bluuebunny/crossref_metadata_2025 huggingface dataset:
Cervical cancer screening through human papillomavirus testing in community health campaigns versus health facilities in rural western Kenya
Authors: Huchko Megan J. , Ibrahim Saduma , Blat Cinthia , Cohen Craig R. , Smith Jennifer S. , Hiatt Robert A. , Bukusi Elizabeth
Published: December 2017

Objective

To determine the effectiveness of community health campaigns (CHCs) as a strategy for human papillomavirus (HPV)‐based cervical cancer screening in rural western Kenya.

Methods

Between January and November 2016, a cluster‐randomized trial was carried out in 12 communities in western Kenya to investigate high‐risk HPV testing offered via self‐collection to women aged 25–65 years in CHCs versus government health facilities. Outcome measures were the total number of women accessing cervical cancer screening and the proportion of HPV‐positive women accessing treatment.

Results

In total, 4944 women underwent HPV‐based cervical cancer screening in CHCs (n=2898) or health facilities (n=2046). Screening uptake as a proportion of total eligible women in the population was greater in communities assigned to CHCs (60.0% vs 37.0%, P<0.001). Rates of treatment acquisition were low in both arms (CHCs 39.2%; health facilities 31.5%; P=0.408).

Discussion

Cervical cancer screening using HPV testing of self‐collected samples reached a larger proportion of women when offered through periodic CHCs compared with health facilities. The community‐based model is a promising strategy for cervical cancer prevention. Lessons learned from this trial can be used to identify ways of maximizing the impact of such strategies through greater community participation and improved linkage to treatment.

ClinicalTrials.gov registration: NCT02124252.
Transcriptional regulation of CacyBP/SIP gene and the influence of increased CacyBP/SIP level on gene expression pattern in colorectal cancer HCT116 cells
Authors: Kądziołka Beata , Dębski Konrad J. , Bieganowski Paweł , Leśniak Wiesława , Filipek Anna
Published: December 2017

The CacyBP/SIP protein is expressed at a particularly high level in brain, spleen, and various tumors. In this work, we have studied transcriptional regulation of the CacyBP/SIP gene and the influence of increased CacyBP/SIP level on gene expression in colorectal cancer HCT116 cells. We have shown that E2F1, EGR1, and CREB transcription factors bind to the CacyBP/SIP gene promoter and stimulate transcription of CacyBP/SIP gene. The role of CREB was further confirmed by the observation that forskolin, a strong activator of CREB phosphorylation/activity, increased CacyBP/SIP gene promoter activity. Moreover, we have shown that CREB dominant negative mutants, CREB133 and KCREB, inhibits CacyBP/SIP promoter activity. To check the biological significance of increased CacyBP/SIP expression/level we have applied RNA microarray analysis and have found that upregulation of CacyBP/SIP entails changes in mRNA level of many genes involved, among others, in immune processes. © 2017 IUBMB Life, 70(1):50–59, 2018
The correlation between SNPs within the gene of adrenergic receptor and neuropeptide Y and risk of cervical vertigo
Authors: Han Jianlong , Zuo Jinliang , Zhu Dengsong , Gao Chunzheng
Published: December 2017

Background

The current investigation was aimed to explore the potential associations of SNPs within ADRB2, ADRB1, NPY, and ADRA1A with risk and prognosis of cervical vertigo.

Methods

Altogether 216 patients with cervical vertigo and 204 healthy controls were gathered, and their DNAs were extracted utilizing the whole‐blood DNA extraction kit. Besides, the PCR reactions were conducted using the TaqManR single nucleotide polymorphism (SNP) genotyping assays, and the SNPs were detected on the 7900HT real‐time fluorogenic quantitative polymerase chain reaction (PCR) instrument. Finally, the severity of cervical vertigo was classified according to the JOA scoring, and the recovery rate (RR) of cervical vertigo was calculated in light of the formula as: urn:x-wiley:08878013:media:jcla22366:jcla22366-math-0001

Results

The SNPs within ADRA1A [rs1048101 (T>C) and rs3802241 (C>T)], NPY [rs16476 (A>C), rs16148 (T>C), and rs5574 (C>T)], ADRB1 [rs28365031 (A>G)] and ADRB2 [rs2053044 (A>G)] were all significantly associated with regulated risk of cervical vertigo (all P < .05). Haplotypes of ADRA1A [CT and TC] and NPY [CCT and ATT] were also suggested as the susceptible factors of cervical vertigo in comparison with other haplotypes. Furthermore, the SNPs within ADRA1A [rs1048101 (T>C)], NPY [rs16476 (A>C), rs16148 (T>C)], as well as ADRB1 [rs28365031 (A>G)] all appeared to predict the prognosis of cervical vertigo in a relatively accurate way (all P < .05). Ultimately, the haplotypes of ADRA1A (CC) and NPY (CCT) tended to decrease the RR.

Conclusions

The SNPs within ADRB2, ADRB1, NPY, and ADRA1A might act as the diagnostic biomarkers and treatment targets for cervical vertigo.
Visual body size norms and the under‐detection of overweight and obesity
Authors: Oldham M. , Robinson E.
Published: December 2017

Objectives

The weight status of men with overweight and obesity tends to be visually underestimated, but visual recognition of female overweight and obesity has not been formally examined. The aims of the present studies were to test whether people can accurately recognize both male and female overweight and obesity and to examine a visual norm‐based explanation for why weight status is underestimated.

Methods

The present studies examine whether both male and female overweight and obesity are visually underestimated (Study 1), whether body size norms predict when underestimation of weight status occurs (Study 2) and whether visual exposure to heavier body weights adjusts visual body size norms and results in underestimation of weight status (Study 3).

Results

The weight status of men and women with overweight and obesity was consistently visually underestimated (Study 1). Body size norms predicted underestimation of weight status (Study 2) and in part explained why visual exposure to heavier body weights caused underestimation of overweight (Study 3).

Conclusions

The under‐detection of overweight and obesity may have been in part caused by exposure to larger body sizes resulting in an upwards shift in the range of body sizes that are perceived as being visually ‘normal’.
Addition of Allopurinol for Altering Thiopurine Metabolism to Optimize Therapy in Patients with Inflammatory Bowel Disease
Authors: Wall Geoffrey C. , Muktar Hamid , Effken Cassandra , Mahajan Pramod B.
Published: December 2017

Thiopurine drugs, including azathioprine and 6‐mercaptopurine, are used commonly in patients with inflammatory bowel disease for maintenance of remission. Although generally well tolerated, adverse effects lead to discontinuation in a significant minority of patients. Pharmacogenomic studies have suggested that metabolic breakdown of azathioprine in an individual is genetically determined. Coupled with the fact that certain thiopurine metabolites, notably 6‐thioguanine nucleotide and 6‐methylmercaptopurine, are associated with antiinflammatory effects and adverse effects, respectively, some investigators have examined intentionally shunting the metabolism of azathioprine toward increasing 6‐thioguanine nucleotide levels by using low doses of the xanthine oxidoreductase inhibitor allopurinol to improve efficacy and decrease toxicity of azathioprine in patients with inflammatory bowel disease. We performed a search of the MEDLINE and Embase databases for basic and clinical research reports of this modality. Pertinent articles were retrieved, reviewed, and assessed by the authors. Case series, cohort studies, and one randomized trial have investigated adding allopurinol to azathioprine therapy in patients with inflammatory bowel disease. Most reports primarily examined metabolite levels in these patients. In general, the literature suggests that this modality was successful at significantly increasing 6‐thioguanine nucleotide levels while decreasing 6‐methylmercaptopurine levels. Several small reports have suggested that patients with increased 6‐thioguanine nucleotide levels had improved symptoms or symptom remission. Adverse effects and discontinuation rates remained similar or were improved in patients who were taking a thiopurine and started allopurinol. In conclusion, the addition of allopurinol may be an option for optimizing thiopurine metabolite production in select patients with low 6‐thioguanine nucleotide levels. Appropriate care and monitoring of these patients are mandatory to prevent neutropenia or other adverse effects.
Memristive switching behaviour in In2Te5 asymmetrical hetero‐structures
Authors: Yuan Yafei , Li Jing
Published: December 2017

On the basis of Ag/In2Te5/W asymmetrical hetero‐structures, the memristive samples were prepared by the magnetron sputtering method. The current–voltage (I–V) measurements show the bipolar resistive switching characteristics at the room temperature. The underlying mechanism can be well interpreted by the space–charge‐limited conduction effect with redistribution and migration of charged defects responsible for the switching effect. The memristive possesses the properties of reversible switching, reproducible resistance, non‐destructive readout, good cycling performance and non‐volatile. It seems to be a promising candidate in the prospective non‐volatile memory and neuromorphic circuit applications.
SLM‐based ACO‐OFDM VLC system with low‐complexity minimum amplitude difference decoder
Authors: Hu Wei‐Wen
Published: December 2017

A novel low‐complexity minimum amplitude difference (MAD) decoder is proposed for selected mapping (SLM)‐based asymmetrically clipped optical orthogonal frequency division multiplexing (ACO‐OFDM) visible light communication (VLC) system. With the proposed scheme, a specific set of symmetric vectors is designed to minimise the peak‐to‐average power ratio (PAPR) of signal without the transmission of side information (SI) and recover SI blindly by the proposed MAD decoder. Simulation results show that the proposed scheme reduces the PAPR effectively and the bit error rate performance of ACO‐OFDM system with MAD decoder is very close to that of conventional selected mapping (CSLM) scheme with maximum likelihood decoder, but at much lower complexity.
Dual‐purpose probe applicable to permittivity measurements and ablation of biological materials
Authors: Seo Taeyoon , Oh Seongwoog , Huh Yeowool , Cho Jeiwon , Kwon Youngwoo
Published: December 2017

A dual‐purpose probe applicable both to permittivity measurements and ablation of biological materials has been developed. For these purposes, a planar‐type open‐ended coaxial probe was used as an applicator due to its capabilities of broadband permittivity measurements and near‐field ablation. In order to maintain highly efficient power transfer during ablation, an impedance matching network is designed. To verify the dual‐purpose probe, the complex permittivity of several biological materials was measured, and a block of pork muscle was ablated. As a result, permittivity measurements were successfully achieved nearly up to 20 GHz, and the surface temperature of pork muscle was raised up to 70°C with only 31 dBm of incident power at 18 GHz.
Hybrid VSS–LMS–LMF based adaptive control of SPV‐DSTATCOM system under distorted grid conditions
Authors: Beniwal Neha , Hussain Ikhlaq , Singh Bhim
Published: December 2017

This study presents a solar photovoltaic distribution static compensator (SPV‐DSTATCOM) system feeding a non‐linear load connected at point of common coupling. A hybrid variable step size–least mean square–least mean fourth (VSS–LMS–LMF) algorithm is proposed for the control of voltage source converter, which acts as DSTATCOM. A weighing factor is used so that LMS and LMF work simultaneously, and a varying step‐size helps in obtaining an adaptable system. The proposed control shows high convergence rate and low value of mean square error. The SPV array uses perturb and observe technique for maximum power extraction. The transition of SPV‐DSTATCOM to DSTATCOM and vice‐versa is also studied. In SPV‐DSTATCOM mode, the SPV feeds power to the load and the grid, resolving the power quality issues of the system, whereas in DSTATCOM mode, the grid feeds power to the load at unity power factor. The system is first simulated in MATLAB environment and then these results are experimentally verified on the developed prototype in the laboratory. The system is studied for both power factor correction and zero voltage regulation modes and under distorted grid conditions. The obtained results adhere to an IEEE‐519 standard.
Optimal robust first‐order frequency controller design for DFIG‐based wind farm utilising 16‐plant theorem
Authors: Toulabi Mohammadreza , Dobakhshari Ahmad Salehi , Ranjbar Ali Mohammad
Published: December 2017

With increasing the share of wind farms in generation profile, their contribution to frequency regulation has become crucial. This study presents an optimal robust first‐order frequency controller in the wind farms, which collectively emulates the inertial response as well as governor droop of synchronous generators. To account for various uncertainties associated with system inertia, damping, and doubly‐fed induction generator (DFIG)‐based wind turbine's parameters, the robustness of controller is verified through the 16‐plant theorem. An analytic method based on the small‐signal model of the system is utilised to determine the stability region of the first‐order controller. To evaluate the performance of the proposed controller, a DFIG‐based wind farm equipped with this controller is added to IEEE 39‐bus test system which is updated with wind farms in MATLAB/Simulink environment, and the response of proposed controller is investigated under different conditions. Simulation results verify the robustness as well as the effectiveness of the proposed controller in system frequency regulation.
Age Differences in Face Processing: The Role of Perceptual Degradation and Holistic Processing
Authors: Boutet Isabelle , Meinhardt-Injac Bozana
Published: December 2017

Objectives

We simultaneously investigated the role of three hypotheses regarding age-related differences in face processing: perceptual degradation, impaired holistic processing, and an interaction between the two.

Methods

Young adults (YA) aged 20–33-year olds, middle-age adults (MA) aged 50–64-year olds, and older adults (OA) aged 65–82-year olds were tested on the context congruency paradigm, which allows measurement of face-specific holistic processing across the life span (Meinhardt-Injac, Persike & Meinhardt, 2014. Acta Psychologica, 151, 155–163). Perceptual degradation was examined by measuring performance with faces that were not filtered (FSF), with faces filtered to preserve low spatial frequencies (LSF), and with faces filtered to preserve high spatial frequencies (HSF).

Results

We found that reducing perceptual signal strength had a greater impact on MA and OA for HSF faces, but not LSF faces. Context congruency effects were significant and of comparable magnitude across ages for FSF, LSF, and HSF faces. By using watches as control objects, we show that these holistic effects reflect face-specific mechanisms in all age groups.

Discussion

Our results support the perceptual degradation hypothesis for faces containing only HSF and suggest that holistic processing is preserved in aging even under conditions of reduced signal strength.
The Relative Drinfeld Commutant of a Fusion Category and α-Induction
Authors: Kawahigashi Yasuyuki
Published: December 2017

We establish a correspondence among simple objects of the relative commutant of a full fusion subcategory in a larger fusion category in the sense of Drinfeld, irreducible half-braidings of objects in the larger fusion category with respect to the fusion subcategory, and minimal central projections in the relative tube algebra. Based on this, we explicitly compute certain relative Drinfeld commutants of fusion categories arising from α-induction for braided subfactors. We present examples arising from chiral conformal field theory.
Efficacy of 8 Different Drug Treatments for Patients With Trigeminal Neuralgia
Authors: Yang Fang , Lin Qiang , Dong Lihua , Gao Xiaohui , Zhang Su’e
Published: December 2017

Objectives:

Trigeminal neuralgia (TN) is commonly seen in older persons and negatively influences their daily life. Although some research on the efficacy of TN drugs has been conducted, the optimal choice still remains uncertain. Therefore, this network meta-analysis (NMA) evaluated the efficacy and performance of 8 drugs with respect to TN.

Methods:

All literature was retrieved from the PubMed and Embase electronic databases by jointly searching key terms. The only outcome was response rate, expressed as the odds ratio with 95% credible/confidence intervals. Both a pairwise meta-analysis and NMA were conducted. Heat plot and node splitting were computed to measure the consistency between direct and indirect evidence. In addition, surface under cumulative ranking curves were utilized to rank different drugs for treating TN.

Results:

In total, 13 studies and 672 TN patients were included in this NMA. With regard to the primary endpoint response rate, only lidocaine (LDC), botulinum toxin type A (BTX-A), and carbamazepine (CBZ) had a statistical better performance than the placebo. According to the surface under cumulative ranking curves, LDC, BTX-A, and CBZ are the most effective drugs for treating patients with TN.

Conclusions:

Among the 8 drugs investigated, all exhibited a capacity to alleviate TN more than the placebo except for pimozide and proparacaine. Moreover, LDC, BTX-A, and CBZ stood out for their high efficacy and could be recommended as the primary choice of treatment for TN.
Negative pressure wound therapy in modern orthopaedic practice
Authors: Holt Andrew M. , Fournier Matthew N. , Beebe Michael J.
Published: December 2017

Negative pressure wound therapy (NPWT) is commonly used in orthopaedic practice. Biochemical and mechanical factors of NPWT optimize the local wound environment by increasing local angiogenesis, interleukin (IL)-8, and cell division to synergistically promote soft-tissue healing. Applications vary widely in orthopaedics. In trauma patients, it can temporize soft-tissue wounds in open fractures, aid in closure of fasciotomy wounds, and improve incorporation of skin grafts. Incisional vacuum therapy can maintain integrity of wound closure in high-risk patients and anatomic locations. When combined with instillation fluid, NPWT has the potential to treat infected tissue and deep hardware. Complications are avoidable but can include skin breakdown, wound contamination, and hemorrhage. Further research continues to clarify the role of NPWT in orthopaedic surgery.
Effects of the antidepressants desipramine and fluvoxamine on latency to immobility and duration of immobility in the forced swim test in adult male C57BL/6J mice
Authors: Koek Wouter , Sandoval Thomas L. , Daws Lynette C.
Published: December 2017

The forced swim test in rodents allows rapid detection of substances with antidepressant-like activity, evidenced as a decreased duration of immobility that is produced by the majority of clinically used antidepressants. Antidepressants also increase the latency to immobility, and this additional measure reportedly can increase the sensitivity of the forced swim test in mice. Extending these findings, the present study examined the effects of desipramine and fluvoxamine in a forced swim test in C57BL/6J mice, a strain commonly used as background for genetic modifications, analyzing results with a method (i.e. survival analysis) that can model the skewed distribution of latencies and that can deal with censored data (i.e. when immobility does not occur during the test), in comparison with the more traditional Student’s t-test. Desipramine increased the latency to immobility at 32 mg/kg, but not at lower doses. Fluvoxamine also did not affect latency at lower doses, but in contrast to desipramine, fluvoxamine decreased the latency to immobility at the highest dose (i.e. 32 mg/kg). At doses affecting latency to immobility, neither desipramine nor fluvoxamine significantly affected duration of immobility. Together, these results are generally consistent with the suggestion that inclusion of the latency measure can increase the sensitivity of the forced swim test to detect antidepressant-like effects in mice.
DIFFUSE RETINAL VASCULAR LEAKAGE AND CONE–ROD DYSTROPHY IN A FAMILY WITH THE HOMOZYGOUS MISSENSE C.1429G>A (P.GLY477ARG) MUTATION IN CRB1
Authors: Alsulaiman Hamad M. , Schatz Patrik , Nowilaty Sawsan R. , Abdelkader Ehab , Abu Safieh Leen
Published: December 2017

Purpose:

To describe a specific cone–rod dystrophy phenotype in a family with the homozygous c.1429G>A; p.Gly477Arg mutation in CRB1. The detailed phenotype of subjects with this specific mutation has not been described previously.

Methods:

Clinical examination included full-field electroretinography and high-resolution and widefield retinal imaging and uveitis workup. Molecular genetic analysis included next-generation sequencing of known retinal dystrophy genes and Sanger sequencing for segregation analysis.

Results:

Three affected male siblings (26, 16, and 8 years old) were diagnosed with cone–rod dystrophy, featuring bilateral macular hypoautofluorescent lesions. In addition, the eldest brother was found to have retinal vascular leakage throughout the retina without telangiectasia. Uveitis laboratory workup was unremarkable. The homozygous c.1429G>A; p.Gly477Arg mutation in CRB1 was found to segregate with disease in this family.

Conclusion:

To the best of our knowledge, diffuse vascular leakage without telangiectasia or exudation, with bull's eye maculopathy, has not been reported previously in CRB1-cone rod dystrophy. This expands the phenotype complexity associated with CRB1 mutations and confirms that dystrophies associated with mutations in this gene may appear with features of uveitis.
Rapid Explantation of Rapid-Deployment Sutureless Valve in Case of Acute Endocarditis
Authors: Di Bacco Lorenzo , Pfeiffer Steffen , Fischlein Theodor J. M. , Santarpino Giuseppe
Published: December 2017

We report a case of infective endocarditis on a Perceval S aortic valve bioprosthesis, and we describe a feasible and useful technique that can help remove the infected valve. These maneuvers consist of an “x-movement” reached with the aid of anatomical forceps. The risk of infective endocarditis in patients with prosthetic valves is a well-known phenomena in cardiac surgery, and it can represent a life-threatening event in many cases. According to guidelines, an emergency surgical intervention is required in case of high risk of embolization, vegetation superior than 1 cm or acute cardiac failure secondary to the acute valve dysfunction. In the reported case, the patient was submitted to emergency surgery because of vegetation with diameter superior to 1 cm on the aortic bioprosthesis. The described “x-movement” technique allowed an easily “en block” excision of the damaged bio-prostheses together with vegetation, minimizing the risk of vegetation fragmentation.
Benefits of Electromagnetic Navigational Bronchoscopy for Identifying Pulmonary Nodules for Robotic Resections
Authors: Pupovac Stevan S. , Chaudhry Alexander , Singh Vijay A.
Published: December 2017

Objective

The ability to localize pulmonary nodules via the robotic thoracic technique can be challenging at times. This is most evident when nodules are small and/or ground glass in nature. Information regarding methods available to localize these difficult nodules, while maintaining a minimally invasive robotic approach, is limited.

Methods

We describe a diagnostic and therapeutic method of combining electromagnetic navigational bronchoscopy with a total minimally invasive robotic approach that identifies these difficult-to-localize pulmonary nodules. The technique entails the use of electromagnetic navigational bronchoscopy to place a pleural dye marker with a subsequent pulmonary resection via a robotic thoracic approach.

Results

A cohort of 15 patients from August 2014 to December 2015 was reviewed. These patients underwent the combined approach of electromagnetic navigational bronchoscopy followed by a robotic pulmonary resection. Fourteen of the 15 patients had a successful combined procedure, which was confirmed with pathology. The range of the nodules was 0.8 to 2 cm. Methylene blue was used for pleural dye marking. On one occasion, the pleural dye was not able to be deciphered. There were no complications from either the electromagnetic navigational bronchoscopy or robotic portions of the procedure.

Conclusions

Pleural dye marking via electromagnetic navigational bronchoscopy can provide an effective method for localizing pulmonary nodules, while maintaining a minimally invasive robotic approach. This tactic allows one to obtain diagnostic tissue more efficiently, while limiting the potential inability to localize a nodule.
The Effect of Adolescents’ Internet Addiction on Smartphone Addiction
Authors: Ayar Dijle , Bektas Murat , Bektas Ilknur , Akdeniz Kudubes Asli , Selekoglu Ok Yasemin , Sal Altan Sema , Celik Isa
Published: December 2017

Objective:

The purpose of this study was to evaluate the effect of adolescents’ Internet addiction levels on smartphone addiction.

Methods:

This study included 609 students from three high schools that are located in western Turkey. Numbers, percentages, and averages were used to evaluate the sociodemographic data. The Kolmogorov–Smirnov and Shapiro–Wilk tests were used to determine whether the data had a normal distribution.

Results:

The average age of the participants was 12.3 ± 0.9 years. Of them, 52.3% were male, and 42.8% were 10th graders. All participants had smartphones, and 89.4% of them connected to the Internet continuously with their smartphones. The study found that there was a statistically significant correlation between Internet addiction and smartphone addiction.

Originality and Value:

It was determined that male adolescents with high levels of Internet addiction also had high smartphone addiction levels. On the other hand, sociodemographic variables had no statistically significant effect on smartphone addiction. A number of studies in the relevant literature examined the effects of Internet addiction on adolescents’ smartphone addiction. However, findings of this study are unique because they are specific to the Turkish culture, and there is a limited database in Turkey regarding this issue. The researchers believe that the findings of this study will be beneficial to show the importance of the issue in the international arena and to guide further studies to prevent this addiction because there is no reliable database about smartphone addiction in Turkey.
A Call for Compassionate Care
Authors: Alexander Karen
Published: December 2017

The Substance Abuse and Mental Health Services Administration (2014) reported that 1.1% of pregnant women used nonprescription opiates (either heroin or prescription pills) in the last 30 days. Methadone and buprenorphine are the most common treatments for opiate addiction in pregnant women. Reasons for seeking opiate maintenance treatment (OMT) include keeping custody of one’s children and the hope of developing a healthy parenting relationship. Yet, healthcare organizations and professionals have mixed opinions regarding health promotion within the maternal OMT population. Proper education regarding the growing and complex opiate epidemic continues to remain a void for many healthcare professionals. It is imperative that nurses who regularly interact with women in OMT show compassion and competence. It is important to highlight the universality of the challenges and needs of caring for the OMT population. This Perspectives column will explore and describe the context of maternal nonprescription opiate use and the care mothers in OMT should receive based on established nursing ethical standards.
Symptoms, Nutrition, Pressure Ulcers, and Return to Community Among Older Women With Heart Failure at Skilled Nursing Facilities
Authors: Pressler Susan J. , Jung Miyeon , Titler Marita , Harrison Jordan , Lee Kayoung
Published: December 2017

Background:

Mortality rate is high for older women with heart failure (HF) who are discharged to skilled nursing facilities (SNFs) after hospitalization, but little is known about their symptoms, nutritional factors, and pressure ulcer status and whether these variables predict the women’s return to the community.

Objectives:

The aims of this study are to characterize symptoms (ie, dyspnea, cognitive dysfunction, depression, and pain) and nutritional and pressure ulcer status, evaluate relationships among symptoms, and examine predictors of return to the community among older women with HF admitted to SNFs.

Methods:

In this pilot observational study, data were collected retrospectively from the electronic medical records and the Minimum Data Set 3.0.

Results:

Data were obtained for 45 women with HF (mean age, 84.8 years). Frequency of symptoms was dyspnea 18%, cognitive dysfunction 20%, depression 5%, and pain 78%. Mean body mass index (BMI) was 29.8 kg/m2. Frequency of pressure ulcer risk was 85% and 18% had pressure ulcers. The 4 symptoms were not significantly related. Younger age (odds ratio, 0.90; P = .023) and BMI of 25 kg/m2 or greater (odds ratio, 5.31; P = .017) predicted return to the community.

Conclusions:

The women in this study had frequent pain, moderately frequent cognitive dysfunction, and high pressure ulcer risk. Surprisingly, few women had dyspnea or depression. Women who were younger with higher BMI were more likely to return to the community. The study needs to be replicated in a larger more diverse group of older patients with HF.
Hinged Lids and Fatal Head Entrapment in Early Childhood
Authors: Byard Roger W. , Cala Allan D.
Published: December 2017

Young children are at risk of head entrapment because they often do not understand potentially dangerous situations or have the intellectual or physical capabilities to self-extricate. Two cases of head entrapment due to hinged lids are presented to demonstrate another rare lethal situation specific to the very young. Case 1 was a 14-month-old boy found suspended by his neck in a semikneeling position under a toilet seat. A horizontal linear bruise measuring 0.6 × 20 mm was present on the right side of the neck with petechial hemorrhages of the forehead. Death was due to neck compression from head entrapment with aspiration of gastric contents. Case 2 was a 17-month-old girl found suspended by her neck from the side of her crib by a hinged cover. A horizontal linear bruise measuring 10 × 50 mm was present immediately below the suprasternal notch with numerous petechial hemorrhages of the conjunctivae and face. Death was due to neck compression from head entrapment. Although these cases are very rare, they do show the potential danger that hinged lids may present to toddlers. Autopsy evaluations require comparisons of injuries with the structure and edges of the entrapping device/object.
Modeling Continuous Prognostic Factors in Survival Analysis
Authors: Cates Justin M.M.
Published: December 2017

Extent of response to neoadjuvant chemotherapy, tumor size, and patient age are important prognostic variables for patients with osteosarcoma, but applying information from these continuous variables in survival models is difficult. Dichotomization is usually inappropriate and alternative statistical techniques should be considered instead. Nonlinear multivariable regression methods (restricted cubic splines and fractional polynomials) were applied to data from the National Cancer Database to model continuous prognostic factors for overall survival from localized, high-grade osteosarcoma of the appendicular and nonspinal skeleton following neoadjuvant chemotherapy and surgical resection (N=2493). The assumption that log hazard ratios were linear in relation to these continuous prognostic factors was tested using likelihood ratio tests of model deviance and Wald tests of spline coefficients. Log hazard ratios for increasing patient age were linear over the range of 4 to 80 years, but showed evidence for variation in the coefficient over elapsed follow-up time. Tumor size also showed a linear relationship with log hazard over the range of 1 to 30 cm. Hazard ratios for chemotherapy effect profoundly deviated from log-linear (P<0.004), with significantly decreased hazard for death from baseline for patients with ≥90% tumor necrosis (hazard ratio, 0.32; 95% confidence interval, 0.20-0.52; P<0.0001). Important implications of these results include: (1) ≥90% tumor necrosis defines good chemotherapy response in a clinically useful manner; (2) staging osteosarcoma by dichotomizing tumor size is inappropriate; and (3) patient age can be modeled as a linear effect on the log hazard ratio in prognostic models with the caveat that risk may change over duration of the analysis.
Hyperkalemia and Acute Kidney Injury in an Adolescent
Authors: Szadkowski Adam , Pollock Allison J. , Al-Subu Awni M.
Published: December 2017

Addison disease is a rare endocrine disorder, which typically presents with nonspecific symptoms including weight loss, fatigue, and nausea in conjunction with hyponatremia and hyperkalemia. This case demonstrates key diagnostic clues in evaluation of an adolescent who presented with severe hyperkalemia and acute kidney injury that was resistant to insulin, glucose, and sodium polystyrene sulfonate and was found to have primary adrenal insufficiency.
The Diagnostic and Prognostic Role of Interleukin 12B and Interleukin 6R Gene Polymorphism in Patients With Ankylosing Spondylitis
Authors: Ruan Wen-Feng , Xie Jiang-Tao , Jin Qi , Wang Wen-Da , Ping An-Song
Published: December 2017

Objectives

Interleukin 23 (IL-23) pathway and IL-1 cluster genes play prominent role in the etiopathology of ankylosing spondylitis (AS). The aim of this study was to investigate the diagnostic and prognostic role of 5 single-nucleotide polymorphisms related to IL-23 pathway and IL-1 cluster genes in AS patients.

Methods

Four hundred thirty-one patients with AS and 206 age- and sex-matched healthy controls were recruited in this prospective cohort study. Five potential single-nucleotide polymorphisms (IL-23R [rs11209026], IL-12B [rs6871626], TYK2 [rs6511701], IL-6R [rs4129267], and IL-1R2 [rs2192752]) related to IL-23 pathway and IL-1 cluster genes by analyzing previous studies were genotyped. Among 431 total AS patients, 198 active cases were treated and followed up for 24 weeks.

Results

Frequencies of IL-12B AA (rs6871626) and IL-6R TT (rs4129267) genotypes were increased in AS patients compared with healthy controls (both P < 0.001), and IL-12B A (rs6871626) as well as IL-6R T (rs4129267) allele increased the risk of AS independently (both P < 0.001). The Bath Ankylosing Spondylitis Disease Activity Index score was found to be elevated in AS patients with IL-12B AA (rs6871626) compared with patients with the CA and CC genotypes (P = 0.002 and P < 0.001, respectively), and the Bath Ankylosing Spondylitis Functional Index score was also increased in AS patents with IL-12B AA (rs6871626) than in those with the CA and CC genotypes (P = 0.001 and P < 0.001). In addition, IL-6R T (rs4129267) allele could predict a worse ASAS-20 (Assessment of SpondyloArthritis international Society) response at week 24 as an independent factor by multivariate logistic regression analysis with additive model (P = 0.011).

Conclusions

Interleukin 12B (rs6871626) and IL-6R (rs4129267) gene polymorphisms could serve as promising biomarkers for diagnosis and prognosis in AS patients.
Large Artery Dysfunction in Primary Antiphospholipid Syndrome
Authors: Osmundo Gilmar S. , Carvalho Jozélio Freire , Bortolotto Luiz A. , Viana Vilma S.T. , Bonfá Eloisa
Published: December 2017

Objective

The aim of this study was to assess the arterial distensibility of large vessels and changes in microvasculature in primary antiphospholipid syndrome.

Methods

Twenty-two antiphospholipid syndrome (APL) patients and 66 age-, sex-, height-, and blood pressure–matched controls were evaluated. Second derivative of the finger photoplethysmogram (SDPTG) was used as a noninvasive method to evaluate the pulse wave. The b/a and d/a indices, which reflect, respectively, large-vessel and small-vessel properties, were calculated from the SDPTG waveform components. Vascular age index was also determined.

Results

Arterial thrombosis occurred in 59.1% (13/22) of APL patients, with a predominance of stroke episodes (61.5%). Venous thromboembolism was observed in 36.4% (all deep venous thrombosis), and obstetric complications in 36.4%. Frequency of diabetes mellitus, smoking, and dyslipidemia was comparable in APL patients and control subjects (P > 0.05). Concerning plethysmography findings, b/a ratio was higher in patients than in control subjects (−0.44 ± 0.16 vs. −0.54 ± 0.18, P = 0.034), whereas d/a ratio (−0.30 ± 0.16 vs. −0.31 ± 0.18, P = 0.83) was comparable. Moreover, SDPTG (−0.16 ± 0.35 vs. −0.30 ± 0.38, P = 0.16) and vascular age index values (53.5 ± 11.6 vs. 51.8 ± 16.1, P = 0.65) were alike in both groups. Regarding disease-related factors, patients with arterial and venous thrombosis had similar b/a, d/a, and vascular age indices (P = 0.95; P = 0.06; P = 0.12, respectively).

Conclusions

The higher b/a ratio in APL patients suggests decreased distensibility of large arteries and may be why APL patients are at higher risk for cardiovascular events. The d/a ratio, that is considered a marker of small vessel vascular resistance, was not different than controls. Further studies are needed to evaluate vascular factors that predispose APL patients to atherosclerotic events.
Sputum Anticitrullinated Protein Antibodies in Patients With Long-standing Rheumatoid Arthritis
Authors: Polachek Ari , Vree Egberts Wilma , Fireman Elizabeth , Druckman Ido , Stark Moshe , Paran Daphna , Kaufman Ilana , Wigler Irena , Levartovsky David , Caspi Dan , Pruijn Ger J.M. , Elkayam Ori
Published: December 2017

Objective

The aim of this study was to evaluate the presence of autoantibodies to cyclic citrullinated synthetic peptides (ACPAs) in the sputum of patients with long-standing rheumatoid arthritis (RA).

Methods

Nineteen consecutive RA patients and 16 age- and sex-matched control subjects participated in this cross-sectional study. All underwent complete lung function tests and provided induced sputum. Antibodies to citrullinated (CitP) and the corresponding norleucine-containing (NorP) peptides in the sputum of the RA patients and control subjects, as well as in the serum of the RA patients, were determined by enzyme-linked immunosorbent assay.

Results

Patients with RA had the following characteristics: mean disease duration of 12 years, Disease Activity Score for 28 joints of 3.44, and Sharp–van der Heijde score of 57.5. Ten of the 19 RA patients showed high titers of ACPAs in their sera. Four of the seropositive (40%), none of the seronegative RA patients, and only 1 of the control subjects showed detectable levels of ACPAs in their sputum. The ratio between the reactivity with CitP and NorP peptides in the sputum was significantly higher in RA sputum than in control sputum (1.33 ± 1.2 vs. 0.64 ± 0.14, P = 0.02). A positive correlation was found between sputum ACPAs and age, serum ACPAs, sputum anti-NorP, serum anti-CitP/NorP reactivity ratio, and the proportion of neutrophils and lymphocytes in the sputum. No significant correlation was found between sputum ACPAs and disease severity, history of smoking, lung function tests, or treatment for RA.

Conclusions

Anticitrullinated protein/peptide antibodies can be detected in the sputum of RA patients and are correlated with the presence in the serum.
Sonographic Findings of Hands and Wrists in Systemic Lupus Erythematosus Patients With Jaccoud Arthropathy
Authors: Lins Carolina Freitas , de Sá Ribeiro Daniel Lima , Santos Willer Gonçalves Dourado , Rosa Genevievi , Machicado Viviane , Pedreira Ana Luiza , da Fonseca Emanuela Pimenta , Souza Anna Paula Mota Duque , Silva Carla Baleeiro Rodrigues , Ferreira Luana Grazielle dos Santos , Galvão Verena , de Oliveira Isabela Silva , Atta Ajax Merces , Santiago Mittermayer Barreto
Published: December 2017

Introduction

Jaccoud arthropathy (JA) is a deforming nonerosive arthropathy, characterized by the presence of “reversible” joint deformity. The study aims at describing the main musculoskeletal ultrasound (US) findings of a series of systemic lupus erythematosus (SLE) patients with JA.

Methods

Consecutive patients diagnosed as having JA and SLE were included in the study. All patients underwent a whole clinical evaluation and US of the hands and wrists. The US scan evaluated the presence of synovial hypertrophy, tenosynovitis, and bone erosions.

Results

Thirty-nine of 40 patients were female. The US examination was performed on 560 joints of the hands and wrists. At least 1 change was observed in the US examination of 20 patients (50.0%), but there was not a statistically significant association with disease activity (P = 0.33). Nineteen patients (47.5%) had synovial hypertrophy, 9 (22.5%) had tenosynovitis, and 7 (17.5%) had both. Isolated small bone erosions were identified in 2 patients (5.0%).

Conclusions

Ultrasound examination is a reliable and noninvasive imaging method for the evaluation of joint involvement in SLE. Half of the patients with JA have ultrasonographic signs of joint inflammation, and these abnormalities may be found even in the absence of disease activity.
Direct peritoneal resuscitation reduces intestinal permeability after brain death
Authors: Weaver Jessica L. , Matheson Paul J. , Matheson Amy , Graham Victoria , Harbrecht Brian G. , Downard Cynthia D. , Garrison R. Neal , Smith Jason W.
Published: December 2017

Background

The profound inflammatory response associated with brain death is frequently cited as the reason organs procured from brain dead donors are associated with worse graft function. The intestine releases inflammatory mediators in other types of shock, but its role is brain death has not been well-studied. Direct peritoneal resuscitation (DPR) improves visceral organ blood flow and reduces inflammation after hemorrhagic shock. We hypothesized that use of DPR would maintain intestinal integrity and reduce circulating inflammatory mediators after brain death.

Methods

Brain death was induced in male Sprague-Dawley rats by inserting a 4F Fogarty catheter into the epidural space and slowly inflating it. After herniation, rats were resuscitated with normal saline to maintain a mean arterial pressure of 80 mm Hg and killed with tissue collected immediately (time 0), or 2 hours, 4 hours, or 6 hours after brain death. Randomly selected animals received DPR via an intraperitoneal injection of 30-mL commercial peritoneal dialysis solution.

Results

Levels of proinflammatory cytokines, including IL-1β and IL-6, as well as high-mobility group box 1 protein and heat shock protein 70, were all increased after brain death and decreased with DPR. Fatty acid binding protein and lipopolysaccharide, both markers of intestinal injury, were increased in the serum after brain death and decreased with DPR. Immunohistochemistry staining for zona occludin-1 showed decreased intestinal tight junction integrity after brain death, which improved with DPR.

Conclusions

Intestinal permeability increases after brain death, and this contributes to the increased inflammation seen throughout the body. Using DPR prevents intestinal ischemia and helps preserve intestinal integrity. This suggests that using this novel therapy as an adjunct to the resuscitation of brain dead donors has the potential to reduce inflammation and potentially improve the quality of transplanted organs.
Gut epithelial cell-derived exosomes trigger posttrauma immune dysfunction
Authors: Kojima Mitsuaki , Costantini Todd W. , Eliceiri Brian P. , Chan Theresa W. , Baird Andrew , Coimbra Raul
Published: December 2017

BACKGROUND

Exosomes are extracellular vesicles that act as endogenous mediators of the immune response. We have previously shown that exosomes released into mesenteric lymph (ML) following trauma (T)/hemorrhagic shock (HS) induce proinflammatory cytokine production in macrophages and are involved in the pathogenesis of postshock acute lung injury. However, the cellular origin of ML exosomes and their role in the posttrauma immune response remains unclear. We hypothesized that exosomes released from damaged-intestinal epithelial cells contribute to posttrauma immune dysfunction by altering the function of dendritic cells (DCs), key regulators of the adaptive immunity.

METHODS

Male rats underwent cannulation of the femoral artery, jugular vein and ML duct. T/HS was induced by laparotomy and 60 minutes of hemorrhagic shock followed by resuscitation. The ML was collected before (preshock) and after T/HS (post-T/HS) for isolation of exosomes. Surface epitopes of exosomes isolated from ML were assessed by flow cytometry to determine their cellular origin and phenotypic changes. The immunomodulatory effects of ML exosomes on DCs were assessed by Annexin V apoptosis assay, expression of costimulatory molecules, and antigen-presenting capacity to lymphocytes.

RESULTS

Exosomes isolated from ML highly expressed CD63 (exosome marker) and epithelial cell-specific marker, suggesting their derivation from intestinal epithelial cells. The expression of immunomodulatory molecules, such as major histocompatibility complex class II and Fas ligand on ML exosomes, was significantly increased after T/HS. Coincubation of DCs with exosomes isolated from ML after T/HS increased DC apoptosis twofold compared with preshock ML exosomes. Furthermore, post-T/HS ML exosomes significantly suppressed lipopolysaccharide-mediated expression of CD80 and CD86 on DCs as well as decreased their antigen-presenting capacity to induce lymphocytes proliferation.

CONCLUSION

Gut epithelial cells release immunomodulatory exosomes into the ML after T/HS and resuscitation. Mesenteric lymph exosomes may be critical mediators of posttraumatic immunosuppression causing depletion and dysfunction of DCs.
Tubastatin A prevents hemorrhage-induced endothelial barrier dysfunction
Authors: Bruhn Peter J. , Nikolian Vahagn C. , Halaweish Ihab , Chang Zhigang , Sillesen Martin , Liu Baoling , Li Yongqing , Alam Hasan B.
Published: December 2017

Background

Microvascular hyperpermeability resulting from endothelial barrier dysfunction (EBD) is associated with worse clinical outcomes in trauma-induced hemorrhagic shock. We have previously shown that treatment with Tubastatin A (TubA), a histone deacetylase 6 inhibitor, improves outcomes in animal models of shock. In this study, we investigate whether TubA treatment may prevent trauma-related EBD.

Methods

Wistar-Kyoto rats subjected to 40% hemorrhage were treated with TubA or vehicle control. Acute lung injury (ALI) was assessed histologically from tissues harvested 6 hours posthemorrhage. In vitro, human umbilical vein endothelial cells (HUVECs) were cultured in EGM BulletKit medium. Medium was exchanged for glucose-free Dulbecco’s Modified Eagle Medium (0.5% fetal bovine serum) with or without TubA, and cells were placed in an anoxic chamber (5% CO2, 95% N2, 20–48 hours). Expression of acetylated tubulin and hypoxia-inducible factor 1α was measured by Western blot. Soluble Intercellular Adhesion Molecule-1 concentration within the medium, a marker of endothelial integrity, was determined using enzyme-linked immunosorbent assay. Monolayers were assessed for permeability via transwell assays using fluorescein isothiocyanate-labeled albumin.

Results

Rats treated with TubA had significantly reduced ALI relative to vehicle control. In vitro, TubA significantly attenuated anoxia-induced hyperpermeability, hypoxia-inducible factor 1α expression, and glycocalyx shedding.

Conclusions

Our findings demonstrate that TubA prevents hemorrhage-induced ALI in rats. Additionally, we have shown that TubA prevents anoxia-induced EBD in vitro. Taken together, these results suggest that TubA could attenuate microvascular hyperpermeability related to hemorrhagic shock.