bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Smoking Cessation Interventions Initiated During Hospitalization Among HIV-Infected Smokers
Authors: Triant Virginia A , Grossman Ellie , Rigotti Nancy A , Ramachandran Rekha , Regan Susan , Sherman Scott E , Richter Kimber P , Tindle Hilary A , Harrington Kathleen F
Published: September 2019

Introduction

Smoking is a key determinant of mortality among people living with HIV (PLWH).

Methods

To better understand the effects of smoking cessation interventions in PLWH, we conducted a pooled analysis of four randomized controlled trials of hospital-initiated smoking interventions conducted through the Consortium of Hospitals Advancing Research on Tobacco (CHART). In each study, cigarette smokers were randomly assigned to usual care or a smoking cessation intervention. The primary outcome was self-reported past 30-day tobacco abstinence at 6-month follow-up. Abstinence rates were compared between PLWH and participants without HIV and by treatment arm, using both complete-case and intention-to-treat analyses. Multivariable logistic regression was used to determine the effect of HIV status on 6-month tobacco abstinence and to determine predictors of smoking cessation within PLWH.

Results

Among 5550 hospitalized smokers, there were 202 (3.6%) PLWH. PLWH smoked fewer cigarettes per day and were less likely to be planning to quit than smokers without HIV. At 6 months, cessation rates did not differ between intervention and control groups among PLWH (28.9% vs. 30.5%) or smokers without HIV (36.1% vs. 34.1%). In multivariable regression analysis, HIV status was not significantly associated with smoking cessation at 6 months. Among PLWH, confidence in quitting was the only clinical factor independently associated with smoking cessation (OR 2.0, 95% CI = 1.4 to 2.8, p < .01).

Conclusions

HIV status did not alter likelihood of quitting smoking after hospital discharge, whether or not the smoker was offered a tobacco cessation intervention, but power was limited to identify potentially important differences.

Implications

PLWH had similar quit rates to participants without HIV following a hospital-initiated smoking cessation intervention. The findings suggest that factors specific to HIV infection may not influence response to smoking cessation interventions and that all PLWH would benefit from efforts to assist in quitting smoking.

Trial Registration

(1) Using “warm handoffs” to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial: NCT01305928. (2) Web-based smoking cessation intervention that transitions from inpatient to outpatient: NCT01277250. (3) Effectiveness of smoking-cessation interventions for urban hospital patients: NCT01363245. (4) Effectiveness of Post-Discharge Strategies for Hospitalized Smokers (HelpingHAND2): NCT01714323.
Phylogenetic Systematics and Evolution of the Spider Infraorder Mygalomorphae Using Genomic Scale Data
Authors: Opatova Vera , Hamilton Chris A , Hedin Marshal , De Oca Laura Montes , Král Jiři , Bond Jason E
Published: September 2019

The infraorder Mygalomorphae is one of the three main lineages of spiders comprising over 3000 nominal species. This ancient group has a worldwide distribution that includes among its ranks large and charismatic taxa such as tarantulas, trapdoor spiders, and highly venomous funnel-web spiders. Based on past molecular studies using Sanger-sequencing approaches, numerous mygalomorph families (e.g., Hexathelidae, Ctenizidae, Cyrtaucheniidae, Dipluridae, and Nemesiidae) have been identified as non-monophyletic. However, these data were unable to sufficiently resolve the higher-level (intra- and interfamilial) relationships such that the necessary changes in classification could be made with confidence. Here, we present a comprehensive phylogenomic treatment of the spider infraorder Mygalomorphae. We employ 472 loci obtained through anchored hybrid enrichment to reconstruct relationships among all the mygalomorph spider families and estimate the timeframe of their diversification. We sampled nearly all currently recognized families, which has allowed us to assess their status, and as a result, propose a new classification scheme. Our generic-level sampling has also provided an evolutionary framework for revisiting questions regarding silk use in mygalomorph spiders. The first such analysis for the group within a strict phylogenetic framework shows that a sheet web is likely the plesiomorphic condition for mygalomorphs, as well as providing insights to the ancestral foraging behavior for all spiders. Our divergence time estimates, concomitant with detailed biogeographic analysis, suggest that both ancient continental-level vicariance and more recent dispersal events have played an important role in shaping modern day distributional patterns. Based on our results, we relimit the generic composition of the Ctenizidae, Cyrtaucheniidae, Dipluridae, and Nemesiidae. We also elevate five subfamilies to family rank: Anamidae (NEW RANK), Euagridae (NEW RANK), Ischnothelidae (NEW RANK), Pycnothelidae (NEW RANK), and Bemmeridae (NEW RANK). Three families Entypesidae (NEW FAMILY), Microhexuridae (NEW FAMILY), and Stasimopidae (NEW FAMILY), and one subfamily Australothelinae (NEW SUBFAMILY) are newly proposed. Such a major rearrangement in classification, recognizing nine newly established family-level rank taxa, is the largest the group has seen in over three decades. [Biogeography; molecular clocks; phylogenomics; spider web foraging; taxonomy.]
Effects of creep feeding and its interactions with other factors on the performance of meat goat kids and dams when managed on pasture
Authors: Hayes Emily G , Lourençon Raquel V , Browning Richard
Published: September 2019

Creep feeding and its possible interactions with other influential factors (genetics, litter type, and sex) for weaning traits were studied in meat goat kids and their dams. Kids across 3 yr were creep fed (254 kids; 5 pens) or not creep fed (255 kids; 5 pens) from 30 to 90 d of age. Creep-fed kids had higher (P ≤ 0.05) preweaning average daily weight gain and weaning weights (113.1 ± 13.0 g/d; 15.0 ± 0.8 kg) than kids not creep fed (99.8 ± 13.1 g/d; 14.0 ± 0.8 kg). However, financial returns were not higher (P > 0.05) for creep-fed kids compared with kids not creep fed. There was no difference (P > 0.05) in kid conformation score or survival rates between the treatment groups. The only important interaction among kid traits was treatment × litter type (P < 0.05) for FAMACHA scores. Within noncreep pens, single kids had lower (better; P < 0.05) FAMACHA scores (2.9 ± 0.3) than twin kids (3.9 ± 0.3). There was no litter-type effect on FAMACHA scores for kids within the creep feed pens. Dams of the creep-fed (n = 175) and noncreep (n = 178) kids were also evaluated. Treatment did not affect (P > 0.05) litter weights, dam weight change, gross revenue for weaned litters, or fecal egg counts. Treatment interacted with litter type (P < 0.05) to effect packed cell volume (PCV). In the noncreep group, dams raising singles had higher (better; P < 0.05) PCV (18.7 ± 1.3%) than dams rearing twin kids (15.7 ± 1.3%). The litter-type effect on dam PCV was not evident (P > 0.05) in the creep-fed group. Creep feeding improved some kid growth traits but did not improve dam traits or financial returns. Interactions of creep treatment with other factors were minimal for doe-kid traits.
Crth2 receptor signaling down‐regulates lipopolysaccharide‐induced NF‐αB activation in murine macrophages via changes in intracellular calcium
Authors: Diwakar Bastihalli T. , Yoast Ryan , Nettleford Shaneice , Qian Fenghua , Lee Tai‐Jung , Berry Svanjita , Huffnagle Ian , Rossi Randall M. , Trebak Mohamed , Paulson Robert F. , Prabhu K. Sandeep
Published: September 2019

Prostaglandin D2 and its cyclopentenone metabolites [cyclopentenone prostaglandins (CyPGs)], Δ12prostaglandin J2 and 15‐deoxy‐Δ12, 14‐prostaglandin J2, act through2GPCRs, d‐type prostanoid 1 and the chemoattractant receptor homologous molecule expressed on type 2 T‐helper cells (Crth2). In addition to its role in allergy and asthma, the role of Crth2 in the resolution of inflammation, to mediate the proresolving functions of endogenous CyPGs, is not well understood. We investigated the regulation of LPS or zymosan‐induced inflammatory response by signals from the Crth2 receptor in macrophages that lack Crth2 expression [knockout (KO)]. Increased expression of proinflammatory genes, including Tnf‐α, was observed in Crth2 KO cells. Targeting the endogenous biosynthetic pathway of CyPGs with indomethacin or HQL79, which inhibit cyclooxygenases or hematopoietic prostaglandin D synthase, respectively, or use of Crth2 antagonists recapitulated the proinflammatory phenotype as in Crth2 KO cells. Ligand‐dependent activation of Crth2 by 13, 14‐dihydro‐15‐keto‐prostaglandin D2 increased Ca2+ influx through store‐operated Ca2+ entry (SOCE) accompanied by the up‐regulation of stromal interaction molecule 1 and calcium release‐activated calcium modulator 1 expression, suggesting that the proresolution effects of CyPG‐dependent activation of SOCE could be mediated by Crth2 during inflammation. Interestingly, Crth2 signaling down‐regulated the Ca2+‐regulated heat stable protein 1 that stabilizes Tnf‐α mRNA via the increased expression of microRNA 155 to dampen inflammatory responses triggered through the TNF‐α‐NF‐αB axis. In summary, these studies present a novel regulatory role for Crth2 during inflammatory response in macrophages.—Diwakar, B. T., Yoast, R., Nettleford, S., Qian, F., Lee, T.‐J., Berry, S., Huffnagle, I., Rossi, R. M., Trebak, M., Paulson, R. F., Prabhu, K. S. Crth2 receptor signaling down‐regulates lipopolysaccharide‐induced NF‐αB activation in murine macrophages via changes in intracellular calcium. FASEB J. 33, 12838–12852 (2019). www.fasebj.org
Identification of ATP synthase α subunit as a new maternal factor capable of protecting zebrafish embryos from bacterial infection
Authors: Ni Shousheng , Zhou Yang , Chen Yan , Du Xiaoyuan , Zhang Shicui
Published: September 2019

Previous studies have shown that ATP synthase α subunit (ATP5A1) plays multiple roles, but our understanding of its biologic functions remains poor and incomprehensive. Here, we clearly demonstrated that zebrafish ATP5A1 was a newly characterized lipoteichoic acid (LTA)‐ and LPS‐binding protein abundantly stored in the eggs and embryos of zebrafish. Zebrafish ATP5A1 acted not only as a pattern recognition receptor, capable of identifying LTA and LPS, but also as an effector molecule, capable of inhibiting the growth of both gram‐positive and ‐negative bacteria. ATP5A1 could disrupt the bacterial membranes by a combined action of membrane depolarization and permeabilization. We also found that the N‐terminal 65 residues were critical for the antibacterial activity of zebrafish ATP5A1. In particular, we showed that microinjection of exogenous recombinant (r)ATP5A1 into early embryos could promote their resistance against pathogenic Aeromonas hydrophila challenge, and this pathogen‐resistant activity was markedly reduced by the coinjection of anti‐ATP5A1 antibody or by the knockdown with morpholino for atp5a1 but not by the coinjection of anti‐actin antibody. Moreover, each egg/embryo contains a sufficient amount of ATP5A1 in vivo to kill A. hydrophila. Furthermore, the N‐terminal 65 residues 1–65 of ATP5A1 α subunit (rA1–65) with in vitro antibacterial activity also promoted the resistance of embryos against A. hydrophila, but the N‐terminal 69 residues 66–134 (rA66–134) or C‐terminal residues 135–551 (rA135–551) of ATP5A1 α subunit without in vitro antibacterial activity did not. Finally, we showed that the antibacterial activity of the N‐terminal 65 residues of ATP5A1 α subunit was conserved throughout animal evolution. Collectively, these results indicate that ATP5A1 is a novel maternal immunocompetent factor that can protect the early embryos of zebrafish from bacterial infection. This work also provides a new viewpoint for understanding the biologic roles of ATP5A1, which is ubiquitously present in animals.—Ni, S., Zhou, Y., Chen, Y., Du, X., Zhang, S. Identification of ATP synthase α subunit as a new maternal factor capable of protecting zebrafish embryos from bacterial infection. FASEB J. 33, 12983–13001 (2019). www.fasebj.org
The Impact of Title VII Dental Workforce Programs on Dentists’ Practice Location: A Difference-in-Differences Analysis
Authors: Chou Chiu-Fang , Holtzman Jennifer S. , Rogers Shane , Chen Candice
Published: September 2019

Purpose

To examine the potential impact of Health Resources and Services Administration (HRSA) funding (predoctoral [PD] and postdoctoral [PDD] programs) on dentists’ practice location in the United States.

Method

The authors linked 2011–2015 data from HRSA’s Electronic Handbooks to 2015 data from the American Dental Association Masterfile, dental health professional shortage areas, and rural–urban commuting area codes. They examined the associations between PD and PDD funding and dentists’ practice location between 2004 and 2015 using a difference-in-differences analysis and multiple logistic regressions, adjusting for covariates.

Results

From 2004 to 2015, 21.2% (1,588/7,506) of dentists graduated from institutions receiving PD funding and 26.8% (2,014/7,506) graduated from institutions receiving PDD funding. Among dentists graduating from institutions receiving PDD funding, after adjusting for covariates, those graduating between 2011 and 2015 were more likely to practice in a rural area than those graduating between 2004 and 2010 (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.04–3.76). The difference-in-differences approach showed that PD and PDD funding significantly increased the odds that a dentist would practice in a rural area (respectively, OR = 2.70; 95% CI = 1.31–5.79/OR = 2.84; 95% CI = 1.40–5.77).

Conclusions

HRSA oral health training program funding had a positive effect on dentists choosing to practice in a rural area. By increasing the number of dentists practicing in rural communities, HRSA is improving access to, and the delivery of, oral health care services to underserved and vulnerable rural populations.
Evaluation of NICU Nurses' Competence in Pain Assessment 5 Years After Implementation of the COMFORTneo Scale
Authors: Stenkjaer Rikke Louise , Pedersen Preben Ulrich , Hundrup Yrsa Andersen , Weis Janne
Published: September 2019

Background:

Adequate pain management of preterm and sick newborn infants is a critical issue in the neonatal intensive care unit, as the infants are small and vulnerable with limited resources to deal with pain and stressful experiences. The use of pain assessment instruments, however, must be applied correctly to achieve consistency and improve continuity in care and treatment among clinicians.

Purpose:

To assess the development of neonatal intensive care unit nurses' interrater agreement in using the COMFORTneo pain assessment tool 5 years after initial implementation, and to identify items needing further development through analysis of discrepancies among nurses' COMFORTneo scores.

Methods:

An evaluation study with a pre- and postdesign comparing nurses' interrater reliability in assessing infant pain using the COMFORTneo pain assessment tool at baseline and 5-year follow-up.

Results:

Eighty-five percent of the nurses in the follow-up group (n = 26) had improved their skills 5 years after the implementation, and the improvement was significant (P < .000). We also found that interrater reliability was satisfactory (κ scores ≥0.65) for all the items of the COMFORTneo tool. However, to obtain “very good” interrater reliability (κ scores ≥0.80) 3 items were identified needing increased focus.

Implications for Practice:

A thorough implementation of a national clinical guideline has been partially effective in ensuring that nurses used the COMFORTneo in their daily practice, which increased their competence in pain assessment.

Implications for Research:

Further research into the education of nurses on the efficacy of pain scales, nonpharmacologic and pharmacologic therapies, and individualized pain assessment is needed to better address pain management.
Circuit Hemodynamics and Circuit Failure During Continuous Renal Replacement Therapy
Authors: Sansom Benjamin , Sriram Shyamala , Presneill Jeffrey , Bellomo Rinaldo
Published: September 2019

Objectives:

To study hemodynamic changes within continuous renal replacement therapy circuits and evaluate their relationship with continuous renal replacement therapy longevity.

Design:

Analysis of downloaded variables recorded by continuous renal replacement therapy machines during multiple episodes of clinical care.

Setting:

Tertiary ICU in Melbourne, Australia.

Patients:

Cohort of 149 ICU patients: 428 episodes of continuous renal replacement therapy.

Interventions:

None.

Measurements and Main Results:

Indices of continuous renal replacement therapy function representing 554,991 minutes were assessed including blood flow, access pressure, effluent pressure, prefilter pressure, and return pressure. We defined three patterns of artificial kidney failure: early (≤ 12 hr), intermediate (> 12–24 hr), and late (> 24 hr) in 35%, 31%, and 34% of circuits, respectively. Mean access pressure in late artificial kidney failure was 7.5 mm Hg (7.1–7.9 mm Hg) less negative than early failing circuits and pressures demonstrated lower variability in such late failing circuits. Access dysfunction, defined as access pressure less than or equal to –200 mm Hg occurred in the first 4 hours in 118 circuits (27%) which had a shorter (median [interquartile range]) life at 12.9 hr [5.5–21.3 hr]) hours than access dysfunction-free circuits (18.8 hr [10.1–33.4 hr]; p < 0.0001). Multivariate analysis found the first occurrence of access dysfunction (as a time-varying covariate) was independently associated with increased hazard of subsequent failure (hazard ratio, 1.75; 1.36–2.26). Classification and regression tree analysis of summary pressure indices in the first 2 hours confirmed minimum access pressure to be a significant predictor, as well as indices of transmembrane pressure and return pressure. A pressure-based predictor correctly identified early and late failing circuits (86.2% and 93.6% specificity, respectively).

Conclusions:

Access dysfunction is a predictor of continuous renal replacement therapy circuit failure. Future monitoring of continuous renal replacement therapy hemodynamics may facilitate remedial actions to improve circuit function.
Impact of Critical Illness on Resource Utilization: A Comparison of Use in the Year Before and After ICU Admission*
Authors: Hirshberg Eliotte L. , Wilson Emily L. , Stanfield Valoree , Kuttler Kathryn G. , Majercik Sarah , Beesley Sarah J. , Orme James , Hopkins Ramona O. , Brown Samuel M.
Published: September 2019

Objectives:

Increasingly, patients admitted to an ICU survive to hospital discharge; many with ongoing medical needs. The full impact of an ICU admission on an individual’s resource utilization and survivorship trajectory in the United States is not clear. We sought to compare healthcare utilization among ICU survivors in each year surrounding an ICU admission.

Design:

Retrospective cohort of patients admitted to an ICU during one calendar year (2012) in a multipayer healthcare system. We assessed mortality, hospital readmissions (categorized by ambulatory care sensitive conditions and emergency department), and outpatient visits. We compared the proportion of patients with visits during the pre-ICU year versus the post-ICU year.

Patients:

People admitted to an Intermountain healthcare ICU for greater than 48 hours in the year 2012

Interventions:

None.

Measurements and Main Results:

Among 4,074 ICU survivors, 45% had increased resource utilization. Readmission rates at 30-day, 90-day, and 1-year were 15%, 26%, and 43%. The proportion of patients with a hospital admission increased significantly in the post-ICU period (43% vs 29%; p < 0.001). Of patients with a readmission in the post-ICU period, 24% were ambulatory care sensitive condition. Patients with increased utilization differed by socioeconomic status, insurance type, and severity of illness. Sixteen percent of patients had either an emergency department or inpatient admission, but no outpatient visits during the post-ICU period.

Conclusions:

An ICU admission is associated with increased resource utilization including hospital readmissions, with many due to an ambulatory care sensitive condition. Lower socioeconomic status and higher severity of illness are associated with increased resource utilization. After an ICU visit patients seem to use hospital resources over outpatient resources. Interventions to improve and coordinate care after ICU discharge are needed.
Frequency, Risk Factors, Causes, and Consequences of Diagnostic Errors in Critically Ill Medical Patients: A Retrospective Cohort Study
Authors: Bergl Paul A. , Taneja Amit , El-Kareh Robert , Singh Hardeep , Nanchal Rahul S.
Published: September 2019

Objective:

Diagnostic errors are a source of significant morbidity and mortality but understudied in the critically ill. We sought to characterize the frequency, causes, consequences, and risk factors of diagnostic errors among unplanned ICU admissions.

Design:

We conducted a retrospective cohort study of randomly selected nonsurgical ICU admissions between July 2015 and June 2016.

Setting:

Medical ICU at a tertiary academic medical center.

Subjects:

Critically ill adults with unplanned admission to the medical ICU.

Measurements and Main Results:

The primary investigator reviewed patient records using a modified version of the Safer Dx instrument, a validated instrument for detecting diagnostic error. Two intensivists performed secondary reviews of possible errors, and reviewers met periodically to adjudicate errors by consensus. For each confirmed error, we judged harm on a 1–6 rating scale. We also collected detailed demographic and clinical data for each patient. We analyzed 256 unplanned ICU admissions and identified 18 diagnostic errors (7% of admissions). All errors were associated with harm, and only six errors (33%) were recognized by the ICU team within the first 24 hours. More women than men experienced a diagnostic error (11.7% vs 2.7%; p = 0.015, χ2 test). On multivariable logistic regression analysis, female sex remained independently associated with risk of diagnostic error both at admission (odds ratio, 5.18; 95% CI, 1.34–20.08) and at 24 hours (odds ratio, 11.6; 95% CI, 1.37–98.6). Similarly, Quick Sequential Organ Failure Assessment score greater than or equal to 2 at admission was independently associated with diagnostic error (odds ratio, 5.73; 95% CI, 1.72—19.01).

Conclusions:

Diagnostic errors may be an underappreciated source of ICU-related harm. Women and higher acuity patients appear to be at increased risk for such errors. Further research is merited to define the scope of error-associated harm and to clarify risk factors for diagnostic errors among the critically ill.
ATX-101 (Deoxycholic Acid Injection) Leads to Clinically Meaningful Improvement in Submental Fat: Final Data From CONTOUR
Authors: Behr Kathleen , Kavali Carmen M. , Munavalli Girish , Teller Craig F. , Yoelin Steve , Breshears Laura , Sangha Sara
Published: September 2019

BACKGROUND

Submental fat (SMF) can negatively affect perceptions of health and attractiveness. The Condition of Submental Fullness and Treatment Outcomes Registry (CONTOUR) was designed to understand SMF treatment in clinical practice.

OBJECTIVE

To report efficacy, treatment characteristics, and safety associated with real-world use of ATX-101 (deoxycholic acid injection).

METHODS

CONTOUR enrolled adults considering treatment for SMF reduction. ATX-101–treated patients who completed the end-of-treatment questionnaire were divided into those who ended treatment because they met their treatment goals (n = 197) and those who did not (n = 196).

RESULTS

Patients who met their goals (a more defined jawline, looking younger, and looking thinner) were more likely to have less SMF at baseline and to receive ≥2 ATX-101 treatments. More patients who met their goals achieved clinically meaningful reduction in SMF and reported increased satisfaction with their appearance (90% vs 57%). Moderate and severe patients' ATX-101 volume was similar for both those who met goals and those who did not, but extreme patients who met their goals required 10 mL more than those patients who did not.

CONCLUSION

Careful patient selection, adequate volume administration, and an appropriate number of treatments (dependent on baseline SMF severity) contribute to successful outcomes with ATX-101.
Assessing the Feasibility of an Alternative Payment Model for Mohs Micrographic Surgery at an Academic Center
Authors: Auh Sogyong , Chitgopeker Pooja , Hammel Josh , Ferguson Nkanyezi , Johnson-Jahangir Hillary , Van Beek Marta
Published: September 2019

BACKGROUND

Mohs micrographic surgery (MMS) is a cost-effective treatment for nonmelanoma skin cancer that bundles costs for surgical excision, tissue processing, and histopathological interpretation. A comprehensive MMS bundle would include all aspects of an episode of care (EOC), including costs of reconstruction, preoperative, and postoperative care.

OBJECTIVE

To assess the feasibility of an alternative payment model for MMS and reconstruction.

METHODS

Retrospective chart review and payment analysis for 848 consecutive patients with 1,056 tumors treated with MMS. Average Medicare payment of an EOC was compared with bundles based on specific repair types.

RESULTS

The bundle for a flap/graft repair averaged $1,028.08 (confidence interval [CI] 95% $951.37–1,104.79), whereas the bundle for a linear closure (LC) averaged $585.07 (CI 95% $558.75–611.38). The average bundle including all repairs was $730.05 (CI 95% $692.31–767.79), which was statistically significant from both the flap/graft and LC bundles.

CONCLUSION

Bundling surgical repairs with MMS based on an average payment does not represent the heterogeneity of the care provided and results in either underpayment or overpayment for a substantial portion of cases. Consequently, EOC payments bundling MMS and surgical repairs would inaccurately reimburse physicians for work completed. Current payment methodology allows for accurate payment for this already cost-effective therapy.
Rigid Gas-Permeable Contact Lenses Fitting Philosophy for Unilateral Aphakic Infants
Authors: Zhang Xiaoxiao , Zeng Junwen , Zhai Zhou , Li Cong , Yang Xiao
Published: September 2019

Purpose:

To provide fitting guidelines with suggested powers and base curves (BCs) and diameters for initial rigid gas-permeable (RGP) contact lenses (CLs) selection for unilateral aphakic infants based on age.

Methods:

Records of 52 children (52 eyes) with RGP CLs to unilateral aphakia between 2014 and 2019 were evaluated. Refractive status was assessed by standard retinoscopy. The original BC and diameter were determined by keratometric readings and fluorescein pattern under sedation. Correlation analysis was performed between age and CLs parameters. Linear regression analysis was used to develop a model for estimating power with the help of infant's age. Subgroup analysis was performed by grouping the eyes into four groups according to age. Lens adjustments and adverse events were also evaluated.

Results:

The median age was 9.0 months (interquartile range [IQR], 5.25–13.0 months). The mean power and BC and diameter of the initial RGP CLs were 25.46±4.83 diopters, 7.57±0.40 mm, and 9.48±0.23 mm, respectively. All these parameters showed correlations with infant's age (Pearson r=−0.676, 0.367, and 0.497, respectively; P=0.000, 0.008, and 0.000, respectively). Regression analysis revealed that CL power =31.66 to 0.62×age (P<0.001). The median follow-up was 7.50 months (IQR, 3.0–11.0 months). Lens adjustments took about every 3 months before 1 year of age and every 5 months afterward (F=3.442; P=0.024). The RGP CLs provided ideal fit characteristics, and no severe lens-related adverse event occurred except only one patient had mild conjunctivitis.

Conclusions:

Our empirical RGP CLs fitting philosophy presented that aphakic infant's age can be used to determine the initial lens if accurate biometry cannot be obtained initially.
Long-term Outcomes on de novo Ocular Hypertensive Response to Topical Corticosteroids After Corneal Transplantation
Authors: Raj Akash , Salvador-Culla Borja , Anwar Hamed , Sykakis Evripidis , Figueiredo María Socorro , Figueiredo Francisco Carlos
Published: September 2019

Purpose:

To determine incidence, demographics, management, and outcomes of topical steroid-induced ocular hypertension after penetrating keratoplasty (PKP) and to establish effects on intraocular pressure (IOP) and graft rejection when alternate corticosteroids are used.

Methods:

A single-center, retrospective review of 568 consecutive PKPs performed between 1997 and 2010 was conducted. Data were collected on demographics, best-corrected visual acuity, surgical indications, lens status, IOP, postoperative management, and incidence of rejection.

Results:

Eighty eyes (14.1%) of 74 patients were included. The most common indication was keratoconus (28.8%). Twenty-seven eyes (33.8%) were phakic, 46 (57.4%) had a posterior chamber intraocular lens, and 7 (8.8%) had an anterior chamber intraocular lens. Mean postoperative IOP increase was only significant in the anterior chamber intraocular lens group (18.7 mm Hg, SD 10.4; P = 0.02). The average time for developing hypertension was 9.8 months (SD 14.8) postoperatively, with an average IOP increase of 13.3 mm Hg (SD 5.9). Prednisolone acetate 1% was switched to rimexolone 1% in 64 eyes (80%) and to fluorometholone 0.1% in 16 eyes (20%), which alone achieved IOP normalization in 26 eyes (32.5%) (P < 0.01). Fifty-four eyes (67.5%) required additional antiglaucoma medication. An average IOP reduction of 12.3 mm Hg (SD 6.9) was achieved at an average of 2.3 months (SD 5.2) after the switch. Seventeen eyes (21%) developed glaucoma and 13 eyes (16.3%) developed graft rejection after switching formulations, with no statistically significant differences between rimexolone and fluorometholone (P > 0.05).

Conclusions:

The use of alternate topical corticosteroids may be considered in cases of steroid-induced ocular hypertension after PKP because they offer good antiinflammatory prophylaxis with reduced hypertensive response.
Prevalence of Novel Candidate Sjögren Syndrome Autoantibodies in the Penn Sjögren's International Collaborative Clinical Alliance Cohort
Authors: Bunya Vatinee Y. , Massaro-Giordano Mina , Vivino Frederick B. , Maguire Maureen G. , Baer Alan N. , Gonzales John A. , Ying Gui-shuang
Published: September 2019

Purpose:

To evaluate the prevalence of novel candidate autoantibodies associated with Sjögren syndrome (SS) and their ability to identify those with SS among participants with dry eye enrolled in the Sjögren's International Collaborative Clinical Alliance (SICCA) study at the University of Pennsylvania (Penn).

Methods:

All participants previously underwent a full ocular and systemic evaluation for possible SS as part of the SICCA study. An enzyme-linked immunosorbent assay was used to detect IgG, IgA, and IgM autoantibodies to salivary protein 1 (SP-1), parotid secretory protein (PSP), and carbonic anhydrase 6 from previously banked baseline serum samples from SICCA study participants enrolled at Penn. The prevalence rate of each autoantibody, calculated by considering the presence of any isotype as antibody positive, was compared between participants with dry eye with SS (n = 81) or without SS (n = 129) using the Fisher exact test.

Results:

The prevalence of SP-1 IgM autoantibodies was higher in those with SS compared with those without SS (14% vs. 5%; P = 0.03). Similarly, the prevalence of PSP IgA autoantibodies was higher in those with SS compared with non-SS dry eye participants (21% vs. 11%; P = 0.048). There was no statistically significant difference in the prevalence of carbonic anhydrase 6 autoantibodies between those with or without SS (15% vs. 20%; P = 0.36).

Conclusions:

In the Penn SICCA cohort, SP-1 IgM and PSP IgA autoantibodies were more prevalent in the serum of SS-related dry eye participants compared with those without SS. Further longitudinal studies are needed to determine the clinical significance of these findings.
The Development and Evaluation of an Analytical Framework to Explore Student Nurses' Cultural Beliefs of Dementia
Authors: OJO Omorogieva , BROOKE Joanne , CRONIN Camille
Published: September 2019

Background:

People diagnosed with dementia need culturally sensitive, person-centered care to promote their health and well-being. Therefore, healthcare professionals should be able to provide culturally competent care, of which an element is the understanding of their own cultural heritage and how this impacts on their beliefs regarding dementia, as cultural norms and values provide meanings and understanding of chronic conditions such as dementia. This study used focus groups to explore the cultural beliefs of student nurses regarding dementia, generating a large set of qualitative data that required structure and a framework to analyze.

Purpose:

One purpose of this article was to present the methodological analysis, which encompasses the analytical framework. The second purpose was to apply the framework to elicit the cultural beliefs regarding dementia among student nurses from multiple national backgrounds.

Methods:

Focus groups with student nurses from five higher education institutes in England, the Philippines, Slovenia, and New Zealand were conducted, audiotaped, and transcribed verbatim. The qualitative data were analyzed using the framework method of analysis. Data from the focus groups conducted at the two higher education institutes in England were analyzed by encompassed synthesizing, refining, and agreeing on the codes, categories, and themes that were established separately by four researchers. The developed analytical framework was then tested on the qualitative data obtained from the focus groups conducted in Slovenia, the Philippines, and New Zealand.

Results:

The results were presented in three parts: the cultural analytical framework, the process of developing the initial categories/themes, and the final themes that emerged from the data obtained from the focus groups.

Conclusions:

An analytical framework was developed and applied to understand student nurses' cultural values and beliefs of dementia.
A meta-analysis of the effects of probiotics and synbiotics in children with acute diarrhea
Authors: Yang Bo , Lu Ping , Li Mei-Xuan , Cai Xiao-Ling , Xiong Wan-Yuan , Hou Huai-Jing , Ha Xiao-Qin
Published: September 2019

Objective:

This meta-analysis assessed the effectiveness of probiotics and synbiotics for acute diarrhea (AD) in children and investigated probiotic formulations, types of interventions, and country factors.

Methods:

Randomized, double-blind, placebo-controlled trials evaluating the effects of probiotics or synbiotics on AD were analyzed. We followed the recommendations of the Cochrane Handbook and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The risks of systematic errors (bias) and random errors were assessed, and the overall quality of the evidence was evaluated using the Grades of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results:

The meta-analysis included 34 studies with 4911 patients. Five and 29 studies presented the results of synbiotic and probiotic interventions, respectively. After intervention, the durations of diarrhea (weighted mean difference (WMD) = −16.63 [−20.16; −12.51]) and hospitalization (risk ratio (RR) = 0.59 [0.48; 0.73]) were shorter, the stool frequency on day 3 (WMD = −0.98 [−1.55; −0.40]) was decreased, and the incidence of diarrhea lasting 3 days was lower in the probiotic and synbiotic groups than in the control groups. Furthermore, in the subgroup analyses, synbiotics were more effective than probiotics at reducing the durations of diarrhea and hospitalization, and Saccharomyces and Bifidobacterium were more effective than Lactobacillus at reducing the duration of diarrhea.

Conclusion:

This meta-analysis supports the potential beneficial roles of probiotics and synbiotics for AD in children. Further research is needed to determine problems associated with probiotic/synbiotic mixtures and appropriate dosages.
Open reduction and internal fixation of mandibular condylar fractures
Authors: Kuang Shi-Jun , He Yi-Qing , Zheng You-Hua , Zhang Zhi-Guang
Published: September 2019

The purpose of this study was to compare outcomes of open reduction and internal fixation (ORIF) versus closed reduction (CR) for mandibular condylar fractures.

Patients included in the National Inpatient Sample (NIS) database (2005–2014) who were admitted to the hospital for unilateral mandibular condylar fracture were included in the analysis. Patient characteristics and clinical outcomes were compared between those who received ORIF and those receiving CR. Logistic regression analysis was performed to estimate odds ratios (ORs) for each aspect of the main observed events.

NIS data of 12,303 patients who underwent ORIF and 4310 patients who underwent CR were analyzed. Compared to CR, ORIF had an increased risk of longer hospital stay (adjusted OR [aOR] = 1.78, 95% confidence intervals [CIs] = 1.51–2.09), higher total medical cost (aOR = 2.57, 95% CI = 2.17–3.05), and hematoma development (aOR = 10.66, 95% CI = 1.43–75.59), but had a lower risk of having wound complications (aOR = 0.86, 95% CI = 0.79–0.93).

Patients with mandibular condylar fractures who receive ORIF have greater risk of having an extended hospital stay, higher total medical costs, and hematoma development but lower risk of experiencing wound complications compared to those who receive CR.
Pre-transplant CD200 and CD200R1 concentrations are associated with post-transplant events in kidney transplant recipients
Authors: Oweira Hani , Khajeh Elias , Mohammadi Sara , Ghamarnejad Omid , Daniel Volker , Schnitzler Paul , Golriz Mohammad , Mieth Markus , Morath Christian , Zeier Martin , Mehrabi Arianeb , Sadeghi Mahmoud
Published: September 2019

CD200 is an immunoglobulin superfamily membrane protein that binds to a myeloid cell-specific receptor and induces inhibitory signaling. The aim of this study was to investigate the role of CD200 and its receptor (CD200R1) on kidney transplant (KTx) outcome. In a collective of 125 kidney recipients (University hospital, Heidelberg, Germany), CD200 and CD200R1 concentrations were evaluated immediately before transplantation. Recipient baseline and clinical characteristics and KTx outcome, including acute rejection (AR), acute tubular necrosis, delayed graft function, cytomegalovirus (CMV) and human polyomaviridae (BK) virus infections, and graft loss were evaluated during the first post-transplant year. The association of CD200 and CD200R1 concentrations and CD200R1/CD200 ratios with the outcome of KTx was investigated for the first time in a clinical setting in a prospective cohort. There was a positive association between pre-transplant CD200R1 concentrations and CMV (re)activation (P = .041). Also, increased CD200R1 concentration was associated with a longer duration of CMV infection (P = .049). Both the frequency of AR and levels of creatinine (3 and 6 months after KTx) were significantly higher in patients with an increased CD200R1/CD200 ratio (median: 126 vs 78, P 
= .008). Increased pre-transplant CD200R1/CD200 ratios predict immunocompetence and risk of AR, whereas high CD200R1 concentrations predict immunosuppression and high risk of severe CMV (re)activation after KTx.
High expression of cytokeratin CAM5.2 in esophageal squamous cell carcinoma is associated with poor prognosis
Authors: He Shujin , Peng Jie , Li Lei , Xu Ying , Wu Xiaoxiao , Yu Juan , Liu Jianli , Zhang Jinguo , Zhang Renya , Wang Wei
Published: September 2019

Esophageal cancer is a common human malignant tumor with high mortality. Glandular epithelial markers, such as CAM5.2, can be expressed in esophageal squamous cell carcinoma (ESCC), but the clinical significance of these cells in ESCC remains elusive.

Immunohistochemical analysis of CAM5.2 was performed on 604 ESCC specimens using tissue microarray. Our study design and study population used retrospective cohorts based on the hospital information system and pathological information management system which included medical information, date of admission, procedures undergone, registration, examinations, and medication.

In total, positive staining of CAM5.2 was 145 of 604 (24%). Statistical analysis showed that the expression of CAM5.2 had no relationship with sex, age, tumor differentiation, tumor size, tumor-node-metastasis (TNM) classification, and lymph node metastasis, but it was significantly associated with poor prognosis of overall survival (P = .0041) and disease-free survival (P = .0048) in ESCC patients.

Herein, we report for the first time that the high expression of the CAM 5.2 is an independent predictor of poor prognosis in patients with ESCC.
Association between the DRD2 TaqIA gene polymorphism and Parkinson disease risk: an updated meta-analysis
Authors: Yu Ming , Huang Feiran , Wang Wei , Zhao Chen
Published: September 2019

Background:

DRD2 TaqIA polymorphism may be associated with an increased risk of developing Parkinson disease (PD). However, the individual study's results are still inconsistent.

Methods:

A meta-analysis of 4232 cases and 4774 controls from 14 separate studies were performed to explore the possible relationship between the DRD2 TaqIA gene polymorphism and PD. Pooled odds ratios (ORs) for the association and the corresponding 95% confidence intervals (CIs) were evaluated by a fixed-effect model.

Results:

The pooled results revealed a significant association between DRD2 gene TaqIA polymorphism under recessive genetic model (OR: 0.91, 95% CI:0.83,0.99, P = .031) and additive genetic models (OR:0.93,95%CI:0.87,0.99, P = .032), but not associated with PD susceptibility under other genetic models in the whole population. Moreover, subgroups based on ethnicity and genotyping methods showed this association in the Caucasian subgroup under recessive genetic model (OR: 0.85, 95% CI:0.76,0.95, P = .003) and additive genetic models (OR:0.87,95%CI:0.79,0.96, P = .004) were existed. Besides, no significant association was detected under 6 genetic models in the Asian populations and PCR-RFLP subgroup.

Conclusions:

The current meta-analysis suggested that a significant association between DRD2 TaqIA polymorphism and PD under the recessive genetic mode, and additive genetic models, especially in Caucasians.
Expression and significance of urinary microRNA in patients with chronic hepatitis B
Authors: Shang Jia-Wei , Yan Xiu-Li , Zhang Hui , Su Shi-Bing
Published: September 2019

The aim of this study was to investigate the alterations of urinary microRNA (miRNA) expression and explore its clinical significance in patients with chronic hepatitis B (CHB).

The expression levels of urinary miRNA were detected by miRNA microarray and quantitative reverse transcription polymerase chain reaction (qRT-PCR) from 106 CHB and 40 healthy controls (Ctrl) subjects. The correlation between the levels of miRNA expression and clinical characteristics were analyzed. Receiver-operator characteristic (ROC) curves were generated to determine the specificity and sensitivity of each individual miRNA. MiRNAs expression were further measured by PCR from exosomes, which were isolated from urine samples. LX2 cells were transfected with miRNA inhibitor and accumulation of cytoplasmic lipid droplets was analyzed by Oil Red O staining.

miRNA expression profile analysis showed that 22 miRNAs were upregulated and 55 miRNAs were downregulated in CHB patients compared with Ctrl subjects (fold-change>1.5 and P < .05). miR-92b-3p, miR-770-5p, miR-5196-5p, and miR-7855-5p were significantly higher (P < .0001) in CHB subjects than in Ctrl subjects. ROC curve analysis showed that these four miRNAs were sensitive and specific enough to distinguish CHB and Ctrl subjects. The levels of miR-92b-3p expression were negatively correlated with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and APOA-1. Moreover, in vitro experiments indicated that inhibition of miR-92b-3p increased lipid droplet formation in LX2 cells.

Aberrant expression of miRNAs has been observed in urine of CHB patients. Our findings may provide novel insights into the pathogenesis of CHB and may assist in the diagnosis of patients with CHB.
Glucagonoma syndrome with severe erythematous rash
Authors: Wang Zhen-Xia , Wang Fei , Zhao Jian-Guo
Published: September 2019

Rationale:

Glucagonoma is a rare neuroendocrine tumor of the pancreas. Glucagonoma syndrome is often misdiagnosed as other skin lesions by clinicians due to a typical clinical sign of necrolytic migratory erythema (NME) with severe erythematous rash.

Patient concerns:

A 48-year-old female patient was admitted to our department because she presented with unclear recurrent severe erythematous rash. The patient was diagnosed as skin disease.

Diagnoses:

Histopathologic examination revealed a pancreatic glucagonoma. Immnohistochemical staining of tumor tissue was positive for glucagon.

Interventions:

The distal pancreatectomy plus splenectomy was performed in 2017.

Outcomes:

The skin lesions disappeared after surgery. She was followed up and showed no recurrence until now.

Lessons:

Clinicians should consider the diagnosis of glucagonoma according to the typical initial symptoms. Early diagnosis is very important to provide a better prognosis. A multidisciplinary approach is effective in patients with unresectable metastatic tumors.
Laparoscopic combined hysteroscopic management of cesarean scar pregnancy with temporary occlusion of bilateral internal iliac arteries
Authors: Xu Wenzhi , Wang Miao , Li Jianqiong , Lin Xiaona , Wu Weili , Yang Jianhua
Published: September 2019

To report on our experience of surgery of cesarean scar pregnancy with temporary occlusion of the bilateral internal iliac arteries.

Single center, retrospective review of patients who were diagnosed as cesarean scar pregnancy between December 2017 and December 2018. All patients were managed by laparoscopic cornuostomy and simultaneously repair the defect with temporary occlusion of the bilateral internal iliac arteries, followed by hysteroscopy to confirm no remnants of the pregnancy and deal with intrauterine lesions synchronously.

Five patients were enrolled, the vital signs of all the patients were stable. All 5 patients were managed by laparoscopic cornuostomy and simultaneously repair the defect with temporary occlusion of the bilateral internal iliac arteries, followed by hysteroscopy to confirm no remnants of the pregnancy and 3 patients’ free intrauterine adhesions synchronously. No one was converted to laparotomy. Intra-operative bleeding was minimal and the postoperative recoveries were uneventful. Human chorionic gonadotropin was normalized after 3 to 4 weeks.

Laparoscopy with temporary internal iliac artery occlusion technique offers effective surgical management of cesarean scar pregnancy, and hysteroscopy is necessary to deal with intrauterine lesions.