bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary Hypertension: Definition, Classification, and Diagnosis
Authors: Alves-Jr Jose , Oleas Francisca , Souza Rogerio
Published: October 2017

Pulmonary hypertension (PH) is a hemodynamic condition characterized by the presence of mean pulmonary artery pressure ≥ 25 mm Hg. Many different baseline conditions and/or risk factors are associated with the development of PH, increasing the complexity for the appropriate diagnosis and classification. Since it was first proposed, PH classification has been adapted to incorporate the increasing knowledge about the disease gathered along the past two decades. Current classification groups together the patients with similar pathophysiological mechanisms, clinical presentation, and management. Nevertheless, correct classification is only possible after a comprehensive diagnostic approach, assessing the most prevalent conditions associated with PH. Most importantly, left ventricular function, lung parenchyma, and the presence of chronic thromboembolic disease have to be evaluated by means of different diagnostic tools. The aim of this review is to summarize the current definitions of PH, which in turn is necessary for determination of the appropriate diagnostic approach.
Medical Treatment of Pulmonary Arterial Hypertension
Authors: Sahay Sandeep , Humbert Marc , Sitbon Olivier
Published: October 2017

Pulmonary arterial hypertension (PAH) is a progressive and life-threatening disease leading to right ventricular failure and death if left untreated. Over the past two decades, progress in the understanding of pathophysiological mechanisms of the disease has led to the development of medications targeting the three major pathways of endothelial dysfunction: prostanoids, endothelin-receptor antagonists, and phosphodiesterase type-5 inhibitors. Efficacy of PAH-targeted medications has been demonstrated in monotherapy through randomized clinical trials leading to their regulatory approval. However, despite the growing numbers of available PAH-targeted medications, many patients with PAH continue to deteriorate and the disease ultimately remains fatal. The availability of multiple classes of drugs targeting different pathophysiological pathways provides strong biological rationale for the use of combination therapy in PAH. Evidence to support this strategy is growing, and many studies have demonstrated that combination therapy, administered as either a sequential or an initial regimen, can improve long-term outcomes in PAH. Treatment strategy for PAH has thereby changed significantly over the past decade, combination therapy becoming progressively the gold standard of care in patients with PAH. This is underscored by the current European Society of Cardiology/European Respiratory Society guidelines, in which combination therapy now plays a central part in the treatment algorithm.
Torsion of an Accessory Hepatic Lobe with Embedded Gallbladder: In an 11-Month-Old Boy
Authors: Thakral Chiman , Shivalingam Ganji , Dar Faizan , Thakral Nimish
Published: October 2017

An accessory lobe of the liver is a rare entity in clinical practice which is diagnosed incidentally. Infrequently, it may present as torsion with a clinical picture of an acute abdomen, a palpable mass, and may be associated with liver function abnormalities. Many of these patients have a history of previous surgery for congenital abdominal wall defects such as omphalocele. We present an extremely rare case of torsion of an accessory hepatic lobe in an 11-month-old male patient who presented in a state of shock. The infant underwent laparotomy and excision of the accessory lobe. Here, we aim to emphasize the importance of prompt management and early resection which is the cornerstone of a favorable outcome.
Treatment of Tuberculosis Infection in Children
Authors: Cruz Andrea
Published: October 2017

The last decade has seen publication of more robust data for shorter course regimens for tuberculosis infection. These regimens are associated with higher completion rates than the traditional 6- to 9-month course of daily isoniazid (INH). These shorter regimens include 4 months of daily rifampin (RIF) and 12 once-weekly doses of INH and a long-acting rifamycin and rifapentine. In addition, a widely used regimen in the United Kingdom is 3 or 4 months of daily INH and RIF. All regimens have demonstrated efficacy in the ideal conditions of clinical studies, and all have very low rates of hepatotoxicity in children. These newer regimens likely are more effective than longer courses of INH once patient and family adherence is considered. Clinicians need to be cognizant of poor completion rates with traditional INH therapy and how the use of rifamycin-containing regimens offers more palatable options for children and their families.
Treatment of Multidrug-Resistant Tuberculosis in Children and Adolescents
Authors: Furin Jennifer , Chiang Silvia
Published: October 2017

Although tens of thousands of children and adolescents become sick with multidrug-resistant tuberculosis (MDR-TB) each year, fewer than 1,500 cases documenting treatment have been reported in the literature. Children treated for MDR-TB tend to have excellent clinical outcomes, but they suffer from the adverse events associated with current management strategies. This article will review the recommendations, evidence base, and future directions for MDR-TB therapy in children and adolescents.
Privately practising nurse practitioners' provision of care subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme in Australia: results from a national survey
Authors: Currie Jane , Chiarella Mary , Buckley Thomas
Published: October 2017

Objective Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. Methods PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Results Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n=25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n=55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n=64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included ‘duplication of services’ and ‘level of reimbursement’. Conclusion The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. What is known about the topic? Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. What does this paper add? This paper provides data on PPNPs’ provision of care subsidised through the MBS and PBS. What are the implications for practitioners? Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care.
First Year Introductory Chemistry at the University of Western Australia: Reflections and Perceptions
Authors: Clemons Tristan D. , Bucat Robert B. , Spagnoli Dino
Published: October 2017

This study investigated two student cohorts enrolled in an introductory tertiary chemistry unit designed for students with little or no previous education in chemistry. Emeritus Professor Graham Chandler was instrumental in the design and development of this unit almost 30 years ago. Therefore, this study has particular interest in this special issue of the Australian Journal of Chemistry, which celebrates Emeritus Professor Graham Chandler’s contribution to Australian chemistry. This paper is divided into two distinct parts that provide two unique perspectives of the unit. The first perspective, Part A, is a historical account of the origins of this unit and is based on an interview with E/Prof. Chandler and Dr Peter Simpson OAM. Both E/Prof. Chandler and Dr Simpson provide an excellent reflection on the need for an introductory chemistry unit in tertiary education, which was not as common then as it is in the present day. The second perspective, Part B, is a research study focussing on the perceptions of students taking this unit in 2013 and 2014. In this study, it was found that the number of students who perceived chemistry to be applicable to real world problems increased during the unit, as did the number of students who enjoyed the unit. However, many students, most of whom did not intend to study chemistry further, did not recognise the application of the content to their future careers. There are many similarities between the aims of E/Prof. Chandler and Dr Simpson for the unit and the perceptions of students taking this unit 30 years later, which is testament to Graham’s contribution to chemistry education at the University of Western Australia.
NaCl markedly improved the reproductive capacity of the euhalophyte Suaeda salsa
Authors: Guo Jianrong , Li Yandi , Han Guoliang , Song Jie , Wang Baoshan
Published: October 2017

The effect of NaCl on reproductive development was investigated in euhalophyte Suaeda salsa L. under controlled conditions. Results showed that NaCl promoted the reproductive growth of S. salsa and 200 mM NaCl was optimal. This was reflected in the increases of seed yield, seed number, flower number per plant and leaf axil, 1000 seed weight, as well as a decrease in flower abortion percentage with supply of NaCl. NaCl reduced the flower abortion percentage by increasing stigma receptivity instead of pollen viability. The Na+ and Cl– concentration in petals, stems and leaves were increased significantly but slightly in stamen and pistil. In contrast, the K+ concentration decreased markedly in leaves, stems and petals but a little in stamen and pistil. The Na+ and Cl– concentrations also increased significantly in seed from mother plants exposed to NaCl, whereas K+ decreased. However, seed quality was not influenced. Our results showed that high concentration of NaCl markedly increases the seed number and quality of S. salsa primarily via increasing flower number and fertility and S. salsa develops strategy to maintain ion homeostasis in reproductive organs for the generation. These factors play a pivotal role in setting up plant populations in saline environment.
Protecting cotton crops under elevated CO2 from waterlogging by managing ethylene
Authors: Najeeb Ullah , Tan Daniel K. Y. , Bange Michael P. , Atwell Brian J.
Published: October 2017

Soil waterlogging and subsequent ethylene release from cotton (Gossypium hirsutum L.) tissues has been linked with abscission of developing cotton fruits. This glasshouse study investigates the effect of a 9-day waterlogging event and CO2 enrichment (eCO2, 700 parts per million (ppm)) on a fully linted cultivar ‘Empire’ and a lintless cotton mutant (5B). We hypothesised that cotton performance in extreme environments such as waterlogging can be improved through mitigating ethylene action. Plants were grown at 28 : 20°C day : night temperature, 50–70% relative humidity and a 14 : 10 light : dark photoperiod under natural light and were exposed to waterlogging and eCO2 at early reproductive growth. Ethylene synthesis was inhibited by spraying aminoethoxyvinylglycine (830 ppm) 1 day before waterlogging. Waterlogging significantly increased ethylene release from both cotton genotypes, although fruit production was significantly inhibited only in Empire. Aminoethoxyvinylglycine consistently reduced waterlogging-induced abscission of fruits, mainly in Empire. Limited damage to fruits in 5B, despite increased ethylene production during waterlogging, suggested that fruit abscission in 5B was inhibited by disrupting ethylene metabolism genetically. Elevated CO2 promoted fruit production in both genotypes and was more effective in 5B than in Empire plants. Hence 5B produced more fruits than Empire, providing additional sinks (existing and new fruit) that enhanced the response to CO2 enrichment.
Shadow Value of Ecosystem Resilience in Complex Natural Land as a Wild Pollinator Habitat
Authors: Matsushita Kyohei , Taki Hisatomo , Yamane Fumihiro , Asano Kota
Published: October 2017

This article investigates the shadow value of resilience in complex natural lands acting as wild pollinator habitats. We capture the linkage between pollination services in crop production and habitat conditions in the surrounding natural land with a bioeconomic model. Our case study is buckwheat, which is produced in the hilly and mountainous region of central Japan and is greatly dependent on diverse fauna for pollination services. We model the mechanism of regime shifts in ecosystems consisting of buckwheat fields and the surrounding natural land with a threshold estimation model. We then find that the forest around the crop fields, which serves as a habitat for wild pollinators, is a determinant of an ecological threshold that causes regime shifts. We calculate the shadow value of resilience provided by forest habitat around a unit of buckwheat field to be $9,796, implying that the total value of resilience in complex natural land amounts to half of the stock price of buckwheat land. This overlooked value gives us useful insights on the sustainable use of ecosystems, including both pollinator‐mediated crop fields and habitats for pollinators.
Decentralized and reproducible geocoding and characterization of community and environmental exposures for multisite studies
Authors: Brokamp Cole , Wolfe Chris , Lingren Todd , Harley John , Ryan Patrick
Published: October 2017

Objective

Geocoding and characterizing geographic, community, and environmental characteristics of study participants is frequently done in epidemiological studies. However, participant addresses are identifiable protected health information (PHI) and geocoding must be conducted in a Health Insurance Portability and Accountability Act–compliant manner. Our objective was to create a software application for this process that addresses limitations in current approaches.

Materials and Methods

We used a containerization platform to create DeGAUSS (Decentralized Geomarker Assessment for Multi-Site Studies), a software application that facilitates reproducible geocoding and geomarker assessment while maintaining the confidentiality of PHI. To validate the software, 215 350 addresses in Hamilton County, Ohio, were geocoded using DeGAUSS, ArcGIS, Google, and SAS and compared to a gold-standard approach. We distributed the DeGAUSS software to sites in an ongoing multisite study (Electronic Medical Records and Genomics, or eMERGE), and individual sites independently geocoded and assigned median census tract–level income and distance to nearest major roadway to their participants’ addresses, removed associated PHI, and returned deidentified data.

Results

Within a multisite study, 52 244 study participants’ addresses across 5 sites were geocoded with a median distance to roadway of 10 022m and a median census tract income of $57 266, demonstrating the feasibility of DeGAUSS within a multisite study. Compared to other commonly used geocoding platforms, DeGAUSS had similar geocoding and geomarker assessment accuracies.

Conclusion

The open source DeGAUSS software overcomes multiple challenges in the use of address data in multisite studies and also serves as a more general reproducible research tool for geocoding and geomarker assessment.
Records of auroral candidates and sunspots in Rikkokushi, chronicles of ancient Japan from early 7th century to 887
Authors: Hayakawa Hisashi , Iwahashi Kiyomi , Tamazawa Harufumi , Ebihara Yusuke , Kawamura Akito Davis , Isobe Hiroaki , Namiki Katsuko , Shibata Kazunari
Published: October 2017

We present the results of the surveys on sunspots and auroral candidates in Rikkokushi, Japanese official histories from the early 7th century to 887, to review the solar and auroral activities. In total, we found one sunspot record and 13 auroral candidates in Rikkokushi. We then examine the records of the sunspots and auroral candidates, compare the auroral candidates with the lunar phase to estimate their reliability, and compare the records of the sunspots and auroral candidates with the contemporary total solar irradiance reconstructed from radioisotope data. We also identify the locations of the observational sites to review possible equatorward expansion of the auroral oval. These discussions suggest a major gap in auroral candidates from the late 7th to early 9th centuries, which includes the candidate of the grand minimum reconstructed from the radioisotope data, a similar tendency as the distributions of sunspot records in contemporary China, and a relatively high magnetic latitude of observational sites with a higher potential for observing aurorae more frequently than at present.
The domestic politics of corporate accountability legislation: struggles over the 2015 UK Modern Slavery Act
Authors: LeBaron Genevieve , Rühmkorf Andreas
Published: October 2017

Over the last decade, the norm of corporate accountability for labour standards in global supply chains has become increasingly prominent within the transnational governance arena. As global governance initiatives to spur due diligence for labour standards and combat exploitation in global supply chains—especially its most severe forms frequently described as modern slavery—have proliferated, societal coalitions have pressured states to pass domestic legislation to the same effect. In this article, we examine the regulatory processes that spurred the passage of one piece of anti-slavery legislation, the UK’s 2015 Modern Slavery Act. Our findings corroborate a number of established expectations regarding business opposition towards new legislation to raise public labour standards, but also provide a clearer picture of the mechanisms through which industry actors impact policymaking processes. Paradoxically, such mechanisms include business actors’ championing of weak regulatory initiatives, CSR activity and partnering with civil society organizations. Understanding industry actors’ use of these strategies improves our understanding of how transnational norms of corporate accountability and anti-slavery are being contested and shaped at domestic scales.
Effects of Hypercapnia on Acute Cellular Rejection after Lung Transplantation in Rats
Authors: Tan Jing , Liu Yanhong , Jiang Tao , Wang Ling , Zhao Can , Shen Dongfang , Cui Xiaoguang
Published: October 2017

Background

Hypercapnia alleviates pulmonary ischemia–reperfusion injury, regulates T lymphocytes, and inhibits immune reaction. This study aimed to evaluate the effect of hypercapnia on acute cellular rejection in a rat lung transplantation model.

Methods

Recipient rats in sham-operated (Wistar), isograft (Wistar to Wistar), and allograft (Sprague–Dawley to Wistar) groups were ventilated with 50% oxygen, whereas rats in the hypercapnia (Sprague–Dawley to Wistar) group were administered 50% oxygen and 8% carbon dioxide for 90 min during reperfusion (n = 8). Recipients were euthanized 7 days after transplantation.

Results

The hypercapnia group showed a higher oxygenation index (413 ± 78 vs. 223 ± 24), lower wet weight-to-dry weight ratio (4.23 ± 0.54 vs. 7.04 ± 0.80), lower rejection scores (2 ± 1 vs. 4 ± 1), and lower apoptosis index (31 ± 6 vs. 57 ± 4) as compared with the allograft group. The hypercapnia group showed lower CD8 (17 ± 4 vs. 31 ± 3) and CD68 (24 ± 3 vs. 43 ± 2), lower CD8+ T cells (12 ± 2 vs. 35 ± 6), and higher CD4/CD8 ratio (2.2 ± 0.6 vs. 1.1 ± 0.4) compared to the allograft group. Tumor necrosis factor-α (208 ± 40 vs. 292 ± 49), interleukin-2 (30.6 ± 6.7 vs. 52.7 ± 8.3), and interferon-γ (28.1 ± 4.9 vs. 62.7 ± 10.1) levels in the hypercapnia group were lower than those in allograft group. CD4, CD4+ T cells, and interleukin-10 levels were similar between groups.

Conclusions

Hypercapnia ameliorated acute cellular rejection in a rat lung transplantation model.
Prevalence of Potentially Distracting Noncare Activities and Their Effects on Vigilance, Workload, and Nonroutine Events during Anesthesia Care
Authors: Slagle Jason M. , Porterfield Eric S. , Lorinc Amanda N. , Afshartous David , Shotwell Matthew S. , Weinger Matthew B.
Published: October 2017

Background

When workload is low, anesthesia providers may perform non–patient care activities of a clinical, educational, or personal nature. Data are limited on the incidence or impact of distractions on actual care. We examined the prevalence of self-initiated nonclinical distractions and their effects on anesthesia workload, vigilance, and the occurrence of nonroutine events.

Methods

In 319 qualifying cases in an academic medical center using a Web-based electronic medical chart, a trained observer recorded video and performed behavioral task analysis. Participant workload and response to a vigilance (alarm) light were randomly measured. Postoperatively, participants were interviewed to elicit possible nonroutine events. Two anesthesiologists reviewed each event to evaluate their association with distractions.

Results

At least one self-initiated distraction was observed in 171 cases (54%), largely during maintenance. Distractions accounted for 2% of case time and lasted 2.3 s (median). The most common distraction was personal internet use. Distractions were more common in longer cases but were not affected by case type or American Society of Anesthesiologists physical status. Workload ratings were significantly lower during distraction-containing case periods and vigilance latencies were significantly longer in cases without any distractions. Three distractions were temporally associated with, but did not cause, events.

Conclusions

Both nurse anesthetists and residents performed potentially distracting tasks of a personal and/or educational nature in a majority of cases. Self-initiated distractions were rarely associated with events. This study suggests that anesthesia professionals using sound judgment can self-manage nonclinical activities. Future efforts should focus on eliminating more cognitively absorbing and less escapable distractions, as well as training in distraction management.
Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial*
Authors: Okonkwo David O. , Shutter Lori A. , Moore Carol , Temkin Nancy R. , Puccio Ava M. , Madden Christopher J. , Andaluz Norberto , Chesnut Randall M. , Bullock M. Ross , Grant Gerald A. , McGregor John , Weaver Michael , Jallo Jack , LeRoux Peter D. , Moberg Dick , Barber Jason , Lazaridis Christos , Diaz-Arrastia Ramon R.
Published: October 2017

Objectives:

A relationship between reduced brain tissue oxygenation and poor outcome following severe traumatic brain injury has been reported in observational studies. We designed a Phase II trial to assess whether a neurocritical care management protocol could improve brain tissue oxygenation levels in patients with severe traumatic brain injury and the feasibility of a Phase III efficacy study.

Design:

Randomized prospective clinical trial.

Setting:

Ten ICUs in the United States.

Patients:

One hundred nineteen severe traumatic brain injury patients.

Interventions:

Patients were randomized to treatment protocol based on intracranial pressure plus brain tissue oxygenation monitoring versus intracranial pressure monitoring alone. Brain tissue oxygenation data were recorded in the intracranial pressure –only group in blinded fashion. Tiered interventions in each arm were specified and impact on intracranial pressure and brain tissue oxygenation measured. Monitors were removed if values were normal for 48 hours consecutively, or after 5 days. Outcome was measured at 6 months using the Glasgow Outcome Scale–Extended.

Measurements and Main Results:

A management protocol based on brain tissue oxygenation and intracranial pressure monitoring reduced the proportion of time with brain tissue hypoxia after severe traumatic brain injury (0.45 in intracranial pressure–only group and 0.16 in intracranial pressure plus brain tissue oxygenation group; p < 0.0001). Intracranial pressure control was similar in both groups. Safety and feasibility of the tiered treatment protocol were confirmed. There were no procedure-related complications. Treatment of secondary injury after severe traumatic brain injury based on brain tissue oxygenation and intracranial pressure values was consistent with reduced mortality and increased proportions of patients with good recovery compared with intracranial pressure–only management; however, the study was not powered for clinical efficacy.

Conclusions:

Management of severe traumatic brain injury informed by multimodal intracranial pressure and brain tissue oxygenation monitoring reduced brain tissue hypoxia with a trend toward lower mortality and more favorable outcomes than intracranial pressure–only treatment. A Phase III randomized trial to assess impact on neurologic outcome of intracranial pressure plus brain tissue oxygenation–directed treatment of severe traumatic brain injury is warranted.
Blood Perfusion in Human Eyelid Skin Flaps Examined by Laser Speckle Contrast Imaging—Importance of Flap Length and the Use of Diathermy
Authors: Nguyen Cu Dinh , Hult Jenny , Sheikh Rafi , Tenland Kajsa , Dahlstrand Ulf , Lindstedt Sandra , Malmsjö Malin
Published: October 2017

Purpose:

It is well known that blood perfusion is important for the survival of skin flaps. As no study has been conducted to investigate how the blood perfusion in human eyelid skin flaps is affected by the flap length and diathermy, the present study was carried out to investigate these in patients.

Methods:

Fifteen upper eyelids were dissected as part of a blepharoplastic procedure, releasing a 30-mm long piece of skin, while allowing the 5 mm wide distal part of the skin to remain attached, to mimic a skin flap (hereafter called a “skin flap”). Blood perfusion was measured before and after repeated diathermy, using laser speckle contrast imaging.

Results:

Blood perfusion decreased from the base to the tip of the flap: 5 mm from the base, the perfusion was 69%, at 10 mm it was 40%, at 15 mm it was 20%, and at 20 mm it was only 13% of baseline values. Diathermy further decreased blood perfusion (measured 15 mm from the base) to 13% after applying diathermy for the first time, to 6% after the second and to 4% after the third applications of diathermy.

Conclusions:

Blood perfusion falls rapidly with distance from the base of skin flaps on the human eyelid, and diathermy reduces blood perfusion even further. Clinically, it may be advised that flaps with a width of 5 mm be no longer than 15 mm (i.e., a width:length ratio of 1:3), and that the use of diathermy should be carefully considered.
In-Office Sutureless Correction of Prolapsed Subconjunctival Orbital Fat
Authors: Raparia Eva , Rafailov Leon , Shinder Roman
Published: October 2017

Purpose:

To describe a minimally invasive, sutureless, small incision surgical technique for the treatment of subconjunctival orbital fat prolapse (SOFP) performed using local anesthesia in an office setting.

Methods:

Retrospective study of the surgical outcome of 45 patients with either bilateral or unilateral SOFP treated by a single surgeon (R.S.) between July 2010 and February 2015.

Results:

Forty-five patients (39 male, 6 female) had a mean age of 67 years. Fat prolapse was bilateral in 23 patients (51%). A total of 68 eyes were operated on. All surgeries were without any intra- or postoperative complications such as infection, dry-eye symptoms, ocular motility impairment, or recurrence with a mean follow up of 37 months. All patients had a favorable postoperative cosmetic improvement.

Conclusions:

The authors propose an office-based, cost-effective, minimally invasive, sutureless technique for treating SOFP with local anesthesia in a safe and effective manner. The lack of complications or recurrence with an adequate follow-up period following this technique is encouraging. Surgeons should consider this technique in the surgical correction of SOFP.
Long-Term Safety of Using Local Anesthetic Injections in Professional Rugby League for Modified Indications
Authors: Sebak Safaa , Orchard John W. , Golding Leigh D. , Steet Elizabeth , Brennan Steph A. , Ibrahim Ameer
Published: October 2017

Objective:

To assess and evaluate the long-term safety of local anesthetic injections before or during games in professional rugby league players.

Design:

Retrospective case series.

Setting:

Professional rugby league team.

Participants:

Sydney Roosters players over a 6-year period (2008-2013), who had been administered a local anesthetic injection for an injury before or during a match to aid return to play.

Interventions:

Follow-up survey (no active intervention).

Main Outcome Measures:

Player self-reported satisfaction. Survey results were compared with a previous cohort who had received local anesthetic injection from 1998 to 2007.

Results:

Thirty-two players who had been injected with local anesthetic on 249 occasions for 81 injuries completed the current survey at an average of 5.64 years postinjection. In the cohort of 2008 to 2013, fewer injections were performed to areas deemed higher risk compared with the 1998 to 2007 cohort (P < 0.00002). The vast majority of players (80/81 cases) would repeat the injection in the same circumstances and reported that ongoing side effects were uncommon. There were 6 cases (8%) in which players reported significant ongoing pain in the area of injection at long-term follow-up.

Conclusions:

This study affirmed the long-term safety of injections in most cases.

Level of Evidence:

IV.
Driveline Site Is Not a Predictor of Infection After Ventricular Assist Device Implantation
Authors: Martin Billie-Jean , Luc Jessica G.Y. , Maruyama Michiko , MacArthur Roderick , Bates Angela R. , Buchholz Holger , Freed Darren H. , Conway Jennifer
Published: October 2017

Driveline infections (DLIs) remain a major source of morbidity for patients requiring long-term ventricular assist device (VAD) support. We aimed to assess whether VAD driveline exit site (DLES) (abdomen versus chest wall) is associated with DLI. All adult patients who underwent insertion of a HeartWare HVAD or HeartMate II (HMII) between 2009 and 2016 were included. Driveline infection was defined as clinical evidence of DLI accompanied by a positive bacterial swab and need for antibiotics. Competing risks analysis was used to assess the association between patient characteristics and DLI. Ninety-two devices (59 HMII) were implanted in 85 patients (72 men; median age 57.4 years) for bridge to transplant or destination therapy. VAD DLES was chest in 28 (30.4%) devices. Median time on VAD support was 347.5 days (IQR 145.5, 757.5), with 28 transplants and 29 deaths (27 on device). DLI occurred in 24 patients (25 devices) at a median of 140 days (IQR 67, 314) from implant. Staphylococcus aureus accounted for 15 infections (60%). Freedom from infection was 72.8% (95% confidence interval [CI] 53.1–78.0%) at 1 year and 41.9% (95% CI 21.1–61.5%) at 3 years. In competing risks regression, abdominal DLES was not predictive of DLI (hazard ratio, HR 1.65 [95% CI 0.63, 4.29]), but body mass index (BMI) >30 kg/m2 was (HR 2.72 [95% CI 1.25, 5.92]). In conclusion, risk of DLI is high among patients on long-term VAD support, and a nonabdominal DLES does not reduce this risk. The only predictor of DLI in this series was an elevated BMI.
Acute kidney injury in trauma patients
Authors: Harrois Anatole , Libert Nicolas , Duranteau Jacques
Published: October 2017

Purpose of review

To review epidemiology and pathophysiology of acute kidney injury (AKI) in trauma patients and propose strategies that aim at preventing AKI after trauma.

Recent findings

AKI in trauma patients has been reported to be as frequent as 50% with an association to a prolonged length of stay and a raise in mortality. Among the specific risk factors encountered in trauma patients, hemorrhagic shock, rhabdomyolysis severity, age, and comorbidities are independently associated with AKI occurrence. Resuscitation with balanced solutes seems to have beneficial effects on renal outcome compared with NaCl 0.9%, particularly in the context of rhabdomyolysis. However, randomized clinical studies are needed to confirm this signal. Abdominal compartment syndrome (ACS) is rare but has to be diagnosed to initiate a dedicated therapy.

The high incidence of AKI in trauma patients should lead to early identification of those at risk of AKI to establish a resuscitation strategy that aims at preventing AKI.
Damage control surgery: current state and future directions
Authors: Benz Daniel , Balogh Zsolt J.
Published: October 2017

Purpose of review

Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and postinjury-induced coagulopathy, the indications for DCS have expanded to the management of extra abdominal trauma and to the management of nontraumatic acute abdominal emergencies. Despite being an accepted treatment algorithm, DCS is based on a limited evidence with current concerns of the variability in practice indications, rates and adverse outcomes in poorly selected patient cohorts.

Recent findings

Recent efforts have attempted to synthesize evidence-based indication to guide clinical practice. Significant progress in trauma-based resuscitation techniques has led to improved outcomes in injured patients and a reduction in the requirement of DCS techniques.

DCS remains an important treatment strategy in the management of specific patient cohorts. Continued developments in early trauma care will likely result in a further decline in the required use of DCS in severely injured patients.
Rotational therapy in thoracic injuries: what is the evidence?
Authors: Störmann Philipp , Marzi Ingo , Wutzler Sebastian
Published: October 2017

Purpose of review

To review the current use of continuous lateral rotational therapy (CLRT) in patients with thoracic injuries and its impact on clinical course, complications and outcome.

Recent findings

Patient positioning is a key factor in the treatment of severe thoracic injuries and CLRT, and intermittent supine and prone position are basic options. There is a lack of randomized controlled studies for trauma patients with chest injury undergoing kinetic therapy as standard of care. A positive effect of kinetic therapy for prevention of secondary respiratory complications has been reported; nevertheless, no positive effect on mortality or length of hospital stay could be affirmed so far. In general, standardized therapeutic regimes for treatment of chest trauma have been implemented, including ventilator settings and positioning therapy. However, the available data do not allow a clear recommendation for rotational/kinetic therapy or prone positioning as superior or inferior.

The benefit of changing the patients’ position for secret mobilization and recruitment of atelectasis after chest trauma and therefore preventing secondary complications seems to be self-evident. Since only few studies report about the utility of CLRT in critically ill chest trauma patients, randomized controlled multicenter trials are necessary to analyze the overall benefit of such means.
Hospital-Community Partnerships to Aid Transitions for Older Adults
Authors: Hung Dorothy , Truong Quan , Yakir Maayan , Nicosia Francesca
Published: October 2017

This study examined the implementation and hospitalwide scaling of a community-based transitional care program to reduce readmissions among adults 65 years or older. Our analysis was guided by the Care Transitions Framework and was based on semistructured interviews with program implementers to identify intervention successes, barriers, and outcomes beyond reducing readmissions. Such outcomes included the program's critical role in providing a safety net and transition to more advanced care, and redefining intervention success from more patient-centered perspectives.
Effectiveness of a Multifaceted Delirium Screening, Prevention, and Treatment Initiative on the Rate of Delirium Falls in the Acute Care Setting
Authors: Ferguson Alice , Uldall Karina , Dunn Jessica , Blackmore Christopher Craig , Williams Barbara
Published: October 2017

Delirium is a potentially modifiable fall risk factor, but few studies address the effects of delirium programs on falls. Beginning in 2011, we implemented a nursing-driven hospitalwide delirium program targeting improvements in risk identification, prevention, detection, and treatment. Over the course of the program, delirium falls decreased from 0.91 to 0.50 per patient day (P = .0002). A decrease in overall falls was also noted (P = .0007).
High Baseline Anal Human Papillomavirus and Abnormal Anal Cytology in a Phase 3 Trial of the Quadrivalent Human Papillomavirus Vaccine in Human Immunodeficiency Virus–Infected Individuals Older Than 26 Years: ACTG 5298
Authors: Cranston Ross D. , Cespedes Michelle S. , Paczuski Pawel , Yang Ming , Coombs Robert W. , Dragavon Joan , Saah Alfred , Godfrey Catherine , Webster-Cyriaque Jennifer Y. , Chiao Elizabeth Y. , Bastow Barbara , Wilkin Timothy
Published: October 2017

Background

The quadrivalent human papillomavirus (HPV) vaccine (qHPV; types 6, 11, 16, 18) is indicated for men and women aged 9 to 26 years to prevent HPV associated anogenital high-grade squamous intraepithelial lesions (HSIL) and cancer. ACTG 5298 was a randomized placebo controlled Phase 3 study in human immunodeficiency virus (HIV)-infected men who have sex with men, and women of qHPV to prevent persistent anal HPV infection. Baseline data are presented here.

Methods

Human immunodeficiency virus–infected men who have sex with men, and women 27 years or older without previous anogenital or oral cancer were enrolled. Baseline anal cytology, high-resolution anoscopy and collection of anal, oral, and vaginal specimens for HPV genotyping were performed and acceptability assessed.

Results

Five hundred seventy-five (575) participants were enrolled (82% men and 18% women). Median age was 47 years. Race/ethnicity was 46% white, 31% black, and 20% Hispanic. Plasma HIV-1 RNA was less than 50 copies/mL in 83% and median CD4 T count was 602 cells/μL. Abnormal anal cytology was detected in 62%, with corresponding HSIL on biopsy (bHSIL) in 33%. Anal HPV 6, 11, 16, and 18 were detected in 25%, 13%, 32%, and 18% of the participants, respectively. Prevalence of 0, 1, 2, 3, and 4 qHPV types was 40%, 38%, 17%, 4%, and 1%, respectively. Oral infection with 1 or more qHPV type was detected in 10% of the participants. Study procedures were generally acceptable.

Conclusions

At study baseline, there was a high prevalence of abnormal anal cytology, bHSIL, and HPV infection. Sixty percent of the participants had anal infection with preventable qHPV types.
Effect of Scattering and Aberrations on Visual Acuity for Band Keratopathy
Authors: Kamiya Kazutaka , Kobashi Hidenaga , Takahashi Masahide , Shoji Nobuyuki , Shimizu Kimiya
Published: October 2017

SIGNIFICANCE

The progressive accumulation of the calcification may deteriorate corneal transparency, especially in the interpalpebral area, and subsequent visual performance for patients with band keratopathy. However, the detailed quantitative analysis of light scattering or higher-order aberrations on visual performance for these patients so far has not been elucidated.

PURPOSE

The aim of this study was to assess the relationship of intraocular forward scattering, corneal backward scattering, and corneal higher-order aberrations with visual acuity in eyes with band keratopathy.

METHODS

This prospective study comprised 27 eyes of 27 consecutive patients who were diagnosed as having band keratopathy and age-matched 27 eyes of 27 healthy subjects. We quantitatively assessed objective scattering index using the double-pass instrument (Optical Quality Analysis System II; Visiometrics, Terrassa, Spain), corneal densitometry using the Scheimpflug rotating camera (Pentacam HR; Oculus, Wetzlar, Germany), and corneal higher-order aberrations using the Hartmann-Shack aberrometry (KR-9000; Topcon, Tokyo, Japan).

RESULTS

The mean objective scattering index, corneal densitometry, corneal higher-order aberrations, and logarithm of the minimal angle of resolution (logMAR) visual acuity in eyes with band keratopathy were 5.14 ± 3.11, 36.42 ± 10.55 gray-scale units, 0.33 ± 0.10 μm, and 0.03 ± 0.11 logMAR, respectively. These parameters were significantly larger in the band keratopathy group than in those in the control group (Mann-Whitney U test, P < .001). We found significant correlations of visual acuity with the objective scattering index (Spearman correlation coefficient, r = 0.465, P = .015), but no significant association with the corneal densitometry (r = 0.082, P = .683) or with corneal higher-order aberrations (r = −0.073, P = .718), in eyes having band keratopathy.

CONCLUSIONS

Intraocular forward scattering, corneal backward scattering, and corneal higher-order aberrations in eyes with band keratopathy were significantly higher than those in normal eyes. Visual acuity was significantly correlated with intraocular forward scattering, but not with corneal backward scattering or corneal aberrations in the band keratopathy group, suggesting that intraocular forward scattering plays a vital role in visual performance in eyes with band keratopathy.
Randomized Trial of Desktop Humidifier for Dry Eye Relief in Computer Users
Authors: Wang Michael T. M. , Chan Evon , Ea Linda , Kam Clifford , Lu Yvonne , Misra Stuti L. , Craig Jennifer P.
Published: October 2017

SIGNIFICANCE

Dry eye is a frequently reported problem among computer users. Low relative humidity environments are recognized to exacerbate signs and symptoms of dry eye, yet are common in offices of computer operators. Desktop USB-powered humidifiers are available commercially, but their efficacy for dry eye relief has not been established.

PURPOSE

This study aims to evaluate the potential for a desktop USB-powered humidifier to improve tear-film parameters, ocular surface characteristics, and subjective comfort of computer users.

METHODS

Forty-four computer users were enrolled in a prospective, masked, randomized crossover study. On separate days, participants were randomized to 1 hour of continuous computer use, with and without exposure to a desktop humidifier. Lipid-layer grade, noninvasive tear-film breakup time, and tear meniscus height were measured before and after computer use. Following the 1-hour period, participants reported whether ocular comfort was greater, equal, or lesser than that at baseline.

RESULTS

The desktop humidifier effected a relative difference in humidity between the two environments of +5.4 ± 5.0% (P < .001). Participants demonstrated no significant differences in lipid-layer grade and tear meniscus height between the two environments (all P > .05). However, a relative increase in the median noninvasive tear-film breakup time of +4.0 seconds was observed in the humidified environment (P < .001), which was associated with a higher proportion of subjects reporting greater comfort relative to baseline (36% vs. 5%, P < .001).

CONCLUSIONS

Even with a modest increase in relative humidity locally, the desktop humidifier shows potential to improve tear-film stability and subjective comfort during computer use.

Trial registration no: ACTRN12617000326392.
The Fate of the Adipose-Derived Stromal Cells during Angiogenesis and Adipogenesis after Cell-Assisted Lipotransfer
Authors: Hong Ki Yong , Yim Sangjun , Kim Hyun Jung , Jin Ung Sik , Lim SooA , Eo SuRak , Chang Hak , Minn Kyung Won
Published: October 2017

Background:

Cell-assisted lipotransfer is a process in which fat grafting is supplemented with autologous adipose-derived stromal cells. Since the efficacy of the technique was demonstrated, studies have focused on the mechanism by which cell-assisted lipotransfer enhances the rate of graft survival. However, the microenvironmental changes in donor and recipient tissue associated with cell-assisted lipotransfer remain unclear.

Methods:

The authors introduced an animal model of cell-assisted lipotransfer using two different transgenic reporter mice. Donor fat from green fluorescent protein–expressing C57BL/6J mice and donor adipose-derived stromal cells from DsRed-expressing C57BL/6J mice were co-transplanted into recipient C57BL/6J mice. During adipose remodeling after cell-assisted lipotransfer, the fate of each donor adipocyte and donor adipose-derived stromal cell was traced using immunofluorescent staining with the whole-mount method.

Results:

Adipose-derived stromal cell supplementation altered inflammation and promoted angiogenesis and subsequent revascularization in recipient tissue. Tracing at postoperative week 4 revealed that surviving donor adipose-derived stromal cells participated in angiogenesis by differentiating into endothelial cells. Moreover, newly differentiated fat from donor adipose-derived stromal cells and recipient tissue integrated with surviving donor fat, leading to improved retention of the graft. Adipose-derived stromal cell supplementation resulted in a quantitative difference in angiogenesis and adipogenesis during adipose remodeling according to the concentration of adipose-derived stromal cells.

Conclusions:

The authors characterized the dynamic changes occurring in donor adipose-derived stromal cells and fat and recipient tissue by tracing these cellular components following cell-assisted lipotransfer. The authors’ findings highlight the therapeutic value of cell-assisted lipotransfer in tissue transplantation.