bluuebunny/crossref_metadata_2025 huggingface dataset:
Shelf life: Identifying the abandonment of online digital humanities projects
Authors: Meneses Luis , Furuta Richard
Published: November 2018

A large portion of the research carried out in the digital humanities has an online digital object (usually referred as a project) as one of its components. In turn, these online digital objects can be catalogued as distributed resources, which implies that the administrative control of information related to a topic may be spread across online resources and/or collections maintained by multiple scholars in different institutions. This administrative decentralization can lead to changes in content that are often unexpected by a researcher, which can be caused by different factors or circumstances. This reasoning led us to formulate the following question: When can online digital humanities projects be considered abandoned? In this article, we carry out a study on the persistence and average life span of online projects in the digital humanities. More specifically, we will elaborate on their reliance on distributed resources and methods for measuring their shelf life: the average length of time that a digital project can endure without updates until it can ultimately be considered abandoned by its researcher.
Prevalence of cryptococcal antigenemia and nasal colonization in a free-ranging koala population
Authors: Schmertmann Laura J , Kan Alex , Mella Valentina S A , Fernandez Cristina M , Crowther Mathew S , Madani George , Malik Richard , Meyer Wieland , Krockenberger Mark B
Published: November 2018

Cryptococcosis, caused by environmental fungi in the Cryptococcus neoformans and Cryptococcus gattii species complexes, affects a variety of hosts, including koalas (Phascolarctos cinereus). Cryptococcal antigenemia and nasal colonization are well characterized in captive koalas, but free-ranging populations have not been studied systematically. Free-ranging koalas (181) from the Liverpool Plains region of New South Wales, Australia, were tested for cryptococcal antigenemia (lateral flow immunoassay) and nasal colonization (bird seed agar culture). Results were related to environmental and individual koala characteristics. Eucalypt trees (14) were also randomly tested for the presence of Cryptococcus spp. by bird seed agar culture. In sum, 5.5% (10/181) and 6.6% (12/181) of koalas were positive for antigenemia and nasal colonization, respectively, on at least one occasion. And 64.3% (9/14) of eucalypts were culture-positive for Cryptococcus spp. URA5 restriction fragment length polymorphism analysis identified most isolates as C. gattii VGI, while C. neoformans VNI was only found in one koala and one tree. Colonized koalas were significantly more likely to test positive for antigenemia. No associations between antigenemia or colonization, and external environmental characteristics (the relative abundance of Eucalyptus camaldulensis and season), or individual koala characteristics (body condition, sex, and age), could be established, suggesting that antigenemia and colonization are random outcomes of host-pathogen-environment interactions. The relationship between positive antigenemia status and a relatively high abundance of E. camaldulensis requires further investigation. This study characterizes cryptococcosis in a free-ranging koala population, expands the ecological niche of the C. gattii/C. neoformans species complexes and highlights free-ranging koalas as important sentinels for this disease.
Direct and indirect costs of end-stage renal disease patients in the first and second years after initiation of nocturnal home haemodialysis, hospital haemodialysis and peritoneal dialysis
Authors: Wong Carlos K H , Chen Julie , Fung Samuel K S , Mok Maggie M Y , Cheng Yuk Lun , Kong Irene , Lo Wai Kei , Lui Sing Leung , Chan Tak Mao , Lam Cindy L K
Published: November 2018

Purpose

To estimate the direct and indirect costs of end-stage renal disease (ESRD) patients in the first and second years of initiating peritoneal dialysis (PD), hospital-based haemodialysis (HD) and nocturnal home HD.

Methods

A cost analysis was performed to estimate the annual costs of PD, hospital-based HD and nocturnal home HD for ESRD patients from both the health service provider’s and societal perspectives. Empirical data on healthcare resource use, patients’ out-of-pocket costs, time spent on transportation and dialysis by ESRD patients and time spent by caregivers were analysed. All costs were expressed in Hong Kong year 2017 dollars.

Results

Analysis was based on 402 ESRD patients on maintenance dialysis (PD: 189; hospital-based HD: 170; and nocturnal home HD: 43). From the perspective of the healthcare provider, hospital-based HD had the highest total annual direct medical costs in the initial year (mean ± SD) (hospital-based HD = $400 057 ± 62 822; PD = $118 467 ± 15 559; nocturnal home HD = $223 358 ± 18 055; P < 0.001) and second year (hospital-based HD = $360 924  ± 63 014; PD = $80 796 ± 15 820; nocturnal home HD = $87 028 ± 9059; P < 0.001). From the societal perspective, hospital-based HD had the highest total annual costs in the initial year (hospital-based HD = $452 151  ± 73 327; PD = $189 191 ± 61 735; nocturnal home HD = $242 038 ± 28 281; P < 0.001) and second year (hospital-based HD = $413 017 ± 73 501; PD = $151 520 ± 60 353; nocturnal home HD = $105 708 ± 23 853; P < 0.001).

Conclusions

This study quantified the economic burden of ESRD patients, and assessed the annual healthcare and societal costs in the initial and second years of PD, hospital-based HD and nocturnal home HD in Hong Kong. From both perspectives, PD is cost-saving relative to hospital-based HD and nocturnal home HD, except that nocturnal home HD has the lowest cost in the second year of treatment from the societal perspective. Results from this cost analysis facilitate economic evaluation in Hong Kong for health services and management targeted at ESRD patients.
The interplay between active galactic nuclei and star formation activities of type 1 active galactic nuclei probed by polycyclic aromatic hydrocarbon 3.3 μm emission feature with AKARI
Authors: Kim Ji Hoon , Im Myungshin , Kim Dohyeong , Woo Jong-Hak , Karouzos Marios , Lee Hyung Mok , Lee Myung Gyoon , Jun Hyunsung D , Nakagawa Takao , Matsuhara Hideo , Wada Takehiko , Oyabu Shinki , Takagi Toshinobu , Ohyama Youichi
Published: November 2018

We investigate the connection between active galactic nucleus (AGN) and star formation activities of AGN host galaxies by studying the 3.3 μm polycyclic aromatic hydrocarbon (PAH) emission feature of 79 type 1 AGNs using the AKARI space telescope. Utilizing the slitless spectroscopic capability of the AKARI Infrared Camera, we obtained the spectra in the wavelength range of 2–5 μm from extended regions of the sample galaxies in order to measure star formation activity from the entire host galaxies. We detected the 3.3 μm PAH emission feature from 18 sample galaxies and measured the luminosities of the feature (LPAH3.3). We found that LPAH3.3 is significantly correlated with AGN luminosities (LAGN), such as 5100 Å monochromatic luminosity, and X-ray luminosity regardless of host galaxy morphology and radio-loudness. The correlation between LPAH3.3 and LAGN follows $L_{\rm {PAH3.3}} \propto L_{\rm {AGN}}^{0.9}$. Therefore we suggest that host galaxies with stronger AGN activities have stronger star formation activities. We also found that the ratios between LPAH3.3 and the bolometric infrared luminosity (LIR) of our sample galaxies are lower than for non-AGN galaxies due to increased LIR. We suggest that this can be attributed to the contribution of AGN to LIR.
Individuals with Chronic Pain Who Misuse Prescription Opioids Report Sex-Based Differences in Pain and Opioid Withdrawal
Authors: Huhn Andrew S , Tompkins D Andrew , Campbell Claudia M , Dunn Kelly E
Published: November 2018

Objective Individuals with chronic pain who misuse prescription opioids are at high risk for developing opioid use disorder and/or succumbing to opioid overdose. The current study conducted a survey to evaluate sex-based differences in pain catastrophizing, opioid withdrawal, and current pain in persons with co-occurring chronic pain and opioid misuse. We hypothesized that women with chronic pain who misused prescription opioids would self-report higher pain ratings compared with men and that the relationship between pain catastrophizing and self-reported current pain would be moderated by symptoms of opioid withdrawal in women only.

Design Survey assessment of the relationship between pain and opioid misuse.

Setting Online via Amazon Mechanical Turk.

Participants Persons with ongoing chronic pain who also misused prescription opioids on one or more days in the last 30 days were eligible (N = 181).

Methods Participants completed demographic and standardized assessments including the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), and Subjective Opiate Withdrawal Scale (SOWS).

Results Women reported higher levels of current (P < 0.001), average (P < 0.001), and worst (P = .002) pain in the last 24 hours compared with men. Women also endorsed higher scores on the PCS (P = 0.006) and marginally higher past-30-day SOWS ratings (P = 0.068) compared with men. SOWS ratings moderated the relationship between PCS and BPI Worst Pain in women (ΔR2 < 0.127, ΔF(1, 78) = 12.39, P = 0.001), but not in men (ΔR2 < 0.000, ΔF(1, 98) = 0.003, P = 0.954).

Conclusions These data suggest a strong relationship between opioid withdrawal, pain catastrophizing, and the experience of pain in women with chronic pain who misuse opioids.
Quality of Patient Education Materials on Safe Opioid Management in the Acute Perioperative Period: What Do Patients Find Online?
Authors: Kumar Gunjan , Jaremko Kellie M , Kou Alex , Howard Steven K , Harrison T Kyle , Mariano Edward R
Published: November 2018

Objective

Guidelines on postoperative pain management recommend inclusion of patient and caregiver education on opioid safety. Patient education materials (PEMs) should be written at or below a sixth grade reading level. We designed this study to compare the readability of online PEMs related to postoperative opioid management produced by institutions with and without a regional anesthesiology and acute pain medicine (RAAPM) fellowship.

Methods

With institutional review board exemption, we constructed our cohort of PEMs by searching RAAPM fellowship websites from North American academic medical centers and identified additional websites using structured Internet searches. Readability metrics were calculated from PEMs using the TextStat 0.4.1 textual analysis package for Python 2.7. The primary outcome was the Flesch-Kincaid Grade Level (FKGL), a score based on words per sentence and syllables per word. We also compared fellowship-based and nonfellowship PEMs on the presence or absence of specific content-related items.

Results

PEMs from 15 fellowship and 23 nonfellowship institutions were included. The mean (SD) FKGL for PEMs was grade 7.84 (1.98) compared with the recommended sixth grade level (P < 0.001) and was not different between groups. Less than half of online PEMs contained explicit discussion of opioid tapering or cessation. Disposal and overdose risk were addressed more often by nonfellowship PEMs.

Conclusions

Available online PEMs related to opioid management are beyond the recommended reading level, but readability metrics for online PEMs do not differ between fellowship and nonfellowship groups. More than two-thirds of RAAPM fellowship programs in North America are lacking readable online PEMs on safe postoperative opioid management.
Coccinonectria pachysandricola, Causal Agent of a New Foliar Blight Disease of Sarcococca hookeriana
Authors: Salgado-Salazar Catalina , Shiskoff Nina , LeBlanc Nicholas , Ismaiel Adnan A. , Collins Maxton , Cubeta Marc A. , Crouch Jo Anne
Published: November 2018

Woody plants of the Buxaceae, including species of Buxus, Pachysandra, and Sarcococca, are widely grown evergreen shrubs and groundcovers. Severe leaf spot symptoms were observed on S. hookeriana at the U.S. National Arboretum in Washington, DC, in 2016. Affected plants were growing adjacent to P. terminalis exhibiting Volutella blight symptoms. Fungi isolated from both hosts were identical based on morphology and multilocus phylogenetic analysis and were identified as Coccinonectria pachysandricola (Nectriaceae, Hypocreales), causal agent of Volutella blight of Pachysandra species. Pathogenicity tests established that Co. pachysandricola isolated from both hosts caused disease symptoms on P. terminalis and S. hookeriana, but not on B. sempervirens. Artificial inoculations with Pseudonectria foliicola, causal agent of Volutella blight of B. sempervirens, did not result in disease on P. terminalis or S. hookeriana. Wounding enhanced infection by Co. pachysandricola and Ps. foliicola on all hosts tested but was not required for disease development. Genome assemblies were generated for the Buxaceae pathogens that cause Volutella diseases: Co. pachysandricola, Ps. buxi, and Ps. foliicola; these ranged in size from 25.7 to 28.5 Mb. To our knowledge, this foliar blight of S. hookeriana represents a new disease for this host and is capable of causing considerable damage to infected plants.
Group 2 innate lymphoid cells and eosinophilic chronic rhinosinusitis
Authors: Tojima Ichiro , Shimizu Takeshi
Published: November 2018

Purpose of review

Chronic rhinosinusitis (CRS) is a heterogeneous disease and is recently classified into two phenotypes, eosinophilic CRS (ECRS) and non-ECRS. ECRS is characterized by Th2-biased eosinophilic inflammation, and non-ECRS is characterized by Th1-biased neutrophilic inflammation. Group 2 innate lymphoid cells (ILC2s) rapidly produce large amounts of Th2 cytokines and exert critical roles in Th2-type immune responses. We summarize our current knowledge about the pathogenic roles of ILC2s in ECRS.

Recent findings

The prevalence of ILC2s is increased in nasal polyps, and it is positively correlated with the number of infiltrating eosinophils. Epithelium-derived cytokines (IL-33, IL-25, and thymic stromal lymphopoietin), cysteinyl leukotrienes, and prostaglandin D2 stimulate the production of Th2 cytokines from ILC2s, which drives eosinophilic inflammation in nasal mucosa. Regulation of ILC2s would be a novel therapeutic approach for the refractory and/or recurrent cases of ECRS.

Increased ILC2s play a pivotal role in the pathophysiology of ECRS by producing large amounts of Th2 cytokines, which lead to Th2-type eosinophilic inflammation in nasal polyps.
“Next Day” Examination Reduces Radiation Exposure in Cervical Spine Clearance at a Level 1 Pediatric Trauma Center: Preliminary Findings
Authors: Kavuri Venkat , Pannu Gurpal , Moront Matthew , Pizzutillo Peter , Herman Martin
Published: November 2018

Background:

Safe and effective clearance of the pediatric cervical spine presents a challenging problem due to a myriad of reasons, which has often led to further imaging studies such as computed tomographic (CT) scans being performed, exposing the pediatric patient to significant radiation with a potential increased cancer risk. The goal of this study is to develop an effective algorithm for cervical spine clearance that minimizes radiation exposure.

Methods:

A cervical spine clearance protocol had been utilized in our institution from 2002 to 2011. In October 2012, the protocol was revised to provide indications for appropriate imaging by utilizing repeat “next day” physical examination. In 2014, the protocol was again revised with the desired goal of decreasing the use of CT scans through increased involvement of the Spine Service. A retrospective review was commenced using information from the Trauma Database from 2011 to 2014. Three groups were analyzed according to which protocol the patients were evaluated under: 2011, 2012, and 2014 protocols.

Results:

During the study period, 762 patients underwent cervical spine clearance; 259 (2011 protocol), 360 (2012 protocol), and 143 (2014 protocol). The average age of all patients was 8.8 years, with 28% of patients younger than 5 years of age. There were no missed or delayed diagnoses of cervical spine injury. The use of CT scans decreased during the study period from 90% (2011 protocol) to 42% (2012 protocol) to 28.7% (2014 protocol). There was an increase in time to removal of the cervical collar at 13 to 24 hours from 8% (2011 protocol) to 22% (2012 protocol) to 19% (2014 protocol). This was not associated with an increase in hospital length of stay, which averaged 2.51 days (2011 protocol), 2.45 days (2012 protocol), and 2.27 days (2014 protocol).

Conclusions:

Repeat “next day” clinical examinations and increased involvement of the Spine Service decreased radiation exposure without compromising the diagnosis of cervical spine injury or increasing the length of stay at a Level One Pediatric Trauma Center in this pilot study.

Level of Evidence:

Level 4—case series.
Lifestyle Modifications in Adults and Older Adults With Chronic Gastroesophageal Reflux Disease (GERD)
Authors: Commisso Antonio , Lim Fidelindo
Published: November 2018

Gastroesophageal reflux disease (GERD) is a chronic disorder that causes the unwanted backflow of gastric contents into the esophagus, throat, and mouth.1 Gastroesophageal reflux disease affects roughly 20% of the US population. It is estimated that older adults experience GERD symptoms more commonly and with greater severity because of age-related physiologic changes. Comorbidities and polypharmacy, common in older adults, can also exacerbate GERD symptoms, which can allow the disease to progress. This integrative review aims to identify key lifestyle-associated risk factors and interventions appropriate for older adults with GERD. Findings can drive evidence-based collaborative best practices to care for patients in both acute and community settings with GERD. Recommendations for nursing education material that aims to address the gap of multilingual and culturally relevant GERD content will be discussed. It is likely that the prevalence of GERD will increase as the prevalence of obesity increases. It is here that registered nurses can play an instrumental role in the prevention and management of GERD in older adults by providing education, promoting health behaviors, and serving as patient advocates.
Measurement and Nonpharmacologic Management of Sleep Disturbance in the Intensive Care Units
Authors: Bani Younis Mohammad , Hayajneh Feryal , Batiha Abdu-Monim
Published: November 2018

The general goal of this review is to summarize, clarify, and evaluate what is known about patients' sleep in the intensive care units (ICUs) in terms of sleep measurement and management. In addition, this review focuses on the gap in knowledge in this field. A review of online databases for relevant articles in the period between 2000 and 2017 was conducted. The results of this study indicate that there are several methods to measure patients' quality of sleep. Polysomnography and actigraphy are the most common standard objective and valid methods used to measure sleep disorders in the ICU. On the contrary, several subjective instruments are used such as the Richards-Campbell Sleep Scale, Verran Snyder Harper Sleep Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Sleep Efficiency Index. To improve patients' sleep in the ICU, various strategies are used internationally. These strategies include reducing the noise and light levels; using relaxation technique, meditation, hypnosis, earplugs, eye masks, relaxation music; and modifying the time of delivering nursing care.
The Clinical Interpretation of Changes in Intraocular Pressure Measurements Using Goldmann Applanation Tonometry: A Review
Authors: Pearce John G. , Maddess Ted
Published: November 2018

Purpose:

The interpretation of changes in serial intraocular pressure (IOP) measurements are critical in the diagnosis and management of glaucoma. Differentiating true change from test-retest variability (TRV) in IOP measurements using Goldmann applanation tonometry (IOPG) is essential when reviewing these measurements. We, therefore, determine clinically applicable guidelines for differentiating TRV from the true change in IOPG by quantitatively summarizing the published evidence from 18 studies.

Methods:

Studies reporting TRV in clinically meaningful ways, such as the coefficient of repeatability or the limits of agreement, were collated and analyzed. A single linear model quantitatively summarized the TRV for the commonly encountered combinations of patient types and intraobserver versus interobserver testing. The best model determined n-fold effects providing asymmetric SEs.

Results:

For the common intraobserver/interobserver visit combination the model results for healthy subjects and glaucoma/ocular hypertensive patients were TRV (±SE) values of 3.16 (2.67 to 3.74) and 4.26 (3.12 to 5.84) mm Hg, respectively. For the interobserver/intervisit case for glaucoma/ocular hypertension patients, the estimated TRV was 5.50 (3.43 to 8.76) mm Hg, for which no published coefficient of repeatability or limits of agreement data exists at present. The overall model was significant at P<0.018.

Conclusions:

Potential improvements in the diagnosis and management of glaucoma are made by providing clinicians with well-estimated values for TRV in IOPG derived from the evidence base. These values not only enable individual clinicians to better interpret changes in IOPG, but they also provide a basis for standardizing the interpretation of changes in IOPG between clinics, clinicians, and patient types.
Influence of Posterior Subcapsular Cataract on Structural OCT and OCT Angiography Vessel Density Measurements in the Peripapillary Retina
Authors: Holló Gábor
Published: November 2018

Purpose:

To investigate the influence of posterior subcapsular cataract (PSC) on structural optical coherence tomography (OCT) and OCT angiography vessel density (VD) measurements.

Materials and Methods:

One eye each of 10 consecutive participants with PSC were imaged using the Angiovue/RTvue-XR OCT via undilated pupil, and 30 minutes later via dilated pupil. Peripapillary retinal nerve fiber layer thickness (RNFLT), peripapillary capillaries and all-vessels VD, ganglion cell complex thickness (GCC), parafoveal VD, and the image quality scores were compared, respectively.

Results:

PSC grade (mean±SD) was 4.0±0.9, and best-corrected visual acuity was 0.8±0.2. Image quality was high for all eyes and images (baseline median signal strength indices for RNFLT and GCC: 66 and 67.5; image quality scores for peripapillary and parafoveal VD: 7.5 and 6.0) and did not change statistically and clinically significantly for pupil dilation (P≥0.0872). The mean RNFLT and GCC values increased by 1.0 and 1.1 μm, respectively (P≥0.1382; ~1% of the normal values). In contrast, the mean peripapillary all-vessels VD value increased by 1.2% (P=0.0349) and the mean peripapillary capillaries VD value by 1.1% (P=0.0599; ~2 to 2.5% of the normal values, for both parameters). No change in parafoveal VD was seen (0.2%, P=0.8209).

Conclusions:

Our results suggest that PSC-related peripapillary VD reduction may falsely suggest glaucoma progression, even when RNFLT is not influenced by PSC. Glaucoma eyes with developing PSC need pupil dilation for peripapillary VD measurements to reduce the PSC-related VD reduction.
Mechanisms underlying mechanical sensitization induced by complement C5a: the roles of macrophages, TRPV1, and calcitonin gene-related peptide receptors
Authors: Warwick Charles A. , Shutov Leonid P. , Shepherd Andrew J. , Mohapatra Durga P. , Usachev Yuriy M.
Published: November 2018

The complement system significantly contributes to the development of inflammatory and neuropathic pain, but the underlying mechanisms are poorly understood. Recently, we identified the signaling pathway responsible for thermal hypersensitivity induced by the complement system component C5a. Here, we examine the mechanisms of another important action of C5a, induction of mechanical hypersensitivity. We found that intraplantar injection of C5a produced a dose-dependent mechanical sensitization and that this effect was blocked by chemogenetic ablation of macrophages in both male and female mice. Knockout of TRPV1 or pretreatment with the TRPV1 antagonists, AMG9810 or 5′-iodoresiniferatoxin (5′-IRTX), significantly reduced C5a-induced mechanical sensitization. Notably, local administration of 5′-IRTX 90 minutes after C5a injection resulted in a slow, but complete, reversal of mechanical sensitization, indicating that TRPV1 activity was required for maintaining C5a-induced mechanical hypersensitivity. This slow reversal suggests that neurogenic inflammation and neuropeptide release may be involved. Indeed, pretreatment with a calcitonin gene-related peptide (CGRP) receptor antagonist (but not an antagonist of the neurokinin 1 receptor) prevented C5a-induced mechanical sensitization. Furthermore, intraplantar injection of CGRP produced significant mechanical sensitization in both wild-type and TRPV1 knockout mice. Taken together, these findings suggest that C5a produces mechanical sensitization by initiating macrophage-to-sensory-neuron signaling cascade that involves activation of TRPV1 and CGRP receptor as critical steps in this process.
Salivaomics in oral cancer
Authors: Aro Katri , Kaczor-Urbanowicz Karolina , Carreras-Presas Carmen Martín
Published: November 2018

Purpose of review

The goal of cancer screening is to detect tumor at an early stage, and early cancer detection is the hallmark of successful treatment. In addition to traditional tissue biopsy-based diagnostics, more reliable, inexpensive, and noninvasive methods are required for early diagnosis of cancer. In this review, we highlight some of the recent advancements in the field of salivary diagnostics in oral cancer.

Recent findings

‘Salivaomics’ is a broad collection of technologies used to explore different types of molecules contained in saliva. Although many protein and mRNA salivary biomarkers have been identified that can detect oral squamous cell carcinoma (OSCC), none have so far been validated for current clinical use. As the heterogeneity in carcinogenesis and multifactorial cause for OSCC, the most reliable results are gathered with the use of multiple biomarker candidates to improve accuracy and sensitivity of the test used. This further requires sensitive technology to detect salivary biomarkers in low quantities.

Large scale studies that incorporate proteomic, transcriptomic, and additional ‘omics,’ need to be initiated to bring technology to clinical point-of-care applications.
Endotypes of chronic rhinosinusitis
Authors: Yip Jonathan , Monteiro Eric , Chan Yvonne
Published: November 2018

Purpose of review

In contrast to the phenotypic classification of chronic rhinosinusitis (CRS), endotyping categorizes disease variants based on their underlying pathophysiologic mechanisms. Defining CRS endotypes may provide information on the risk for disease progression, recurrence and comorbid conditions, as well as identify suitable therapeutic targets. With the emergence of biologics, endotyping may enable personalized pharmacotherapy for recalcitrant CRS. The purpose of this review is to briefly summarize the pathophysiology and endotypes of CRS, and highlight the biologics that target mediators of CRS.

Recent findings

CRS is due to dysregulated immunologic responses to external stimuli, which induces inflammatory mediators. The linkage between innate lymphoid cells, adaptive CD4+ T helper and CD8 + cytotoxic T cells has led to proposed endotypes that are based around immune response deviation into type 1, type 2 and type 3 responses. Cluster analysis has attempted to define endotypes, accounting for clinical characteristics, molecular and cellular biomarkers, and treatment response. Biologics targeting epithelial-derived cytokines and immunoglobulin E, as well as mediators of type 1, type 2 and type 3 inflammation, are being investigated in CRS.

Although there have been significant advances made in the understanding of the pathomechanisms of CRS, there currently remains a lack of full characterization of CRS endotypes.
Contemporary management of juvenile angiofibroma
Authors: Bertazzoni Giacomo , Schreiber Alberto , Ferrari Marco , Nicolai Piero
Published: November 2018

Purpose of review

To illustrate the latest developments and trends in the management of juvenile angiofibroma.

Recent findings

Endoscopic surgery is currently the primary management strategy for juvenile angiofibroma. Recent reports on the use of multiportal approaches have contributed to further extend its indications. Studies from different countries suggest that the lesion can display variable growth rates not only in relation to patient age. The same concept applies to residual lesions. For this reason, retreatment of persistent juvenile angiofibromas is indicated when serial imaging clearly shows that the lesion is growing. When redo surgery is potentially associated with high morbidity for the critical relationships of the lesion with adjacent structures, stereotactic or intensity-modulated radiation therapy can be an alternative. Early use of MRI in the postoperative course is a highly effective way to detect residual lesions.

Contemporary management of juvenile angiofibroma should primarily rely on endoscopic surgery to obtain radical tumor resection. Recent evidence on the behavior of residual postoperative juvenile angiofibroma and the development of conformal RT techniques have helped to clarify the role of watchful waiting and radiotherapy (RT) as alternatives to aggressive procedures in cases with critical extension of the lesion. Although radical excision is the primary therapeutic objective, the benign nature of juvenile angiofibroma and the reported tendency of small residual lesions to remain stable or involute, especially in postpubertal patients, should always be kept in mind to avoid unnecessary morbidity.

Video abstract

In the video, two of the authors describe the content of the review and present the main topics discussed in the article. http://links.lww.com/COOH/A37.
Management of sphenoid lateral recess encephalocoeles
Authors: Govindaraju Revadi , Tang Ing Ping , Prepageran Narayanan
Published: November 2018

Purpose of review

Sphenoid sinus lateral recess encephalocoeles (SSLRE) are rare occurrences and pose unique challenges due to limited surgical access for endoscopic endonasal repair and also the lack of consensus on optimal perioperative managements specifically in the spontaneous cases, which are also believed to be a variant of idiopathic intracranial hypertension (IIH). Endoscopic endonasal approaches have largely replaced the transcranial route and the techniques are continuously being refined to reduce the neurovascular morbidity and improve outcome.

Recent findings

Transpetrygoid is the most utilized approach with modifications suggested to limit bone removal, exposure and preservation of the neurovascular structures as dictated by the extent of the lateral recess. As more experience is gained, extended transphenoidal techniques were also successfully used for access. Lateral transorbital is a new approach to the lateral recess investigated in cadavers. IIH treatment is still controversial in the setting of SSLRE, but it appears rationale to evaluate, monitor and treat if necessary.

SSLRE management should be tailored to the specific anatomical variances and cause. Modifications of techniques have been described giving different options to access the lateral recess. Successful repair for spontaneous SSLRE may require treatment of IIH if present, but the long-term outcome is still unclear.
Review and update on extracorporeal septoplasty
Authors: McGrath Monica , Bell Evan , Locketz Garrett D. , Becker Daniel G.
Published: November 2018

Purpose of review

To examine the recent literature on extracorporeal septoplasty.

Recent findings

The literature suggests that extracorporeal septoplasty is an effective approach for both functional and cosmetic treatment of moderate to severe deformities of the caudal and dorsal septum. The procedure can be performed via an endonasal or external approach based on the nature of the deformity and the experience of the surgeon, although recent literature highlights various advantages of an external approach. The use of polydioxanone foil as a scaffold for septal reconstruction is widely accepted, and can enhance the technical performance of this technique. Although reported complication rates are low, tip deprojection and rotation have been observed in cases where extracorporeal septoplasty is performed without simultaneous rhinoplasty.

Extracorporeal septoplasty is a useful technique in the armamentarium of surgeons addressing deviations of the dorsal and caudal septum.
The rhinologist's role in the management of rathke's cleft cysts
Authors: Kuan Edward C. , Palmer James N. , Adappa Nithin D.
Published: November 2018

Purpose of review

To review the recent literature regarding the growing role of rhinologists and otolaryngologists with neurosurgeons in the joint multidisciplinary team approach for managing patients with Rathke's cleft cysts (RCC).

Recent findings

The transnasal endoscopic approach to the skull base has become relatively mainstream for surgical treatment of RCCs. Suprasellar lesions, especially those that are purely suprasellar, are associated with higher recurrence rates, though an extended approach may improve dissection and access and therefore aid in lesion removal. Endoscopic cyst drainage is a well tolerated and effective way to treat RCC, and often avoids the postoperative endocrinopathies associated with complete cyst wall removal. Novel techniques have been described for maintaining tract patency, including the use of stents and flaps, in order to prevent cyst stenosis and reaccumulation. A frontier in skull base surgery is in applications for pediatric patients, and managing RCCs in this population surgically appears to be associated with positive outcomes overall.

Team-based endoscopic skull base surgery has spurred advances in our understanding of skull base disease, including RCCs. Optimal outcomes are most apparent when the experience and technique of both the endoscopist and neurosurgeon have developed jointly over time.
Advances in pediatric antimicrobial agents development
Authors: Wood James B. , Cravens Lauryn B. , Creech C. Buddy
Published: November 2018

Purpose of review

Rising rates of multidrug-resistant organisms has necessitated the development of novel antimicrobials. In this review, we will highlight agents that have recently received licensure and those that are in clinical development.

Recent findings

In recent years, development of novel antimicrobial agents has accelerated. Although most studies have targeted the adult population, studies in pediatric patients are underway. Adequately powered clinical trials are needed to establish the safety and role of these new drugs.

The recent development of novel antimicrobials to combat multidrug-resistant organisms is encouraging; however, more studies in the pediatric population are needed.
Role of Immunohistochemistry to Distinguish Grade 3 Endometrioid Carcinoma and Uterine Serous Carcinoma
Authors: Zaidi Ariba , Gupta Parikshaa , Gupta Nalini , Rajwanshi Arvind , Rai Bhavana , Gainder Shalini
Published: November 2018

Aim:

The categorization of endometrial carcinomas into endometrioid and serous categories has prognostic implications but many-a-times, it is difficult to categorize based solely on morphology. The present study was conducted to determine an appropriate immunohistochemical panel to distinguish grade 3 endometrioid carcinoma from serous carcinoma.

Experimental Design:

This study was a retrospective and a prospective study including 63 cases of endometrial carcinoma diagnosed on morphology as either grade 3 endometrioid (n=29) or serous endometrial carcinomas (n=34). Immunohistochemistry (IHC) was performed using tissue microarrays for 8 immunomarkers on 60 cases.

Results:

The mean age of presentation was not significantly different for both types of carcinomas and the most common presentation was postmenopausal bleeding (93% of the total cases, P=0.66). Obesity (P=0.038), lymph nodal involvement (P=0.044), and stage at presentation (P=0.042) were found to be significantly different among the 2 types of carcinomas. Estrogen and progesterone receptor (ER, PR) positivity was more common (47.6% and 28.2%, respectively) in endometrioid carcinomas as compared with serous. Mutation type (diffuse or null) p53 staining was a powerful predictor of serous carcinomas. IMP3 and p16 were found to be positive in most cases of serous carcinoma (64.1% and 79.5%, respectively). Vimentin and β-catenin were found to be of limited utility. On the basis of IHC, 21 cases could be categorized as grade 3 endometrioid carcinomas and 39 as type 2 carcinomas (serous and clear cell carcinoma).

Conclusions:

The most appropriate IHC panel to differentiate endometrioid and serous endometrial carcinomas includes ER, PR, IMP3, p53, and p16.
A Spoonful of Lead: A 10-Year Look at Spices as a Potential Source of Lead Exposure
Authors: Hore Paromita , Alex-Oni Kolapo , Sedlar Slavenka , Nagin Deborah
Published: November 2018

Context:

While lead-based paint and occupational lead hazards remain the primary sources of lead exposures among New York City's lead-poisoned children and men, respectively, these are not the only possible lead sources. Certain consumer products are often implicated. Between 2008 and 2017, the New York City Department of Health and Mental Hygiene tested more than 3000 samples of consumer products during lead poisoning case investigations and surveys of local stores, and of these, spices were the most frequently tested (almost 40% of the samples).

Objectives:

To describe spice samples—types, origin, lead concentrations, and the implication of findings for public health programs and global food safety regulations.

Design:

Descriptive study of lead contamination in spices systematically collected as part of lead poisoning investigations.

Setting and Participants:

A total of 1496 samples of more than 50 spices from 41 countries were collected during investigations of lead poisoning cases among New York City children and adults and local store surveys.

Results:

More than 50% of the spice samples had detectable lead, and more than 30% had lead concentrations greater than 2 ppm. Average lead content in the spices was significantly higher for spices purchased abroad than in the United States. The highest concentrations of lead were found in spices purchased in the countries Georgia, Bangladesh, Pakistan, Nepal, and Morocco.

Conclusions:

Certain commonly used spices, particularly those purchased abroad in Georgia, Bangladesh, Pakistan, Nepal, and Morocco, can have very high lead levels, which can contribute to lead body burden. This underscores the need to develop comprehensive interventions that educate consumers and initiate intergovernmental efforts for stricter global food regulations.
Using Medicaid Data to Improve Childhood Lead Poisoning Prevention Program Outcomes and Blood Lead Surveillance
Authors: Bruce Shelley A. , Christensen Krista Y. , Coons Marjorie J. , Havlena Jeffrey A. , Meiman Jon G. , Walsh Reghan O.
Published: November 2018

Context:

Wisconsin-specific data revealed that not all Medicaid providers were testing children appropriately for blood lead levels and not all blood lead tests were reported to the Department of Health Services, Childhood Lead Poisoning Prevention Program. The Medicaid program requires blood lead screening for all Medicaid-enrolled children at specific ages. Wisconsin state law requires reporting of all blood lead test results. Projects were implemented to encourage appropriate testing for Medicaid-enrolled children and improve blood lead surveillance.

Methods:

Medicaid billing data were linked to blood lead data to identify Medicaid-enrolled children who had not received the required tests. Medicaid provider report cards were distributed annually from 2006 to 2011 to inform providers of their compliance with federal testing requirements and of the names of children within their practice who had not been tested. Blood lead tests billed to Medicaid but not in the blood lead database were identified and billing providers were contacted to obtain the test report.

Results:

The number of children tested increased from 81 834 children per year in 2006 to 106 003 children per year in 2010. Testing of Medicaid-enrolled children increased by 31% from 2006 to 2010. The percentage of Medicaid-enrolled children receiving an age-appropriate test increased from 46% in 2004 to a high of 55% in 2010. There were 9035 blood lead tests identified in the Medicaid billing data that had not been reported from 2007 to 2015. There were 468 billing providers who had unreported tests. All sites with unreported tests were contacted, 84% of test results were obtained, and 14% of test records could not be retrieved. Outpatient clinics accounted for the majority of all unreported tests (72%) and irretrievable test records (74%).

Discussion:

Childhood lead poisoning prevention programs can effectively utilize Medicaid data to increase testing and improve blood lead surveillance. Primary health care providers should ensure that Medicaid-enrolled children in their care receive the age-appropriate tests. Many Wisconsin health care providers lack awareness of blood lead test reporting requirements. Outpatient clinics account for the largest proportion of unreported tests and highest priority should be given working with these sites to improve reporting practices.
Comparison of Technical Details and Short-term Outcomes of Single-incision Versus Multiport Laparoscopic Adrenalectomy
Authors: Agcaoglu Orhan , Sengun Berke , Senol Kazim , Gurbuz Bulent , Ozoran Emre , Carilli Senol , Tezelman Serdar
Published: November 2018

To date, the single-incision laparoscopic surgery (SILS) technique has been applied to a wide range of general surgical procedures; however, there are still scant data and debates on adrenal procedures. The aim of this study was to compare surgical outcomes of single-incision versus laparoscopic multiport adrenalectomy. The patients were divided into 2 study groups on the basis of the surgical approach: SILS (group 1) and multiport laparoscopic surgery (group 2). Patient demographics and their perioperative and postoperative results were evaluated retrospectively from the medical records. A total of 80 patients were included in the study. There were 44 patients in group 1 and 36 patients in group 2. The average operative time, estimated blood loss, and tumor size were similar between the study groups. There were no mortalities in both groups and the mean duration of hospital stay was 3 days for both groups. Without using any single-incision access trocars and articulated instrumentation, we achieved the same surgical outcomes in our SILS adrenalectomy series compared with conventional multiport laparoscopy series in terms of postoperative short-term outcomes and cost-effectivity.
Dynamic Frailty Before Kidney Transplantation: Time of Measurement Matters
Authors: Chu Nadia M. , Deng Arlinda , Ying Hao , Haugen Christine E. , Garonzik Wang Jacqueline M. , Segev Dorry L. , McAdams-DeMarco Mara A.
Published: November 2018

Background.

Frail kidney transplant (KT) recipients have higher risk of adverse post-KT outcomes. Yet, there is interest in measuring frailty at KT evaluation and then using this information for post-KT risk stratification. Given long wait times for KT, frailty may improve or worsen between evaluation and KT. Patterns, predictors, and post-KT adverse outcomes associated with these changes are unclear.

Methods.

Five hundred sixty-nine adult KT candidates were enrolled in a cohort study of frailty (November 2009-September 2017) at evaluation and followed up at KT. Patterns of frailty transitions were categorized as follows: (1) binary state change (frail/nonfrail), (2) 3-category state change (frail/intermediate/nonfrail), and (3) raw score change (−5 to 5). Adjusted Cox proportional hazard and logistic regression models were used to test whether patterns of frailty transitions were associated with adverse post-KT outcomes.

Results.

Between evaluation and KT, 22.0% became more frail, while 24.4% became less frail. Black race (relative risk ratio, 1.98; 95% confidence interval [CI], 1.07-3.67) was associated with frail-to-nonfrail transition, and diabetes (relative risk ratio, 2.56; 95% CI, 1.22-5.39) was associated with remaining stably frail. Candidates who became more frail between 3-category states (hazard ratio, 2.27; 95% CI, 1.11-4.65) and frailty scores (hazard ratio, 2.36; 95% CI, 1.12-4.99) had increased risk of post-KT mortality and had higher odds of length of stay ≥2 weeks (3-category states: odds ratio, 2.02; 95% CI, 1.20-3.40; frailty scores: odds ratio, 1.92; 95% CI, 1.13-3.25).

Conclusions.

Almost half of KT candidates experienced change in frailty between evaluation and KT, and those transitions were associated with mortality and longer length of stay. Monitoring changes in frailty from evaluation to admission may improve post-KT risk stratification.
CD44v6 expression is a novel predictive marker of therapy response and poor prognosis in gastric cancer patients
Authors: Pereira Carla , Ferreira Daniel , Lemos Carolina , Martins Diana , Mendes Nuno , Almeida Daniela , Granja Pedro , Carneiro Fátima , Almeida Raquel , Almeida Gabriela M , Oliveira Carla
Published: November 2018

Late diagnosis, modest treatment options and lack of predictive markers of therapy response dictate the poor overall survival (OS) of ∼1 year in most gastric cancer (GC) patients. We hypothesized that the level of CD44v6 expression in tumor cells could predict therapy response and prognosis in GC patients.

We analyzed a surgical tumor series of GC patients for the extension of CD44v6 membranous immuno-expression, clinical-pathological features, patient survival, and response to therapy. By integrating this information, we assessed the value of CD44v6 expression to predict benefit from current treatment regimens and prognosis in GC patients. We used GC cell lines and mouse xenografts to assess and/validate the biological impact of CD44v6 expression in GC cells behavior.

We demonstrated that GC patients whose tumors present higher levels of CD44v6 membranous expression benefit from adding chemotherapy to surgery as opposed to those without CD44v6 expression. Moreover, patients bearing CD44_high tumors presented worse OS than those bearing CD44_absent/low tumors, consolidating the role of CD44v6 expression as an independent factor of poor prognosis in this disease. Finally, ourin vitroand patients’ data pinpoints the CD44v6+ cell population as the driver of tumor recurrence following conventional chemotherapy, in heterogeneous tumors composed by CD44v6- and CD44v6+ cells.

Our study pioneers the identification of CD44v6 as a potential predictive marker of response to conventional chemotherapy, and consolidates CD44v6 as an independent marker of poor prognosis in GC. Overall, our data strongly supports selection of patients with high CD44v6 expressing tumors for conventional chemotherapy with or without surgery, regardless of the TNM stage.