fluid collection caused by POPF after DP and should be considered as a therapeutic option.
Testing the metabolic homeostasis hypothesis in amphibians
Authors: Kreiman Lucas E. , Solano-Iguaran Jaiber J. , Bacigalupe Leonardo D. , Naya Daniel E.
Published: June 2019

A number of hypotheses about compensatory mechanisms that allow ectothermic animals to cope with the latitudinal decrease in ambient temperature (TA) have been proposed during the last century. One of these hypotheses, the ‘metabolic homeostasis’ hypothesis (MHH), states that species should show the highest thermal sensitivity of the metabolic rate (Q10-SMR) at the colder end of the range ofTAs they usually experience in nature. This way, species should be able to minimize maintenance costs during the colder hours of the day, but quickly take advantage of increases inTAduring the warmer parts of the day. Here, we created a dataset that includesQ10-SMRvalues for 58 amphibian species, assessed at four thermal ranges, to evaluate three predictions derived from the MHH. In line with this hypothesis, we found that: (i)Q10-SMRvalues tended to be positively correlated with latitude when measured at lowerTAs, but negative correlated with latitude when measured at higherTAs, (ii)Q10-SMRmeasured at lowerTAs were higher in temperate species, whereasQ10-SMRmeasured at higherTAs were higher in tropical species, and (iii) the experimentalTAat whichQ10-SMRwas maximal for each species decreased with latitude. This is the first study to our knowledge showing that the relationship betweenQ10-SMRand latitude in ectotherms changes with theTAat whichQ10-SMRis assessed, as predicted from an adaptive hypothesis.

This article is part of the theme issue ‘Physiological diversity, biodiversity patterns and global climate change: testing key hypotheses involving temperature and oxygen’.
Physiological diversity, biodiversity patterns and global climate change: testing key hypotheses involving temperature and oxygen
Authors: Spicer John I. , Morley Simon A. , Bozinovic Francisco
Published: June 2019

Documenting and explaining global patterns of biodiversity in time and space have fascinated and occupied biologists for centuries. Investigation of the importance of these patterns, and their underpinning mechanisms, has gained renewed vigour and importance, perhaps becoming pre-eminent, as we attempt to predict the biological impacts of global climate change. Understanding the physiological features that determine, or constrain, a species' geographical range and how they respond to a rapidly changing environment is critical. While the ecological patterns are crystallizing, explaining the role of physiology has just begun. The papers in this volume are the primary output from a Satellite Meeting of the Society of Experimental Biology Annual Meeting, held in Florence in July 2018. The involvement of two key environmental factors, temperature and oxygen, was explored through the testing of key hypotheses. The aim of the meeting was to improve our knowledge of large-scale geographical differences in physiology, e.g. metabolism, growth, size and subsequently our understanding of the role and vulnerability of those physiologies to global climate warming. While such an aim is of heuristic interest, in the midst of our current biodiversity crisis, it has an urgency that is difficult to overstate.

This article is part of the theme issue ‘Physiological diversity, biodiversity patterns and global climate change: testing key hypotheses involving temperature and oxygen’.
Effect of various bacteriological media on the plaque morphology of Staphylococcus and Vibrio phages
Authors: Ramesh Nachimuthu , Archana Loganathan , Madurantakam Royam Madhav , Manohar Prasanth , Eniyan Kandasamy
Published: June 2019

The influence of media composition on the life cycle of bacteriophages to exhibit diverse plaque morphology on various bacteriological media was investigated by a double agar overlay method. Both

Staphylococcus aureus

phage and

Vibrio parahaemolyticus

phage showed altered plaque morphology from small to large and from clear to turbid, in different culture media used for the double agar overlay method.
DNA shape complements sequence-based representations of transcription factor binding sites
Authors: DeFord Peter , Taylor James
Published: June 2019

The position weight matrix (PWM) has long been a useful tool for describing variation in the composition of regions of DNA such as transcription factor (TF) binding sites. It is difficult, however, to relate the sequence-based representation of a DNA motif to the biological features of the interaction of a TF with its binding site. Here we present an alternative strategy for representing DNA motifs – called Structural Motif (StruM) – that can easily represent different sets of structural features. Structural features are inferred from dinucleotide properties listed in the Dinucleotide Property Database. StruMs are able to specifically model TF binding sites, using an encoding strategy that is distinct from sequence-based models. This difference in encoding strategies makes StruMs complementary to sequence-based methods of TF binding site identification.
Construction of simplified microbial consortia to degrade recalcitrant materials based on enrichment and dilution-to-extinction cultures
Authors: Kang Dingrong , Jacquiod Samuel , Herschend Jakob , Wei Shaodong , Nesme Joseph , Sørensen Søren J.
Published: June 2019

The capacity of microbes degrading recalcitrant materials has been extensively explored from environmental remediation to industrial applications. Although significant achievements were obtained with single strains, focus is now going toward the use of microbial consortia because of advantages in terms of functional stability and efficiency. While consortia assembly attempts were made from several known single strains, another approach consists in obtaining consortia from complex environmental microbial communities in search for novel microbial species, genes and functions. However, assembling efficient microbial consortia from complex environmental communities is far from trivial due to large diversity and biotic interactions at play. Here we propose a strategy containing enrichment and dilution-to-extinction cultures to construct simplified microbial consortia (SMC) for keratinous waste management, from complex environmental communities. Gradual dilutions were performed from a keratinolytic microbial consortium, and dilution 10−9was selected to construct a SMC library. Further compositional analysis and keratinolytic activity assays demonstrated that microbial consortia were successfully simplified, without impacting their biodegradation capabilities. These SMC possess promising potential for efficient keratinous valorization. More importantly, this reasoning and methodology could be transferred to other topics involving screening for simplified communities for biodegradation, thus considerably broadening its application scope.

Importance

Microbial consortia have got more and more attention and extensive applications due to their potential advantages. However, a high diversity of microbes is likely to hide uncontrollable risks in practice specific to novel strains and complicated interaction networks. Exploring a convenient and efficient way to construct simplified microbial consortia is able to broaden the applied scope of microbes. This study presents the approach based on enrichment and dilution-to-extinction cultures, which gain abundance microbial consortia including some without losing efficiency from the enriched functional microbial community. The microbial interactions at the strain level were evaluated by using compositional identification and correlation analysis, which contribute to revealing the roles of microbes in the degradation process of recalcitrant materials. Our findings provide a systematic scheme to achieve optimizing microbial consortia for biodegradation from an environmental sample, could be readily applied to a range of recalcitrant materials management from environmental remediation to industrial applications.