bluuebunny/crossref_metadata_2025 huggingface dataset:
Approach to cutaneous vasculitides with special emphasis on small vessel vasculitis: histopathology and direct immunofluorescence
Authors: Demirkesen Cuyan
Published: October 2016

Purpose of review

The present review will focus on recent publications in cutaneous vasculitides.

Recent findings

Some histopathological and clinical features, such as papillary dermal edema, perivascular C3 deposition, clinically evident edema, and lesions above the waist, may point out renal or gastrointestinal involvement in Henoch–Schönlein purpura (HSP). HSP associated with familial Mediterranean fever differs from typical isolated HSP by showing no deposits of IgA, much younger age, and location of the lesions on the face or the trunk. Single-organ cutaneous small vessel vasculitis is a more restricted entity than hypersensitivity vasculitis and HSP. Because cutaneous polyarteritis nodosa and macular lymphocytic arteritis share some clinicopathologic features, the question is raised whether they are not two different entities. Several histopathological features defining IgG4-related disease are found in granuloma faciale and erythema elevatum diutinum, two localized chronic cutaneous vasculitis; however, in a recent series no diagnostic criteria for IgG4-related disease was detected in them.

When a patient presents with skin lesions, in which necrotizing or leukocytoclastic vascuitis is confirmed histologically, irrespective of the size of the affected vessel, the possibility of systemic vasculitis, an infection, medication, or a systemic disease such as systemic lupus erythematosus must be searched before reaching definitive diagnosis.
Cervical Decompression Surgery for Cervical Spondylotic Myelopathy and Concomitant Hypertension
Authors: Yang Liang , Yang Cheng , Pang Xiaodong , Li Duanming , Chen Xiongsheng , Shi Jiangang , Zhou Xuhui , Wu Ye , Lu Xiang , Yang Hong , Jia Lianshun , Peng Baogan
Published: October 2016

Study Design.

We performed decompression surgery or conservative treatments on 135 cervical spondylotic myelopathy (CSM) patients with concomitant hypertension and did follow-up assessments up to 1 year to examine the change of blood pressure, spinal cord function, and cervical pain.

Objective.

The aim of this study was to determine whether concomitant hypertension is relieved after decompression surgery, and whether it is related to the improvement of spinal cord function or cervical pain.

Summary of Background Data.

In clinical practice, we often found that some patients with CSM have concomitant hypertension. Interestingly, after CSM was treated successfully by decompression surgery, some patients’ high blood pressure returned to normal range even without oral medications.

Methods.

We enrolled 135 CSM patients with hypertension, 103 of whom received decompression surgery, and remaining 32 patients accepted conservative treatments. We did follow-up assessments at 3, 6, and 12 months. The primary endpoints were changes of blood pressure, and secondary endpoints were changes of modified Japanese Orthopedic Association (mJOA) score and cervical pain visual analogue scale (VAS). Spearman correlation coefficients were calculated between changes in systolic blood pressure (SBP) and mJOA scores, VAS scores.

Results.

In patients with decompression surgery, the significant decrease in both SBP and diastolic blood pressure (DBP) that was seen 3 months and sustained through subsequent visit at 12 months. Paired-samples t test showed that both SBP and DBP were significantly lower than baseline blood pressure at all time points after procedure (P < 0.001). Significant correlation was found between the improvement rates of mJOA score and changes in SBP (r = −0.579, P < 0.001). But the correlation between changes in VAS score and changes in SBP was not significant (r = 0.58, P = 0.571).

Conclusion.

Cervical decompression surgery could reduce concomitant high blood pressure in CSM patients, indicating a significant association between the decrease in blood pressure and the improvement of spinal cord function.

Level of Evidence: 2
Restrained Differential Growth
Authors: Crijns Tom Joris , Stadhouder Agnita , Smit Theodoor Henri
Published: October 2016

Study Design.

An experimental model study and a short review of literature.

Objective.

The purpose of this study was to explore a new hypothesis suggesting that the curvatures seen in adolescent idiopathic scoliosis (AIS) originate from restrained differential growth between the vertebral column and the surrounding musculo-ligamentary structures.

Summary of Background Data.

Despite decades of research, there is no generally accepted theory on the physical origin of the severe spinal deformations seen in AIS. The prevailing theories tend to focus on left-right asymmetry, rotational instability, or the sagittal spinal profile in idiopathic scoliosis.

Methods.

We test our hypothesis with a physical model of the spine that simulates growth, counteracted by ligaments and muscles, modeled by tethers and springs. Growth of the spine is further restrained by an anterior band representing the thorax, the linea alba, and abdominal musculature. We also explore literature in search of molecular mechanisms that may induce differential growth.

Results.

Differential growth in the restrained spine model first induces hypokyphosis and mild lateral bending of the thoracic spine, but then suddenly escalates into a scoliotic deformity, consistent with clinical observations of AIS. The band simulating the ventral structures of the body had a pivotal effect on sagittal curvature and the initiation of lateral bending and rotation. In literature, several molecular mechanisms were found that may explain the occurrence of differential growth between the spine and the musculo-ligamentary structures.

Conclusion.

While AIS is a three-dimensional deformation of the spine, it appears that restrained differential growth in the sagittal plane can result in lateral bending and rotation without a pre-existing left-right asymmetry. This supports the concept that AIS may result from a growth imbalance rather than a local anatomical defect.

Level of Evidence: N/A
Minimum Clinically Important Difference and Substantial Clinical Benefit in Pain, Functional, and Quality of Life Scales in Failed Back Surgery Syndrome Patients
Authors: Park Ki Byung , Shin Joon-Shik , Lee Jinho , Lee Yoon Jae , Kim Me-riong , Lee Jun-Hwan , Shin Kyung-Min , Shin Byung-Cheul , Cho Jae-Heung , Ha In-Hyuk
Published: October 2016

Study Design..

Prospective observational 1-year study.

Objective..

To determine minimum clinically important difference (MCID) and substantial clinical benefit (SCB) of outcome measures in failed back surgery syndrome (FBSS) patients, as these metrics enable assessment of whether and when an intervention produces clinically meaningful effects in a patient.

Summary of Background Data..

Several methods have been devised to quantify clinically important difference, but MCID and SCB for FBSS patients has yet to be determined.

Methods..

Patients with persisting/recurrent low back pain (LBP) and/or leg pain after lumbar surgery who completed 16 weeks of treatment (n = 105) at two hospitals in Korea from November 2011 to September 2014 were analyzed. Global perceived effect was used to determine receiver operating characteristic curves in visual analogue scale (VAS), Oswestry disability index (ODI), and short form-36 (SF-36) in an anchor-based approach.

Results..

MCIDs for ODI, LBP and leg pain VAS, physical component summary, mental health component summary (MCS), and overall health scores of SF-36 were 9.0, 22.5, 27.5, 10.2, 4.0, and 8.9, and SCBs were 15.0, 32.5, 37.0, 19.7, 19.3, and 21.1, respectively. MCID and SCB area under the curve was ≥0.8, and ≥0.7, respectively.

Conclusion..

LBP and leg pain VAS, ODI, and physical component summary of SF-36 may be used to measure responsiveness in FBSS patients.

Level of Evidence: 3
Comparison of Three Surgical Approaches for Thoracic Spinal Tuberculosis in Adult
Authors: Wang Long-jie , Zhang Hong-qi , Tang Ming-xing , Gao Qi-le , Zhou Zhen-hai , Yin Xin-hua
Published: October 2016

Study Design.

Retrospective study.

Objective.

To assess the minimum 5-year follow up outcomes of the surgical management of adults with thoracic tuberculosis by comparing posterior only (PO), anterior only (AO), and combined posterior and anterior (AP) surgical approaches.

Summary of Background Data.

Surgeons use multiple methods to treat spinal tuberculosis, including an anterior, posterior, and combined anterior and posterior approach. However, there are a few reports comparing the mid- and long-term outcomes of these surgical methods.

Methods.

The medical records for 184 patients treated for thoracic tuberculosis between January 2003 and November 2010 were retrospectively reviewed. Among them, 62 patients were treated with a single-stage posterior debridement and interbody fusion with instrumentation (Group A), 65 patients with posterior instrumentation, anterior debridement, and bone graft in a single or two-stage procedure (Group B), and 57 patients with anterior debridement and strut grafting with instrumentation (Group C). Operative time, blood loss, Visual Analog Scale for pain, complications, recovery of neurological function, Cobb angle, correction rate, and loss angle were compared among all groups.

Results.

Groups A, B, and C were followed for 72.7 ± 3.8 months, 74.3 ± 4.2 months, and 73.6 ± 4.5 months, respectively. The operative time, blood loss, and rate of complications for Group A were significantly less than Groups B and C (P < 0.05). The correction rate and loss angle were superior in Groups A and B compared with C, whereas the Visual Analog Scale for pain and fusion time showed no statistically significant difference among the groups (P > 0.05).

Conclusion.

For patients with thoracic tuberculosis, use of the AO approach should be limited. Although the AP approach produced satisfactory outcomes, it remains more traumatic. Therefore, the PO approach is recommended, not only because it achieves good results, but because it has reduced complications, operative time, and blood loss.

Level of Evidence: 3
Nurses’ Use of iPads in Home Care—What Does It Mean to Patients?
Authors: Vilstrup Dorte Lindstrøm , Madsen Esben Elholm , Hansen Christl Fandt , Wind Gitte
Published: October 2016

Although the use of technology is growing, little is known about how patients perceive technology in the form of tools used by health professionals. The prevailing view in the literature is that technology is cold, compared with the warm hands of nurses, but research regarding nurses’ use of technology such as tablets is scarce. Even scarcer is research on how patients perceive the use of technological tools. This study examines patients’ perspectives on the use of iPads by home care nurses. Semistructured interviews were conducted with seven participants who were receiving home care in Denmark, aged 62 to 90 years, with different backgrounds and experiences with technology. Participants viewed nurses’ use of iPads as an everyday occurrence, reflecting societal growth in the use of technology, and some perceived it as a sign of professionalism with the potential to enhance care. Their perceptions varied somewhat according to their baseline knowledge and experience with the technology. Although nurses may view technology as cold, the findings suggest that patients have a slightly warmer view of it. More patient-centered research into the use of technology in healthcare is needed.
Family planning and the Zika era
Authors: Goldthwaite Lisa M. , Velasquez Griselda
Published: October 2016

Purpose of review

To review the current evidence regarding the impact of the Zika virus epidemic on pregnancy and the implications for family planning and reproductive health services for women in affected countries.

Recent findings

In the past 2 years, over the course of the Zika epidemic, much has been learned about the virus. Specifically in regard to pregnancy, a causative relationship has been established between the Zika virus and adverse fetal outcomes, and sexual transmission of the virus has been documented. Broad recommendations by government agencies and public health officials regarding avoidance of pregnancy for women at risk of acquiring the Zika virus have theoretical and documented implications for abortion and contraception demand and access.

Additional research is needed to better understand the impact of Zika virus health recommendations and advisories on women's decision making around pregnancy, as well as their impact on demand, access and safety of family planning services.
Injectable contraception: updates and innovation
Authors: Schivone Gillian , Dorflinger Laneta , Halpern Vera
Published: October 2016

Purpose of review

Injectable contraception is a highly effective form of birth control that is globally popular. Recent research has focused on ways to make injectables such as depot medroxyprogesterone acetate (DMPA) more accessible and to improve the side-effect profile of injectables. This review will focus on new directions and approaches to the use of injectable contraception.

Recent findings

Research in the area of injectable contraception has focused on improving access for women through home or self-injection, and also task-shifting and community-based distribution in low-resource areas. Specific to DMPA, studies have focused on lowering the overall dose of medication while maintaining efficacy, and improving drug-delivery systems. More research into the association between DMPA and HIV is needed, and also the effects of administration of DMPA at the time of medication abortion.

Injectable contraceptives are an important part of the global method mix of highly effective birth control. Improving the accessibility and side effect profile of commodities such as DMPA will make injectables even more valuable for women seeking effective contraception.
Secondary Cleft Lip Reconstruction and the Use of Pedicled, Deepithelialized Scar Tissue
Authors: Nadjmi Nasser , Amadori Sara , Van de Casteele Elke
Published: October 2016

Background:

The optimal time to create symmetry in a cleft lip is during primary repair; a secondary effort later is more difficult due to potential scarring and possible tissue deficiency of the repaired cleft lip. A plethora of methods for secondary correction have been described that have the goal of constructing the philtral column, ameliorating bad scar results, and augmenting lip volume, for example. Nevertheless, there is no single procedure that yields completely satisfactory results. In addition, the appropriate timing for secondary surgical corrections of the cleft lip is still under debate.

Methods:

We present a new technique for secondary lip reconstruction of unilateral and bilateral cleft patients using pedicled, de-epithelialized cleft scar tissue as an autologous graft to obtain sustainable lip volume. Our results were evaluated by physicians and patient-parent satisfaction surveys.

Results:

The esthetic outcomes of 29 patients were assessed using a patient satisfaction questionnaire and a physician survey based on the preoperative and postoperative clinical images. The success of the procedure was evaluated using a 5-point scale. The total scores of both the physician and patient assessments were high, although no correlation was found between the scores.

Conclusions:

Cleft lip reconstruction using pedicled, deepithelialized scar tissue leads to excellent physician and patient satisfaction scores; this technique can be executed at any patient age and as a secondary repair for any given primary type of cleft disorder.
RESOLUTION OF A MACULAR HOLE COMPLICATING A PSEUDOPHAKIC MACULAR EDEMA WITH NONSURGICAL TREATMENT
Authors: Lam Delphine , Srour Mayer , Semoun Oudy , Tilleul Julien , Souied Eric H.
Published: October 2016

Background:

Pseudophakic cystoid macular edema (PCME) is a common complication of cataract surgery. We report the management of a case presenting with PCME in his left eye complicated by a full-thickness macular hole (MH). Four weeks after a cataract surgery on his left eye, a 75-year-old man presented with a vision loss on the same eye (best-corrected visual acuity: 20/64). A PCME complicated by a full-thickness MH was diagnosed. After oral acetazolamide treatment, the PCME completely regressed and the full-thickness MH closed after medical treatment.

Conclusion:

Macular edema may rarely lead to MHs, by inducing mechanical changes and probable inflammatory mechanisms as well as a thinning of the fovea. We report a case of spontaneous closure of MH complicating a PCME, with medical treatment.
Mid-term Clinical Results of CO2 Laser-assisted Sclerectomy Surgery (CLASS) for Open-Angle Glaucoma Treatment
Authors: Geffen Noa , Mimouni Michael , Sherwood Mark , Assia Ehud I.
Published: October 2016

Purpose:

To evaluate the efficacy and safety of CO2 Laser-assisted Sclerectomy Surgery (CLASS) in primary and pseudoexfoliative open-angle glaucoma.

Materials and Methods:

Single-arm, open-label study included data from 9 medical centers located in 7 countries. Subjects underwent nonpenetrating CLASS procedure with a CO2 laser system (IOPtiMate). Intraocular pressure (IOP) and number of medications were measured at baseline, 1, 2, 4, and 6 weeks, and 3, 6, 12, 24, and 36 months. Complete success was defined as 5≤IOP≤18 mm Hg and at least 20% IOP reduction with no medications, and qualified success as the same with or without medications at 12, 24, and 36 months.

Results:

A total of 111 consecutive eyes were enrolled in the study, 14 were excluded from the study due to protocol deviation or operator error. The mean age was 69.3±12.8 and 73.9% were whites. Percent change in IOP from baseline at 1, 2, and 3 years was, respectively, 45.1%, 46.8%, and 42.5% (P<0.001). Complete success rates after 12, 24, and 36 months were 60.2%, 57.9%, and 47.8%, respectively. Qualified success rates after 12, 24, and 36 months were 79.6%, 91.2%, and 84.8%, respectively. Number of medications dropped from 2.39±1.24 to 0.47±0.84, 0.53±0.75, and 0.71±0.89 at 12, 24, and 36 months, respectively (P<0.001).

Conclusions:

The CLASS procedure may be a simple and effective treatment for open-angle glaucoma providing extended relief of elevated IOP.
Predictive Value of HRT Stereometric Parameters and Blue-on-Yellow Perimetry Global Indices in Glaucoma-suspected Subjects
Authors: Rallis Konstantinos , Kymionis George D. , Georgalas Ilias , Moschos Marilita M. , Koutsandrea Chryssanthi , Grentzelos Michael A. , Papaconstantinou Dimitris
Published: October 2016

Objective:

To determine subtle changes of Heidelberg retina tomography (HRT) stereometric parameters and blue-on-yellow (B/Y) perimetry global indices for the early diagnosis of glaucoma in suspected subjects.

Patients and Methods:

Cross-sectional data on 174 eyes of 87 subjects from a larger cohort, attending the Glaucoma Department of the “G. Gennimatas” General Hospital of Athens from January 2004 to February 2014, were used in the study. Subjects were assigned to 3 groups: (a) “normals” not requiring treatment throughout the study (group 1), (b) suspects who developed glaucoma and required treatment during the study (group 2), and (c) patients with incipient glaucoma (group 3). Specific HRT and B/Y perimetry variables were compared among the 3 groups.

Results:

Significant differences were established for the following HRT parameters: “reference height” differed significantly between groups 1 and 2 and groups 1 and 3; “cup shape measure” differed significantly between groups 1 and 2 and groups 2 and 3. B/Y perimetry global index “mean deviation” significantly distinguished group 2 from groups 1 and 3.

Conclusions:

The results of the present study suggest the predictive value of the HRT stereometric parameters “reference height” and “cup shape measure” and of the B/Y perimetry global index “mean deviation” in glaucoma-suspected subjects; further corroboration through longitudinal studies is warranted.
Patterns of Diagnosis and Misdiagnosis in Pediatric Cancer and Relationship to Survival
Authors: Chen Jing , Mullen Craig A.
Published: October 2016

Background:

Pediatric cancer is rare and its symptoms are often ambiguous. The aims of this study were to investigate the time needed to make a diagnosis, assess the frequency of misdiagnosis, and to determine whether these factors affected survival.

Methods:

A review of records of 364 pediatric patients diagnosed with cancer at the University of Rochester Golisano Children’s Hospital between 2004 and 2012 was conducted. Data were extracted on patient and health care system–related factors and clinical outcomes.

Results:

The median time from symptom onset to diagnosis was shortest for leukemia (18.5 d) and longest for bone tumors (86.5 d). Tumor type was the only factor associated with time to diagnosis. In 52% of cases an incorrect nononcological diagnosis was initially made. Soft tissue sarcomas and brain tumors were misdiagnosed most often. Neither prolonged time to diagnosis nor initial misdiagnosis was associated with reduced survival. Tumor type and presence of metastatic disease at diagnosis were significantly associated with survival.

Conclusions:

There is significant variation in the time from symptom onset to diagnosis of pediatric cancers, and incorrect initial diagnostic impressions are common. Despite this there is no impact of prolonged time to diagnosis on survival.
Relationship of Self-reported Attentional Fatigue to Perceived Work Ability in Breast Cancer Survivors
Authors: Von Ah Diane , Storey Susan , Crouch Adele , Johns Shelley A. , Dodson Jill , Dutkevitch Sarah
Published: October 2016

Background:

Breast cancer survivors (BCSs) have identified attentional fatigue, a decrease in the ability to focus, as a persistent daily challenge; however, little is known regarding its impact on work ability.

Objective:

The purpose of this study was to examine the relationship between attentional fatigue and perceived work ability in BCSs controlling for the known covariates of age, education, household income, and time posttreatment.

Methods:

A cross-sectional, descriptive design was used. Breast cancer survivors who were currently employed and at least 1 year post–adjuvant treatment participated. Breast cancer survivors completed the Attentional Function Index and Work Ability Index questionnaires. Descriptive statistics, linear regression, and Fisher exact test were used for analysis.

Results:

Sixty-eight female BCSs, ranging from 29 to 68 years of age (mean, 52.1 [SD, 8.6]) and on average 4.97 (SD, 3.36) years posttreatment, participated. More than one-fourth of BCSs (26.5%) reported poor to moderate perceived work ability, indicating substantial concerns regarding work performance. Attentional fatigue was found to significantly predict perceived work ability (P < .001), explaining 40% of the variance of perceived work ability.

Conclusions:

Attentional fatigue is a prevalent symptom posttreatment that is negatively related to perceived work ability in BCSs.

Implications for Practice:

Nurses are in a prime position to assess and intervene to alleviate attentional fatigue to improve work ability. Findings suggest a need for individual, comprehensive survivorship care plans to effectively address symptoms that impact work ability and, ultimately, the quality of life of cancer survivors.
Budgetary Impact of Compliance With STI Screening Guidelines in Persons Living With HIV
Authors: Eaton Ellen F. , Hudak Kathryn , Muzny Christina A.
Published: October 2016

Introduction:

The 2015 Centers for Disease Control Sexually Transmitted Diseases Treatment Guidelines recommend annual screening of all people living with HIV (PLWH) for Neisseria gonorrhoeae, Chlamydia trachomatis, and syphilis; annual Trichomonas vaginalis screening is recommended for HIV-infected women. The study objective was to evaluate the budgetary impact of sexually transmitted infection (STI) screening. We hypothesized that recommended STI screening is costly and would not be covered in full by insurers.

Methods:

This cost analysis evaluates charges and reimbursement for recommended screening for the above 4 STIs. This study projects the net yield (reimbursement minus expenditures) of providing tests to eligible PLWH receiving care at an urban HIV clinic in Birmingham, AL. Four scenarios evaluated the net yield when different laboratory providers, rates of compliance, and Ryan White Program fund availability were examined.

Results:

The number of patients receiving care at our HIV clinic from August 2014 to August 2015 was 3163 (768 female and 2395 male patients). Annual screening for N. gonorrhoeae, C. trachomatis, syphilis, and T. vaginalis would lead to a mean net loss of $129,416, $118,304, $72,625, and $13,523, respectively. Most costly scenarios for a health system include the use of a regional laboratory (−$1,241,101) and lack of Ryan White HIV/AIDS Program funding (−$85,148).

Discussion:

Compliance with STI screening practices is costly. Sustainability will require critical analysis of true costs and cost-effectiveness of STI screening tests in PLWH. Providers, policy makers, and insurers each have a role in ensuring the provision of these evidence-based services to PLWH.
Association of HIV and Opportunistic Infections With Incident Stroke: A Nationwide Population-Based Cohort Study in Taiwan
Authors: Yen Yung-Feng , Chen Marcelo , Jen Ian , Lan Yu-Ching , Chuang Pei-Hung , Liu Yen-Ling , Lee Yun , Chen Yi-Ming Arthur
Published: October 2016

Background:

HIV-associated vasculopathy and opportunistic infections (OIs) might cause vascular atherosclerosis and aneurysmal arteriopathy, which could increase the risk of incident stroke. However, few longitudinal studies have investigated the link between HIV and incident stroke. This cohort study evaluated the association of HIV and OIs with incident stroke.

Methods:

We identified adults with HIV infection in 2000–2012, using the Taiwan National Health Insurance Research Database. A control cohort without HIV infection, matched for age and sex, was selected for comparison. Stroke incidence until December 31, 2012 was then ascertained for all patients. A time-dependent Cox regression model was used to determine the association between OIs and incident stroke among patients with HIV.

Results:

Among a total of 106,875 patients (21,375 patients with HIV and 85,500 matched controls), stroke occurred in 927 patients (0.87%) during a mean follow-up period of 5.44 years, including 672 (0.63%) ischemic strokes and 255 (0.24%) hemorrhagic strokes. After adjusting for other covariates, HIV infection was an independent risk factor for incident all-cause stroke [adjusted hazard ratio (AHR) 1.83; 95% confidence interval (CI): 1.58 to 2.13]. When the type of stroke was considered, HIV infection increased the risks of ischemic (AHR 1.33; 95% CI: 1.09 to 1.63) and hemorrhagic stroke (AHR 2.01; 95% CI: 1.51 to 2.69). The risk of incident stroke was significantly higher in patients with HIV with cryptococcal meningitis (AHR 4.40; 95% CI: 1.38 to 14.02), cytomegalovirus disease (AHR 2.79; 95% CI: 1.37 to 5.67), and Penicillium marneffei infection (AHR 2.90; 95% CI: 1.16 to 7.28).

Conclusions:

Patients with HIV had an increased risk of stroke, particularly those with cryptococcal meningitis, cytomegalovirus, or P. marneffei infection.
ERAS Protocol Reduces IL-6 Secretion in Colorectal Laparoscopic Surgery: Results From a Randomized Clinical Trial
Authors: Mari Giulio , Crippa Jacopo , Costanzi Andrea , Mazzola Michele , Rossi Michele , Maggioni Dario
Published: October 2016

Background:

Enhanced Recovery After Surgery (ERAS) program applied to colorectal laparoscopic surgery is well known to reduce hospitalization improving short-terms outcomes. Its goal is to minimize the surgical stress response in order to maintain the physiological homeostasis altered by surgery. However, there is little knowledge about the involved dynamics in the reduction of the surgical stress that these programs allow. The primary aim of this study was to compare the level of immune and nutritional serum investigators across surgery in patients undergoing elective colorectal laparoscopic surgery within an ERAS protocol or according to a standard care program.

Materials and Methods:

One hundred forty patients undergoing major colorectal laparoscopic surgery were enrolled and randomized in 2 groups (70 per arm).

Cortisol, C-reactive protein (CRP), white blood cell count, prolactin, interleukin (IL)-6 levels were collected preoperatively, 1, 3, and 5 days after surgery. Transferrin, prealbumin, albumin, and triglyceride level were collected preoperatively, 1 and 5 days after surgery. Short-term outcomes were also prospectively assessed.

Results:

IL-6 levels were lower in the ERAS group on 1, 3, and 5 days postoperatively (P<0.05). IL-6 levels in the enhanced group, differently from control group, returned to preoperative level 3 days after surgery. CRP level was lower in the enhanced group on day 1, 3, and 5 (P<0.05). There was no difference in cortisol and prolactin levels between groups. Prealbumin serum level was higher on day 5 (P<0.05) compared to standard group.

Conclusions:

ERAS protocol applied to colorectal laparoscopic surgery affects surgical stress response, decreasing IL-6 and CRP levels postoperatively and improving prealbumin postoperative synthesis.
Bladder Control Problems in Elders
Authors: Neville Cynthia E.
Published: October 2016

Older adults have a 50% or greater prevalence of urinary incontinence and other lower urinary tract symptoms such as urinary urgency and nocturia, or waking from sleep to urinate. These bladder control problems place older adults at increased risk of falling, and are associated with a wide range of negative health and rehabilitation outcomes. Rehabilitation clinicians can identify and assess bladder control problems in their patients and provide basic interventions, which may improve quality of life and health and rehabilitation outcomes of the aging adult. This clinical commentary aims to systematically explain assessment and treatment options for bladder control problems in elders that can be used by all rehabilitation clinicians.
Old Women Body Balance
Authors: Jácomo Raquel Henriques , Alves Aline Teixeira , Garcia Patrícia Azevedo , Amatuzzi Fellipe , de Campos-Lobato Luiz Felipe , Carvalho Gustavo Azevedo , de Sousa João Batista
Published: October 2016

Pelvic organ prolapse (POP) is a common condition in older women. We have observed that patients with advanced POP complain of body imbalance. The purpose of this study was to investigate impact of advanced POP on older women's body balance. Thirty-eight consecutive women were selected. Body balance was assessed by stabilometric measures (SM) and the Berg Balance Scale (BBS). Groups, nonadvanced versus advanced POP, were statistically similar on the BBS and all SM, but median center of pressure displacement speed (COPd-speed) was P = .04. A univariate analysis did not confirm any association between advanced POP and increased COPd-speed. Advanced POP may have no impact on older women's body balance.
Temporal Changes in Deceased Kidney Donor Characteristics in Australia
Authors: Chan Samuel , Campbell Scott B. , Clayton Phillip A. , Mudge David W. , Cho Yeoungjee , Hawley Carmel M. , Johnson David W. , Francis Ross S.
Published: October 2016

Background

Demand for deceased donor kidneys has exceeded supply in Australia over the past 2 decades. With a desire to use as many donor organs as possible, the health characteristics of accepted donors may have changed over time.

Methods

All deceased kidney donors actually transplanted in Australia between January 1, 1994, and December 31, 2013, were retrospectively analyzed, using data from the Australian and New Zealand Organ Donor Registry.

Results

Of 4172 deceased donors, 57% were men. Mean donor age increased from 37.2 ± 16.8 years to 46.1 ± 17.7 years over time, and donor numbers increased from 162 in 1994 to 334 in 2013. As the primary cause of death, motor vehicle accidents decreased from 27% to 12%, whereas cerebral pathology persisted at 50%. There was an increase in the proportion of donors with hypertension (12% to 24%), diabetes (2% to 7%), and an increase in mean body mass index (24.4 ± 4.4 kg/m2 to 27.5 ± 6.3 kg/m2) between 1994 and 2013. These changes were reflected by an increase in the median kidney donor risk index from 1.08 (interquartile range, 0.85-1.25) to 1.32 (interquartile range, 0.95-1.53). The proportion of medically higher risk donors increased over time.

Conclusions

Because deceased kidney donor numbers have increased, the range of donor quality has broadened, with an increase in both the proportion and number of high-risk donors, as well as a decline in donor quality. These data highlight the need for kidney allocation algorithms to evolve to ensure appropriate allocation of deceased donor kidneys.
Temporary Lumbar Drain as Treatment for Pediatric Fulminant Idiopathic Intracranial Hypertension
Authors: Jiramongkolchai Kim , Buckley Edward G. , Bhatti M. Tariq , Muh Carrie R. , Wiggins Robert E. , Jiramongkolchai Pawina , El-Dairi Mays A.
Published: October 2016

Fulminant idiopathic intracranial hypertension (FIIH) is a subtype of idiopathic intracranial hypertension (IIH) characterized by rapid, severe, progressive vision loss. Surgical intervention is often performed either as a cerebrospinal fluid (CSF) shunt procedure or an optic nerve sheath fenestration or, at times, both. These surgical procedures carry a significant risk of morbidity and failure. We present 2 patients in whom a temporary lumbar drain was successfully used in the management of medically undertreated pediatric FIIH, and circumvented the need for surgical intervention.
Comparing Hypertropia in Upgaze and Downgaze Distinguishes Congenital From Acquired Fourth Nerve Palsies
Authors: Ivanir Yair , Trobe Jonathan D.
Published: October 2016

Background:

Isolated fourth nerve palsies are commonly caused by decompensation of a congenitally dysfunctional superior oblique muscle (“decompensated congenital palsies”). Distinguishing such palsies at initial presentation from palsies caused by presumed microvascular ischemia (“ischemic palsies”) has value for patient reassurance and in forestalling ancillary testing. Abnormally large vertical fusional amplitudes traditionally have been used to identify decompensated congenital palsies, but that may not be a reliable distinguishing feature. This study was undertaken to determine if the amount of hypertropia in upgaze and downgaze might be a more efficient separator. We also studied traumatic and tumorous fourth nerve palsies to see if they could be distinguished from decompensated congenital palsies by using this hypertropia comparison.

Methods:

Retrospective review of case records of patients diagnosed with isolated fourth nerve palsies at the University of Michigan Neuro-Ophthalmology Clinics over the past 15 years. We recorded the age, gender, vascular risk factors, duration of follow-up, cause, side of palsy, and alignment measurements in all patients.

Results:

Inclusion criteria were met by 118 patients. Hypertropia was equal or greater in upgaze than downgaze in 50 of the 58 decompensated congenital palsies (86%) in whom those data were recorded. Hypertropia was never greatest in upgaze in the 15 patients with traumatic palsies. Vertical fusional amplitudes were increased in only 15 of 27 patients (56%) with decompensated palsies in whom those data were recorded. Torsional misalignment on double Maddox rod testing was present in 16 (94%), 13 (87%), and 3 (100%) patients with ischemic, traumatic, and tumorous palsies, but also in 19 patients (54%) with decompensated congenital palsies in whom those data were recorded.

Conclusions:

Hypertropia greater in upgaze than downgaze or equal in upgaze and downgaze was an efficient separator of congenital from ischemic and tumorous fourth nerve palsies, being characteristic of patients with decompensated congenital palsies and never present in patients with ischemic, traumatic, or tumorous palsies. Vertical fusional amplitudes and torsional misalignment did not effectively differentiate between the patient groups. Comparing the hypertropia in upgaze and downgaze improved differential diagnosis and reduces the potential for unnecessary ancillary tests.
Behavioural adaptations to flight into thin air
Authors: Sherub Sherub , Bohrer Gil , Wikelski Martin , Weinzierl Rolf
Published: October 2016

Soaring raptors can fly at high altitudes of up to 9000 m. The behavioural adjustments to high-altitude flights are largely unknown. We studied thermalling flights of Himalayan vultures (Gyps himalayensis) from 50 to 6500 m above sea level, a twofold range of air densities. To create the necessary lift to support the same weight and maintain soaring flight in thin air birds might modify lift coefficient by biophysical changes, such as wing posture and increasing the power expenditure. Alternatively, they can change their flight characteristics. We show that vultures use the latter and increase circle radius by 35% and airspeed by 21% over their flight altitude range. These simple behavioural adjustments enable vultures to move seamlessly during their annual migrations over the Himalaya without increasing energy output for flight at high elevations.
Biodiversity and ecosystem risks arising from using guppies to control mosquitoes
Authors: El-Sabaawi Rana W. , Frauendorf Therese C. , Marques Piata S. , Mackenzie Richard A. , Manna Luisa R. , Mazzoni Rosana , Phillip Dawn A. T. , Warbanski Misha L. , Zandonà Eugenia
Published: October 2016

Deploying mosquito predators such as the guppy (
Poecilia reticulata
) into bodies of water where mosquitoes breed is a common strategy for limiting the spread of disease-carrying mosquitoes. Here, we draw on studies from epidemiology, conservation, ecology and evolution to show that the evidence for the effectiveness of guppies in controlling mosquitoes is weak, that the chances of accidental guppy introduction into local ecosystems are large, and that guppies can easily establish populations and damage these aquatic ecosystems. We highlight several knowledge and implementation gaps, and urge that this approach is either abandoned in favour of more effective strategies or that it is used much more rigorously. Controlling mosquitoes does not need to come at the expense of freshwater biodiversity.
Pigmentation and fitness trade-offs through the lens of artificial selection
Authors: Rajpurohit Subhash , Richardson Rani , Dean John , Vazquez Raul , Wong Grace , Schmidt Paul S.
Published: October 2016

Pigmentation is a classic phenotype that varies widely and adaptively in nature both within and among taxa. Genes underlying pigmentation phenotype are highly pleiotropic, creating the potential for functional trade-offs. However, the basic tenets of this trade-off hypothesis with respect to life-history traits have not been directly addressed. In natural populations ofDrosophila melanogaster, the degree of melanin pigmentation covaries with fecundity and several other fitness traits. To examine correlations and potential trade-offs associated with variation in pigmentation, we selected replicate outbred populations for extreme pigmentation phenotypes. Replicate populations responded rapidly to the selection regime and after 100 generations of artificial selection were phenotyped for pigmentation as well as the two basic fitness parameters of fecundity and longevity. Our data demonstrate that selection on pigmentation resulted in a significant shift in both fecundity and longevity profiles. Selection for dark pigmentation resulted in greater fecundity and no pronounced change in longevity, whereas selection for light pigmentation decreased longevity but did not affect fecundity. Our results indicate the pleiotropic nature of alleles underlying pigmentation phenotype and elucidate possible trade-offs between pigmentation and fitness traits that may shape patterns of phenotypic variation in natural populations.
The first fossil parrot (Aves, Psittaciformes) from Siberia and its implications for the historical biogeography of Psittaciformes
Authors: Zelenkov Nikita V.
Published: October 2016

Modern parrots (crown Psittaciformes) are a species-rich group of mostly tropical and subtropical birds with a very limited fossil record. A partial tarsometatarsus from the late Early Miocene of Siberia (Baikal Lake) is the first pre-Quaternary find of crown Psittaciformes in Asia (and Siberia in particular) and is also the northern-most find of this bird order worldwide. This find documents a broad geographical distribution of parrots during the warmest phase of the Miocene (the so-called ‘Miocene Climatic Optimum’), which has implications for the historical biogeography of Psittaciformes. The presence of parrots on both sides of the Pacific Ocean at the end of the Early Miocene implies a (most probably eastwards) trans-Beringian dispersal which likely took place about 16–18 Ma. The broad Eurasian distribution of parrots in the past further supports a hypothesis that ancestors of modern generaCoracopsisandAgaporniscould reach Africa from Eurasia.
Steady dynein forces induce flutter instability and propagating waves in mathematical models of flagella
Authors: Bayly P. V. , Dutcher S. K.
Published: October 2016

Cilia and flagella are highly conserved organelles that beat rhythmically with propulsive, oscillatory waveforms. The mechanism that produces these autonomous oscillations remains a mystery. It is widely believed that dynein activity must be dynamically regulated (switched on and off, or modulated) on opposite sides of the axoneme to produce oscillations. A variety of regulation mechanisms have been proposed based on feedback from mechanical deformation to dynein force. In this paper, we show that a much simpler interaction between dynein and the passive components of the axoneme can produce coordinated, propulsive oscillations. Steady, distributed axial forces, acting in opposite directions on coupled beams in viscous fluid, lead to dynamic structural instability and oscillatory, wave-like motion. This ‘flutter’ instability is a dynamic analogue to the well-known static instability, buckling. Flutter also occurs in slender beams subjected to tangential axial loads, in aircraft wings exposed to steady air flow and in flexible pipes conveying fluid. By analysis of the flagellar equations of motion and simulation of structural models of flagella, we demonstrate that dynein does not need to switch direction or inactivate to produce autonomous, propulsive oscillations, but must simply pull steadily above a critical threshold force.
Physical confinement signals regulate the organization of stem cells in three dimensions
Authors: Hadjiantoniou Sebastian V. , Sean David , Ignacio Maxime , Godin Michel , Slater Gary W. , Pelling Andrew E.
Published: October 2016

During embryogenesis, the spherical inner cell mass (ICM) proliferates in the confined environment of a blastocyst. Embryonic stem cells (ESCs) are derived from the ICM, and mimicking embryogenesisin vitro, mouse ESCs (mESCs) are often cultured in hanging droplets. This promotes the formation of a spheroid as the cells sediment and aggregate owing to increased physical confinement and cell–cell interactions. In contrast, mESCs form two-dimensional monolayers on flat substrates and it remains unclear if the difference in organization is owing to a lack of physical confinement or increased cell–substrate versus cell–cell interactions. Employing microfabricated substrates, we demonstrate that a single geometric degree of physical confinement on a surface can also initiate spherogenesis. Experiment and computation reveal that a balance between cell–cell and cell–substrate interactions finely controls the morphology and organization of mESC aggregates. Physical confinement is thus an important regulatory cue in the three-dimensional organization and morphogenesis of developing cells.
Label-freein situimaging of oil body dynamics and chemistry in germination
Authors: Waschatko Gustav , Billecke Nils , Schwendy Sascha , Jaurich Henriette , Bonn Mischa , Vilgis Thomas A. , Parekh Sapun H.
Published: October 2016

Plant oleosomes are uniquely emulsified lipid reservoirs that serve as the primary energy source during seed germination. These oil bodies undergo significant changes regarding their size, composition and structure during normal seedling development; however, a detailed characterization of these oil body dynamics, which critically affect oil body extractability and nutritional value, has remained challenging because of a limited ability to monitor oil body location and composition during germinationin situ. Here, we demonstrate viain situ, label-free imaging that oil bodies are highly dynamic intracellular organelles that are morphologically and biochemically remodelled extensively during germination. Label-free, coherent Raman microscopy (CRM) combined with bulk biochemical measurements revealed the temporal and spatial regulation of oil bodies in native soya bean cotyledons during the first eight days of germination. Oil bodies undergo a cycle of growth and shrinkage that is paralleled by lipid and protein compositional changes. Specifically, the total protein concentration associated with oil bodies increases in the first phase of germination and subsequently decreases. Lipids contained within the oil bodies change in saturation and chain length during germination. Our results show that CRM is a well-suited platform to monitorin situlipid dynamics and local chemistry and that oil bodies are actively remodelled during germination. This underscores the dynamic role of lipid reservoirs in plant development.
Nervous system and ciliary structures of Micrognathozoa (Gnathifera): evolutionary insight from an early branch in Spiralia
Authors: Bekkouche Nicolas , Worsaae Katrine
Published: October 2016

Recent studies show that Gnathifera, comprising Rotifera, Gnathostomulida and Micrognathozoa, constitute the sister group to the remaining Spiralia (containing, e.g. flatworms, segmented worms and molluscs). Therefore, a better understanding of Gnathifera is central for unravelling the evolution of the highly diverse Spiralia. Here, we describe the previously unstudied nervous system and ciliary structures of Micrognathozoa, using immunohistochemistry and confocal laser scanning microscopy. The nervous system is simple with a large brain, paired sub-esophageal ganglia, two trunk commissures, two pairs of ventral longitudinal nerves and peripheral nerves. The paired ventro-lateral nerve cords are confirmed to be a symplesiomorphy of Gnathifera (possibly even Spiralia), whereas the paired ventro-median nerves are not previously reported in Gnathifera. A pharyngeal ganglion is described for Micrognathozoa: a complex structure with two apical tufts of ciliary receptors, now shown to be shared by all Gnathifera. The ventral pattern of external ciliophores is re-described, and protonephridia with multi-ciliated collecting tubules similar to those of Rotifera are confirmed. A range of new details from a simple nervous system and complex set of ciliary structures in a microscopic metazoan are hereby unravelled. The many resemblances with Rotifera corroborate their close relationship, and shed more light on the evolution of Gnathifera.