bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of an Animation Education Program on Promoting Compliance With Active Respiratory Rehabilitation in Postsurgical Lung Cancer Patients
Authors: Li Jina , Davies Marianne , Ye Man , Li Yingxia , Huang Lingzhi , Li Lezhi
Published: November 2019

Background

Non–small cell lung cancer is the most common type of lung cancer. Lung resection is proven to be the most effective curative treatment for early-stage non–small cell lung cancer (stages I-IIIA). Studies show evidence-based pulmonary rehabilitation is critical for improving exercise capacity and pulmonary function, reducing burden of cancer-related symptoms, and facilitating quality of life following a lung resection.

Objective

To explore the effectiveness of an animation education program to promote respiratory rehabilitation outcomes for postsurgical lung cancer patients.

Interventions/Methods

Eighty lung cancer patients who had undergone lung resection were equally randomized to 2 groups with 40 participants in each group. The intervention group received animation education. The control group received traditional face-to-face education. The training-related knowledge and exercise compliance were evaluated at baseline, 3 days after education, and the day of discharge, along with related pulmonary functional indicators.

Results

Eighty of 99 eligible participants were enrolled (80.8%). Mean scores of training-related knowledge and exercise compliance in the intervention group were higher than those of the control group. Occurrences of postoperative pulmonary complications and the indwelling time of thoracic drainage tube were lower, and 6-minute walk distance was longer compared with the control group. No statistical differences in other pulmonary functional indicators were found.

Conclusions

Educational animation is effective for promoting training-related knowledge and exercise compliance with active respiratory rehabilitation in postsurgical lung cancer patients.

Implications for Practice

Oncology nurses can implement animation as an innovative educational method for improving cancer patients’ uptake and compliance on health education.
Challenges in the Diagnosis of a Posterior Lingual Abscess, a Potential Lethal Disorder
Authors: Schweigert Jessica , Christian Rylee , Kemp Walter L.
Published: November 2019

A lingual abscess is a rare but potentially life-threatening disorder. Since the introduction of antibiotics, the incidence of posterior lingual abscesses has significantly declined; however, this condition is often missed on physical examination or misdiagnosed as another condition. The consequence of this misdiagnosis can be severe because airway obstruction with subsequent difficult or unattainable intubation can develop and lead rapidly to death. Being relatively rare yet potentially lethal, consideration of a lingual abscess at the time of autopsy is important; otherwise, it may be missed. During most autopsies, the base of the tongue is often examined grossly in a cursory fashion, if at all, and microscopic sections of this region are not commonly used. As this case report will illustrate, such an approach would most likely miss this important condition.
Riga-Fede Disease
Authors: Lee Jonathan J. , Sarangam Maithri , Feldman Kenneth W. , Tieder Joel S.
Published: November 2019

Objectives

The following case presents a pediatric patient with Riga-Fede disease (RFD), a rare disorder in children under 2 years of age characterized by sublingual ulceration of the tongue due to trauma from repeated rubbing against the primary teeth. Riga-Fede disease is well reported in dental literature but is relatively unknown to the general pediatric community. It can be confused with nonaccidental trauma (NAT) from forced feeding or other abusive trauma because it presents with injury of oral structures including the sublingual frenulum and often results in problems with growth. This case highlights the importance for physicians to recognize RFD as a source of isolated oral injury that is distinct from NAT. Although approximately 35 cases of RFD have been reported in the literature, this is the first case to describe the process of distinguishing this disease from child abuse.

Methods

We present a case of an 8-month-old female infant who presented with extensive injury of her ventral tongue from RFD who underwent a full workup for NAT. We review the literature for guidance on diagnosing RFD and discuss how to distinguish it from abuse.

Results

Infants with characteristic ulceration of the ventral tongue opposing new teeth and with no other medical, social, or developmental concerns do not need to undergo further workup. Clinical examination and thorough history are sufficient to make the diagnosis.

Conclusions

Traumatic intraoral injury in nonmobile children is highly concerning for child abuse. However, RFD is a well described cause of sublingual ulceration in infants that is not associated with abuse.
Impact of Wartime Stress Exposures and Mental Health on Later-Life Functioning and Disability in Vietnam-Era Women Veterans: Findings From the Health of Vietnam-Era Women’s Study
Authors: Smith Brian N. , Spiro Avron , Frayne Susan M. , Kimerling Rachel , Cypel Yasmin , Reinhard Matthew J. , Kilbourne Amy M. , Magruder Kathryn M.
Published: November 2019

Objective

The effect of stress exposures and mental health sequelae on health-related outcomes is understudied among older women veterans. We examined a) the impact of wartime stress exposures on later-life functioning and disability in Vietnam-era women veterans and b) the extent to which mental health conditions known to be associated with stress—posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD)—are associated with additional later-life functioning and disability.

Methods

Data were collected in 2011 to 2012 using a mail survey and telephone interview of 4219 women veterans who were active duty during the Vietnam Era. Health functioning was assessed using the Veterans RAND 36-Item Health Survey, and disability was assessed using the World Health Organization Disability Assessment Schedule 2.0. Wartime exposures were assessed using the Women’s War-Zone Stressor Scale—Revised; the Composite International Diagnostic Interview, version 3.0 was used to assess PTSD, MDD, and GAD.

Results

Several wartime stress exposures—including job-related pressures, dealing with death, and sexual discrimination and harassment—were associated with worse later-life health (β ranges, −0.04 to −0.26 for functioning, 0.05 to 0.30 for disability). Current PTSD was linked with lower health functioning (physical, β = −0.06; mental, β = −0.15) and greater disability (β = 0.14). Current MDD and GAD were also associated with lower mental health functioning (MDD, β = −0.29; GAD, β = −0.10) and greater disability (MDD, β = 0.16; GAD, β = 0.06).

Conclusions

Results underscore the importance of detection and treatment of the potential long-term effects of wartime stressors and mental health conditions among women veterans.
Impact of HIV and antiretroviral drug exposure on lung growth and function over 2 years in an African Birth Cohort
Authors: Gray Diane M. , Wedderburn Catherine J. , MacGinty Rae P. , McMillan Lauren , Jacobs Carvern , Stadler Jacob A.M. , Hall Graham L. , Zar Heather J.
Published: November 2019

Objective:

To assess the impact of HIV and antiretroviral exposure without infection on lung growth and function over the first 2 years of life.

Design:

Prospective observational study of an African birth cohort, Drakenstein Child Health Study.

Method:

Infants enrolled antenatally had lung function measured at 6 weeks, 1 and 2 years. HIV-infected women received antiretroviral therapy (ART) as per local guidelines. The association between HIV and antiretroviral exposure with lung function was assessed using mixed effects modelling.

Results:

Of 1143 infants born, two HIV-infected infants were excluded from analysis; 909 (80%) infants had lung function collected at 6 weeks [190 (21%) were HIV-exposed uninfected (HEU)]; 782 (69%) at 1 year and 741 (65%) at 2 years. At 6 weeks HEU infants had larger tidal volume compared with HIV-unexposed infants (1.13 ml, confidence interval: 0.02–2.23, P = 0.045). High maternal viral load was associated with a 17% lower expiratory flow over 2 years (0.17, confidence interval 0.00–0.34, P = 0.046). First-line ART initiated during pregnancy was associated with lower infant tidal volume at 6 weeks compared with those who initiated ART before pregnancy (−2.7 ml, −5.31 to −0.10, P = 0.042), and low maternal CD4+ cell counts associated with lower infant tidal over 2 years (−11.1 ml, −18.58–3.58, P = 0.004).

Conclusion:

HIV exposure is associated with altered lung function in early life, with a vulnerable HEU subgroup based on maternal disease severity, immunological compromise and ART exposure. These data highlight the importance of ongoing surveillance of respiratory health in HEU children.
Association of HIV Infection and Antiretroviral Therapy With Sudden Cardiac Death
Authors: Yen Yung-Feng , Lai Yun-Ju , Chen Yu-Yen , Lai Hsin-Hao , Chuang Pei-Hung , Chen Chu-Chieh , Deng Chung-Yeh
Published: November 2019

Background:

HIV infection potentially increases coronary artery disease and heart failure risks. However, the association between HIV infection and sudden cardiac death (SCD) has not been extensively studied. This nationwide cohort study aimed to determine SCD risks in Taiwanese patients with and without HIV infection.

Methods:

Adult people living with HIV/AIDS (PLWHA) since January 1, 2003, were identified from the Taiwan Centers for Disease Control HIV surveillance system. HIV-infected individuals were defined as positive HIV-1 Western blot. A control cohort without HIV infection, matched for age and sex, was selected for comparison from the Taiwan National Health Insurance Research Database. All patients were followed up until SCD, mortality for another cause, or till December 31, 2014. A time-dependent Cox proportional hazards model was used to determine the association of HIV and antiretroviral therapy (ART) with SCD.

Results:

During a mean 5.86-year follow-up, 5342 (4.40%) of 121,530 patients (24,306 PLWHA and 97,224 matched controls) died; among them, 150 (0.12%) died of SCD. Among 150 SCD events, 97 (64.7%) and 53 (33.3%) occurred in PLWHA and controls, respectively, which corresponded to incidences of 68.31 in PLWHA and 9.31 per 100,000 person-years in controls (P < 0.001). After adjusting for age, sex, and comorbidities, HIV infection was an independent risk factor for SCD (adjusted hazard ratio, 8.15; 95% confidence interval: 5.58 to 11.90). SCD incidence was significantly lower in PLWHA receiving ART (adjusted hazard ratio 0.53; 95% confidence interval: 0.32 to 0.87).

Conclusions:

HIV infection is an independent risk factor for SCD. SCD rates are low in PLWHA receiving ART.
Brief Report: Low Sensitivity of the Fracture Risk Assessment Tool in Young HIV-Infected Patients: Time to Revise Our Screening Strategy
Authors: van Welzen Berend J. , Yesilay Sultan , Arends Joop E. , Hoepelman Andy I. M. , Mudrikova Tania
Published: November 2019

Objectives:

The burden of reduced bone mineral density (BMD) is high among HIV-infected patients. As a screening strategy, current guidelines recommend calculating a Fracture Risk Assessment Tool (FRAX) score in patients aged 40–49 years. Patients with a 10-year risk of a major osteoporotic fracture ≥10% should undergo dual-energy x-ray absorptiometry (DXA) to assess BMD. The aim of this study was to establish the sensitivity of this threshold to identify patients with risk of osteoporosis in this age category—as a surrogate marker for high fracture risk.

Methods:

The study group consisted of patients aged 50–59 years and living with HIV for at least 10 years who recently underwent dual-energy x-ray absorptiometry (DXA). A clinical risk factor–based FRAX score was calculated using patient characteristics from 10 years earlier. In this way, we assessed which patients would have undergone DXA while they were 40–49 year old.

Results:

The cohort consisted of 126 patients; 23 patients (18.3%) had osteoporosis. Ten years before the DXA, none of them met the guideline threshold of a 10-year major osteoporotic fracture probability of ≥10%, resulting in a sensitivity of 0% in this cohort. There was no difference between the median FRAX score between patients who developed osteoporosis and those who did not (3.3% vs. 3.4%. P = 0.55).

Conclusions:

FRAX lacks sensitivity to determine which HIV-infected patients aged 40–49 years should undergo BMD testing to identify reduced BMD. Its role should be limited to treatment decisions.
Brief Report: Adipogenic Expression of Brown Fat Genes in HIV and HIV-Related Parameters
Authors: Srinivasa Suman , Torriani Martin , Fitch Kathleen V. , Maehler Patrick , Iyengar Sanjna , Feldpausch Meghan , Cypess Aaron M. , Grinspoon Steven K.
Published: November 2019

Context:

Persons with HIV are at increased risk for adipose dysfunction, which could mediate metabolic complications such as cardiovascular disease, fatty liver disease, and diabetes. We have previously reported reduced browning and beiging capacity of the subcutaneous adipose depot in HIV.

Objective:

We sought to evaluate how HIV-related parameters are related to the expression of brown and beige fat genes in the abdominal subcutaneous adipose tissue.

Design:

Eighteen persons with HIV underwent punch biopsy of abdominal subcutaneous fat to determine mRNA expression of adipose-related genes using quantitative reverse transcriptase-polymerase chain reaction.

Results:

Duration of antiretroviral therapy use, particularly related to protease inhibitor use, was significantly related to reduced expression of multiple brown and beige fat genes (including UCP1, PGC1α, PRDM16 and others, allP≤ 0.04) in the abdominal subcutaneous fat. In addition, duration of HIV and CD4 T-cell count were significantly correlated with reduced expression of multiple brown and beige fat genes in the abdominal subcutaneous fat (PGC1α, P2XR5, TMEM26, CD137, allP≤ 0.05 for duration of HIV; and PGC1α, ZIC1, PRDM16, PAT2, P2RX5, TMEM26, CD137, allP≤ 0.04). In contrast, HIV viral load did not correlate with any brown or beige fat genes.

Conclusions:

Key HIV-related parameters reflective of nonacute infection (increased duration of HIV and duration of antiretroviral therapy use) or relatively reduced immunologic function (lower CD4 count) were linked to reduced expression of brown and beige fat gene in the abdominal subcutaneous adipose depot.

Clinical Trial Registration:

NCT01098045.
Exosomal MicroRNAs Associate With Neuropsychological Performance in Individuals With HIV Infection on Antiretroviral Therapy
Authors: O'Meara Tess , Kong Yong , Chiarella Jennifer , Price Richard W. , Chaudhury Rabib , Liu Xinran , Spudich Serena , Robertson Kevin , Emu Brinda , Lu Lingeng
Published: November 2019

Background:

Neurocognitive dysfunction remains prevalent among people living with HIV (PLWH), even after viral suppression on combination antiretroviral therapy (cART). We investigated associations between neuropsychological performance (NP) and patterns of circulating exosomal microRNA (exo-miRNA) expression in PLWH on cART.

Setting:

A cross-sectional examination of plasma exo-miRNA among PLWH on cART with systemic viral suppression and volunteers without HIV infection.

Methods:

Thirty-one PLWH who started cART during early infection (n = 19) or chronic infection (n = 12) participated in phlebotomy and an 11-test neuropsychological battery after >1 year on treatment. NP higher- or lower-performing participants were categorized based on normalized neuropsychological scores. Total RNA was extracted from purified exosomes of 31 PLWH and 5 volunteers without HIV and subject to small RNA sequencing. Differential expression of exo-miRNAs was examined and biological functions were predicted.

Results:

Eleven exo-miRNAs were up-regulated in NP lower-performing (n = 18) relative to higher-performing PLWH (n = 13). A high proportion of the differentiating exo-miRNA target the axon guidance KEGG pathway and neurotrophin tyrosine receptor kinase signaling Gene Ontology pathway. Differential expression analysis of exo-miRNAs between NP lower- (n = 7) and higher-performing (n = 12) PLWH within the early infection group alone confirmed largely consistent findings.

Conclusions:

Plasma exo-miRNA content differed between NP higher- and lower-performing PLWH. Several differentially expressed exo-miRNAs were predicted to be involved in inflammation and neurodegeneration pathways. Exo-miRNA in plasma may indicate cross-talk between the circulation and central nervous system and thus may be clinically relevant for neurocognitive dysfunction in PLWH.
Long-Term Outcomes of HIV-Infected Women Receiving Antiretroviral Therapy After Transferring Out of an Integrated Maternal and Child Health Service in South Africa
Authors: Phillips Tamsin K. , Mogoba Pheposadi , Brittain Kirsty , Gomba Yolanda , Zerbe Allison , Myer Landon , Abrams Elaine J.
Published: November 2019

Background:

Integrated maternal and child health (MCH) services improve women's postpartum antiretroviral therapy (ART) outcomes during breastfeeding; however, long-term outcomes after transfer to general ART services remain unknown.

Methods:

The MCH-ART trial demonstrated that maternal retention and viral suppression at 12-months postpartum were improved significantly among women randomized to integrated MCH services continued in the antenatal clinic through cessation of breastfeeding (MCH-ART arm) compared with immediate transfer to general ART services postpartum (standard of care). We reviewed electronic health records for all women who participated in the MCH-ART trial to ascertain retention and gaps in care and invited all women for a study visit 36- to 60-months postpartum including viral load testing.

Results:

Of 471 women in MCH-ART, 450 (96%) contributed electronic health record data and 353 (75%) completed the study visit (median 44-month postpartum). At this time, outcomes were identical in both trial arms: 67% retained in care (P = 0.994) and 56% with viral loads <50 copies/mL (P = 0.751). Experiencing a gap in care after delivery was delayed in the MCH-ART arm with 17%, 36%, and 45% of women experienced a gap in care by 12-, 24-, and 36-months postpartum compared with 35%, 48%, and 57% in the standard of care arm, respectively.

Conclusions:

The benefits of integrated maternal HIV and child health care did not persist after transfer to general ART services. The transfer of women postpartum to routine adult care is a critical period requiring interventions to support continuity of HIV care.
Multifocal Urinary Bladder Paragangliomas With Negative 68Ga-DOTATATE Uptake and Positive 123I-MIBG Uptake
Authors: Parra Laura A. , Swanson Scott K. , Salomao Marcela A. , Yang Ming
Published: November 2019

We report a case of an adult male patient with multifocal urinary bladder paragangliomas, which were negative on 68Ga-DOTATATE PET/CT scan, but positive on 123I-MIBG SPECT/CT scan. While the 68Ga-DOTA analog PET/CT exhibits superior performance in diagnosis and staging of pheochromocytoma and paraganglioma, our case demonstrates negative somatostatin receptor expression in this rare entity and indicates that 123I-MIBG SPECT/CT still plays a vital role in characterization of bladder paraganglioma.
Albucasis
Authors: Asaad Malke , Rajesh Aashish , Zazo Aya , Banuelos Joseph , Kaadan Abdulnaser
Published: November 2019

The middle ages in the Arab world etched medical advancements that laid the foundations of modern medical practice. Among the several renowned physicians of historical importance, Abu Alkasem al-Zahrawi (Albucasis) left his mark in the fields of medicine and surgery. He is notably famous for his 30-volume compendium Kitab-al Tasreef, which served as his magnum opus. The last volume of this work was reserved for surgery. During his lifetime, Albucasis made contributions of unparalleled luminosity to the field of surgery. He described surgical techniques for a range of procedures encompassing several subspecialties that comprise modern plastic surgery. Beyond just a physician and surgeon, Albucasis was a remarkable teacher who taught medical students with fervor and emphasized the importance of affording treatment to patients of all social classes and the value of physician-patient relationships. The focus of this review is to explore the contributions of Albucasis to the field of plastic surgery.
A Comparative Study of Finger Pulp Reconstruction Using Free Distal Ulnar Artery Perforator Flaps and Reverse Dorsal Homodigital Island Flaps
Authors: Tu Qiming , Liu Shaodong , Chen Tingxiang , Li Shi , Yan Hede , Li Zhijie
Published: November 2019

Purpose

This study aimed to compare and analyze the outcomes of finger reconstruction using free distal ulnar artery perforator (FDUAP) and reverse dorsal homodigital island (RDHI) flaps.

Methods

The study included 27 patients with finger pulp defects that were reconstructed using FDUAP or RDHI flaps. Standardized assessment of outcomes included objective sensory recovery, duration of operation, range of motion in the repaired fingers, pain at the reconstructed finger pulps and donor sites, and recovery time before returning to work. Subjective assessment of outcomes included the cold intolerance, aesthetic appearance, and functional recovery.

Results

All flaps in the series showed complete survival. The average surgical time for the RDHI flaps was significantly smaller than that for the FDUAP flaps. Sensory recovery was significantly better with FDUAP flaps than with RAHI flaps. No significant differences were detected between the 2 procedures regarding range of motion, cold intolerance, or pain of the injured finger pulps and donor sites. The outcomes of aesthetic result and functional recovery satisfied all patients. Optimal cosmetic satisfaction was obtained in the FDUAP flap group.

Conclusions

Although both types of flaps offer a satisfactory approach for finger reconstruction with small-to-medium defects, FDUAP flaps are more suitable for such operations because of the better sensory reconstruction and aesthetic results.
Computer-Aided-Design/Computer-Aided-Manufacturing Titanium Cranioplasty in a Child: Critical Appraisal
Authors: Zegers Thomas , Koper David , Lethaus Bernd , Kessler Peter , ter Laak-Poort Mariel
Published: November 2019

Large skull bone defects of the cranial vault can result from various reasons. Reconstruction of these defects is performed for protective and aesthetic reasons but is also required for adequate intracranial homeostasis. Computer-aided-design/computer-aided-manufacturing (CAD/CAM) patient-specific skull implants have become the most valuable alternative to the traditional methods of reconstruction and a growing number of publications is dealing with this topic in adults. Literature related to the application of these implants in pediatric cranioplasty is, however, still scarce.

The authors present a case of a 9-year-old boy, where cranioplasty using a CAD/CAM additive manufactured titanium implant led to improvement of symptoms attributed to cerebrospinal fluid circulation problems and intracranial homeostasis disbalance. The authors further reflect on what the role of cranioplasty should be in the therapeutic treatment plan.
Persistent Opioid Use After Combat Injury and Subsequent Long-term Risk of Abuse
Authors: Beyer Carl A. , Poltavskiy Eduard , Walker Lauren E. , Pettey Warren , Suo Ying , Redd Andrew , Rittel Alex G. , Kazanis William H. , Dunham Jacob R. , Zarzabal Lee A. , Rutter W. Cliff , Sim Alan , Watrous Jessica R. , Howard Jeffrey T. , Janak Jud C. , Stewart Ian J. , Gundlapalli Adi
Published: November 2019

Objective:

To determine whether persistent opioid use after injury is associated with subsequent long-term development of clinically recognized opioid abuse.

Summary Background Data:

Opioid abuse is an epidemic in the United States and trauma can initiate persistent use; however, it remains unclear whether persistent opioid use contributes to the subsequent development of opioid abuse. The care of combat casualties by the Departments of Defense and Veterans Affairs uniquely allows investigation of this long-term outcome.

Methods:

This retrospective cohort study randomly selected 10,000 battle-injured United States military personnel. We excluded patients who died during initial hospitalization or within 180 days of discharge, had a preinjury opioid abuse diagnosis, or had missing data in a preselected variable. We defined persistent opioid use as filling an opioid prescription 3 to 6 months after discharge and recorded clinically recognized opioid abuse using relevant diagnosis codes.

Results:

After exclusion, 9284 subjects were analyzed, 2167 (23.3%) of whom developed persistent opioid use. During a median follow-up time of 8 years, 631 (6.8%) patients developed clinically recognized opioid abuse with a median time to diagnosis of 3 years. Injury severity and discharge opioid prescription amount were associated with persistent opioid use after trauma. After adjusting for patient and injury-specific factors, persistent opioid use was associated with the long-term development of clinically recognized opioid abuse (adjusted hazard ratio, 2.39; 95% confidence interval, 1.99–2.86).

Conclusions:

Nearly a quarter of patients filled an opioid prescription 3 to 6 months after discharge, and this persistent use was associated with long-term development of opioid abuse.
Prophylaxis of Wound Infections-antibiotics in Renal Donation (POWAR)
Authors: Ahmed Zubir , Uwechue Raphael , Chandak Pankaj , van Dellen David , Barwell Jamie , Heap Sarah , Szabo Laszlo , Hemsley Carolyn , Olsburgh Jonathon , Kessaris Nicos , Mamode Nizam
Published: November 2019

Background:

Postoperative infection after hand-assisted laparoscopic donor nephrectomy (HALDN) confers significant morbidity to a healthy patient group. Current UK guidelines cite a lack of evidence for routine antibiotic prophylaxis. This trial assessed if a single preoperative antibiotic dose could reduce post HALDN infections.

Methods:

Eligible donors were randomly and blindly allocated to preoperative single-dose intravenous co-amoxiclav or saline. The primary composite endpoint was clinical evidence of any postoperative infection at 30 days, including surgical site infection (SSI), urinary tract infection (UTI), and lower respiratory tract infection (LRTI).

Findings:

In all, 293 participants underwent HALDN (148 antibiotic arm and 145 placebo arm). Among them, 99% (291/293) completed follow-up. The total infection rate was 40.7% (59/145) in the placebo group and 23% (34 of 148) in the antibiotic group (P = 0.001). Superficial SSIs were 20.7% (30/145 patients) in the placebo group versus 10.1% (15/148 patients) in the antibiotic group (P = 0.012). LRTIs were 9% (13/145) in the placebo group and 3.4% (5/148) in the antibiotic group (P = 0.046). UTIs were 4.1% (6/145) in the placebo group and 3.4% (5/148) in the antibiotic group (P = 0.72).

Antibiotic prophylaxis conferred a 17.7% (95% confidence interval 7.2%–28.1%), absolute risk reduction in developing postoperative infection, with 6 donors requiring treatment to prevent 1 infection.

Interpretation:

Single-dose preoperative antibiotic prophylaxis dramatically reduces post-HALDN infection rates, mainly impacting SSIs and LRTIs.
Incidence and Risk Factors of Postoperative Mortality and Morbidity After Elective Versus Emergent Abdominal Surgery in a National Sample of 8193 Patients With Cirrhosis
Authors: Johnson Kay M. , Newman Kira L. , Green Pamela K. , Berry Kristin , Cornia Paul B. , Wu Peter , Beste Lauren A. , Itani Kamal , Harris Alex H. S. , Kamath Patrick S. , Ioannou George N.
Published: November 2019

Objective:

To describe the incidence and risk factors for mortality and morbidity in patients with cirrhosis undergoing elective or emergent abdominal surgeries.

Background:

Postoperative morbidity and mortality are higher in patients with cirrhosis; variation by surgical procedure type and cirrhosis severity remain unclear.

Methods:

We analyzed prospectively-collected data from the Veterans Affairs (VA) Surgical Quality Improvement Program for 8193 patients with cirrhosis, 864 noncirrhotic controls with chronic hepatitis B infection, and 5468 noncirrhotic controls without chronic liver disease, who underwent abdominal surgery from 2001 to 2017. Data were analyzed using random-effects models controlling for potential confounders.

Results:

Patients with cirrhosis had significantly higher 30-day mortality than noncirrhotic patients with chronic hepatitis B [4.4% vs 1.3%, adjusted odds ratio (aOR) 2.80, 95% confidence interval (CI) 1.57–4.98] or with no chronic liver disease (0.8%, aOR 4.68, 95% CI 3.27–6.69); mortality difference was highest in patients with Model for End-stage Liver Disease (MELD) score ≥10. Among patients with cirrhosis, postoperative mortality was almost 6 times higher after emergent rather than elective surgery (17.2% vs. 2.1%, aOR 5.82, 95% CI 4.66–7.27). For elective surgeries, 30-day mortality was highest after colorectal resection (7.0%) and lowest after inguinal hernia repair (0.6%). Predictors of postoperative mortality included cirrhosis-related characteristics (high MELD score, low serum albumin, ascites, encephalopathy), surgery-related characteristics (emergent vs elective, type of surgery, intraoperative blood transfusion), comorbidities (chronic obstructive pulmonary disease, cancer, sepsis, ventilator dependence, functional status), and age.

Conclusions:

Accurate preoperative risk assessments in patients with cirrhosis should account for cirrhosis severity, comorbidities, type of procedure, and whether the procedure is emergent versus elective.
Effects of Passiflora incarnata Linnaeus on polysomnographic sleep parameters in subjects with insomnia disorder: a double-blind randomized placebo-controlled study
Authors: Lee Jeewon , Jung Han-Young , Lee Soyoung Irene , Choi Ji Ho , Kim Shin-Gyeom
Published: November 2019

The purpose of the present double-blind randomized placebo-controlled clinical study was to investigate the effects of Passionflower on polysomnographic sleep parameters in subjects with insomnia disorder. A total number 110 adult participants (mean age = 40.47 ± 11.68, Female = 53.6%) met the inclusion criteria of insomnia disorder according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). After randomization, patients received either the Passionflower extract or the placebo for 2 weeks. Patients underwent an overnight polysomnography and completed sleep diaries, Insomnia Severity Index, and Pittsburgh Sleep Quality Index. Within group comparisons were analyzed with paired t-tests or Wilcoxon’s signed rank tests, and between-group comparisons were analyzed with independent t-tests or Mann–Whitney U Tests, as appropriate. Total sleep time (TST) was significantly increased in the Passionflower group compared with placebo (Passionflower vs placebo, 23.05 ± 54.26 vs −0.16 ± 53.12; P = 0.049). Sleep efficiency and wake after sleep onset (WASO) significantly improved after 2 weeks in the Passionflower group but there was no difference compared with the placebo group. The current study demonstrated the positive effects of Passionflower on objective sleep parameters including TST on polysomnography in adults with insomnia disorder. Further study is needed to investigate the clinical efficacy of Passionflower on insomnia.
Use of cardiovascular and antidiabetic drugs before and after starting with clozapine versus other antipsychotic drugs: a Dutch database study
Authors: van der Zalm Yvonne , Termorshuizen Fabian , Sommer Iris E. , Selten Jean-Paul
Published: November 2019

Reports of decreased mortality among patients with schizophrenia who use clozapine may be biased if clozapine is prescribed to relatively healthy patients and if intensive monitoring during its use prevents (under-treatment of) somatic disorder. We aimed to assess whether there is a difference in: (1) somatic comorbidity between patients who start with clozapine and those who start with other antipsychotics and (2) prescribed somatic medication, between patients using clozapine and those using olanzapine. Cohort study based on insurance claims (2010–2015). After selecting new users of antipsychotics and those who subsequently switched to clozapine (N = 158), aripiprazole (N = 295), olanzapine (N = 204) or first-generation antipsychotics (N = 295), we compared the clozapine starters to others on cardiovascular or diabetic comorbidity. Those using clozapine and olanzapine were compared on new prescriptions for cardiovascular or antidiabetic drugs. The ORadj of cardiovascular or diabetic comorbidity among other starters compared with clozapine starters was 0.77 [95% confidence interval (CI): 0.43–1.39], that is, a nonsignificantly increased prevalence associated with clozapine was found. Users of clozapine received significantly more new prescriptions for cardiovascular or antidiabetic medication (ORadj: 2.70, 95% CI: 1.43–5.08). Starters with clozapine were not cardiovascular/metabolic healthier than starters with other antipsychotics. During its use, they received more somatic treatment.
Variation in the quality characteristics of different rice bran cultivar extracts upon hexane or supercritical fluid extraction
Authors: Kim Jung-Min , Gu Yul-Ri , Park Bo-Yeon , Hong Joo-Heon , Youn Kwang-Sup
Published: November 2019

The quality characteristic properties of rice bran extracts from a range of cultivars (i.e., Bukkyeong 2012-2, Hanahreum, and Jasmin 85) that had been prepared using different extraction methods (i.e., supercritical fluid or hexane) were investigated. The pH values of the hexane rice bran extracts were higher than those of the supercritical fluid extracts, while the L values, a values, and b values were found to be 43.70-56.51, -1.73-0.80, and -0.08-9.97, respectively. In addition, the iodine values of the supercritical fluid rice bran extracts (58.46-59.30 g) were higher than those of the hexane extracts (41.30-42.80 g), while the acid values of the Jasmin 85 cultivars obtained from the supercritical fluid and hexane rice bran extracts were 23.66 and 2.15 mg/g, respectively, which were lower values than those obtained for the other extracts. Furthermore, the peroxide values of the bran extracts were 3.33-70.06 meq/kg, where the values obtained for the supercritical fluid rice bran extracts (44.71-70.06 meq/kg) were higher than those of the hexane extracts (3.33-35.67 meq/kg). In the case of the TBA value, the supercritical fluid rice bran extracts gave higher values (68.23-124.55 mg/kg) than the hexane extracts (5.33-97.16 mg/kg). Moreover, the total tocopherol contents of the supercritical fluid and hexane rice bran extracts were 10.20 and 10.63 g/100 g for the Bukkyeong 2012-2 cultivar, 8.30 and 7.35 g/100 g for the Hanahreum cultivar, and 4.85 and 6.94 g/100 g for the Jasmin 85 cultivar. The fatty acid contents of the rice bran extracts decreased in the order of oleic acid, linoleic acid, then palmitic acid, and the unsaturated fatty acid contents of the Hanahreum rice bran extracts (81.21 and 80.60%) were higher than those of the Bukkyeong 2012-2 and Jasmin 85 rice bran extracts. Our results therefore indicate that the quality characteristics of the supercritical fluid Bukkyeong 2012-2 and Hanahreum rice bran extracts render them useful for application in the food industry.
Neuroprogesterone signals through Src kinase within RP3V neurons to induce the luteinizing hormone surge in female rats
Authors: Chuon Timbora , Feri Micah , Carlson Claire , Ondrejik Sharity , Micevych Paul , Sinchak Kevin
Published: November 2019

Neural circuits in female rats are exposed to estradiol and sequential progesterone to regulate the luteinizing hormone (LH) surge and thus ovulation. Estradiol induces progesterone receptors (PGRs) in rostral periventricular region of the third ventricle (RP3V) kisspeptin neurons, and positive feedback estradiol concentrations induce neuroprogesterone (neuroP) synthesis in hypothalamic astrocytes that signal to PGRs expressed in kisspeptin neurons to trigger the LH surge. We tested the hypothesis that neuroP-PGR signals through Src family kinase (Src) to trigger the LH surge. As in vitro, PGR and Src are co-expressed in RP3V neurons. Estradiol treatment increased the number of PGR immunopositive cells and PGR and Src colocalization. Infusion of the Src inhibitor (PP2) into the RP3V, attenuated the LH surge measured by ELISA in trunk blood collected 53 hours post-EB injection. While PP2 reduced the LH surge in 50 μg EB treated ovariectomized/adrenalectomized (ovx/adx) rats, activation of either PGR or Src in 2μg EB primed animals significantly elevated LH concentrations compared with DMSO treated ovx/adx rats. These results support the importance of Src in the estradiol and neuroP triggering of the LH surge.
Fat food exacerbates post-prandial hypothalamic inflammation involving GFAP+ cells and microglia
Authors: Cansell C. , Stobbe K. , Le Thuc O. , Mosser CA. , Ben-Fradj S. , Leredde J. , Lebeaupin C. , Debayle D. , Fleuriot L. , Brau F. , Devaux N. , Benani A. , Audinat E. , Blondeau N. , Nahon JL. , Rovère C.
Published: November 2019

In humans, obesity was associated with brain inflammation and glial cell proliferation. Studies in rodents showed that glial cell proliferation occurs within 24 hours of high-fat diet (HFD) consumption, before obesity development. This proliferation was mainly observed in the hypothalamus (HT), a crucial brain structure for controlling body weight. Therefore, we sought to characterize the post-prandial HT inflammatory response to 1-3-6 hours exposure to a standard diet and HFD. HFD exposure increased gene expression of astrocyte and microglial marker (GFAP and Iba1) compare to standard treated mice and induced morphological modifications of microglial cells in HT. This remodeling was associated with higher expression of inflammatory genes and differential activation of hypothalamic neuropeptides involved in energy balance regulation. DREADD and PLX5622 technologies, used to modulate GFAP-positive or microglial cells activity respectively, showed that both glial cell types are involved in hypothalamic post-prandial inflammation, but in a different time frame and with a diet specificity Thus, an exacerbated post-prandial inflammation in brain might predispose individuals to obesity and needs to be characterized to address this worldwide crisis.
Transcranial Near-Infrared Light: Dose-Dependent Effects on EEG Oscillations but not Cerebral Blood Flow
Authors: Spera Vincenza , Sitnikova Tatiana , Ward Meredith J. , Farzam Parya , Hughes Jeremy , Bui Eric , Maiello Marco , De Taboada Luis , Hamblin Michael R. , Franceschini Maria Angela , Cassano Paolo
Published: November 2019

Objective

Our objective was to assess whether transcranial photobiomodulation (tPBM) with near-infrared light (NIR) shows modulatory effects on cerebral electrical activity through electroencephalogram (EEG) and cerebral blood flow (CBF).

Background

tPBM has emerged as a novel intervention for several neuropsychiatric conditions due to its neuroprotective and neuroenhancement effects.

Methods

We conducted a single-blind, sham-controlled pilot study to test the effect of continuous (c-tPBM), pulse (p-tPBM) and sham (s-tPBM) transcranial photobiomodulation on EEG oscillations and CBT using diffuse correlation spectroscopy (DCS) in a sample of ten healthy subjects [6 F/ 4 M; mean age 28.6 ± 12.9 (SD) years]. c-tPBM NIR (830 nm; 54.8 mW/cm²; 65.8 J/cm²; 2.3 kJ) and p-tPBM (830 nm; 10Hz; 54.8 mW/cm²; 33%; 21.7 J/cm²; 0.8 kJ) were delivered concurrently to the frontal areas (F4, Fp2, Fp1, F3 - total surface 35.8 cm²) by four LED clusters (TPBM-1000 Litecure). EEG and DCS recordings were performed weekly before, during, and after each tPBM session (in sequence: c-tPBM, s-tPBM and p-tPBM).

Results

Only c-tPBM significantly boosted gamma (t = 3.02, df = 7, p < .02) and beta (t = 2.91, df = 7, p < .03) EEG spectral powers in eyes-open recordings and gamma power (t = 3.61, df = 6, p < .015) in eyes-closed recordings, with the largest effects in the posterior regions. There was no significant effect of NIR-tPBM on CBF compared to sham.

Conclusions

Our data suggest a dose-dependent effect of tPBM with NIR (c-tPBM) on cerebral gamma and beta neuronal activity. Altogether, our findings support the neuromodulatory effect of transcranial NIR.
Experimental and simulated CO2 responses of photosynthesis in leaves of Hippophae rhamnoides L. under different soil water conditions
Authors: Wu Qin , Li Cheng , Chen Qiang
Published: November 2019

CO2 concentrations and soil moisture conditions seriously affect tree growth and physiological mechanisms. CO2 responses of photosynthesis are an important part of plant physiology and ecology research. This study investigated the photosynthetic CO2 responses in the leaves of two-year-old Hippophae rhamnoides L. under eight soil water conditions in a semi-arid loess hilly region, and discussed the quantitative relationship between CO2 responses and soil moisture. CO2 response curves and parameters were fitted using a rectangular hyperbola model, non-rectangular hyperbola model, exponential equation, and modified rectangular hyperbola model. Results revealed that the relative soil water content (RWC) required to maintain a high photosynthetic rate (Pn) and carboxylation efficiency (CE) ranged from 42.8% to 83.2%. When RWC fell outside these ranges, the photosynthetic capacity (Pnmax), CE, and CO2 saturation point (CSP) decreased. CO2 response curves and three parameters, CE, CO2 compensation point (Γ), and photorespiration rate (Rp), were well fitted by the four models when RWC was appropriate. When RWC exceeded the optimal range, only the modified rectangular hyperbola model fitted the CO2 response curves and photosynthetic parameters better.
Training deep neural density estimators to identify mechanistic models of neural dynamics
Authors: Gonçalves Pedro J. , Lueckmann Jan-Matthis , Deistler Michael , Nonnenmacher Marcel , Öcal Kaan , Bassetto Giacomo , Chintaluri Chaitanya , Podlaski William F. , Haddad Sara A. , Vogels Tim P. , Greenberg David S. , Macke Jakob H.
Published: November 2019

Mechanistic modeling in neuroscience aims to explain observed phenomena in terms of underlying causes. However, determining which model parameters agree with complex and stochastic neural data presents a significant challenge. We address this challenge with a machine learning tool which uses deep neural density estimators— trained using model simulations— to carry out Bayesian inference and retrieve the full space of parameters compatible with raw data or selected data features. Our method is scalable in parameters and data features, and can rapidly analyze new data after initial training. We demonstrate the power and flexibility of our approach on receptive fields, ion channels, and Hodgkin–Huxley models. We also characterize the space of circuit configurations giving rise to rhythmic activity in the crustacean stomatogastric ganglion, and use these results to derive hypotheses for underlying compensation mechanisms. Our approach will help close the gap between data-driven and theory-driven models of neural dynamics.
Topaz-Denoise: general deep denoising models for cryoEM and cryoET
Authors: Bepler Tristan , Kelley Kotaro , Noble Alex J. , Berger Bonnie
Published: November 2019

Cryo-electron microscopy (cryoEM) is becoming the preferred method for resolving protein structures. Low signal-to-noise (SNR) in cryoEM images reduces the confidence and throughput of structure determination during several steps of data processing, resulting in impediments such as missing particle orientations. Denoising cryoEM images can not only improve downstream analysis but also accelerate the time-consuming data collection process by allowing lower electron dose micrographs to be used for analysis. Here, we present Topaz-Denoise, a deep learning method for reliably and rapidly increasing the SNR of cryoEM images and cryoET tomograms. By training on a dataset composed of thousands of micrographs collected across a wide range of imaging conditions, we are able to learn models capturing the complexity of the cryoEM image formation process. The general model we present is able to denoise new datasets without additional training. Denoising with this model improves micrograph interpretability, enabling us to solve the first 3D single particle closed and partially open structures of clustered protocadherin, an elongated particle with previously-elusive views. We then show for the first time that low dose collection, enabled by Topaz-Denoise, improves downstream analysis in addition to reducing data collection time. We also present the first general 3D denoising model for cryoET. Topaz-Denoise and pre-trained general models are now included in Topaz. We expect that Topaz-Denoise will be of broad utility to the cryoEM community for improving micrograph and tomogram interpretability and accelerating analysis.
HIP IMO Report: Analyzing Phenotypic Properties of Bladder Cancer Using Ordinary Differential Equation (ODE) Models
Authors: Sherwin Benjamin
Published: November 2019

Bladder cancer is composed of proliferative and immunogenic phenotypes, which ultimately play a significant role in the growth of the tumor. By using ordinary differential equation models, this paper models the impact of high and low immunogenic cell populations on non-muscle invasive bladder cancer when treated with and without the Bacillus Calmette-Guerin vaccine. Furthermore, this paper models the impact that the Bacillus Calmette-Guerin vaccine has on inflammatory cytokines, which inhibit the growth of tumors by stimulating an immune response. We focus primarily on how the immunogenicity phenotype impacts population dynamics in non-muscle invasive bladder cancer.