bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and crystal structure of a native-like HIV-1 envelope trimer that engages multiple broadly neutralizing antibody precursors in vivo
Authors: Medina-Ramírez Max , Garces Fernando , Escolano Amelia , Skog Patrick , de Taeye Steven W. , Del Moral-Sanchez Ivan , McGuire Andrew T. , Yasmeen Anila , Behrens Anna-Janina , Ozorowski Gabriel , van den Kerkhof Tom L.G.M. , Freund Natalia T. , Dosenovic Pia , Hua Yuanzi , Gitlin Alexander D. , Cupo Albert , van der Woude Patricia , Golabek Michael , Sliepen Kwinten , Blane Tanya , Kootstra Neeltje , van Breemen Mariëlle J. , Pritchard Laura K. , Stanfield Robyn L. , Crispin Max , Ward Andrew B. , Stamatatos Leonidas , Klasse Per Johan , Moore John P. , Nemazee David , Nussenzweig Michel C. , Wilson Ian A. , Sanders Rogier W.
Published: August 2017

Induction of broadly neutralizing antibodies (bNAbs) by HIV-1 envelope glycoprotein immunogens would be a major advance toward an effective vaccine. A critical step in this process is the activation of naive B cells expressing germline (gl) antibody precursors that have the potential to evolve into bNAbs. Here, we reengineered the BG505 SOSIP.664 glycoprotein to engage gl precursors of bNAbs that target either the trimer apex or the CD4-binding site. The resulting BG505 SOSIP.v4.1-GT1 trimer binds multiple bNAb gl precursors in vitro. Immunization experiments in knock-in mice expressing gl-VRC01 or gl-PGT121 show that this trimer activates B cells in vivo, resulting in the secretion of specific antibodies into the sera. A crystal structure of the gl-targeting trimer at 3.2-Å resolution in complex with neutralizing antibodies 35O22 and 9H+109L reveals a native-like conformation and the successful incorporation of design features associated with binding of multiple gl-bNAb precursors.
Effects of Crop Insurance Premium Subsidies on Crop Acreage
Authors: Yu Jisang , Smith Aaron , Sumner Daniel A.
Published: August 2017

Crop insurance premium subsidies affect patterns of crop acreage for two reasons. First, holding insurance coverage constant, premium subsidies directly increase expected profit, which encourages more acreage of insured crops (direct profit effect). Second, premium subsidies encourage farms to increase crop insurance coverage. With more insurance coverage, farms obtain more subsidies, and farm revenue becomes less variable as indemnities offset revenue shortfalls, so acreage of insured crops likely increases (indirect coverage effect). By exploiting exogenous policy changes and using approximately 180,000 county‐crop‐year observations, we estimate the sum of these two effects of premium subsidies on the pattern of U.S. acreage across seven major field crops. We estimate that a 10% increase in the premium subsidy causes a 0.43% increase in the acreage of a crop in a county holding the premium subsidy of its competing crop constant. Taking into account the small share of premium subsidies in expected crop revenue, this subsidy impact is analogous to an own‐subsidy acreage elasticity of 1.24, which exceeds own‐price acreage elasticity estimates in the literature. One explanation for the larger acreage response to premium subsidies is that insurance causes an indirect coverage effect in addition to a direct profit effect.
A computable pathology report for precision medicine: extending an observables ontology unifying SNOMED CT and LOINC
Authors: Campbell Walter S , Karlsson Daniel , Vreeman Daniel J , Lazenby Audrey J , Talmon Geoffrey A , Campbell James R
Published: August 2017

Background

The College of American Pathologists (CAP) introduced the first cancer synoptic reporting protocols in 1998. However, the objective of a fully computable and machine-readable cancer synoptic report remains elusive due to insufficient definitional content in Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT) and Logical Observation Identifiers Names and Codes (LOINC). To address this terminology gap, investigators at the University of Nebraska Medical Center (UNMC) are developing, authoring, and testing a SNOMED CT observable ontology to represent the data elements identified by the synoptic worksheets of CAP.

Methods

Investigators along with collaborators from the US National Library of Medicine, CAP, the International Health Terminology Standards Development Organization, and the UK Health and Social Care Information Centre analyzed and assessed required data elements for colorectal cancer and invasive breast cancer synoptic reporting. SNOMED CT concept expressions were developed at UNMC in the Nebraska Lexicon© SNOMED CT namespace. LOINC codes for each SNOMED CT expression were issued by the Regenstrief Institute. SNOMED CT concepts represented observation answer value sets.

Results

UNMC investigators created a total of 194 SNOMED CT observable entity concept definitions to represent required data elements for CAP colorectal and breast cancer synoptic worksheets, including biomarkers. Concepts were bound to colorectal and invasive breast cancer reports in the UNMC pathology system and successfully used to populate a UNMC biobank.

Discussion

The absence of a robust observables ontology represents a barrier to data capture and reuse in clinical areas founded upon observational information. Terminology developed in this project establishes the model to characterize pathology data for information exchange, public health, and research analytics.
Clustering of galaxies around AGNs in the HSC Wide survey
Authors: Shirasaki Yuji , Akiyama Masayuki , Nagao Tohru , Toba Yoshiki , He Wanqiu , Ohishi Masatoshi , Mizumoto Yoshihiko , Miyazaki Satoshi , Nishizawa Atsushi J , Usuda Tomonori
Published: August 2017

We have measured the clustering of galaxies around active galactic nuclei (AGNs) for which single-epoch virial masses of the super-massive black hole (SMBH) are available to investigate the relation between the large-scale environment of AGNs and the evolution of SMBHs. The AGN samples used in this work were derived from the Sloan Digital Sky Survey (SDSS) observations and the galaxy samples were from the 240 deg2 S15b data of the Hyper Suprime-Cam Subaru Strategic Program (HSC-SSP). The investigated redshift range is 0.6–3.0, and the masses of the SMBHs lie in the range 107.5–1010 M⊙. The absolute magnitude of the galaxy samples reaches to Mλ310 ∼ −18 at rest-frame wavelength 310 nm for the low-redshift end of the samples. More than 70% of the galaxies in the analysis are blue. We found a significant dependence of the cross-correlation length on redshift, which primarily reflects the brightness-dependence of the galaxy clustering. At the lowest redshifts the cross-correlation length increases from 7 h−1 Mpc around Mλ310 = −19 mag to >10 h−1 Mpc beyond Mλ310 = −20 mag. No significant dependence of the cross-correlation length on BH mass was found for whole galaxy samples dominated by blue galaxies, while there was an indication of BH mass dependence in the cross-correlation with red galaxies. These results provides a picture of the environment of AGNs studied in this paper being enriched with blue star-forming galaxies, and a fraction of the galaxies are evolving into red galaxies along with the evolution of SMBHs in that system.
Effect of Bronchoconstriction-induced Ventilation–Perfusion Mismatch on Uptake and Elimination of Isoflurane and Desflurane
Authors: Kretzschmar Moritz , Kozian Alf , Baumgardner James E. , Borges Joao Batista , Hedenstierna Göran , Larsson Anders , Hachenberg Thomas , Schilling Thomas
Published: August 2017

Background

Increasing numbers of patients with obstructive lung diseases need anesthesia for surgery. These conditions are associated with pulmonary ventilation/perfusion (VA/Q) mismatch affecting kinetics of volatile anesthetics. Pure shunt might delay uptake of less soluble anesthetic agents but other forms of VA/Q scatter have not yet been examined. Volatile anesthetics with higher blood solubility would be less affected by VA/Q mismatch. We therefore compared uptake and elimination of higher soluble isoflurane and less soluble desflurane in a piglet model.

Methods

Juvenile piglets (26.7 ± 1.5 kg) received either isoflurane (n = 7) or desflurane (n = 7). Arterial and mixed venous blood samples were obtained during wash-in and wash-out of volatile anesthetics before and during bronchoconstriction by methacholine inhalation (100 μg/ml). Total uptake and elimination were calculated based on partial pressure measurements by micropore membrane inlet mass spectrometry and literature-derived partition coefficients and assumed end-expired to arterial gradients to be negligible. VA/Q distribution was assessed by the multiple inert gas elimination technique.

Results

Before methacholine inhalation, isoflurane arterial partial pressures reached 90% of final plateau within 16 min and decreased to 10% after 28 min. By methacholine nebulization, arterial uptake and elimination delayed to 35 and 44 min. Desflurane needed 4 min during wash-in and 6 min during wash-out, but with bronchoconstriction 90% of both uptake and elimination was reached within 15 min.

Conclusions

Inhaled methacholine induced bronchoconstriction and inhomogeneous VA/Q distribution. Solubility of inhalational anesthetics significantly influenced pharmacokinetics: higher soluble isoflurane is less affected than fairly insoluble desflurane, indicating different uptake and elimination during bronchoconstriction.
Glucose Gel as a Treatment Strategy for Transient Neonatal Hypoglycemia
Authors: Newnam Katherine M. , Bunch Marissa
Published: August 2017

Background:

Transient asymptomatic neonatal hypoglycemia (TANH) is common as infants transition from their mother's energy stores to their own. There is little evidence supporting the blood glucose threshold that indicates a need for treatment although sustained hypoglycemia has been correlated with negative neurodevelopmental consequences. Treatment of TANH includes a stepwise approach from supplemental enteral feedings, buccal glucose gel, intravenous dextrose infusion, and/or transfer to special care units including neonatal intensive care units.

Purpose:

The purpose of this evidence-based practice brief is to review current evidence on 40% buccal glucose gel administration as a treatment strategy for TANH.

Methods/Search Strategy:

CINAHL, Cochrane, Google Scholar, and PubMed were searched using the key words and restricted to English language over the last 7 years.

Findings/Results:

The use of buccal dextrose gel for TANH may reduce neonatal intensive care unit admissions, reduce hospital length of stay and cost, support the mother–infant dyad through reduced separation, support exclusive breastfeeding, and improve parental satisfaction without adverse neurodevelopmental consequences.

Implications for Practice:

Timely collection of blood glucose levels following intervention is critical to support clinical decisions. Clinicians should offer family education regarding the rationale for serial glucose monitoring and treatment indications including buccal glucose administration. Clinical protocols can be revised to include use of buccal dextrose gel.

Implications for Research:

There is a need for rigorous long-term studies comparing treatment thresholds and neurodevelopmental outcomes among various treatment strategies for TANH.
Impact of Diuretic Therapy in the Treatment of Bronchopulmonary Dysplasia and Acute Kidney Injury in the Neonatal Population
Authors: Johnson Alexandra Kesler , Lynch Natalie , Newberry Desi , Jnah Amy J.
Published: August 2017

Background:

Diuretics are among the most frequently prescribed medications in the neonatal intensive care unit (NICU), despite minimal data regarding the safety and efficacy of their use in the neonatal population. Off-label diuretic therapy is used in preterm and full-term infants to both optimize kidney function and improve respiratory status.

Purpose:

This article examines the literature specific to the impact of diuretic therapy in the NICU and compares the benefits versus risks of utilization as they pertain to the prevention and treatment of renal and pulmonary dysfunction in this population.

Methods/Search Strategy:

A comprehensive literature search of online databases was performed, utilizing: CINAHL via EBSCO, PubMed, and ProQuest. Full-text, peer-reviewed, clinical trials, and review articles published in the English language between 2005 and 2015 were searched.

Findings/Results:

Diuretics rank as the seventh most frequently prescribed medication in the NICU. More than 8% of all NICU patients and 37% of infants born at less than 32 gestational weeks and weighing less than 1500 g are exposed to diuretics. Benefits include lung fluid resorption acceleration, improved urine output, fluid retention counteraction, and augmentation of physiologic weight loss.

Implications for Practice:

Diuretics are currently utilized in the NICU at an alarming rate, without adequate clinical trials regarding their safety and efficacy of use.

Implications for Research:

Updated studies are needed regarding short- and long-term outcomes of diuretic use, as well as overall general outcome data regarding the impact and evaluation of diuretic usage in the NICU population.
Double-Sided Mechanical Shocks Provoke Larger Seated Postural Reactions Compared With Single-Sided Mechanical Shocks
Authors: Stenlund Tobias Carl , Öhberg Fredrik , Lundström Ronnie , Lindroos Ola , Häger Charlotte K. , Neely Gregory , Rehn Börje
Published: August 2017

Study Design.

Human volunteers were exposed experimentally to single-sided mechanical shocks (SSMS) and double-sided mechanical shocks (DSMS) while seated.

Objective.

The aim of this study was to describe and contrast seated postural reactions due to SSMS or DSMS in healthy male adults.

Summary of Background Data.

Mechanical shocks to the body, caused when driving on irregular terrain, are suggested to be hazardous to the spine and may be associated with the reported musculoskeletal pain of the back and neck among professional drivers. However, very little is known about the characteristics of seated postural reactions and the biomechanical effects caused by mechanical shocks.

Methods.

Twenty healthy male subjects (18–43 years old) were exposed while seated to 5 SSMS and 15 DSMS in lateral directions. The second acceleration in the DSMS was in the opposite direction to the first acceleration and was fast, medium, or slow depending on the speed of direction change. Surface electromyography (EMG) was recorded in muscles of the upper neck, trapezius, erector spinae, and external oblique, while kinematics were recorded with inertial sensors placed at the neck, trunk, and pelvis. Muscle activity was normalized to maximum voluntary contractions (MVCs).

Results.

The EMG amplitudes were significantly higher (0.6–1%; P < 0.001) for the fast DSMS than all other shocks. Range of motion (ROM) of the neck and trunk was greater during the DSMS than the SSMS. Evoked muscle activity was less than 2% MVC in the trapezius, less than 10% MVC in the erector spinae and upper neck, while the activity exceeded 10% MVC in the external oblique muscles.

Conclusion.

Fast DSMS in lateral directions appear more demanding than SSMS, demonstrating augmented seated postural reactions. However, the present mechanical shocks employed did not seem to induce postural reactions with regard to ROM or muscle activity of a magnitude likely to cause musculoskeletal overload.

Level of Evidence: 4
Spinal Deformities in Romantic Operas
Authors: Andreotti Mattia , Caruso Gaetano , Massari Leo , Riva Michele Augusto
Published: August 2017

The librettos of several of the most famous Romantic operas contain references to disease. These operas can serve as valuable sources of information regarding how spinal deformities were understood during the nineteenth century by physicians and lay persons alike. Original librettos of the operas “Rigoletto” (1851) by Giuseppe Verdi (1813–1901) and “La Esmeralda” (1836) by Louise Bertin (1805–1877) were analyzed. In both operas, spinal deformities of Rigoletto and Quasimodo are a central issue. In detail, Quasimodo could suffer from von Recklinghausen's neurofibromatosis, while Rigoletto could be affected by severe adolescent idiopathic scoliosis. The plays are an expression of the nineteenth century attitude toward deformity: the hunchbacks are ridiculed and excluded from the society due to their deformity. Thus, they are forced by society to act as ugly and evil beings. Although both Rigoletto and Quasimodo show an intense love, at the end of each opera, they are defeated by loss of this love. This is an evident sign that, despite its willingness to tackle the subject, nineteenth-century society was not still ready to attribute success or human value to people affected by disabilities.

Level of Evidence: 5
Valproic Acid Combined With Postcardiac Arrest Hypothermic-Targeted Temperature Management Prevents Delayed Seizures and Improves Survival in a Rat Cardiac Arrest Model
Authors: Oh Joo Suk , Tulasi Jinka , Xiaodan Ren , Stacey William C. , Neumar Robert W.
Published: August 2017

Objectives:

High-dose valproic acid in combination with hypothermic-targeted temperature management has been reported to synergistically improve neurologic outcomes after cardiac arrest. This study investigated the potential synergistic mechanisms.

Design:

Prospective, randomized, experimental study.

Setting:

University research institution.

Subjects:

Male Long Evans rats.

Intervention:

Rats resuscitated from asphyxial cardiac arrest were randomized to one of the three groups: normothermic-targeted temperature management (37°C ± 1°C), hypothermic-targeted temperature management (33° ± 1° × 24 hr + placebo infusion), hypothermic-targeted temperature management plus high-dose valproic acid (300 mg/kg IV × 1 initiated 5 min post return of spontaneous circulation and infused over 20 min) (hypothermic-targeted temperature management + valproic acid).

Measurements and Main Results:

Seventy-two-hour survival was significantly greater with hypothermic-targeted temperature management + valproic acid, compared to hypothermic-targeted temperature management and normothermic-targeted temperature management (p < 0.05). Survival with good neurologic function, neurodegeneration, expression of HSP70, phosphorylation of Akt and Erk1/2 were not significantly different between hypothermic-targeted temperature management and hypothermic-targeted temperature management + valproic acid. The prevalence of seizures during the first 72-hour postcardiac arrest was significantly lower with hypothermic-targeted temperature management + valproic acid compared to hypothermic-targeted temperature management and normothermic-targeted temperature management (p = 0.01).

Conclusions:

High-dose valproic acid combined with hypothermic-targeted temperature management prevents postcardiac arrest seizures and improves survival. It remains to be determined if the mechanism of seizure prevention is through the antiepileptic effect of valproic acid or direct neuroprotection. Overall, the combination of high-dose valproic acid and hypothermic-targeted temperature management remains a promising strategy to improve cardiac arrest outcomes.
Interventions to Improve Hand Hygiene Compliance in the ICU: A Systematic Review
Authors: Lydon Sinéad , Power Michael , McSharry Jennifer , Byrne Molly , Madden Caoimhe , Squires Janet Elaine , O’Connor Paul
Published: August 2017

Objectives:

To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described.

Data Sources:

Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened.

Study Selection:

English language, peer-reviewed studies that evaluated an intervention to improve hand hygiene in an adult ICU setting, and reported hand hygiene compliance rates collected via observation, were included.

Data Extraction:

Data were extracted on the setting, participant characteristics, experimental design, hand hygiene measurement, intervention characteristics, and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist.

Data Synthesis:

Thirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 of 24 (sd= 2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were education (78.9%), enablement (71.1%), training (68.4%), environmental restructuring (65.8%), and persuasion (65.8%). Intervention outcomes were variable, with a mean relative percentage change of 94.7% (sd= 195.7; range, 4.3–1155.4%) from pre to post intervention.

Conclusions:

This review demonstrates that best practice for improving hand hygiene in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important.
Nebulized Versus IV Amikacin as Adjunctive Antibiotic for Hospital and Ventilator-Acquired Pneumonia Postcardiac Surgeries: A Randomized Controlled Trial*
Authors: Hassan Nehal A. , Awdallah Faten Farid , Abbassi Maggie M. , Sabry Nirmeen A.
Published: August 2017

Objective:

Nebulized antibiotics offer high efficacy due to significant local concentrations and safety with minimal blood levels. This study evaluates the efficacy and nephrotoxicity of nebulized versus IV amikacin in postcardiothoracic surgical patients with nosocomial pneumonia caused by multidrug-resistant Gram- negative bacilli.

Design:

Prospective, randomized, controlled study on surgical patients divided into two groups.

Setting:

Postcardiac surgery ICU.

Interventions:

The first gtroup was administered IV amikacin 20 mg/kg once daily. The second group was prescribed amikacin nebulizer 400 mg twice daily. Both groups were co-administered IV piperacillin/tazobactam empirically.

Patients:

Recruited patients were diagnosed by either hospital-acquired pneumonia or ventilator-associated pneumonia where 56 (42.1%) patients were diagnosed with hospital-acquired pneumonia, 51 (38.34%) patients were diagnosed with early ventilator-associated pneumonia, and 26 (19.54%) patients with late ventilator-associated pneumonia.

Measurements and Main Results:

Clinical cure in both groups assessed on day 7 of treatment was the primary outcome. Efficacy was additionally evaluated through assessing the length of hospital stay, ICU stay, days on amikacin, days on mechanical ventilator, mechanical ventilator-free days, days to reach clinical cure, and mortality rate. Lower nephrotoxicity in the nebulized group was observed through significant preservation of kidney function (p < 0.001). Although both groups were comparable regarding length of hospital stay, nebulizer group showed shorter ICU stay (p = 0.010), lower number of days to reach complete clinical cure (p = 0.001), fewer days on mechanical ventilator (p = 0.035), and fewer days on amikacin treatment (p = 0.022).

Conclusion:

Nebulized amikacin showed better clinical cure rates, less ICU stay, and fewer days to reach complete recovery compared to IV amikacin for surgical patients with nosocomial pneumonia. It is also a less nephrotoxic option associated with less deterioration in kidney function.
Antifungal Prevention of Systemic Candidiasis in Immunocompetent ICU Adults: Systematic Review and Meta-Analysis of Clinical Trials
Authors: Dupont Hervé , Mahjoub Yazine , Chouaki Taieb , Lorne Emmanuel , Zogheib Elie
Published: August 2017

Objectives:

The aim of this study was to identify the impact of antifungal prevention in critically ill immunocompetent adult patients on mortality and subsequent infection.

Data Sources:

A systematic review and meta-analysis of randomized controlled trials comparing any antifungal use versus placebo to prevent candidiasis in ICU patients were performed.

Study Selection:

Searches were performed on PubMed, Embase, Scopus, main conference proceedings, and ClinicalTrials.gov, as well as reference lists.

Data Extraction:

The primary outcomes were mortality and invasive candidiasis. The secondary outcome was the rate of Candida albicans and nonalbicans strains after treatment. A random effect model was used, and sensitivity analysis was performed for both outcomes. Results are expressed as risk ratios and their 95% CIs.

Data Synthesis:

Nineteen trials (10 with fluconazole, four with ketoconazole, one with itraconazole, three with micafungin, and one with caspofungin) including 2,792 patients were identified. No individual trial showed a decreased mortality rate. Combined analysis showed that preventive antifungal did not decrease mortality (risk ratio, 0.88; 95% CI, 0.74–1.04; p = 0.14) but significantly decreased secondary fungal infections by 50% (risk ratio, 0.49; 95% CI, 0.35–0.68; p = 0.0001). No shift across nonalbicans strains was observed during treatment (risk ratio, 0.62; 95% CI, 0.19–1.97; p = 0.42). However, publication biases preclude any definite conclusions for prevention of infection.

Conclusions:

Antifungal prevention of systemic candidiasis in immunocompetent critically ill adults did not reduce mortality and may have decreased secondary fungal infection rates. However, significant publication bias was present.
Prevalence of sexual symptoms in relation to menopause in women in Asia: a systematic review
Authors: Islam Rakibul M. , Bell Robin J. , Davis Susan R.
Published: August 2017

Objective:

This systematic review of the literature was undertaken to investigate the prevalence of sexual symptoms in women in Asia in relation to their menopause status.

Methods:

MEDLINE, EMBASE, PsycINFO, CINAHL, SCOPUS, and Google scholar were searched systematically for relevant population-based prevalence studies published between 1988 and 2016. The included studies were assessed for risk of bias using a risk-of-bias tool developed explicitly for the systematic review of prevalence studies.

Results:

A total of 34 articles, comprising 24,743 women, were included. In Asia, diminished sexual desire appears to be highly prevalent amongst postmenopausal women. Vulvovaginal atrophy symptoms are common after menopause in some Asian countries, but are either less common or under-reported in other Asian countries. The review highlights the paucity of data pertaining to menopause and sexual well-being in Asia, and the lack of prevalence studies that have assessed sexual function using a validated questionnaire. Most of the included studies had a high risk of bias, especially in the four items that pertain to external validity.

Conclusions:

The available data, despite its limitations, suggests that after menopause, lowered sexual desire and vulvovaginal atrophy symptoms, including dryness, irritation, soreness, and dyspareunia, are common in women in Asia. The extent to which such symptoms cause women distress is not known. Studies of representative samples of premenopausal, perimenopausal, and postmenopausal women that use robustly translated and culturally appropriate validated questionnaires, and that collect detailed demographic data are still needed to determine the prevalence of sexual symptoms in relation to menopause in women in Asia.
Mucosal Perfusion Preservation by a Novel Shapeable Tissue Expander for Oral Reconstruction
Authors: Barwinska Daria , Garner John , Davidson Darrell D. , Cook Todd G. , Eckert George J. , Tholpady Sunil S. , March Keith L. , Park Kinam , Barco Clark T.
Published: August 2017

Background:

There are few methods for expanding oral mucosa, and these often cause complications such as tissue necrosis and expander eruption. This study examines mucosal blood perfusion following insertion of a novel shapeable hydrogel tissue expander (HTE). The canine model used subgingival insertion of HTE following tooth extraction and alveolar bone reduction. The primary goal of this study was to gain understanding of epithelial perfusion and reparative responses of gingival mucosa during HTE expansion.

Methods:

Nine Beagle dogs underwent bilateral premolar maxillary and mandibular tooth extraction. Three to four months later, HTE-contoured inserts were implanted submucosally under the buccal surface of the alveolar ridge. After removal and following a 6- to 7-month period of healing, new HTE implants were inserted at the same sites. The area was assessed weekly for tissue perfusion and volume of expansion. Biopsies for histological analysis were performed at the time of expander removal.

Results:

Within 2 weeks following the second insertion, blood flow returned to baseline (defined as the values of perfusion measurements at the presurgery assessment) and remained normal until hydrogel full expansion and removal. Volume expansion analysis revealed that the hydrogel doubled in volume. Histological assessment showed no macrophage or inflammatory infiltration of the mucosa. No superficial fibrosis, decreased vascularity, or mucosal change was seen.

Conclusion:

Maintenance of adequate tissue perfusion is a clinically important aspect of tissue expander performance to reduce risk of device loss or injury to the patient, particularly for areas with a history of previous surgeries.
Can Adapted Motivational Interviewing Improve Uptake of Surgical or Laser Treatment for Glaucoma in Nigeria: Randomized Controlled Trial
Authors: Abdull Mohammed M. , McCambridge Jim , Evans Jennifer , Muazu Fatima , Gilbert Clare
Published: August 2017

Purpose:

To assess whether adapted motivational interviewing (MI) has any impact on the proportion of participants who subsequently underwent surgery or laser treatment for glaucoma.

Materials and Methods:

A single site randomized controlled trial in Bauchi, Nigeria. Participants were new patients with a confirmed diagnosis of primary open-angle glaucoma in 1 or both eyes, where surgery or laser was recommended. Intervention was a session of MI adapted for glaucoma and the local context, using an interview guide based on local qualitative research. Participants were randomly allocated to intervention or usual care. Usual care was routine explanation by an ophthalmologist and an educational pamphlet. After the interview, a 12-item Working Alliance Inventory questionnaire was administered to patient-interviewer pairs to assess the collaborative relationship.

Results:

Two hundred seventy-six glaucoma patients participated; 70% males. One hundred thirty-five (49%) were assigned to adapted MI and 141 to usual care. All received the intervention as allocated. Uptake (ie, the proportion who underwent treatment) of laser or surgery in the MI group was 52% compared with 45% in the usual care group (risk difference 7.2%; 95% confidence interval, −4.5% to 18.9%). Mean Working Alliance Inventory scores were 68.0 for interviewers and 68.5 for participants with a combined reliability coefficient of 93.9% (ie, high internal consistency and reliability).

Conclusions:

We observed only a small increase in the uptake of surgery or laser with MI compared with usual care which was not statistically significant. Although only 1 in 2 patients accepted surgery or laser in this trial, this is a much higher proportion than in other studies.
Evaluating the Quality of Life of Glaucoma Patients Using the State-Trait Anxiety Inventory
Authors: Otori Yasumasa , Takahashi Genichiro , Urashima Mitsuyoshi , Kuwayama Yasuaki
Published: August 2017

Purpose:

To evaluate anxiety felt by glaucoma patients.

Patients and Methods:

In total, 472 glaucoma patients responded to a questionnaire on anxiety, subjective symptoms, and vision-related quality of life (VR-QOL) associated with glaucoma. Anxiety was evaluated using the State-Trait Anxiety Inventory (STAI), state anxiety (STAI-State) subscale along with our novel questionnaire, assessing visual function and subjective symptoms, specialized for glaucoma. VR-QOL was evaluated using 5 subitems from the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). Adherence to ophthalmic antiglaucoma agents was confirmed. As indexes of visual function, corrected visual acuity (measured by eye chart), mean deviation (MD) score (measured with static perimetry), and 4 thresholds at the center of vision were determined. Stages were classified according to the Aulhorn Classification. From the STAI-State scores, the prevalence of anxiety in glaucoma patients was evaluated. We analyzed the correlation between the STAI-State and VFQ-25, anxiety, subjective symptoms, adherence, and visual function indexes.

Results:

In total, 78% of glaucoma patients experienced at least an intermediate level of anxiety. The STAI-State correlated significantly with anxiety and subjective symptoms as measured by our novel questionnaire, particularly for questions “current anxiety about loss of vision” and “current anxiety in life” (r=0.468 and 0.500; both P<0.0001). However, STAI-State correlated weakly with VFQ-25, and not at all with visual function indexes and adherence.

Conclusions:

Many glaucoma patients feel anxiety. The STAI-State is correlated with the VR-QOL and anxiety in glaucoma patients, making it useful for understanding the anxiety present in glaucoma patients.
Yield of Anaerobic Blood Cultures in Pediatric Emergency Department Patients
Authors: Gross Itai , Gordon Oren , Abu Ahmad Wiessam , Benenson Shmuel , Piatkowski Ben Simon , Eventov-Friedman Smadar , Hashavya Saar
Published: August 2017

Background:

Anaerobic bacteremia is rare in children and current recommendations advocate against the routine use of anaerobic cultures in children. However, the incidence of anaerobic bacteremia and the utility of anaerobic blood cultures in children have not been assessed in recent years. Our pediatric emergency department (PED) policy still supports the use of both aerobic and anaerobic blood cultures in all cases of suspected bacteremia. This allowed us to re-evaluate the yield of anaerobic cultures in PED settings.

Methods:

Retrospective data of all blood cultures taken in the PED in a single tertiary center from 2002 to 2016 were collected. The incidence and characteristics of children with positive anaerobic blood cultures were assessed. Risk factors for anaerobic bacteremia were defined.

Results:

Of the 68,304 blood culture sets taken during the study period, 971 (1.42%) clinically significant positive cultures were found. Pathogenic obligatory anaerobic bacteria were isolated in 33 (0.05%) cultures. The leading risk factors for anaerobic bacteremia were head and neck abscess and intra-abdominal infection. Of all the true positive cultures, 187 (22%) were only detected in the anaerobic culture and would have otherwise been missed.

Conclusions:

True anaerobic bacteremia is extremely rare in children admitted to the PED. Nevertheless, using anaerobic cultures may increase the overall yield of blood cultures.
Perspectives on How to Engage Consumers in Health System Transformation
Authors: Wiitala Kris , Hwang Ann
Published: August 2017

While health care organizations and public programs have recently demonstrated an increased interest in engaging patients and consumers as part of the implementation of new programs and policies, there is little published to date to guide these organizations in how to best engage consumers. We turn to an unconventional source—health care consumer advocates—who have developed experience in the type of consumer outreach, engagement, and activation that could help inform health care organizations and policy makers in further defining and studying engagement. We share perspectives from the field of advocacy that we believe could be applicable to health care organizations and policy makers working to build patient and family engagement, particularly in organizational governance and policy.
Prevalence of thiopurine S-methyltransferase gene polymorphisms in patients with inflammatory bowel disease from the island of Crete, Greece
Authors: Coucoutsi Constantina , Emmanouil George , Goulielmos George , Sfakianaki Ourania , Koutroubakis Ioannis E. , Kouroumalis Elias A.
Published: August 2017

Background

There is evidence that genotyping for the thiopurine S-methyltransferase (TPMT) gene variants is useful for the prediction of response to thiopurine analogs (azathioprine and 6-mercaptopurine) in patients with inflammatory bowel disease (IBD). The aim of the present study was to determine the prevalence of TPMT gene polymorphisms in a genetic homogenous population of IBD patients in Crete and to correlate the results with adverse reactions to thiopurine drugs.

Patients and methods

Genotyping for the most common TPMT variants TPMT*2, TPMT*3A, TPMT3*C, and TPMT*3B was performed using the PCR-restriction fragment length polymorphism method in 223 consecutive IBD patients and 119 age-matched and sex-matched healthy controls. The hospital medical records were reviewed for thiopurine use in these patients and related adverse events.

Results

The prevalence of TPMT variants TPMT*2, TPMT*3A, TPMT*3B, and TPMT*3C was 1.8, 2.7, 1.3, and 1.8%, respectively. The G238C mutation was detected in four (1.8%) out of 223 patients, three (1.3%) patients were carriers of the G460A mutation, four (1.8%) of the A719G mutation, and six (2.7%) of both G460A and A719G mutations. In healthy controls, only one (0.8%) carried both the G460A and the A719G mutation, whereas TPMT*2, TPMT*3C, and TPMT*3B were not detected. None of the genotypes was homozygous. A statistically significant correlation between the presence of the G460A mutation and the development of leucopenia after the administration of thiopurines was observed (P=0.048).

Conclusion

This study showed a lower frequency of total TPMT variants and a higher frequency of TPMT*3B in Cretan IBD patients compared with other Caucasian populations. The presence of the G460A mutation is associated with the development of leukopenia.
Viral hepatitis screening in transgender patients undergoing gender identity hormonal therapy
Authors: Mangla Neeraj , Mamun Rifat , Weisberg Ilan S.
Published: August 2017

Background and aim

Viral hepatitis is a global health issue and can lead to cirrhosis, liver failure, and hepatocellular carcinoma. Guidelines for viral hepatitis screening in the transgender population do not exist. Transgender patients may be at higher risk for contracting viral hepatitis due to socioeconomic and behavioral factors. The aim of this study was to measure the quality of screening, prevalence, and susceptibility of viral hepatitis, and to identify barriers to screening in transgender patients undergoing gender identity hormonal therapy.

Methods

LGBTQ-friendly clinic visits from transgender patients older than 18 years in New York City from 2012 to 2015 were reviewed.

Results

Approximately 13% of patients were screened for any viral hepatitis on initial consultation. Screening rates for hepatitis C virus (HCV), hepatitis B virus (HBV), and hepatitis A virus (HAV) at any point were 27, 22, and 20%. HAV screening was performed in 28% of the female to male (FtM) patients and 16% of male to female (MtF) (P<0.05) patients. HBV screening was performed in 30% of FtM patients and 18% of MtF patients (P<0.05). Thirty-one percent of FtM, 24% of MtF, and 17% of genderqueer patients were tested for HCV (P>0.05). Prevalence of HCV, HBV, and HIV in FtM was 0, 0, and 0.44% and that in MtF was 1.78, 0.89, and 1.78%, respectively. Percentage of patients immune to hepatitis A in FtM and MtF subgroups were 55 and 47% (P>0.05). Percentage of patients immune to HBV in FtM and MtF subgroups were 54 and 48% (P>0.05).

Conclusion

This study indicates a significant lack of hepatitis screening in the transgender population and a concerning proportion of patients susceptible to disease.
MRI assessed pancreatic morphology and exocrine function are associated with disease burden in chronic pancreatitis
Authors: Madzak Adnan , Olesen Søren Schou , Lykke Poulsen Jakob , Bolvig Mark Esben , Mohr Drewes Asbjørn , Frøkjær Jens Brøndum
Published: August 2017

Background and aim

The aim of this study was to explore the association between morphological and functional secretin-stimulated MRI parameters with hospitalization, quality of life (QOL), and pain in patients with chronic pancreatitis (CP).

Patients and methods

This prospective cohort study included 82 patients with CP. Data were obtained from clinical information, QOL, and pain as assessed by questionnaires (The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and modified Brief Pain Inventory short form). Secretin-stimulated MRI morphological parameters included pancreatic gland volume, main pancreatic duct diameter, the modified Cambridge Classification of Duct Abnormality, apparent diffusion coefficient, fat signal fraction, and the pancreatic secretion volume as a functional parameter. The primary outcomes were time to first hospitalization related to the CP, as well as annual hospitalization frequency and duration. The secondary outcomes were pain severity, QOL, and pain interference scores.

Results

A main pancreatic duct diameter below 5 mm was associated with reduced time to first hospitalization (hazard ratio=2.06; 95% confidence interval: 1.02–4.17; P=0.043). Pancreatic secretion volume was correlated with QOL (r=0.31; P=0.0072) and pain interference score (r=−0.27; P=0.032), and fecal elastase was also correlated with QOL (r=0.28; P=0.017). However, functional and morphological findings were not related to pain intensity.

Conclusion

Advanced pancreatic imaging techniques may be a highly sensitive tool for prognostication and monitoring of disease activity and its consequences.
Accommodative Behavior of Eyes Wearing Aspheric Single Vision Contact Lenses
Authors: Altoaimi Basal H. , Almutairi Meznah S. , Kollbaum Pete , Bradley Arthur
Published: August 2017

SIGNIFICANCE

Wearing aspheric contact lenses adds significant amounts of negative spherical aberration (SA). Also, when accommodated and converged to near targets, pupil size shrinks and SA shift from positive to more negative direction. Interestingly, in this study, pupil miosis was fully or partially able to compensate for the additional accommodation-induced negative SA.

PURPOSE

The present study aims to examine the accommodative response characteristics of young eyes fit with aspheric single vision contact lenses (SVCLs) that add significant negative SA to the eye responding to a wide range of accommodation stimuli.

METHODS

Using a Shack–Hartmann aberrometer, the accommodation behavior in eight young adult eyes (mean age and spherical equivalent is 27.25 ± 2.05 years and −1.75 ± 1.80D, respectively) was measured while subjects fixated binocularly and monocularly 20/40 letter E, which were moved from 2 m to 20 cm (0.5 to 5D) in 0.25D steps. Using natural pupils, refractive state was defined using three standard criteria: the dioptric power that (1) minimized the root mean square error (minRMS), (2) best-fit paraxial, and (3) provided the peak image quality (peak IQ).

RESULTS

Wearing aspheric lenses with negative SA shifts the mean SA of the unaccommodated eyes from +0.05 μm (eyes only) to −0.029 μm (eyes + SVCL) and increases the negative SA for the eye + lens when accommodating from −0.029 to −0.07 μm for natural pupils. Aberration changes with accommodation were attenuated by the accommodative pupil miosis, which reduced binocular viewing pupil diameters from 3.9 to 3.3 mm. This alteration of the typical SA levels by the aspheric SVCL did not prevent accurate accommodation (mean ± standard deviation accommodative lag under binocular viewing were −0.08 ± 0.12D, −0.38 ± 0.12D, and −0.26 ± 0.08D for paraxial, minRMS, and peak IQ, respectively).

CONCLUSIONS

These data clearly show that aspheric contact lenses designed to correct some or all of the unaccommodated eye’s positive SA do not interfere with accommodation.
Poroid Condyloma Versus Poroma With Atypias Because of Human Papillomavirus Infection
Authors: Fernandez-Flores Angel , Cassarino David S.
Published: August 2017

We present the case of a 43-year-old white man with a complex lesion at the base of the penis that combines features of both a poroma and a condyloma with human papillomavirus (HPV) infection, atypias, and focal ductal differentiation. It was a papillomatous lesion with epidermal hyperplasia, which mainly contained focally pigmented monotonous basaloid cells. Ductal lumina with cuticular cells were easily identified. Atypias were focally evidenced, with nuclear enlargement and hyperchromasia. Hypergranulosis and koilocytosis were also present. Immunohistochemical studies indicated p16 and p53 immunoexpression in the areas with cellular atypia and koilocytosis. Studies with in situ hybridization showed positivity for HPVs 16/18 and 31/33 in such areas, with a high rate of proliferation indicated by Ki-67. There was no positivity for HPV 6/11. Epithelial membrane antigen highlighted the ductal lumina, whereas there was no immunostaining for carcinoembryonic antigen.
Two Unique Cases of Ciprofloxacin-Associated Avulsion of Ligament and Tendon
Authors: Smith Jeffrey David , Irwin Robert W. , Wolff Erin T.
Published: August 2017

Ciprofloxacin is recognized to have a deleterious relationship with tendons, particularly Achilles tendinopathy, which makes up most case reports. Tendinopathy seems to occur because of induction of collagen-degrading enzymes causing damage and ischemia of the poorly vascularized regions preventing repair. The focus on the relationship of ciprofloxacin and the Achilles tendon leaves patients on fluoroquinolones with non-Achilles tendinopathy symptoms at risk of misdiagnosis. There have not been any documented instances of ligament damage with ciprofloxacin administration in the literature, although ligament and tendon compositions are similar and should have similar susceptibility. This report includes two cases, one presenting with right lateral thumb pain and a medical history of gastroenteritis treated with ciprofloxacin. Physical examination showed swelling of the right metacarpophalangeal joint and ultrasound confirmed disruption of the radial collateral ligament at insertion on first metacarpal; the second case is of a woman presenting with right hip pain in setting of chronic recurrent diverticulitis treated with ciprofloxacin. She received work-up for lumbar disc disease and spondylosis. After standard therapy with pharmacotherapy and physical therapy for radiculopathy failed, magnetic resonance imaging was performed showing near complete avulsion of the right hamstring tendons from the ischial tuberosity.
Is Horizontal Mattress Suturing More Effective Than Simple Interrupted Suturing on Postoperative Complications and Primary Wound Healing After Impacted Mandibular Third Molar Surgery?
Authors: Acar Ahmet Hüseyin , Kazancioğlu Hakki Oğuz , Erdem Necip Fazil , Asutay Fatih
Published: August 2017

The aim of this clinical study was to compare the influence of 2 different suturing techniques on postoperative complications and wound healing after surgical extractions of impacted mandibular third molars. In this randomized split mouth study, 30 patients were examined in whom 60 consecutive surgical extractions of symmetrically positioned impacted mandibular third molars were performed. After the extractions, the surgical flaps were sutured with either the simple interrupted or horizontal mattress suturing technique. Postoperative swelling and trismus were recorded on the 2nd, 7th, and 10th days. Pain was recorded in a 7-day diary and wound dehiscence was recorded on the10th postoperative day. Statistical evaluation of data was made using Mann–Whitney U test and Pearson correlation. There were no statistical differences between the 2 suturing techniques in terms of postoperative pain, trismus, and swelling (P > 0.05). There was significantly less wound dehiscence in the horizontal mattress suturing group than in the simple interrupted suturing group (P: 0017). According to the results of this study, the horizontal mattress suturing technique is more effective than the simple interrupted suturing technique on wound healing after impacted mandibular third molar surgery, although it does not decrease the levels of pain, trismus, and swelling.