bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Cutaneous CD8+ T-cell Lymphoma, an Indolent and Locally Aggressive Form Mimicking Paronychia
Authors: Beggs Sarah M. , Friedman Ben J. , Kornreich Davida , Okon Lauren , Alpdogan Onder , Shi Wenyin , Sahu Joya
Published: October 2017

CD8+ T-cell lymphomas comprise a wide spectrum of lymphomas, many which have yet to be formally classified. We present a case of a 43-year-old woman with an enlarging tumor distal to the distal interphalangeal joint of the fourth finger, compressing the underlying nail matrix. Magnetic resonance imaging showed bony involvement of the underlying distal phalanx. Histology showed a dense epidermotropic and pandermal infiltrate composed of medium-sized, uniformly pleomorphic lymphocytes with cleaved nuclei, which raised the possibility of primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma. However, the patient's clinical photograph was inconsistent with this diagnosis. Other diagnoses, such as primary cutaneous acral CD8+ T-cell lymphoma—a provisional entity, were also considered but did not capture all the features of this patient's lymphoma. We propose to classify this case as a primary cutaneous CD8+ T-cell lymphoma, an indolent and locally aggressive form.
Mixed Lichenoid and Follicular T- and B-Cell Lymphoid Reaction to Red Tattoos With Monoclonal T Cells
Authors: Zaaroura Hiba , Bergman Reuven
Published: October 2017

Pseudolymphomatous reactions have been described to occur in tattoos. Most cases have exhibited T-cell predominance and polyclonal T-cell receptor gene rearrangements. One case with monoclonal IgH gene rearrangements progressed into B-cell lymphoma. Lichenoid infiltrates are commonly described but lymphoid follicles much less frequently. We report a case with mixed lichenoid and follicular T- and B-cell reaction to red tattoos. The histopathology and the immunohistochemical studies were constant with a mixed T- and B-cell pseudolymphoma, the IgH gene rearrangement study was polyclonal, but the T-cell receptor gene rearrangement study was monoclonal. The patient who responded to intralesional corticosteroid injections remains under close scrutiny.
Family Members’ and Intensive Care Unit Nurses’ Response to the ECG Memento© During the Bereavement Period
Authors: Beiermann Mary , Kalowes Peggy , Dyo Melissa , Mondor Amanda
Published: October 2017

Background

In the United States, 20% of patients die in the intensive care unit (ICU), yet little is known about bereavement strategies to aid grieving families.

Objective

The primary aim was to study the bereavement experience for families in the ICU; secondary aim was to measure nurses' perception of end-of-life care, and a third was to evaluate the impact of the ECG Memento© by families and nurses.

Methods

A prospective, descriptive study design was used, with a postsurvey methodology. Fifty ICU patient families agreed to participate, although only 28 returned the Satisfaction With Bereavement Experience Questionnaire. In addition, 38 of 100 eligible nurses completed the Quality of Dying and Death in the Intensive Care Unit survey.

Results

The Satisfaction With Bereavement Experience Questionnaire data showed families as highly satisfied with hospital (mean, 1.5), personal (mean, 1.6), ritual (mean, 1.3), and posthospital experiences (mean, 1.9). Quality of Dying and Death in the Intensive Care Unit results indicated that ideal control of patients' symptoms was reported by only 26% of nurses surveyed. Half of the families reported that the death was unexpected. Families (86%) responded positively to the ECG Memento©, and according to 98% of the nurses, the ECG Memento© was very well received.

Discussion

Despite most families reporting high satisfaction with the bereavement experience, nurses reported a low level of patient symptom control; also, families often found the death to be unexpected. This suggests that the bereavement experience is a complex process requiring nurses to implement various interventions during this vulnerable period. Most families responded positively to this novel bereavement tool, which may aid families as they transition from anticipatory grieving to bereaved status. Further studies are needed to evaluate the ECG Memento© as an innovation on a wider scale and to develop additional interventions to positively impact the grieving process for families.
Adjuvant Stromal Amphotericin B Injection for Late-Onset DMEK Infection
Authors: Tu Elmer Y. , Majmudar Parag A.
Published: October 2017

Purpose:

To report the successful medical management of a late-onset Descemet membrane endothelial keratoplasty (DMEK)-related interface infection.

Methods:

A case of DMEK endothelial keratoplasty-related infection treated with intrastromal antifungal injection was identified. The following information was collected: demographic data, surgical indications, donor rim cultures, donor mate outcomes, clinical course, diagnostic tests, and clinical outcome.

Results:

A DMEK patient developed a single infiltrate approximately 1 month after uncomplicated DMEK. Donor rim culture was positive for Candida glabrata but no prophylactic treatment was initiated. Anterior segment optical coherence tomography confirmed the location of the infiltrate, and the patient was treated with oral fluconazole and an intrastromal injection of amphotericin B with an inadvertent, but negligible, intracameral volume of the same drug. The lesion significantly regressed on examination 2 days later with complete involution and excellent visual acuity to date.

Conclusions:

Medical therapy, including systemic and intrastromal application, is a viable initial treatment option for late-onset, presumed yeast interface keratitis in patients who have undergone DMEK.
Learning DMEK From YouTube
Authors: McKee Hamish D. , Jhanji Vishal
Published: October 2017

Purpose:

To evaluate the outcomes of the first cases of Descemet membrane endothelial keratoplasty (DMEK) performed by an anterior segment surgeon, learning the procedure, including graft preparation, primarily from watching YouTube videos. DMEK surgery was not learned during fellowship training; there was no attendance at DMEK courses, no witnessing of live surgery, and no supervision by an experienced DMEK surgeon. All graft tissue was prepared by the surgeon on the day of surgery.

Methods:

This is a retrospective review of the 3-month postoperative results of the first 40 consecutive cases. The success rate of graft preparation, intraoperative and postoperative complications, spectacle-corrected visual acuity, endothelial cell density, and central corneal thickness were evaluated.

Results:

Grafts were successfully prepared in all cases with no loss of donor tissue. DMEK surgery was successful in 39 of 40 eyes with the one failure occurring in a vitrectomized eye without an intact iris–lens diaphragm. Spectacle-corrected visual acuity was ≥6/6 in 23 of the 25 eyes without comorbidity. Mean endothelial cell density was 1515 (±474) cells/mm2. Mean central corneal thickness decreased from 624 (±40) μm preoperatively to 513 (±34) μm postoperatively.

Conclusions:

Although formal training is desirable, good results can be obtained by an anterior segment surgeon learning DMEK, including graft preparation, without it. DMEK should no longer be considered a procedure with a long learning curve in routine cases.
Risk Factors Associated With Glaucomatous Progression in Pseudoexfoliation Patients
Authors: Moon Yeji , Sung Kyung Rim , Kim Joon Mo , Shim Seong Hee , Yoo Chungkwon , Park Ji Hye
Published: October 2017

Purpose:

To investigate risk factors associated with glaucomatous progression in pseudoexfoliation glaucoma (PXG) patients.

Patients and Methods:

A retrospective observational study with a total of 48 PXG patients and age, sex, and visual field (VF) test mean deviation–matched 48 primary open-angle glaucoma (POAG) patients recruited from 3 university-based hospitals. Glaucomatous progression was defined by 2 criteria, either optic disc/retinal nerve fiber layer photographic assessment or serial VF data. Univariate and multivariate Cox proportional hazard models were used to detect associations between risk factors and progression in each subgroup and shared frailty model were used in total participants.

Results:

In total participants, PXG diagnosis [hazard ratio (HR), 7.245; P=0.050], a higher baseline intraocular pressure (IOP) (HR, 1.221; P=0.025) and a greater number of glaucoma medications (HR, 3.537; P=0.016) were significant factors for glaucoma progression. In the PXG group, a higher baseline IOP (HR, 1.131; P<0.001), a lower IOP reduction (HR, 0.966; P=0.027), a greater number of glaucoma medications (HR, 2.413; P=0.004), and worse baseline VF mean deviation (HR, 0.875; P=0.004) were significant factors, whereas the number of glaucoma medications (HR, 3.493; P=0.019) and disc hemorrhage (HR, 3.953; P=0.043) showed association in the POAG group.

Conclusions:

Factors associated with progression differed between PXG and POAG groups. Higher baseline IOP and requirement for a greater number of glaucoma medications were related with PXG progression.
Safety and Efficacy of Micafungin in Extremely Low Birth Weight Infants
Authors: Schüller Simone S. , Bauer Carina , Unterasinger Lukas , Berger Angelika
Published: October 2017

Little is known about the side effects of micafungin in extremely low birth weight infants. In a retrospective single-center study, 19 extremely low birth weight infants were analyzed for micafungin efficacy and safety. At a mean±standard deviation daily dosage of 7.5 ± 2.0 mg/kg, no clinically relevant side effects were observed. A significant increase of liver enzymes was reversible after treatment.
High-risk prescribing and opioid overdose: prospects for prescription drug monitoring program–based proactive alerts
Authors: Geissert Peter , Hallvik Sara , Van Otterloo Joshua , O'Kane Nicole , Alley Lindsey , Carson Jody , Leichtling Gillian , Hildebran Christi , Wakeland Wayne , Deyo Richard A.
Published: October 2017

To develop a simple, valid model to identify patients at high risk of opioid overdose–related hospitalization and mortality, Oregon prescription drug monitoring program, Vital Records, and Hospital Discharge data were linked to estimate 2 logistic models; a first model that included a broad range of risk factors from the literature and a second simplified model. Receiver operating characteristic curves, sensitivity, and specificity of the models were analyzed. Variables retained in the final model were categories such as older than 35 years, number of prescribers, number of pharmacies, and prescriptions for long-acting opioids, benzodiazepines or sedatives, or carisoprodol. The ability of the model to discriminate between patients who did and did not overdose was reasonably good (area under the receiver operating characteristic curve = 0.82, Nagelkerke R
2 = 0.11). The positive predictive value of the model was low. Computationally simple models can identify high-risk patients based on prescription history alone, but improvement of the predictive value of models may require information from outside the prescription drug monitoring program. Patient or prescription features that predict opioid overdose may differ from those that predict diversion.
Long-term Hearing Preservation After Resection of Vestibular Schwannoma: A Systematic Review and Meta-analysis
Authors: Ahsan Syed F. , Huq Farhan , Seidman Michael , Taylor Andrew
Published: October 2017

Objective:

The objective is to perform a systematic review and meta-analysis of the literature on the long-term results of hearing preservation after vestibular schwannoma resection.

Data Sources:

Ovid/Medline, PubMed, Embase, and the Cochrane library from January 1980 to January 2015.

Study Selection:

Inclusion criteria: age ≥18 years, minimum 10 patients in the treatment group, hearing preserving microsurgery, no previous radiation treatment, serviceable hearing at immediate postop follow-up, hearing outcomes reported using Gardner Robinson or the American Academy of Otolaryngology-Head and Neck Surgeons hearing grading scales, and average follow-up of 5 years. Preoperative, immediate postoperative, and last follow-up audiograms were required. Exclusion criteria included neurofibromatosis type 2 patients and surgery for salvage therapy or decompression.

Data Extraction:

Quality evaluated using Methodological Index for Non-Randomized Studies.

Data Synthesis:

Meta-analysis was performed using R v3.2.2, Metafor package v 1.9-7. Cohen's D was used to determine effect size. Ten reports had at least 5-year follow-up and used standardized hearing grading scales. The systematic review found that if hearing was preserved at Class A or B at early postop visit, the chance of preserving hearing at 5 years was excellent. Those who maintained speech discrimination score ≥ 89% at the early postoperative follow-up had better long-term hearing preservation. The meta-analysis reveals that only preoperative and postoperative pure-tone average was associated with long-term hearing preservation.

Conclusion:

Long-term (>5 yr) hearing durability rates are generally very good. Most studies do not report patient and tumor characteristics, therefore precluding combining studies for meta-analysis. Only preoperative and postoperative postoperative pure-tone average was associated with long-term hearing durability.
Influence of laboratory-related and endoscopy-related factors on the assessment of serum pepsinogens and gastrin-17
Authors: Goni Elisabetta , Venerito Marino , Schulz Christian , Weigt Jochen , Langner Cosima , Link Alexander , Malfertheiner Peter
Published: October 2017

Background and aim

Serum pepsinogen I (PGI) and pepsinogen II (PGII) are noninvasive parameters in the detection of atrophic gastritis. The diagnostic add-on value of serum gastrin-17 (G-17) remains uncertain. The aim of this study was to assess the stability of these serum parameters over time and to evaluate the influence of clinical factors, such as upper gastrointestinal (GI) endoscopy and bowel cleansing, on serum PGI, PGII, and G-17 assessment.

Patients and methods

A prospective study was carried out in healthy individuals and patients. For the stability analyses, the plasma and serum samples from 23 individuals were processed at different time points with and without the addition of a stabilizer. Ten patients were included to evaluate the influence of upper GI endoscopy and 18 patients to evaluate the effect of bowel cleansing before colonoscopy.

Results

PGI, PGII, and G-17 levels were not statistically different in the serum and plasma. PGI and PGII serum levels were stable over time. G-17 is associated with time-dependent degradation (P=0.0001). The addition of the G-17 stabilizer showed no improvement in stability. Upper GI endoscopy and bowel preparation before colonoscopy were associated with minimal variations in PGI and PGII, whereas G-17 showed patient-specific alterations.

Conclusion

PGI and PGII serum levels are stable over time. However, G-17 stability is strongly dependent on the time of processing and storage; therefore, samples for G-17 analysis need to be processed no later than 6 h after blood collection. Upper GI endoscopy and colonoscopy preparation lead to minimal nonsignificant changes in basal PGI, PGII, and G-17 levels.
Rapid cardiothoracic ultrasound protocol for diagnosis of acute heart failure in the emergency department
Authors: Öhman Jonas , Harjola Veli-Pekka , Karjalainen Pasi , Lassus Johan
Published: October 2017

Objectives

The aim of this study was to evaluate the performance of a rapid cardiothoracic ultrasound protocol (CaTUS), combining echocardiographically derived E/eʹ and lung ultrasound (LUS), for diagnosing acute heart failure (AHF) in patients with undifferentiated dyspnea in an emergency department (ED).

Patients and results

We enrolled 100 patients with undifferentiated dyspnea from a tertiary care ED, who all had CaTUS done immediately upon arrival in the ED. CaTUS was positive for AHF with an E/eʹ > 15 and congestion, that is bilateral B-lines or bilateral pleural fluid, on LUS. In addition, an inferior vena cava index was also recorded to analyze whether including a central venous pressure estimate would add diagnostic benefit to the CaTUS protocol. All 100 patients had a brain natriuretic peptide (BNP) sample withdrawn, and 96 patients underwent chest radiography in the ED, which was analyzed later by a blinded radiologist. The reference diagnosis of AHF consisted of either a BNP of more than 400 ng/l or a BNP of less than 100 ng/l in combination with congestion on chest radiography and structural heart disease on conventional echocardiography.

CaTUS had a sensitivity of 100% (95% confidence interval: 91.4–100%), a specificity of 95.8% (95% confidence interval: 84.6–99.3%), and an area under the curve of 0.979 for diagnosing AHF (P<0.001). The diagnostic accuracy of CaTUS was higher than of either E/eʹ or LUS alone. Adding the inferior vena cava index to CaTUS did not improve diagnostic accuracy. CaTUS seemed helpful also for differential diagnostics of dyspnea, mainly regarding pneumonias and pulmonary embolisms.

Conclusion

CaTUS, combining E/eʹ and LUS, provided excellent accuracy for diagnosing AHF.
Homeopathy as Boundary Object and Distributed Therapeutic Agency. A Discussion on the Homeopathic Placebo Response
Authors: Rughiniş Cosima , Ciocănel Alexandra , Vasile Sorina
Published: October 2017

Background:

We discuss homeopathy's placebo effect as the result of a distributed therapeutic agency involving humans, objects, and texts. Homeopathy has been involved in controversies for centuries, and the dispute whether it is therapy or quackery is as lively as ever. Still, homeopathy has retained significant popularity and acceptance within the medical establishment.

Areas of Uncertainty:

We bracket the issue of biochemical effectiveness of homeopathic remedies as we only discuss homeopathy's potential to elicit a placebo response within its therapeutic alliance, in virtue of its social, symbolic, and material features.

Data Sources:

The review is based on literature discussing homeopathic effectiveness, including historical, biographical, sociological, and epistemological perspectives. We build upon research that clarifies the therapeutic relationship, examining its activities and meanings for practitioners and patients.

Results:

Previous analyses discussing homeopathy's placebo effect stress the importance of the individualized consultation that functions as psychotherapy and generates empathy and hope. We enlarge the discussion, highlighting homeopathy's distributed therapeutic agency across humans, texts, and materials. The historical evolution of homeopathy in relation to biomedicine and science is important to understand its institutional integration into mainstream medicine and its appeal to scientifically minded doctors. Anecdotes of healing and the message of no-harm encourage patients to try homeopathy and hope for the best. The esthetics and ritual of remedies, coupled with computers' scientific legitimacy and time-saving power constitute a material infrastructure of therapeutic persuasion.

Conclusions:

Through its relation with biomedicine, its doctrine, consultation design, and treatment rituals, homeopathy offers a powerful medium to elicit a placebo response in a therapeutic alliance. By virtue of its proximity and radical difference from the scientific and biomedical enterprises, its material and textual organization, its storytelling and esthetics, homeopathy offers doctors and patients the opportunity and the tools to collaborate, to witness healing, and to hope for success against adversity.
Incident Cardiovascular Risk Factors Among Men and Women Veterans After Return From Deployment
Authors: Haskell Sally G. , Brandt Cynthia , Burg Matthew , Bastian Lori , Driscoll Mary , Goulet Joseph , Mattocks Kristin , Dziura James
Published: October 2017

Background:

Stressors associated with military service and reintegration may impact psychologic well-being and behaviors that result in increased incidence rates for cardiovascular (CV) risk factors.

Objective:

Using electronic health record data from the Veterans Health Administration we sought to measure the incidence of newly diagnosed CV risk factors and how these incident risks were moderated by race and mental health conditions.

Design:

A cohort study including Veterans whose end of last deployment was between October 1, 2001 and July 31, 2014.

Subjects:

A total of 267,305 Operations Iraqi Freedom, Enduring Freedom, and New Dawn Veterans were present.

Main Outcome Measures:

Incident risk factors (hypertension, obesity, dyslipidemia, diabetes, or coronary artery disease), identified through new International Classification of Diseases, 9th Revision, Clinical Modification diagnostic codes or measurement recordings at primary care visits.

Results:

The rate of developing at least 1 risk factor or coronary artery disease was 240 and 151 per 1000 person-years in men and women, respectively. Except for obesity, women were significantly less likely to develop any other CV risk factor compared with men (Crude hazard ratios ranging from 0.44 to 0.82). The impact of sex on hypertension (P<0.001) and obesity (P<0.001) was modified by race and the impact of sex on the combined event of any risk factor (P=0.007) and obesity (P<0.001) was modified by depression.

Conclusions:

Compared with men, women Veterans were more likely to become obese after return from deployment, but less likely to develop any other risk . For black women, the protective effect of female sex on the combined event (any risk factor), and hypertension was lessened compared with white women. The increased risk of obesity for women was greater in black women, and those with depression.
Leaving the nest: anticipatory guidance for the college-bound youth
Authors: Sidhu Sharnendra , Adesman Andrew
Published: October 2017

Purpose of review

The number of students enrolling in college is on the rise; however, the number of students dropping out is increasing as well. Given that the transition to attending college poses challenges with independent academic functioning, social adjustment, health behaviors, and lifestyle choices, the purpose of this review is to describe some of the issues that these students will encounter so that pediatricians can help teens who are going to college successfully transition to their new academic, social, and living environment.

Recent findings

Students who have the opportunity to go to college must successfully balance their scholastic commitments and their personal development outside the classroom. Their newfound independence poses several other challenges – obtaining adequate sleep, proper nutrition, and regular exercise as well as risks related to alcohol use, drug use, and sexual activity.

Pediatricians can play an important role by counseling college-bound teens about these common issues, perils and pitfalls. With anticipatory counseling focused on these concerns, pediatricians can help foster the personal growth and social/intellectual development of teenagers to better prepare them for success in college and then later in life.
Advances in pharmacotherapies for movement disorders in children: current limitations and future progress
Authors: Lin Jean-Pierre
Published: October 2017

Purpose of review

In childhood, movement disorders are generated by a very large number of disorders of the nervous system, and the very different developmental ages at which these occur make studies of pharmacotherapy efficacy extremely difficult. In most clinical practices, medication used in management is by trial and error, and limited by lack of efficacy and/or adverse drug reactions leading to drug intolerance. Nevertheless, symptom reduction using polypharmacy must be balanced against any accompanying comorbidities such as poor attention and concentration, constipation, ileus, urinary retention, blurred vision sedation and respiratory depression.

Recent findings

A ‘personalised medicine’ approach may lead to specific management breakthroughs that are beneficial to a wider number of children. At present, neuromodulation with implantable devices offers greater proven efficacy for dystonia, myoclonus and dystonic-choreoathetosis, but enteral, intravenous and, more recently, transdermal medication strategies with clonidine patches and enteral gabapentin may provide important relief for both home management and critical care settings.

The current review brings the clinician up-to-date with the latest, albeit limited, thinking on the pharmacological management of movement disorders in children by focussing on goal-directed outcome measures to improve clinical decision-making in an evidence-light clinical setting.
Intestinal Fatty Acid Binding Protein and Citrulline as Markers of Gut Injury and Prognosis in Patients With Acute Pancreatitis
Authors: Goswami Pooja , Sonika Ujjwal , Moka Praneeth , Sreenivas Vishnubhatla , Saraya Anoop
Published: October 2017

Objectives

Severe acute pancreatitis (AP) is associated with high mortality due to systemic inflammatory response syndrome in the early phase and secondary infection in the later phase. Concomitant intestinal ischemia often results in gut injury. We studied intestinal fatty acid binding protein (IFABP) and citrulline levels as markers of gut injury to predict prognosis in AP.

Methods

Acute pancreatitis patients at admission and controls were studied. Serum IFABP was measured by enzyme-linked immunosorbent assay and plasma citrulline by high-performance liquid chromatography technique. Ultrastructural changes in duodenal biopsy were also compared between the 2 groups.

Results

The IFABP concentration was significantly higher in AP cases (n = 94) compared with controls (n = 100) (mean [standard deviation], 592.5 [753.6] vs 87.8 [67.6] pg/mL; P < 0.001) and in patients with severe AP versus mild AP (738.3 [955.3] vs 404.0 [263.3] pg/ mL, P = 0.03). Citrulline concentration was lower in AP versus controls (29.9 [33.8] vs 83.9 [60.1] μg/L, P < 0.001). We propose a model by which these biomarkers (IFABP >350 pg/mL and citrulline <18 μg/L) are able to predict poor prognosis in 33.9% of patients with AP. The gut injury was also validated via ultrastructural changes.

Conclusions

Intestinal fatty acid binding protein is a promising prognostic marker in acute pancreatitis.
Effects of ω-3 Fatty Acids on Toll-like Receptor 4 and Nuclear Factor κB p56 in the Pancreas of Rats With Severe Acute Pancreatitis
Authors: Wang Bin , Xu Xiao-Bing , Jin Xin-Xin , Wu Xiao-Wei , Li Min-Li , Guo Mei-Xia , Zhang Xiao-Hua
Published: October 2017

Objectives

The aims of this study were to determine the effects of ω-3 fatty acids (ω-3FAs) on the Toll-like receptor 4 (TLR4)/nuclear factor κB p56 (NF-κBp56) signaling pathway in the pancreas of rats with severe acute pancreatitis (SAP).

Methods

Sixty-four Sprague-Dawley rats were randomly divided into 4 groups: the control, SAP-saline, SAP–soybean oil, and SAP–ω-FA groups. Severe acute pancreatitis was induced by the retrograde infusion of sodium taurocholate into the pancreatic duct. The expression of TLR4 and NF-κBp56 in the pancreas was evaluated by immunohistochemistry and Western blot analysis. The levels of the proinflammatory cytokines interleukin 6 and tumor necrosis factor α in the pancreas were measured by enzyme-linked immunosorbent assays.

Results

Toll-like receptor 4, NF-κBp56, and inflammatory cytokine expression in the pancreas was increased significantly in the SAP group compared with that in the control group (P < 0.05), but was significantly decreased in the ω-3FA group compared with that in the soybean oil group at 24 and 48 hours (P < 0.05).

Conclusions

Our results suggest that during the initial stage of SAP ω-3FAs could efficiently lower the inflammatory response by activating the TLR4/NF-κBp56 signaling pathway.
Concurrent Diabetic Ketoacidosis in Hypertriglyceridemia-Induced Pancreatitis
Authors: Wang Yuchen , Attar Bashar M. , Hinami Keiki , Jaiswal Palashkumar , Yap John Erikson , Jaiswal Radhika , Devani Kalpit , Simons-Linares Carlos Roberto , Demetria Melchor V.
Published: October 2017

Objectives

Concurrent diabetic ketoacidosis (DKA) is highly prevalent in patients with hypertriglyceridemia-induced pancreatitis (HP). Diabetic ketoacidosis could potentially complicate the diagnosis, management, and prognosis of HP. This study aimed to directly compare the clinical course of HP with and without DKA and assess the outcomes of frequently used severity-prediction scores in such population.

Methods

We retrospectively analyzed 140 patients with HP; 37 patients (26.4%) had concurrent DKA. We compared epidemiologic characteristics, initial laboratory values, and clinical courses between the DKA and non-DKA groups. Bedside Index for Severity in Acute Pancreatitis score, Sequential Organ Failure Assessment score, Ranson criteria, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Marshall score were calculated and compared between groups.

Results

We observed more acute kidney injury in the DKA group. Patients with DKA more likely required intensive care unit admission, received intravenous insulin, and were discharged on subcutaneous insulin. Ranson criteria and APACHE II score were significantly higher with DKA.

Conclusions

Concurrent DKA does not affect length of stay, in-hospital mortality, and readmission rate in patients with HP. Higher Ranson criteria and APACHE II score likely reflected derangement of clinical parameters secondary to DKA rather than true severity of pancreatitis in such population.
Effects of Ghrelin miRNA on Inflammation and Calcium Pathway in Pancreatic Acinar Cells of Acute Pancreatitis
Authors: Tang Xiping , Tang Guodu , Liang Zhihai , Qin Mengbin , Fang Chunyun , Zhang Luyi
Published: October 2017

Objectives

The study investigated the effects of endogenous targeted inhibition of ghrelin gene on inflammation and calcium pathway in an in vitro pancreatic acinar cell model of acute pancreatitis.

Methods

Lentiviral expression vector against ghrelin gene was constructed and transfected into AR42J cells. The mRNA and protein expression of each gene were detected by reverse transcription polymerase chain reaction, Western blotting, or enzyme-linked immunosorbent assay. The concentration of intracellular calcium ([Ca2+]i) was determined by calcium fluorescence mark probe combined with laser scanning confocal microscopy.

Results

Compared with the control group, cerulein could upregulate mRNA and protein expression of inflammatory factors, calcium pathway, ghrelin, and [Ca2+]i. mRNA and protein expression of inflammatory factors increased significantly in cells transfected with ghrelin miRNA compared with the other groups. Intracellular calcium and expression of some calcium pathway proteins decreased significantly in cells transfected with ghrelin miRNA compared with the other groups.

Conclusions

Targeted inhibition of ghrelin gene in pancreatic acinar cells of acute pancreatitis can upregulate the expression of the intracellular inflammatory factors and alleviate the intracellular calcium overload.
Contributors to Screening Positive for Mental Illness in Lebanon's Shatila Palestinian Refugee Camp
Authors: Segal Steven P. , Khoury Vicky C. , Salah Ramy , Ghannam Jess
Published: October 2017

This study evaluates contributors to the mental health status of Palestinians, Syrians, and nonrefugee residents of Lebanon's Shatila Refugee Camp. Primary health care clinic patients in Shatila were screened for mental illness between 2012 and 2013 using the K6, the Primary Care Posttraumatic Stress Disorder (PTSD), and the Modified Mini International Neuropsychiatric Interview. Logistic regressions enabled the consideration of potential contributors to participants' positive mental illness screens. The sample (n = 254) included 63.4% Palestinians, 18.5% Syrians, and 18.1% nonrefugees. People lived in the camp for 21.1 years (±17), 63% had stable housing and 78% had war event exposure. Mental illness prevalence was 51.6% in total (34.8% serious mental illness [SMI] alone, 5.1% PTSD alone, 11.4% comorbid SMI/PTSD, and 0.08% comorbid psychotic spectrum disorder SMI/PTSD). For Palestinians and nonrefugees, respectively, stable housing accounted for a 79% and a 98% reduction in positive SMI screen risk. For Syrians, access to paid employment accounted for a 66% risk reduction. Stable living situations and economically productive employment for those trapped in a refugee situation, even in the face of war trauma, seem most important for ensuring reduced mental disorder risk.
Evaluation of the C-MAC Miller Video Laryngoscope Sizes 0 and 1 During Tracheal Intubation of Infants Less Than 10 kg
Authors: Raimann Florian J. , Cuca Colleen E. , Kern Detlev , Zacharowski Kai , Rolle Udo , Meininger Dirk , Weber Christian F. , Byhahn Christian , Mutlak Haitham
Published: October 2017

Study Objective

Video laryngoscopy has primarily been developed to assist in difficult airways. Using video laryngoscopy in pediatric airway management is an up-and-coming topic. The aim of the presented study was to compare the intubation conditions obtained when using the C-MAC video laryngoscope with Miller blades sizes 0 and 1 for standard direct laryngoscopy and indirect laryngoscopy in children weighing less than 10 kg.

Design

This was a prospective study.

Setting

The study was performed in a university hospital.

Patients

Following ethical approval, 86 infants weighing less than 10 kg and undergoing surgery under general anesthesia were studied prospectively.

Intervention

Indirect and direct laryngoscopy either with C-MAC Miller blade size 0 or size 1.

Measurements

First, direct laryngoscopy was performed, and the best obtained view was graded without looking at the video monitor. A second investigator blinded to the view obtained under direct laryngoscopy graded the laryngeal view on the video monitor. Time to intubation, intubation conditions, and intubation attempts were recorded.

Results

In infants less than 10 kg, intubation conditions were excellent. There were no significant differences between the use of Miller blade 0 or 1 in reference to Cormack-Lehane grade, time to intubation, time to best view, or intubation attempts. Comparing direct and indirect intubation conditions using either Miller blade 0 or 1 revealed that the use of indirect laryngoscopy provided a significantly better view (P < 0.05) of the vocal cords. In 3 infants weighing more than 8 kg, the Miller blade 0 was described as too short and narrow for intubation.

Conclusions

Both devices allowed for an excellent visualization of the vocal cords.
Urgent Care Transfers to an Academic Pediatric Emergency Department
Authors: McCarthy Jennifer L. , Clingenpeel Joel M. , Perkins Amy M. , Eason Margaret K.
Published: October 2017

Objectives

The aim of this study was to investigate the hypothesis that a significant percentage of urgent care center to pediatric ED transfers can be discharged home without emergency department (ED) resource utilization.

Methods

A retrospective chart review was completed for a 6-month period on all patients transferred from urgent care centers. A data collection tool focusing on demographics, diagnoses, reason for transfer, ED resource utilization, ED disposition, and 72-hour ED return was used. Each encounter was classified as “urgent” or “nonurgent” based on resource utilization criteria. Descriptive statistics were reported for demographics, encounter data, and 72-hour ED return stratified by nonurgent versus urgent classification. Two-sample t, χ2, and Fisher exact tests were used to assess differences in characteristics between the nonurgent and urgent groups.

Results

One hundred nine patients met inclusion criteria. Of these, 93 (85%) were discharged from the ED. Twenty nine (27%) of the transferred patients were discharged without ED resource utilization. Seventy-two–hour return was noted for only 1 patient who was again discharged at the subsequent encounter.

Conclusions

A large proportion of patients transferred from urgent care centers were directly discharged from the ED without any ED resource utilization. Eliminating or reducing such transfers has the potential to limit the amount of nonurgent ED visits, thus producing cost savings and better patient care.
Switch From Originator to Equivalent Drug in the Era of Generic Antiepileptic Drugs: Study of Keppra Versus Epitiram Clinical Equivalence
Authors: Fanella Martina , Morano Alessandra , Fattouch Jinane , Albini Mariarita , Basili Luca M. , Casciato Sara , Manfredi Mario , Giallonardo Anna T. , Di Bonaventura Carlo
Published: October 2017

Objectives

Generic antiepileptic drugs represent a measure to maximize cost saving. Levetiracetam (LEV) is one of most commonly used and effective antiepileptic drugs. The objective of our work was to demonstrate the effectiveness and safety of overnight switch from monotherapy with Keppra (original drug) to epitiram (generic drug) at the same dose.

Methods

In our observational study, we consecutively enrolled 37 seizure-free patients with epilepsy who expressed the wish to switch to a generic drug for economic reasons. During the 6-month evaluation period, we assessed treatment efficacy, tolerability, compliance, and intersubject variability of LEV serum concentration. At each visit, clinical and neurological examination, scales, video-electroencephalogram, and blood sample analysis to evaluate LEV plasma level were performed.

Results

A total of 36 of 37 enrolled patients switched from Keppra to epitiram, which was administered at the same dose in monotherapy. Three of 36 patients dropped out during follow-up for adverse events. The other 33 subjects had neither seizures nor adverse events. No significant differences in electroencephalogram features and scale scores were revealed; the intersubject variability of LEV serum concentration did not differ significantly at follow-up evaluation (P= 0.53). All the patients expressed good clinical personal impression and continued to take epitiram. The switchback rate was 8 %.

Conclusions

The switch from Keppra to epitiram was easy and safe in our population, and epitiram can be considered as effective and tolerable as Keppra. Only a slight, non–statistically significant variability in LEV serum concentration was documented after the switch from Keppra to epitiram. Larger epileptic populations should be studied to confirm these results.
Weak value controversy
Authors: Vaidman L.
Published: October 2017

Recent controversy regarding the meaning and usefulness of weak values is reviewed. It is argued that in spite of recent statistical arguments by Ferrie and Combes, experiments with anomalous weak values provide useful amplification techniques for precision measurements of small effects in many realistic situations. The statistical nature of weak values is questioned. Although measuring weak values requires an ensemble, it is argued that the weak value, similarly to an eigenvalue, is a property of a single pre- and post-selected quantum system.

This article is part of the themed issue ‘Second quantum revolution: foundational questions’.
Note on transmitted complexity for quantum dynamical systems
Authors: Watanabe Noboru , Muto Masahiro
Published: October 2017

Transmitted complexity (mutual entropy) is one of the important measures for quantum information theory developed recently in several ways. We will review the fundamental concepts of the Kossakowski, Ohya and Watanabe entropy and define a transmitted complexity for quantum dynamical systems.

This article is part of the themed issue ‘Second quantum revolution: foundational questions’.
Genetic load and mutational meltdown in cancer cell populations
Authors: Zhang Yuezheng , Li Yawei , Shen Xu , Zhu Tianqi , Tao Yong , Li Tao , Li Xueying , Wang Di , Ma Qin , Hu Zheng , Liu Jialin , Zheng Caihong , Ruan Jue , Cai Jun , Wu Chung-I , Wang Hurng-Yi , Lu Xuemei
Published: October 2017

ABSRACT

Large and non-recombining genomes are prone to accumulating deleterious mutations faster than natural selection can purge (Muller’s ratchet). A possible consequence would then be the extinction of small populations. Relative to most single-cell organisms, cancer cells, with large and non-recombining genomes, could be particularly susceptible to such “mutational meltdown”. Curiously, deleterious mutations in cancer cells are rarely noticed despite the strong signals in cancer genome sequences. Here, by monitoring single-cell clones from HeLa cell lines, we characterize deleterious mutations that retard cell proliferation. The main mutational events are copy number variations (CNVs), which happen at an extraordinarily high rate of 0.29 events per cell division. The average fitness reduction, estimated to be 18% per mutation, is also very high. HeLa cell populations therefore have very substantial genetic load and, at this level, natural population would likely experience mutational meltdown. We suspect that HeLa cell populations may avoid extinction only after the population size becomes large. Because CNVs are common in most cell lines and cancer tissues, the observations hint at cancer cells’ vulnerability, which could be exploited by therapeutic strategies.
A framework for generating interactive reports for cancer genome analysis
Authors: Okada Ai , Chiba Kenichi , Tanaka Hiroko , Miyano Satoru , Shiraishi Yuichi
Published: October 2017

We introduce paplot, the software for generating dynamic reports that are frequently necessary in the post analytical phases of cancer genome studies. The “interactive” nature of the paplot-generated reports enables users to extract much richer information than that obtained from static graphs via most conventional visualization tools.

Availability and implementation

The python implementation for paplot (MIT license) is available athttps://github.com/Genomon-Project/paplot. The documentation is athttp://paplot-doc.readthedocs.io/en/latest/.

Contact

yshira@hgc.jp
Probing the evolutionary robustness of two repurposed drugs targeting iron uptake inPseudomonas aeruginosa
Authors: Rezzoagli Chiara , Wilson David , Weigert Michael , Wyder Stefan , Kümmerli Rolf
Published: October 2017

Background and objectives

Treatments that inhibit the expression or functioning of bacterial virulence factors hold great promise to be both effective and exert weaker selection for resistance than conventional antibiotics. However, the evolutionary robustness argument, based on the idea that anti-virulence treatments disarm rather than kill pathogens, is controversial. Here we probe the evolutionary robustness of two repurposed drugs, gallium and flucytosine, targeting the iron-scavenging pyoverdine of the opportunistic human pathogenPseudomonas aeruginosa.

Methodology

We subjected replicated cultures of bacteria to two concentrations of each drug for 20 consecutive days in human serum as an ex-vivo infection model. We screened evolved populations and clones for resistance phenotypes, including the restoration of growth and pyoverdine production, and the evolution of iron uptake by-passing mechanisms. We whole-genome sequenced evolved clones to identify the genetic basis of resistance.

Results

We found that mutants resistant against anti-virulence treatments readily arose, but their selective spreading varied between treatments. Flucytosine resistance quickly spread in all populations due to disruptive mutations inupp, a gene encoding an enzyme required for flucytosine activation. Conversely, resistance against gallium arose only sporadically, and was based on mutations in transcriptional regulators, upregulating pyocyanin production, a redox-active molecule promoting siderophore-independent iron acquisition. The spread of gallium resistance could be hampered because pyocyanin-mediated iron delivery benefits resistant and susceptible cells alike.

Conclusions and implications

Our work highlights that anti-virulence treatments are not evolutionarily robustper se. Instead, evolutionary robustness is a relative measure, with specific treatments occupying different positions on a continuous scale.
Adaptation in plant genomes: bigger is different
Authors: Mei Wenbin , Stetter Markus G , Gates Daniel J , Stitzer Michelle C , Ross-Ibarra Jeffrey
Published: October 2017

Here we have proposed thefunctional space hypothesis, positing that mutational target size scales with genome size, impacting the number, source, and genomic location of beneficial mutations that contribute to adaptation. Though motivated by preliminary evidence, mostly fromArabidopsisand maize, more data are needed before any rigorous assessment of the hypothesis can be made. If correct, the functional space hypothesis suggests that we should expect plants with large genomes to exhibit more functional mutations outside of genes, more regulatory variation, and likely less signal of strong selective sweeps reducing diversity. These differences have implications for how we study the evolution and development of plant genomes, from where we should look for signals of adaptation to what patterns we expect adaptation to leave in genetic diversity or gene expression data. While flowering plant genomes vary across more than three orders of magnitude in size, most studies of both functional and evolutionary genomics have focused on species at the extreme small edge of this scale. Our hypothesis predicts that methods and results from these small genomes may not replicate well as we begin to explore large plant genomes. Finally, while we have focused here on evidence from plant genomes, we see noa priorireason why similar arguments might not hold in other taxa as well.
Dissociable signatures of visual salience and behavioral relevance across attentional priority maps in human cortex
Authors: Sprague Thomas C. , Itthipuripat Sirawaj , Vo Vy A. , Serences John T.
Published: October 2017

Computational models posit that visual attention is guided by activity within spatial maps that index the image-computable salience and the behavioral relevance of objects in the scene. However, the simultaneous influence of these factors on putative neural ‘attentional priority maps’ in human cortex is not well understood. We tested the hypothesis that visual salience and behavioral relevance independently impact the activation profile across retinotopically-organized cortical regions by quantifying attentional priority maps measured in human brains using functional MRI while participants attended one of two differentially-salient stimuli. We find that the topography of activation in priority maps, as reflected in the modulation of region-level patterns of population activity, independently indexed the physical salience and behavioral relevance of each scene element. Moreover, salience strongly impacted activation patterns in early visual areas, whereas later visual areas were dominated by relevance. This suggests that prioritizing spatial locations relies on distributed neural codes containing graded representations of salience and relevance across the visual hierarchy.

Significance Statement

Often, it is necessary to orient towards bright, unique, or sudden events in the environment – that is, salient stimuli. However, we can focus processing resources on less salient visual information if it is relevant to the task at hand. We tested a theory which supposes that we represent different scene elements according to both their salience and their relevance in a series of ‘priority maps’ by measuring fMRI activation patterns across the human brain and reconstructing spatial maps of the visual scene under different task conditions. We found that different regions indexed either the salience or the relevance of scene items, but not their interaction, suggesting an evolving representation of salience and relevance across different visual areas.