bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Second-stage Pushing and Body Mass Index on Postdural Puncture Headache
Authors: Franz A.M. , Jia S.Y. , Bahnson H.T. , Goel A. , Habib A.S.
Published: August 2017

(J Clin Anesth. 2017;37:77–81)

The generally accepted mechanism of postdural puncture headache (PDPH) is leakage of cerebrospinal fluid (CSF) from a dural defect, resulting in decreased CSF volume. However, while pushing during the second stage of labor and increased body mass index (BMI) may affect CSF leakage, and thus the incidence of PDPH, studies have reported conflicting results. The authors of the present study explored how pushing during labor and BMI affect the development of PDPH in parturients who experienced dural puncture with a Tuohy epidural needle.
Mechanical and Pharmacologic Methods of Labor Induction: A Randomized Controlled Trial
Authors: Levine L.D. , Downes K.L. , Elovitz M.A. , Parry S. , Sammel M.D. , Srinivas S.K.
Published: August 2017

(Obstet Gynecol. 2016;128(6):1357–1364)

Labor induction is one of the most common procedures performed during pregnancy. Studies have suggested that the use of a combination method of mechanical and pharmacologic induction agents may reduce labor time and the risk of cesarean delivery. Consequently, the authors of the present study compared the time to delivery among 4 different cervical-ripening methods, including 2 combination methods. They hypothesized that induction with a combination method would lead to a shorter time to delivery than a single agent method.
Effect of a High-rate Versus a Low-rate Oxytocin Infusion for Maintaining Uterine Contractility During Elective Cesarean Delivery: A Prospective Randomized Clinical Trial
Authors: Duffield A. , McKenzie C. , Carvalho B. , Ramachandran B. , Yin V. , El-Sayed Y.Y. , Riley E.T. , Butwick A.J.
Published: August 2017

(Anesth Analg. 2017;124(3):857–862)

Oxytocin is routinely used for prophylaxis against uterine atony after vaginal or cesarean delivery (CD), as it has been shown to decrease the risk of postpartum hemorrhage (PPH). In fact, a low dose delivered during elective CD can initiate adequate uterine tone after placental delivery. However, consensus is lacking on the effective oxytocin infusion rate for achieving this outcome and there exists marked variation in prescribed oxytocin regimens. The authors of the present study thus evaluated the effect of a high-rate (15 U/h) versus low-rate (2.5 U/h) infusion of oxytocin on total estimated blood loss (EBL).
Commonly Used Versus Less Commonly Used Methods in the Loss of Resistance Technique for Identification of the Epidural Space: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Carvalho L.P. , Agarwal A. , Kashiwagi F.T. , Corrêa I. , Pereira J.E. , El Dib R.
Published: August 2017

(J Clin Anesth. 2017;38:41–51)

The loss of resistance (LOR) technique is the most commonly used method for identification of the epidural space during epidural catheter placement. However, as there have been a variety of LOR methods introduced over the last 3 decades, there is no consensus on the most appropriate strategy. In this systematic review, the authors evaluated the efficacy and safety of commonly used methods versus less commonly used methods of LOR for identification of the epidural space.
Blood Loss as a Function of Body Surface Area Redefining Parameters of Obstetric Blood Loss
Authors: Burtch R. , Scott C. , Zimmerman L. , Patel A.
Published: August 2017

(Obstet Gynecol. 2016;128:1274–1280)

Postpartum hemorrhage is often defined by a static, standard volume (500 mL) and may not reflect the true physiological effect of blood loss in women with varying body dimensions. The volume of blood loss seen at the time of delivery as a proportion of a woman’s total blood volume may be a more appropriate measure. In the present study, authors identified average estimated blood loss in vaginal and cesarean deliveries in a cohort of women based on body surface area and compared this with the standard definition.
Effect of Intralipid on the Dose of Ropivacaine or Levobupivacaine Tolerated by Volunteers: A Clinical and Pharmacokinetic Study
Authors: Dureau P. , Charbit B. , Nicolas N. , Benhamou D. , Mazoit J.X.
Published: August 2017

(Anesthesiology. 2016;125(3):474–483)

On the basis of case reports since 2006 and laboratory studies dating back to 1998, rapid intravenous administration of lipid emulsion—“lipid rescue”—has become standard treatment for local anesthetic systemic toxicity (LAST). Hence, the purpose of this crossover study in volunteers was to determine the effect of Intralipid (Fresenius, Paris, France) administration on the time to neurologic symptoms during local anesthetic systemic toxicity (eg, convulsions; severe arrhythmias).
Lipid Emulsion in Local Anesthetic Toxicity: Long-winded, Rude, and Right
Authors: Harvey M. , Cave G.
Published: August 2017

(Anesthesiology. 2016;125(3):451–453)

This editorial accompanied the article by Dureau et al and reviewed some of the theories regarding the antidotal mechanism of lipid emulsions in local anesthetic toxicity (LAST). The “lipid sink” theory postulates that sequestration of lipophilic local anesthetics into a newly created intravascular lipid phase may counter cardiotoxicity. However, this theory is now thought to be an oversimplification and not fully true based on results from extensive pharmacokinetic and pharmacodynamic trials.
Prenatal Parental Depression and Preterm Birth: A National Cohort Study
Authors: Liu C. , Cnattingius S. , Bergström M. , Östberg V. , Hjerna A.
Published: August 2017

(BJOG. 2016;123(12):1973–1982)

Preterm birth is a major cause of infant mortality and has long-term health consequences for survivors. Maternal psychosocial stress has been suggested as a risk factor for adverse pregnancy outcomes, including preterm birth. Paternal depression may also increase maternal stress levels and indirectly affect the pregnancy outcomes. This national cohort study was undertaken to investigate maternal and paternal depression as risk factors for preterm birth.
Nifedipine Maintenance Tocolysis and Perinatal Outcome: An Individual Participant Data Meta-Analysis
Authors: van Vliet E.O.G. , Dijkema G.H. , Schuit E. , Heida K.Y. , Roos C. , van der Post J.A.M. , Parry E.C. , McCowan L. , Lyell D.J. , El-Sayed Y.Y. , Carr D.B. , Clark A.L. , Mahdy Z.A. , Uma M. , Sayin N.C. , Varol G.F. , Mol B.W. , Oudijk M.A.
Published: August 2017

(BJOG. 2016;123:1753–1760)

Preterm birth (<37 wk of gestation) is the leading cause of neonatal mortality and morbidity in developed countries, accounting for 75% of perinatal deaths and more than 50% of childhood neurological disorders. In addition, the rate of preterm birth has been increasing.
Low–molecular-weight Heparin and Recurrent Placenta-mediated Pregnancy Complications: A Meta-Analysis of Individual Patient Data From Randomized Controlled Trials
Authors: Rodger M.A. , Gris J.C. , De Vries J.I.P. , Martinelli I. , Rey É. , Schleussner E. , Middeldorp S. , Kaaja R. , Langlois N.J. , Ramsay T. , Mallick R. , Bates S.M. , Abheiden C.N.H. , Perna A. , Petroff D. , De Jong P. , van Hoorn M.E. , Bezemer P.D. , Mayhew A.D.
Published: August 2017

(Lancet. 2016;388:2629–2641)

Placenta-mediated pregnancy complications include preeclampsia, birth of a small for gestational age (SGA) neonate, placental abruption, and late pregnancy loss. They are significant contributors to maternal and neonatal morbidity and mortality. Patients experiencing these complications are also at risk of placenta-mediated complications occurring in subsequent pregnancies. Effective preventive measures for these complications are generally lacking. The current investigators had previously published a study-level meta-analysis that indicated low–molecular-weight heparin (LMWH) could reduce the risk of recurrence. However, there was significant heterogeneity in that study so they decided to perform an individual patient data meta-analysis to evaluate the efficacy of LMWH to prevent recurrent placenta-mediated complications in subsequent pregnancies.
Atosiban Versus Fenoterol as a Uterine Relaxant for External Cephalic Version: Randomized Controlled Trial
Authors: Velzel J. , Vlemmix F. , Opmeer B.C. , Molkenboer J.F. , Verhoeven C.J. , van Pampus M.G. , Papatsonis D.N. , Bais J.M. , Vollebregt K.C. , van der Esch L. , Van der Post J.A. , Mol B.W. , Kok M.
Published: August 2017

(BMJ. 2017;356:i6773)

Breech presentation occurs in approximately 4% of term singleton pregnancies, and has been reported to be the third most common indication for elective cesarean delivery. External cephalic version (ECV) is a safe procedure that can successfully convert a breech presentation to a cephalic presentation in about 50% of women who undergo the procedure, thereby decreasing the cesarean delivery rate.
Survival and Neurodevelopmental Outcomes Among Periviable Infants
Authors: Younge N. , Goldstein R.F. , Bann C.M. , Hintz S.R. , Patel R.M. , Smith P.B. , Bell E.F. , Rysavy M.A. , Duncan A.F. , Vohr B.R. , Das A. , Goldberg R.N. , Higgins R.D. , Cotten C.M.
Published: August 2017

(N Engl J Med. 2017;376(7):617–628)

Care of periviable infants remains a great challenge in neonatal and perinatal medicine. Although data from the past 5 years indicate that mortality has declined among periviable infants, little is known about the relationship between survival and neurodevelopmental outcomes. The authors of the present study thus evaluated changes over time in survival and neurodevelopmental outcomes among infants born at 22 to 24 weeks of gestation, as assessed at 18 to 22 months of corrected age.
Neonatal Intensive Care: The Only Constant Is Change
Authors: Shah Prakesh S.
Published: August 2017

(N Engl J Med. 2017;376(7):694–696)

In this editorial, the author discussed concerns regarding Younge et al’s study on periviable infants (born ≤24 wk). This study found a 4-percentage point increase in the rate of survival without clinically significant neurodevelopmental impairment in periviable infants born between the periods of 2000-2003 to 2008-2011 (P=0.001) and a 1-percentage point increase in the rate of survival with clinically significant neurodevelopmental impairment from the periods of 2000-2003 to 2008-2011 although this was not statistically significant (P=0.29).
Neonatal Abstinence Syndrome
Authors: McQueen K. , Murphy-Oikonen J.
Published: August 2017

(N Engl J Med. 2016;375(25):2468–2479)

This review discussed the current literature, clinical characteristics, prevention, identification, and treatment of neonatal abstinence syndrome (NAS). NAS refers to a postnatal opioid withdrawal syndrome that occurs in 55% to 94% of newborns who are exposed in utero to opioids. Its incidence has increased substantially in the past decade, corresponding with reports of increased opioid use for pain control in pregnant women, increased illicit use of oxycodone and heroin, and an increase in opioid-substitution addiction treatment programs (methadone and buprenorphine clinics).
Prevalence of Maternal Chronic Diseases During Pregnancy: A Nationwide Population Based Study From 1989 to 2013
Authors: Jølving L.R. , Nielsen J. , Kesmodel U.S. , Nielsen R.G. , Beck-Nielsen S.S. , Nørgård B.M.
Published: August 2017

(Acta Obstet Gynecol Scand. 2016;95(11):1295–1304)

Maternal chronic disease has been found to have a negative impact on neonatal outcomes. These impacts can be caused by both the maternal disease process as well as by the treatments involved. Knowledge of the magnitude of this problem is limited to one American study in which women self-reported data. This population-based, nationwide Danish study aimed to explore the prevalence of maternal chronic diseases over time.
Maternal and Neonatal Outcomes of Attempted Vaginal Compared With Planned Cesarean Delivery in Triplet Gestations
Authors: Lappen J.R. , Hackney D.N. , Bailit J.L.
Published: August 2017

(Am J Obstet Gynecol. 2016;215(4):493.e1–e6)

In the United States, the clear majority of triplet births occur via planned cesarean section; however, there is limited and conflicting evidence concerning the most successful route of delivery for triplet gestations. Previous data comparing cesarean delivery versus vaginal delivery have significant limitations, including study size and differences relevant to perinatal outcomes between vaginal and cesarean delivery groups. Many do not compare planned or attempted delivery routes but only the actual delivery routes. This study was designed to use a large, multi-institution cohort to compare neonatal and maternal outcomes for planned cesarean delivery and attempted vaginal delivery of triplets. The study determined the likelihood of success for attempted vaginal delivery for a triplet gestation.
Pregnancy as a Window to Future Health: Maternal Placental Syndromes and Short-term Cardiovascular Outcomes
Authors: Cain M.A. , Salemi J.L. , Tanner J.P. , Kirby R.S. , Salihu H.M. , Louis J.M.
Published: August 2017

(Am J Obstet Gynecol. 2016;215(4):484.e1–484.e14)

Pregnancy-related morbidities, such as preeclampsia and placental infarction and abruption, have been linked to the development of future cardiovascular disease (CVD), the leading cause of death among women in the United States. Previous studies have mostly focused on these maternal placental syndromes (PS) and long-term risk (up to 15 y after giving birth) of CVD. This study investigated the short-term risk (up to 5 years after first pregnancy) of CVD, which would likely occur within the mother’s reproductive timespan and could impact future pregnancies. The study also examined the impact of PS and CVS on health care costs and utilization.
The Influence of Body Mass Index on Sensorimotor Block and Vasopressor Requirement During Spinal Anesthesia for Elective Cesarean Delivery
Authors: Ngaka T.C. , Coetzee J.F. , Dyer R.A.
Published: August 2017

(Anesth Analg. 2016;123(6):1527–1534)

General anesthesia for cesarean delivery (CD) in morbidly obese patients is associated with significantly increased maternal and fetal risk. Neuraxial anesthesia using local anesthetics and opioids is preferred. Recent studies have suggested that the dose requirement for CD spinal anesthesia (SA) is lower in obese patients than in nonobese patients. However, the authors of this study hypothesized that obesity does not have a clinically important effect on vasopressor requirements or block height. In the present study, they compared responses in patients with widely differing body mass indices (BMIs) to an identical dose of spinal bupivacaine 10 mg and fentanyl 10 μg.
A Randomized Controlled Trial of Music Use During Epidural Catheter Placement on Laboring Parturient Anxiety, Pain, and Satisfaction
Authors: Drzymalski D.M. , Tsen L.C. , Palanisamy A. , Zhou J. , Huang C.C. , Kodali B.S.
Published: August 2017

(Anesth Analg. 2017;124(2):542–547)

Listening to music during labor and delivery has been associated with lower anxiety and pain scores, in both laboring women and their male partners. However, the effect of music use in the clinical setting is still poorly understood. In this prospective, randomized, controlled trial, the authors determined the effects of music use during epidural catheter placement on laboring parturients as well as on anesthesia providers.
Intraperitoneal Instillation of Lidocaine Improves Postoperative Analgesia at Cesarean Delivery: A Randomized, Double-Blind, Placebo-controlled Trial
Authors: Patel R. , Carvalho J.C. , Downey K. , Kanczuk M. , Bernstein P. , Siddiqui N.
Published: August 2017

(Anesth Analg. 2017;124(2):554–559)

Poorly controlled postpartum pain can place a patient at risk for chronic pain, postpartum depression, and negatively impact maternal-fetal interactions. Although multimodal analgesia has greatly improved pain control in general for these women, there remain a proportion of patients who report inadequate postoperative pain relief. Intraperitoneal local anesthetics, which have proven successful in abdominal surgery pain control, may be an effective adjunct. The authors of this study evaluated the effect of intraperitoneal lidocaine on postcesarean delivery pain as part of a multimodal analgesia regimen.
Anaesthetic Management of Parturients With Univentricular Congenital Heart Disease and the Fontan Operation
Authors: Monteiro R.S. , Dob D.P. , Cauldwell M.R. , Gatzoulis M.A.
Published: August 2017

(Int J Obstet Anesth. 2016;28:83–91)

Over the past few decades, as surgical treatment of congenital heart disease (CHD) has improved, an increasing number of women with CHD are becoming pregnant and obstetric anesthesiologists must be able to manage these women during labor and delivery. One of the newest challenges is that presented by women with a single ventricular circulation that has been palliated with the Fontan operation.
Anesthetic Management of a Parturient With Varicella Presenting for Cesarean Delivery
Authors: Janardhan A.L. , Gupta N. , Prakash S. , Gogna R.L.
Published: August 2017

(Int J Obstet Anesth. 2016;28:92–94)

Varicella (chicken pox) is caused by the varicella zoster virus (VZV) and usually occurs during childhood. Adult varicella cases are uncommon, but 5% to 10% of expectant mothers do not have antibodies to VZV and are at risk of becoming infected. The risk of maternal and fetal morbidity and mortality is high in parturients with VZV infection. A serious complication in adults with varicella is pneumonia. Approximately 25% of varicella-associated deaths occur in adults, and pneumonia is a common cause. When a parturient with VZV infection requires delivery, there is not a clearly defined preferred anesthetic technique. This case report describes the anesthetic management of a 25-year-old parturient infected with varicella who required emergency cesarean delivery.
Labor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal
Authors: Dickerson D.M. , Dai R. , Scavone B.M. , McDade W.
Published: August 2017

(Reg Anesth Pain Med. 2016;41(6):776–779)

This case report detailed the complications that arose with epidural analgesia by describing the case of a 34-year-old patient who developed pain in the upper back, neck, and shoulders following bolus injection into the epidural space. These symptoms were due in this patient to congenital spinal stenosis with a significantly narrowed cervical spinal canal.
Delayed Neuraxial Hematoma in Parturient With Fontan Circulation Following Neuraxial Anesthesia for Cesarean Section
Authors: Chiaghana C.O. , Bremer J.M. , Sappenfield J.W. , Wendling A.L.
Published: August 2017

(Reg Anesth Pain Med. 2016;41(6):773–775)

This case report described the challenges posed by parturients with Fontan circulation, including the treatment for congenital heart disease and anticoagulation management during cesarean delivery performed under neuraxial anesthesia. Pregnancy, in general, increases the risk of venous thromboembolism and this is a common complication in patients with Fontan circulation. In this case, the 30-year-old parturient with Fontan circulation developed a neuraxial hematoma four days after her cesarean delivery performed with continuous spinal anesthesia. Morbid obesity and superficial phlebitis added to the complications in this case.
Subdural Hematoma Associated With Labor Epidural Analgesia: A Case Series
Authors: Lim G. , Zorn J.M. , Dong Y.J. , DeRenzo J.S. , Waters J.H.
Published: August 2017

(Reg Anesth Pain Med 2016;41(5):628–631)

Subdural hematoma (SDH) is a rare but potentially serious adverse outcome following neuraxial analgesia. A wide differential diagnosis complicates the issue but SDH, especially after labor epidural analgesia, is more common than historically estimated. This case series estimated the rate of SDH after labor epidural at 0.026% or 1:3900 rather than the 1:250,000 to 1:500,000 estimated from previously published data. In addition, if a dural puncture occurs at the time of epidural placement the rate was estimated to be as high as 1.1% or 1:87. Thus, a postdural puncture headache (PDPH) following a neuraxial procedure must be monitored closely to avoid this complication and/or an incorrect diagnosis.
Which nonautoimmune myopathies are most frequently misdiagnosed as myositis?
Authors: Mammen Andrew L.
Published: August 2017

Purpose of review

To discuss the spectrum of nonautoimmune myopathies that may be misdiagnosed as autoimmune myopathy.

Recent findings

Inherited myopathies, such as dysferlinopathy, calpainopathy, and facioscapulohumeral dystrophy may be misdiagnosed as autoimmune myopathy, especially when they have inflammatory muscle biopsies. Inclusion body myositis is frequently misdiagnosed as polymyositis when rimmed vacuoles are absent on muscle biopsy, and a careful neuromuscular evaluation is not performed. Hypothyroid myopathy can be misdiagnosed as immune-mediated necrotizing myopathy if thyroid function tests, including a T4 level, are not obtained. Self-limited statin myopathy can be distinguished from statin-associated autoimmune myopathy because patients with the former do not have autoantibodies recognizing 3-hydroxy-3-methylglutaryl-coenzyme A reductase.

Autoimmune myopathies can usually be distinguished from nonautoimmune myopathies based on a combination of the patient history, neuromuscular exam, laboratory findings, and/or muscle biopsy features.
Hallux Varus and Plantar Plate Repair
Authors: Ortiz Cristian , Wagner Emilio
Published: August 2017

One of the most frequent problems encountered in foot and ankle are hallux valgus and lesser toes deformities. One of the complications after hallux valgus treatment is a iatrogenic hallux varus. This deformity can be solved at 2 levels, namely the skeletal level, through a metatarsal osteotomy to correct the varus component of the bone and at the soft tissue level, to compensate and rebalance soft tissue tension surrounding the metatarsophalangeal (MTP) joint. The soft tissue reconstruction may include capsular releases, capsulorraphies, tendon transfers, and augmentations such as nonreabsorbable suture reinforcement of some MTP capsular components. Lesser toe deformities have historically shown moderate to low levels of satisfaction after surgical treatment. Ten years ago the MTP component of lesser toes deformity was solved with some type of metatarsal shortening osteotomy and soft tissue release, specially including dorsal structures over the metatarsal head. Over the last few years’ knowledge from a series of articles have shown the importance in recognizing and repairing the MTP plate to regain stability and alignment at the joint. Different alternatives of repair exist at this level, and some of them are discussed in this article.

Level of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.
Chronic Syndesmotic Injuries and Reconstruction
Authors: Dekker Robert G. , Barbosa Mauricio P. , Kadakia Anish R.
Published: August 2017

Chronic instability of the distal tibiofibular syndesmosis is associated with poor functional outcomes and the development of arthritis. Stabilization of the distal tibiofibular joint after a neglected or recurrent diastasis can be accomplished using a variety of surgical procedures; however, no 1 technique has shown clear superiority. Arthrodesis is considered the most reproducible means of restoring stability at the distal tibiofibular joint; however, the limitation of motion can be associated with ankle pain and may exacerbate symptoms from early ankle degenerative disease. This article presents an algorithmic approach using a double limb allograft reconstruction for symptomatic patients with persistent radiographic widening and either subtle syndesmotic instability or significant disruption and lateral talar shift due to attenuated or disrupted syndesmotic ligaments. The technique primarily reconstructs the interosseous ligament and does not attempt to individually recreate each ligament of the syndesmosis to preserve physiological fibula rotation and translation. Early outcomes have been excellent.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Thrombosis in adult patients with acute leukemia
Authors: Del Principe Maria Ilaria , Del Principe Domenico , Venditti Adriano
Published: August 2017

Purpose of review

Recent studies indicate that the risk of thrombosis in hematologic patients may be similar or even higher than that found in patients with solid tumors. However, available information about pathogenesis and incidence of thrombosis in acute leukemia is limited. This review focuses on mechanisms underlying thrombosis in acute leukemia and discusses recent literature data.

Recent findings

In the last few years, proofs have been provided that leukemic cells release free prothrombotic products, such as micro-vesicles, tissue factors, circulating free DNA and RNA. Furthermore, leukemic blasts can activate the procoagulant population of platelets, which initiate and amplify coagulation, causing thrombosis. In addition to factors produced by acute leukemia itself, others concur to trigger thrombosis. Some drugs, infections and insertion of central venous catheter have been described to increase risk of thrombosis in patients with acute leukemia.

Thrombosis represents a serious complication in patients affected by myeloid and lymphoid acute leukemia. A proper knowledge of its pathophysiology and of the predisposing risk factors may allow to implement strategies of prevention. Improving prevention of thrombosis appears a major goal in patients whose frequent conditions of thrombocytopenia impede an adequate delivery of anticoagulant therapy.
Current status of blood ‘pharming’: megakaryoctye transfusions as a source of platelets
Authors: Gollomp Kandace , Lambert Michele P. , Poncz Mortimer
Published: August 2017

Purpose of review

Donor-derived platelets have proven to be of hemostatic value in many clinical settings. There is a fear that the need for platelets may outgrow the donor pool in first-world countries. Moreover, there are other challenges with donor platelets that add to the impetus to find an alternative platelet source, especially after the megakaryocyte cytokine thrombopoietin was identified. Megakaryocytes have since been differentiated from numerous cell sources and the observed released platelet-like particles (PLPs) have led to calls to develop such products for clinical use. The development of megakaryocytes from embryonic stem cell also supported the concept of developing nondonor-based platelets.

Recent findings

Several groups have claimed that nondonor-based platelets derived from in-vitro grown megakaryocytes may soon become available to supplement or replace donor-derived products, but their number and quality has been wanting. A possible alternative of directly infusing megakaryocytes that release platelets in the lungs – similar to that recently shown for endogenous megakaryocytes – has been proposed.

This present review will describe the present state-of-the-art in generating and delivering nondonor-derived platelets. Progress has been slow, but advances in our ability to generate human megakaryocytes in culture, generate PLPs from these cells, and test the functionality of the resultant platelets in vitro and in vivo have identified important remaining challenges and raised alternative potential solutions.
Do Children and Adolescents With Inflammatory Bowel Disease Complete Clinical Disease Indices Similar to Physicians?
Authors: Diederen Kay , Gerritsma Jorn J. , Koot Bart G.P. , Tabbers Merit M. , Benninga Marc A. , Kindermann Angelika
Published: August 2017

Objectives:

The degree to which children and adolescents with inflammatory bowel disease (IBD) complete clinical disease activity indices in accordance with their physician is indefinite. Therefore, we investigated the agreement between patient‐ and physician‐based clinical indices in children and adolescents with a previous diagnosis of IBD.

Methods:

In this cross‐sectional study, IBD patients (8–18 years) were included prospectively. Patients completed a patient‐based short Pediatric Crohn's Disease Activity Index (shPCDAI) for Crohn disease or the Pediatric Ulcerative Colitis Activity Index (PUCAI) for ulcerative or indeterminate colitis. Physicians completed the original physician‐based shPCDAI or PUCAI. Agreement was calculated with linear weighted kappa.

Results:

In total, 154 pairs of clinical indices were collected: 89 pairs of shPCDAI's (median age at assessment 15.6 years, 61% men) and 55 pairs of PUCAI's (median age at assessment 14.0 years, 44% men). The shPCDAI disease activity category only fairly agreed between patient‐ and physician‐based indices (kappa: 0.40 [95% confidence interval 0.24–0.55], P < 0.001), with perfect agreement in 58% of pairs. In the majority of disagreement (81%), patients scored in a higher shPCDAI disease activity category. The PUCAI disease activity category substantially agreed between patient‐ and physician‐based indices (kappa: 0.64 [95% confidence interval 0.45–0.83], P < 0.001), with perfect agreement in 78% of pairs. In the majority of disagreement (75%), patients scored in a higher PUCAI disease activity category.

Conclusions:

Patient‐ and physician‐based shPCDAI and PUCAI do not always agree, particularly the shPCDAI, and therefore, should not be interpreted equivalently in management and research on children and adolescents with IBD.
Post–Hospital Medication Discrepancies at Home
Authors: Costa Linda L. , Byon Ha Do
Published: August 2017

The purpose of this study was to evaluate the occurrence of medication discrepancies during transitional care home visits and the association with emergency department (ED) visits. Using secondary data analysis, the relationships between in-home medication discrepancies and 30- and 90-day ED utilization were examined. For every in-home medication discrepancy, the odds of being admitted to the ED within 90 days increased by 31%. This brief intervention could add a valuable component to post–hospital transition management.
Audit and Feedback
Authors: Clark Rebecca Culver , Carter Kimberly Ferren , Jackson Julie , Hodges Deborah
Published: August 2017

The purpose of this quality improvement study was to explore the impact of audit and feedback on the pneumococcal immunization rate for at-risk adults in ambulatory settings. Study findings support the hypothesis that timely, individualized audit and feedback can have a positive impact on immunization rate; generalized feedback that did not provide actionable information did not have the same impact. The difference between the interventions was significant, χ2 (1, N = 1993) = 124.7, P <.001.
Nursing Students and Service Learning
Authors: McGahee Thayer , Bravo Maureen , Simmons Lisa , Reid Tom
Published: August 2017

This research is an example of a service learning partnership between a prelicensure nursing program and local school district. Through this partnership, students participated in a thoughtfully organized project that met the needs of a community and promoted the humanizing of health care education. Nursing students, under the guidance of faculty, performed required physical examinations for Special Olympics athletes who represented a wide range of age, physical, social, and intellectual levels. Research findings indicated an increase in nursing students’ affective and cognitive development after this activity.
High 18Fluor-DCFPyL Uptake in Adrenal Adenomas
Authors: Peper Johannes Gerrit Karel , Srbljin Sandra , van der Zant Friso Martijn , Knol Remco Johannes Jacob , Wondergem Maurits
Published: August 2017

Radioisotope-labeled prostate-specific membrane antigen (PSMA) tracers have been proven accurate for detection of prostate cancer localizations. Uptake of those tracers in other malignant and benign lesions has been reported, including faint accumulation of 68Ga-PSMA-HBED-CC in adrenal adenoma. A 77-year-old man with prostate carcinoma was scanned with 18F-DCFPyL, a promising 18F-labeled PSMA ligand, for prostate-specific antigen progression while on luteinizing hormone–releasing hormone agonist therapy. The PET/CT shows 18F-DCFPyL uptake in bilateral enlarged adrenals. Non–contrast-enhanced CT scan indicated left adrenal adenoma. Regarding the high positive predictive value of multiphase contrast-enhanced CT (98%), presence of right adrenal adenoma is also likely.
Application of the Radio-Guided Occult Lesion Localization Technique for Renal Lumpectomy
Authors: Betancourt Hernández Jesus Andres , Vera Donoso Cesar , Martinez-Sarmiento Manuel , Monserrat Juan Jose , Bello Jarque Pilar , Boronat Tormo Francisco
Published: August 2017

Incidence of small renal masses is increasing, and preservation of healthy kidney tissue along surgical removal is a challenge, especially if the tumor is small or nonexophytic. To facilitate the location and complete excision of the tumor during surgery, we have implemented the application of the radio-guided occult lesion localization technique from initial idea to clinical application.
2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology
Authors: Hecht Harvey S. , Cronin Paul , Blaha Michael J. , Budoff Matthew J. , Kazerooni Ella A. , Narula Jagat , Yankelevitz David , Abbara Suhny
Published: August 2017

The Society of Cardiovascular Computed Tomography (SCCT) and the Society of Thoracic Radiology (STR) have jointly produced this document. Experts in this subject have been selected from both organizations to examine subject-speciﬁc data and write this guideline in partnership. A formal literature review, weighing the strength of evidence has been performed. When available, information from studies on cost was considered. Computed tomography (CT) acquisition, CAC scoring methodologies and clinical outcomes are the primary basis for the recommendations in this guideline. This guideline is intended to assist healthcare providers in clinical decision making. The recommendations reﬂect a consensus after a thorough review of the best available current scientiﬁc evidence and practice patterns of experts in the ﬁeld and are intended to improve patient care while acknowledging that situations arise where additional information may be needed to better inform patient care.
Lung Cancer
Authors: Benveniste Marcelo F. , Gomez Daniel , Viswanathan Chitra , Shroff Girish S. , Betancourt Cuellar Sonia L. , Carter Brett W. , Marom Edith M.
Published: August 2017

Over the last few decades, advances in radiation therapy technology have markedly improved radiation delivery. Advancements in treatment planning with the development of image-guided radiotherapy and techniques such as proton therapy, allow precise delivery of high doses of radiation conformed to the tumor. These advancements result in improved locoregional control while reducing radiation dose to surrounding normal tissue. The radiologic manifestations of these techniques can differ from radiation induced lung disease seen with traditional radiation therapy. Awareness of these radiologic manifestations and correlation with radiation treatment plans are important to differentiate expected radiation induced lung injury from recurrence, infection and drug toxicity.
Targeted Therapy and Imaging Findings
Authors: Shroff Girish S. , Benveniste Marcelo F. , de Groot Patricia M. , Wu Carol C. , Viswanathan Chitra , Papadimitrakopoulou Vassiliki A. , Truong Mylene T.
Published: August 2017

Non–small cell lung cancer (NSCLC) is usually diagnosed when it is not amenable to curative surgery or radiation. Many of these patients are candidates for systemic therapy. Median survival is only approximately 10 months, and, accordingly, treatment in advanced NSCLC is evolving toward a more personalized approach with the identification of genetic abnormalities based on biomarkers. For example, gene mutations in EGFR (epidermal growth factor receptor) and ALK (anaplastic lymphoma kinase) lead to a cascade of pathways resulting in uncontrolled growth, proliferation, and survival of tumor cells. Targeted therapies are aimed at the products of these mutated genes and include agents such as erlotinib and gefitinib (in EGFR-mutant NSCLC) or crizotinib (in ALK-positive NSCLC). Antiangiogenesis agents such as bevacizumab are another category of targeted therapy that inhibits vascular endothelial growth factors. The imaging characteristics of advanced NSCLC with genetic abnormalities, the evolution of targeted therapies and their imaging manifestations will be discussed.
Multi-institutional analysis of neutrophil-to-lymphocyte ratio (NLR) in patients with severe hemorrhage: A new mortality predictor value
Authors: Duchesne Juan Carlos , Tatum Danielle , Jones Glenn , Davis Brandy , Robledo Rosemarie , DeMoya Marc , O’Keeffe Terence , Ferrada Paula , Jacome Tomas , Schroll Rebecca , Wlodarczyk Jordan , Prakash Priya , Smith Brian , Inaba Kenji , Khor Desmond , Duke Marquinn , Khan Mansoor
Published: August 2017

BACKGROUND

The neutrophil/lymphocyte ratio (NLR) has been associated as a predictor for increased mortality in critically ill patients. We sought to determine the relationship between NLR and outcomes in adult trauma patients with severe hemorrhage requiring the initiation of massive transfusion protocol (MTP). We hypothesized that the NLR would be a prognostic indicator of mortality in this population.

METHODS

This was a multi-institutional retrospective cohort study of adult trauma patients (≥18 years) with severe hemorrhage who received MTP between November 2014 and November 2015. Differentiated blood cell counts obtained at days 3 and 10 were used to obtain NLR. Receiver operating characteristic (ROC) curve analysis assessed the predictive capacity of NLR on mortality. To identify the effect of NLR on survival, Kaplan-Meier (KM) survival analysis and Cox regression models were used.

RESULTS

A total of 285 patients with severe hemorrhage managed with MTP were analyzed from six participating institutions. Most (80%) were men, 57.2% suffered blunt trauma. Median (IQR) age, Injury Severity Score, and Glasgow Coma Scale were 35 (25–47), 25 (16–36), and 9 (3–15), respectively. Using ROC curve analysis, optimal NLR cutoff values of 8.81 at day 3 and 13.68 at day 10 were calculated by maximizing the Youden index. KM curves at day 3 (p = 0.05) and day 10 (p = 0.02) revealed an NLR greater than or equal to these cutoff values as a marker for increased in-hospital mortality. Cox regression models failed to demonstrate an NLR over 8.81 as predictive of in-hospital mortality at day 3 (p = 0.056) but was predictive for mortality if NLR was greater than 13.68 at day 10 (p = 0.036).

CONCLUSIONS

NLR is strongly associated with early mortality in patients with severe hemorrhage managed with MTP. Further research is needed to focus on factors that can ameliorate NLR in this patient population.

LEVEL OF EVIDENCE

Prognostic study, level III.
L(3)mbt and the LINT complex safeguard tissue identity in the Drosophila ovary
Authors: Coux Rémi-Xavier , Karam Teixeira Felipe , Lehmann Ruth
Published: August 2017

Maintenance of cellular identity is essential for tissue development and homeostasis. At the molecular level, cell identity is determined by the coordinated activation and repression of defined sets of genes. Defects in the maintenance of the genetic programs required for identity can have dire consequences such as organ malformation and cancer. The tumor suppressor L(3)mbt was shown to secure cellular identity in Drosophila larval brains by repressing germline-specific genes. Here we interrogate the temporal and spatial requirements for L(3)mbt in the Drosophila ovary, and show that it safeguards the integrity of both somatic and germline tissues.L(3)mbtmutant ovaries exhibit multiple developmental defects, which we find to be largely caused by the inappropriate expression of a single gene,nanos, a key regulator of germline fate, in the somatic cells of the ovary. In the female germline, we find that L(3)mbt represses testis-specific and neuronal genes. Molecularly, we show that L(3)mbt function in the ovary is mediated through its cofactor Lint1 but independent of the dREAM complex. Together, our work uncovers a more complex role for L(3)mbt than previously understood and demonstrates that L(3)mbt secures tissue identity by preventing the simultaneous expression of original identity markers and tissue-specific misexpression signatures.
Distributed cortical structural properties contribute to motor cortical excitability and inhibition
Authors: Dayan Eran , López-Alonso Virginia , Liew Sook-Lei , Cohen Leonardo G.
Published: August 2017

The link between the local structure of the primary motor cortex and motor function has been well documented. However, motor function relies on a network of interconnected brain regions and the link between the structural properties characterizing these distributed brain networks and motor function remains poorly understood. Here, we examined whether distributed patterns of brain structure, extending beyond the primary motor cortex can help classify two forms of motor function: corticospinal excitability and intracortical inhibition. To this effect, we recorded high-resolution structural magnetic resonance imaging scans in 25 healthy volunteers. To measure corticospinal excitability and inhibition in the same volunteers we recorded motor evoked potentials (MEPs) elicited by single-pulse transcranial magnetic stimulation (TMS) and short-interval intracortical inhibition (SICI) in a separate session. Support vector machine (SVM) pattern classification was used to identify distributed multivoxel gray matter areas, which distinguished subjects who had lower and higher MEPs and SICIs. We found that MEP and SICI classification could be predicted based on a widely distributed, largely non-overlapping pattern of voxels in the frontal, parietal, temporal, occipital and cerebellar regions. Thus, structural properties distributed over the brain beyond the primary motor cortex relate to motor function.
Labeling of prokaryotic mRNA in live cells using fluorescentin situhybridization of transcript-annealing molecular beacons (FISH-TAMB)
Authors: Harris Rachel L. , Lau Maggie C. Y. , van Heerden Esta , Cason Errol , Vermeulen Jan-G , Taneja Anjali , Kieft Thomas L. , DeCoste Christina , Laevsky Gary , Onstott Tullis C.
Published: August 2017

High-throughput sequencing and cellular imaging have expanded our knowledge of microbial diversity and expression of cellular activity. However, it remains challenging to characterize low-abundance, slow-growing microorganisms that play key roles in biogeochemical cycling. With the goal of isolating transcriptionally active cells of these microorganisms from environmental samples, we developed fluorescentin situhybridization of transcript-annealing molecular beacons (FISH-TAMB) to label living prokaryotic cells. FISH-TAMB utilizes polyarginine cell-penetrating peptides to deliver molecular beacons across cell walls and membranes. Target cells are fluorescently labeled via hybridization between molecular beacons and messenger RNA of targeted functional genes. FISH-TAMB’s target specificity and deliverance into both bacterial and archaeal cells were demonstrated by labeling intracellular methyl-coenzyme M reductase A (mcrA) transcripts expressed byEscherichia colimcrA+,Methanosarcina barkeri,and a methanogenic enrichment of deep continental fracture fluid. Growth curve analysis supported sustained cellular viability following FISH-TAMB treatment. Flow cytometry and confocal microscopy detected labeled single cells and single cells in aggregates with unlabeled cells. As FISH-TAMB is amenable to target any functional gene of interest, when coupled with cell sorting, imaging, and sequencing techniques, FISH-TAMB will enable characterization of key uncharacterized rare biosphere microorganisms and of the syntrophically activated metabolic pathways between physically associated microorganisms.
Detection of domain motion in NADPH-cytochrome P450 oxidoreductase through polarization anisotropy measurements
Authors: Kovrigina Elizaveta A , Xia Chuanwu , Kim Jung-Ja P. , Kovrigin Evgenii L
Published: August 2017

Conformational transitions between closed and open states in the NADPH-cytochrome P450 oxidoreductase (POR) play a critical role in its electron-transport function. In this study, we determined rotational diffusion coefficients of the EDANS fluorophore attached to the cytosolic POR construct lacking the N-terminal transmembrane region. We identified two dynamic modes, slow and fast, which are interpreted as the rotational diffusion of POR as a whole and the local domain motion, respectively. Timescale of the local rotational diffusion component suggests that it may correspond to the transient opening of the fully oxidized POR structure.
NMR studies reveal that protein dynamics critically mediate aggregation of the well-folded and very solubleE. coliS1 ribosomal protein
Authors: Lu Yimei , Lim Liangzhong , Song Jianxing
Published: August 2017

Unlike mammalian aging associated with many hallmarks,E. coliaging is only significantly characterized by protein aggregation, thus offering an excellent model for addressing the relationship between protein aggregation and aging. Here we characterized conformations, unfolding and dynamics of ribosomal protein S1 and its D3/D5 domains using NMR, CD and fluorescence spectroscopy. S1 is a 557-residue modular protein containing six S1 motifs. Paradoxically, while S1 is well-folded and very solublein vitro, it was found in various lists of aggregatedE. coliproteins. Our results decipher: 1) S1 has dynamic inter-domain interactions. Strikingly, S1 and its D3/D5 domains have significantly exposed hydrophobic patches characterized by irreversible unfolding. 2) Although D5 has significantly restricted backbone motion on ps-ns time scale, it has global μs-ms conformational dynamics and particularly high “global breathing” motions. 3) D5 assumes the conserved β-barrel fold but contains large hydrophobic patches at least dynamically accessible. Taken together, our study reveals that S1 could be prone to aggregation due to significant dynamics at two levels: inter-domain interactions and individual domains, which may even render buried hydrophobic patches/cores accessible for driving aggregation. This mechanism is most likely to operate in many proteins ofE. coliand other organisms including human.
Oncogenic G12D mutation alters local conformations and dynamics of K-Ras
Authors: Vatansever Sezen , Erman Burak , Gümüş Zeynep H.
Published: August 2017

K-Ras is the most frequently mutated oncoprotein in human cancers, and G12D is its most prevalent mutation. To understand how G12D mutation impacts K-Ras function, we need to understand how it alters the regulation of its dynamics. Here, we present local changes in K-Ras structure, conformation and dynamics upon G12D mutation, from long-timescale Molecular Dynamics simulations of active (GTP-bound) and inactive (GDP-bound) forms of wild-type and mutant K-Ras, with an integrated investigation of atomistic-level changes, local conformational shifts and correlated residue motions. Our results reveal that the local changes in K-Ras are specific to bound nucleotide (GTP or GDP), and we provide a structural basis for this. Specifically, we show that G12D mutation causes a shift in the population of local conformational states of K-Ras, especially in Switch-II (SII) and α3-helix regions, in favor of a conformation that is associated with a catalytically impaired state through structural changes; it also causes SII motions to anti-correlate with other regions. This detailed picture of G12D mutation effects on the local dynamic characteristics of both active and inactive protein helps enhance our understanding of local K-Ras dynamics, and can inform studies on the development of direct inhibitors towards the treatment of K-RasG12D-driven cancers.