bluuebunny/crossref_metadata_2025 huggingface dataset:
Jeans instability for an inert binary mixture: a kinetic theory approach in the Euler regime
Authors: Sandoval-Villalbazo A , Sagaceta-Mejía A R
Published: July 2020

The Jeans stability criterion for gravitational collapse is examined for the case of an inert binary mixture in local equilibrium, neglecting dissipative effects. The corresponding transport equations are established using kinetic theory within the Euler regime approximation. It is shown that the corresponding dispersion relation is modified; yielding corrections to the Jeans wave number that can be generalized for several interesting cases involving positive entropy production such as matter- antimatter systems and ordinary matter-dark matter dynamics.
Stoichiometric redox reaction-controlled, combustion assisted spray pyrolyzed zirconia films on stainless steel
Authors: Vardhan Robbi Vivek , M Manjunatha , Mandal Saumen
Published: July 2020

In this contribution, an efficient aqueous solution combustion technique was implemented to achieve zirconia films on stainless steel substrates at 400 °C, by low capital and facile spray pyrolysis of a combustible precursor comprising stoichiometric amounts of zirconium oxynitrate hydrate and glycine. Detailed derivation of stoichiometric redox reaction is emphasized in the present work. Thermal behaviour of combustible precursor revealed the combustion temperature at ∼220 °C. Crystalline tetragonal zirconia film was deposited at 400 °C with a wavy morphological surface inferred from diffraction patterns and microstructural studies, respectively. Besides, an approach to fabricate spray pyrolysed YSZ films through combustion at 400 °C was successfully accomplished. These films can have a potential impact on biomedical and thermal barrier applications.
The HIF target ATG9A is essential for epithelial barrier function and tight junction biogenesis
Authors: Dowdell Alexander S. , Cartwright Ian M. , Goldberg Matthew S. , Kostelecky Rachael , Ross Tyler , Welch Nichole , Glover Louis E. , Colgan Sean P.
Published: July 2020

The transcription factor hypoxia-inducible factor (HIF) mediates adaptation to hypoxia. We found that HIF regulates the autophagy protein ATG9A in intestinal epithelial cells. Subsequent knockdown of ATG9A resulted in tight junction mislocalization and cytoskeletal defects. These results suggest a link among the hypoxia response, autophagy, and junctional biogenesis.
Pharmacist-driven medication reconciliation reduces oral oncolytic medication errors during transitions of care
Authors: Heffner Colleen , Dillaman Megan , Hill Jordan
Published: July 2020

Purpose

The purpose of this study was to characterize medication errors associated with oral oncolytics as patients with cancer were admitted to the inpatient setting and identify contributing factors that lead to errors.

Methods

A review of patients prescribed a cyclic oral oncolytic who were then admitted to the inpatient setting at a large, academic medical center from July 1, 2013, to June 30, 2018, was conducted.

Results

Eighty-one patients were included in the analysis. Thirty-five errors (43%) related to transcription of the oral oncolytic regimen from the outpatient to the inpatient setting were identified. Categorization of errors revealed that 46% were due to delays in treatment. Within this error subset, 75% of the delays were related to unavailability of nonformulary oral oncolytics. There was a significant decrease in error for patients who received medication reconciliation by a pharmacist (P = 0.032) after admission. There were no other significant differences observed among variables that may have led to increased error rates. Three percent of errors were reported to the internal medication safety reporting system at our institution.

Conclusion

The inability to fully confirm patients’ home regimen via chart review poses great risk to accurate medication ordering upon hospital admission. Completion of medication reconciliations by pharmacists serves to decrease rates of errors that may occur during hospital admission in cancer patients undergoing treatment with oral oncolytic therapies.
Best practices for safe use of SGLT-2 inhibitors developed from an expert panel Delphi consensus process
Authors: Pamulapati Lauren G , Rochester-Eyeguokan Charmaine D , Pincus Kathleen J
Published: July 2020

Purpose

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors have demonstrated glycemic efficacy and cardiovascular and renal benefits in people with type 2 diabetes mellitus (T2DM). However, they are also associated with serious adverse events (AEs), but little consensus exists for clinicians regarding AE management. This study aimed to develop a list of best practices for the safe use and monitoring of SGLT-2 inhibitors in people with T2DM.

Methods

A 15-member interprofessional panel was surveyed in a four-round Delphi process. Panelists were asked to comment on and rank statements regarding initial prescribing considerations and actions for minimizing and managing eight specific AEs and a broad category for other AEs. In the final round, panelists selected if the statements should be considered a best practice specific to SGLT-2 inhibitors, a best practice for general safe medication use in T2DM, or if the statement should not be considered as a best practice for safe medication use.

Results

Consensus was achieved for 36 best practice statements specific to SGLT-2 inhibitors and 24 statements as general best practices for safe medication use. Fifty-six percent of the best practice statements for SGLT-2 inhibitors related to managing and/or preventing hypotension, urinary tract infections, and genital infections. The general best practices for safe medication use primarily focused on medication histories, past medical history considerations, physical exam components, and patient education.

Conclusion

A list of best practice statements was developed using the Delphi method, which can be utilized by clinicians to guide the safe use and monitoring of SGLT-2 inhibitors in people with T2DM.
The distinctive status of international arbitration agreements in English private international law?
Authors: Phua Myron , Chan Matthew
Published: July 2020

This Case Note critically discusses the Court of Appeal’s recent decision in Enka v Chubb [2020] EWCA Civ 574, where it held that (i) the doctrine of forum non conveniens (FNC) can never apply where an English court is asked to determine if a London arbitration agreement should be enforced by injunction, and that (ii) the ‘separability’ of an arbitration clause from the contract containing it entailed that, absent an express choice of law for it, there was a ‘strong presumption’ that the parties implicitly chose the seat law as its proper law. In doing so, the Court abandoned its previous approach in Sulamérica v Enesa, and indirectly cast doubt on its recent suggestion in Kabab-ji v KFG that ‘implied choices’ of law arguably involved the implication of a term into the arbitration agreement on ‘business efficacy’ grounds. Further, the Court appeared not to acknowledge that, outwith the arbitration context, (i) ‘FNC waiver’ clauses and exclusive jurisdiction agreements do not categorically foreclose FNC, and that (ii) ‘implied choices’ of law should not be casually inferred nowadays. The Court’s analysis in Enka was distinctly arbitration-centric: it was minded to emphasize the non-derogability of the seat courts’ supervisory role, and the ‘separability’ of an arbitration agreement from the contractual document containing it. Enka is an intriguing example of how international arbitration doctrine, particularly as regards arbitration agreements, can materially diverge from cognate principles of private international law. Nevertheless, we question whether international arbitration agreements are truly distinctive enough to justify such differences in treatment. Our assessment is that the answer is probably ‘no’.
To Trade, or not to Trade, that is the Question: New Roles for Incomplete Contracts in Dynamic Settings
Authors: Che Yeon-Koo , Sákovics József
Published: July 2020

We reexamine the role of incomplete contracts in a dynamic model of renegotiation that endogenizes the timing of investments and trade. The interaction between bargaining and investment significantly alters the lessons learned from static models. When the opportunity to trade is expected to be long lasting, contracts that exacerbate the parties’ absolute vulnerability to hold-up—especially following under-investment—are desirable. For example, joint ownership of complementary assets can be optimal, an exclusivity agreement can protect the investments of its recipient, and trade contracts can facilitate purely cooperative investment.
Dietary Effects on the Development of Calliphora dubia and Chrysomya rufifacies (Diptera: Calliphoridae): Implications for Postmortem Interval
Authors: Rogers Ella K B , Franklin Daniel , Voss Sasha C
Published: July 2020

Forensic entomology relies on insect development data generated within a laboratory setting in the estimation of minimum postmortem interval (mPMI). The methodologies used to produce these data vary considerably within the field and there is no accepted standard approach to laboratory rearing of forensically relevant species. A wide range of rearing media are used across published studies, including different species of animal and types of tissue (e.g., muscle and liver). Differing methodologies, particularly rearing diet, can introduce considerable variation into the baseline data upon which forensic estimates of the mPMI are calculated. Consequently, research establishing a widely available, standard and/or optimal, rearing medium for blow fly development for forensic application is desirable. This study examined dietary effects on the development of two forensically relevant blow fly species: Calliphora dubia Macquart, 1855, and Chrysomya rufifacies Macquart 1842 (Diptera: Calliphoridae). Larvae of both species were reared on pork liver, pork mince, pork loin, beef liver, beef mince, and guinea pig carcass under two constant temperature regimes (24 ± 1°C and 30 ± 1°C; 70 ± 10% humidity; 12-h/12-h photoperiod) to assess the influence of temperature on developmental response to diet. Fundamental developmental data pertaining to both species are reported. Developmental response to diet was species-specific and influenced by temperature with indication that the optimal temperature for C. dubia development is below 30°C. Pork mince was the most appropriate dietary standard of the rearing media investigated for the formulation of forensic development data for both species investigated.
Feasibility of Igniting Prescribed Fires in Bottomland Hardwood Forests
Authors: Cash James S , Anderson Christopher J
Published: July 2020

There is emerging interest in using prescribed fire to manage bottomlands for wildlife habitat, invasive species control, and overall forest function. We evaluated the feasibility of conducting prescribed fires in bottomland hardwood forests in west-central Alabama as part of a broader strategy to control the invasive shrub Chinese privet (Ligustrum sinense). We used 22 small-scale plots (0.04 hectares) in areas with residual slash from privet cutting operations and initiated prescribed fires on each to assess the overall feasibility and the relation of in-stand weather (i.e., microclimate), stand composition, and litter measurements to fire behavior. Overall, prescribed fire ignition was difficult, and only half the trials successfully burned >10 percent of the plot. We found that stand composition was most correlated with percent plot burned, and plots with higher proportions of tree species with flammable leaf traits (e.g., Quercus spp.) tended to burn best. Although further investigation is warranted, managers interested in using prescribed fire for bottomland hardwoods likely face short time windows and limited forest conditions in which fires can be reliably set.

Study Implications

There is increasing interest in using prescribed fires in bottomland hardwood forests. This exploratory study evaluated whether prescribed fires could be reliably set in bottomlands. Prescribed fires were difficult to establish and tended to be very patchy with fire spread related to tree canopy composition (because of differences in leaf litter flammability) and litter loads. Results suggest that it would be difficult to apply fire on a large scale in bottomland hardwood forests and that small-scale fires could only be set under certain conditions.
Improving the College-Going Process of Nursing Education for African American Students
Authors: Bundy Jawanza
Published: July 2020

The lack of diversity in the nursing workforce is concerning. Because schools of nursing play an important role in diversifying the nursing workforce, effective strategies must be developed to feed the pipeline. One such strategy is mentoring. The Diversity in Nursing Awareness Project was a mentoring program developed to assist African American students and their parents through the college-going process of nursing education. The aim of the program was not only to bring awareness of nursing as viable career option but also to increase acceptance and enrollment rates of African Americans into baccalaureate degree nursing programs.
Spinal cord injury
Authors: Perkins Amanda
Published: July 2020

Timely and appropriate management of patients with this type of injury is essential to ensure survival. Learn about the nurse's role in patient care and prevention.
Rebound phenomenon after hemiepiphysiodesis: Determination of risk factors after tension band plate removal in coronal plane deformities of lower extremities
Authors: Ramazanov Rafik , Ozdemir Erdi , Yilmaz Guney , Caglar Omur , Cemalettin Aksoy Mehmet
Published: July 2020

Risk factors for rebound phenomenon (ReP) have not been investigated in detail. Aim of this study is to investigate risk factors of ReP in lower extremity deformities after two-hole plate removal. Patients who underwent hemiepiphysiodes were retrospectively reviewed. Joint orientation angles of tibia and femur, deformity type, age of patient at initial surgery and plate removal, deformity correction rate, bone growth rate were noted. An increase of 5° or more in joint orientation angles in the direction of the initial deformity was considered ReP. A relationship between the patient parameters and ReP was evaluated. Ninety-four segments (55 femurs and 39 tibias) of 43 patients (15 males and 28 females) were included. ReP was observed in 56.2% of all valgus deformities (n = 73), and in 23.8% of varus deformities (n = 21). The ReP rate was 60% (n = 27) and 20% (n = 2) in femoral segments with preoperative valgus and varus deformities, respectively (P = 0.03). When gender, etiology, sides and age of implant application and removal were compared, there was no difference between ReP(+) and ReP(−) groups in femur and tibia. The correction rate of mechanical lateral distal femoral angle in ReP(−) and ReP(+) femurs was 0.7 ± 0.4°/month and 1.1 ± 0.3°/month, respectively (P = 0.01). Age at implant application and removal in the femoral valgus group was significantly lower in the ReP(+) group (P = 0.008 and P = 0.005, respectively). The ReP rate was higher in femoral segments with overcorrection (P = 0.008). The ReP rate was higher in femoral valgus deformities. Younger age at plate application and removal, higher correction rate in deformity and intentional overcorrection increased risk for ReP.
Displaced diaphyseal tibia fractures managed by elastic stable intramedullary nailing with or without the use of intraoperative traction table during nail insertion: a comparative analysis of 160 patients
Authors: Alberghina Flavia , Andreacchio Antonio , Cravino Mattia , Dimeglio Alain , Canavese Federico
Published: July 2020

The use of an orthopedic traction table (OTT) during elastic stable intramedullary nailing (ESIN) in the management of displaced diaphyseal tibia fractures (DTFs) is controversial. The aim of this study was to evaluate the clinical and radiological outcome of children with displaced DTF managed by ESIN with and without the use of an OTT. Medical records were retrospectively reviewed for all pediatric patients sustaining DTF managed by ESIN from 2011 to 2019 at two different institutions. In all, 160 consecutive children with displaced DTF were recorded, of whom 80 underwent operative treatment by ESIN without OTT (group A), and 80 by ESIN with the use of an OTT and skeletal traction (group B). ESIN outcome measure scale, Beaty radiologic criteria and Radiographic Union Scale for Tibia fractures (RUST) score were used to evaluate the results. Average patient age at time of injury was 10.8 years (range 7–15). The mean follow-up was 55.8 months (range 12–96). All complications (2.5%) and poorer results according to ESIN outcome measure scale and Beaty radiological criteria were recorded among children managed with OTT. No complications related to pin insertion for skeletal traction were observed. Mean RUST score, length of surgery and cumulative time of radiation exposure were comparable between the two groups. Children with a displaced DTF treated by ESIN without the use of OTT showed superior results as there are no additional procedures (traction wire insertion and removal) decreased theater time and no complications with similar radiation dose.
State of the Science of Dimensions of Nurses' User Experience When Using an Electronic Health Record
Authors: Tolentino Dante Anthony , Gephart Sheila M.
Published: July 2020

This integrative review synthesized relevant studies in the last decade associated to nurses' experience with the electronic health record using Robert and Lesage's dimensions of User Experience: functional, physical, perceptual, cognitive, psychological, and social. A comprehensive search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance across four electronic databases. We included articles if they were specific to nurses' electronic health record experience and workflow, published between January 2008 and June 2018, and available in English. The search resulted in 793 records with 26 articles included in the final analysis. Articles ranged from quantitative, qualitative, mixed-methods, and quality improvement studies. Across studies, the suboptimal design of the electronic health record affected the functional experience of nurses, often resulting in interruptions. The navigational design contributed to nurses' perceptual experience leading to many workarounds and workflow mismatches. Most of the studies reported overall satisfaction with the electronic health record that represented the psychological dimension of nurses' experience. Communication barriers due to the use of the electronic health record prevented nurses from having meaningful interaction with other clinicians and patients. Although nurses reported substandard user experience, many stated that reverting to a linear paper-based system was not an option.
Informatics Experience Can Help Predict Doctor of Nursing Practice Student Mastery of Informatics Competencies
Authors: Kupferschmid Barbara , Creech Constance , Lesley Marsha , Schoville Rhonda
Published: July 2020

With information technology increasingly guiding nursing practice, Doctor of Nursing Practice students must be prepared to use informatics to optimize patient outcomes despite their varied experience and education. Understanding how students' baseline experience affects their mastery of informatics competencies could help faculty design Doctor of Nursing Practice course content. Therefore, the aim of this retrospective descriptive study was to evaluate whether Doctor of Nursing Practice students' baseline informatics experience affected their mastery of four competencies: meaningful use, datasets, e-health, and clinical support systems. Participants were Doctor of Nursing Practice students (n = 55) enrolled in an online informatics course. Participant experience was compared to competency mastery using χ2tests. Logistic regression was performed to assess the effect of experience and highest degree obtained on competency mastery. Analysis revealed that participants with meaningful use experience were significantly more likely to master the meaningful use competency than were those without it. Relevant experience did not predict mastery of dataset competencies. Participants with e-health experience were significantly more likely to master the e-health competency (applying e-health resources to vulnerable patients' learning needs). While not significant, a greater percentage of students with clinical support systems experience mastered the clinical support systems competency. Informatics courses might need to be designed to address students' needs based on their experience.
Loss of skeletal muscle area and fat-free mass during dabrafenib/trametinib and vemurafenib/cobimetinib treatments in patients with BRAF-mutant metastatic malignant melanoma
Authors: Sengul Samanci Nilay , Çelik Emir , Bagcilar Omer , Erol Burak Caglar , Bicki Ela , Oruc Kerem , Bedir Sahin , Degerli Ezgi , Derin Sumeyra , Demirci Nebi Serkan , Demirelli Fuat Hulusi
Published: July 2020

This study aimed to assess whether dabrafenib/trametinib and vemurafenib/cobimetinib treatments are associated with a change in skeletal muscle area (SMA) and total fat-free mass (FFM) assessed by computed tomography (CT), and to compare the efficacy and safety profile of these treatments in patients with metastatic melanoma. Thirty-one patients treated with B-Raf proto-oncogene, serine/threonine kinase/MAPK extracellular receptor kinase inhibitors were included between 2016 and 2019. Eighteen patients received dabrafenib/trametinib and remaining patients received vemurafenib/cobimetinib. CT scans were performed at baseline and at 4–6 months of follow-up to measure cross-sectional areas of SMA. FFM and skeletal muscle index (SMI) values were calculated. Of the patients, including 18 treated with dabrafenib/trametinib (58.1%) and 13 with vemurafenib/cobimetinib (41.9%); 58.1% were male, 41.9% were female and median age was 52 years. A significant decrease in SMA was observed after dabrafenib/trametinib and vemurafenib/cobimetinib treatments (P = 0.003 and P = 0.002, respectively). A significant decrease in FFM values was observed after dabrafenib/trametinib and vemurafenib/cobimetinib treatments (P = 0.003 and P = 0.002, respectively). Dose-limiting toxicity (DLT) was observed in 35.9% of the patients with sarcopenia. No significant difference was seen between the dabrafenib/trametinib and vemurafenib/cobimetinib groups in median progression-free survival (PFS) (11.9 vs. 7.3 months, respectively, P = 0.28) and in median overall survival (OS) (25.46 vs. 13.7 months, respectively, P = 0.41). Baseline sarcopenia was not significantly associated with PFS or OS (P = 0.172 and P = 0.326, respectively). We found a significant decrease in SMI values determined at 4–6 months compared to the values before treatment both in dabrafenib/trametinib and vemurafenib/cobimetinib groups. DLT was similar with both treatments. Baseline sarcopenia was not significantly associated with PFS or OS.
The role of MC1R gene variants and phenotypical features in predicting high nevus count
Authors: van der Poel Louise A.J. , Bergman Wilma , Gruis Nelleke A. , Kukutsch Nicole A.
Published: July 2020

Variants in the Melanocortin 1 Receptor (MC1R) gene have been associated with an increased risk of melanoma, but the role in nevus count is unclear. We investigated if specific MC1R gene variants or the number of MC1R gene variants and phenotypical features were associated with nevus count. A total of 494 participants of the ‘Leiden skin cancer study’ were included and the MC1R gene coding sequence was analysed by single-strand conformation polymorphism analysis followed by sequencing of unknown variants. The association between MC1R gene variants and nevus count and the association between age, gender and phenotypical features and nevus count were studied using the Chi-square test. Study of nine frequently occurring MC1R gene variants in participants without skin cancer (n = 203) showed that the ‘r’ Val60Leu variant was significantly associated with high nevus count (>50 nevi) (P = 0.017). This association was very strong among women (P < 0.001), but not present among men. Having one or two MC1R variants in general did not show a significant difference in the nevus count. Hair colour, skin type, eye colour and age were not significantly associated with nevus count, whereas gender showed a significant association (P = 0.008), with the highest nevus counts in female. The Val60Leu variant of the MC1R gene could be a promising candidate as an independent predictor of high nevus count, particularly in women. This information about the genetic makeup could promote personalized follow-up strategies and might help to prevent skin cancer in the future.
MYB Translocations in Both Myoepithelial and Ductoglandular Epithelial Cells in Adenoid Cystic Carcinoma: A Histopathologic and Genetic Reappraisal in Six Primary Cutaneous Cases
Authors: Goto Keisuke , Kajimoto Kazuyoshi , Sugino Takashi , Nakatsuka Shin-ichi , Yoshida Makoto , Noto Mai , Kono Michihiro , Takai Toshihiro
Published: July 2020

Adenoid cystic carcinoma (ACC) is an infiltrating carcinoma composed of 2 cell types, myoepithelial and ductoglandular epithelial cells. Although approximately 70% of ACC exhibit translocations of the MYB proto-oncogene or MYB proto-oncogene like 1 (MYBL1), expression of MYB is known to be limited in myoepithelial cells. We investigated the histopathologic and genetic characteristics of ACC in 6 primary cutaneous cases. Histopathologically, 3 cases (50%) exhibited well-demarcated nodules composed of large nests, easily misdiagnosed as polymorphous sweat gland carcinoma. Two cases (33%) harbored large cystic structures resembling spiradenoma, hidradenoma, and digital papillary adenocarcinoma. A papillary pattern was focally observed in 2 cases (33%). A melting phenomenon within the myxoid stroma was seen in one case (17%). Fluorescence in situ hybridization (FISH) revealed MYB break-apart in 3 cases (50%). A combined FISH and immunohistochemical method revealed MYB break-apart signals in both p63-positive myoepithelial and p63-negative ductoglandular epithelial cells, suggesting that both cell types constitute elements of the tumor in ACC. Moreover, we established a well-circumscribed variant of ACC and proposed 3 new patterns of cystic, papillary, and melting in addition to the 3 patterns of cribriform, tubular, and solid growth.
Role of enterocyte-specific gene polymorphisms in response to adjuvant treatment for stage III colorectal cancer
Authors: Suenaga Mitsukuni , Cao Shu , Zhang Wu , Matsusaka Satoshi , Okazaki Satoshi , Berger Martin D. , Miyamoto Yuji , Schirripa Marta , Barzi Afsaneh , Yamamoto Noriko , Yamaguchi Toshiharu , Lenz Heinz-Josef
Published: July 2020

Objectives

The enterocyte subtype of colorectal cancer (CRC) responds favorably to oxaliplatin-based adjuvant treatment for stage III CRC. We examined the clinical significance of single-nucleotide polymorphisms (SNPs) in enterocyte-related genes MS4A12 and CDX2 in response to adjuvant treatment for stage III CRC.

Patients and methods

A total of 350 patients with stage III CRC were included: 274 received adjuvant treatment with surgical resection (discovery cohort) and 76 received surgery alone (control cohort). In the discovery cohort, 68 patients received FOLFOX and 206 received oral fluoropyrimidine. SNPs were analyzed by PCR-based direct sequencing.

Results

In the discovery cohort, the MS4A12 rs4939378 G/G variant was associated with lower 5-year survival than any A allele [70% vs. 90%, univariate: hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.03–5.06, P = 0.035; multivariate: HR 2.58, 95% CI 1.15–5.76, P = 0.021]. Patients with the CDX2 rs3812863 G/G variant had better overall survival than those with any A allele, although this was not significant in multivariate analysis (5 year-survival: 95% vs. 82%, univariate: HR 0.34, 95% CI 0.12–0.97, P = 0.034; multivariate: HR 0.39, 95% CI 0.13–1.11, P = 0.078). The SNPs did not show significant association with overall survival in the control cohort, and significant interaction was observed between MS4A12 genotypes and groups (P = 0.007).

Conclusions

Our findings suggest that MS4A12 and CDX2 gene polymorphisms may predict outcome in stage III CRC. However, the clinical significance of SNPs for response to oxaliplatin may differ by tumor stage.
Physiologic vasomotor symptoms are associated with verbal memory dysfunction in breast cancer survivors
Authors: Fogel Jessica , Rubin Leah H. , Kilic Ece , Walega David R. , Maki Pauline M.
Published: July 2020

Objective:

Vasomotor symptoms (VMS), sleep disturbance, and cognitive complaints are common among women with a history of breast cancer and contribute to decreased quality of life. Studies in healthy women showed an association between verbal memory performance and physiologic VMS measured with ambulatory skin conductance monitors but not with VMS by self-report. We hypothesized that we would find a similar association in women with breast cancer.

Methods:

Participants included 30 female breast cancer survivors (mean age 52.7 y; 26.7% African-American) with moderate-to-severe VMS enrolled in a larger clinical trial of a nonhormonal intervention for VMS. At baseline, participants completed assessments of physiologic VMS, actigraphy-based assessments of sleep, questionnaires about mood, and two tests of verbal memory – Logical Memory (LM) and the California Verbal Learning Test (CVLT). Using baseline data, we conducted multivariate regression analyses to examine the association between VMS and memory, controlling for sleep and other factors.

Results:

On average, women reported 46% of total physiologic VMS. A higher frequency of physiologic VMS – but not reported VMS – was significantly associated with lower scores on the California Verbal Learning Test short-delay free recall (r[28] = −0.41, P = 0.03), long-delay free recall (r[28] = −0.42, P = 0.03), and total clustering, (r[28] = −0.39, P = 0.04). These associations were independent of sleep, mood, and other factors.

Conclusions:

Independent of their effect on sleep, VMS may be a modifiable contributor to memory difficulties in women with breast cancer. These findings underscore the importance of objective measurement of VMS in cognitive studies.

Video Summary:
http://links.lww.com/MENO/A623.
LONG-TERM SURGICAL OUTCOMES OF LENS CAPSULAR FLAP TRANSPLANTATION IN THE MANAGEMENT OF REFRACTORY MACULAR HOLE
Authors: Peng Jie , Chen Chunli , Zhang Hongtao , Zhang Lihua , Liu Jingjing , Ren Jianing , Zhao Peiquan
Published: July 2020

Purpose:

To report long-term surgical outcomes of autologous and allogenic lens capsular flap transplantation (LCFT) in refractory macular hole (MH) treatment.

Methods:

Fifty consecutive eyes with refractory MH who received LCFT were reviewed retrospectively. Twelve eyes underwent autologous LCFT (LCF obtained from the same eye in 7 eyes and the fellow eye in 5 eyes) and 38 eyes with allogenic LCFT. All eyes underwent complete vitrectomy, internal limiting membrane peeling if not peeled, LCF transplantation, and 15% perfluoropropane tamponade. Simultaneous autologus whole-blood application was applied in 31 eyes to reduce LCF dislocation. The patients maintained a facedown position for 2 weeks postoperatively. Demographic information, functional results, and structural changes were evaluated.

Results:

The mean preoperative MH diameter was 1,102.00 µm ± 561.63 µm. The mean follow-up duration was 18.50 months ± 6.05 months (range, 12.0–38.9 months). The MH was completely closed in 48 eyes (96.00%) (18 eyes receiving autologous LCFT and 30 receiving allogenic LCFT). There are no differences of age, previous MH surgery times, MH diameter, preoperative and postoperative best-corrected visual acuity, and closure rate between the subgroups. The median visual acuity improved from 1.78 (interquartile range, 1.28–1.85) logarithm of the minimum angle of resolution (median Snellen acuity: 20/1,200) preoperatively to 1.00 (interquartile range, 0.90–1.70) logarithm of the minimum angle of resolution (median Snellen acuity: 20/200) (P < 0.01) in all patients.

Conclusion:

Both autologous and allogenic LCFT application may provide anatomical and visual improvements in refractory MH cases. Blood application can be applied in selected cases to reduce LCF dislocation. LCFT can be performed as first-line treatment for refractory MHs.
PARACENTRAL ACUTE MIDDLE MACULOPATHY IN A PATIENT WITH FREQUENT MIGRAINE WITH AURA: A CASE REPORT
Authors: Dasari Vijaya R. , Selliyan Ananth , Gratton Sean M.
Published: July 2020

Background/Purpose:

To explore the possible relationship between Paracentral Acute Middle Maculopathy (PAMM) and migraine. Paracentral acute middle maculopathy is a recently described clinical and optical coherence tomography entity involving infarction of the inner nuclear layer secondary to deep retinal capillary ischemia. It presents as a painless paracentral scotoma and often results in permanent visual deficits. Migraine, especially migraine with aura, has been shown to cause structural changes in the retinal microvasculature and to be a risk factor for retinal ischemia.

Methods:

A case report and review of the literature.

Results:

A 39-year-old woman with migraine with visual aura presented with a discrete, monocular, painless “buffalo-shaped” paracentral scotoma, which started during a period of frequent typical visual auras. Her exam and optical coherence tomography were consistent with PAMM.

Conclusion:

We propose that migraine is a risk factor for the development of PAMM. The changes in retinal microvasculature in migraine may increase a patient's susceptibility to retinal ischemia. Other risk factors for retinal ischemia, including diabetes, hypertension, hyperlipidemia, sickle cell disease, and orbital trauma, have been shown to be associated with PAMM. Further research should be conducted to determine whether there is a definite relationship between migraine and PAMM.
Cosmetic Keratopigmentation in Sighted Eyes: Medium- and Long-term Clinical Evaluation
Authors: D'Oria Francesco , Alio Jorge L. , Rodriguez Alejandra E. , Amesty Maria A. , Abu-Mustafa Sabat K.
Published: July 2020

Purpose:

To assess the medium- and long-term outcomes of keratopigmentation (KTP) as a surgical alternative to change the cosmetic appearance of healthy eyes.

Methods:

A prospective, interventional, consecutive, multicenter, series of cases of cosmetic KTP was included in the study. Forty consecutive patients underwent KTPs with mineral micronized pigments using a femtosecond laser–assisted intrastromal or superficial technique. Main outcomes were cosmetic evaluation, subjective patients' satisfaction, and complications. The outcomes were evaluated at 6 months after the last operation and then yearly.

Results:

This study included 79 eyes of 40 patients, with a mean age of 34 ± 11 years; femtosecond laser–assisted intrastromal keratopigmentation was performed in 39 patients (97.5%) and superficial automated keratopigmentation in 1 patient. Mean follow-up was 29 months (range 6–69). Observer's evaluation was excellent in 90% of cases, and patient's satisfaction was excellent in 92.5% of cases. Twenty-eight eyes (35.4%) were reoperated; of them, 7 eyes (8.9%) had 2 color touch ups and 4 eyes (5.1%) had 3 color touch ups. After the retreatments, all the patients were satisfied with the cosmetic aspect. Light sensitivity at first month was the most common complication (30%), followed by change in the color (7.5%), color fading (5%), and visual field limitations in a case with 4.5-mm pupil size (2.5%). One patient with a previous laser in situ keratomileusis developed corneal ectasia.

Conclusions:

Cosmetic KTP achieves good cosmetic results and is associated with high patient satisfaction. Most of the complications could be managed adequately. It might offer a safe and effective new surgical alternative for those patients motivated to change the apparent color of their eyes.
Free Tarsal Graft and Free Skin Graft for Lower Eyelid Reconstruction
Authors: Bortz John G. , Al-Shweiki Sameer
Published: July 2020

Purpose:

To determine whether reconstruction of lower eyelid defects involving the eyelid margin with a free tarsal graft and an overlying free skin graft, without retention or provision of any vascular support, would yield acceptable functional and cosmetic results.

Methods:

We present here a clinical series of 4 patients treated between April 2019 and September 2019 who underwent reconstruction of large postcarcinoma excision, eyelid-margin-inclusive eyelid defects. Surgery was performed by the same surgeon (J.G.B.) at the Westchester Medical Center, Department of Ophthalmology and Dobbs Ferry Hospital in New York. Without retaining a conjunctival pedicle (modified Hughes procedure), and without a myocutaneous or other vascularized flap, the lower eyelids were reconstructed with a free tarsal graft and a separate overlying free skin graft. The primary outcomes measured were eyelid apposition to the globe, margin reflex distance 2 at least 6 months postoperatively, ocular surface integrity, and patient comfort and patient satisfaction with the procedure.

Results:

The patients included in the clinical series ranged in age from 73 to 82, 3 were men and 1 women. Each had recent Moh’s excision of carcinoma (3 basal; 1 squamous) resulting in large tissue defects of the lower eyelids. All carcinomas were T1N0M0. The mean postoperative margin reflex distance 2 of the reconstructed eyelids was 5.5 mm, range 5–7.5 mm. Two of the 4 patients underwent a secondary revision within 2–3 weeks following initial reconstruction for lateral ectropion or dehiscence. All eyelids were well-opposed to the globes after revision (except for the nasal eyelid in patient number 2 who had a preexisting ectropion from prior carcinoma excision in the same eyelid). Functional and esthetic results were on par with those of the modified Hughes procedure. All 4 patients were pleased that they had chosen to undergo the procedure being discussed.

Conclusion:

In this clinical series of 4 patients, reconstruction of lower eyelid defects with a free tarsal graft and overlying free skin graft resulted in an acceptable functional and esthetic lower eyelid suggesting that retention of or provision of vascular support in either the anterior or posterior lamella may not be necessary.
Combined effects of obesity and di-(2-ethylhexyl) phthalate on testosterone levels and kisspeptin/GPR54 expression in hypothalamus and testes of male mice
Authors: Zhai Ling-Ling , Zhao Jian , Bai Ying-Long , Wei Wei , Sun Qi , Jia Li-Hong
Published: July 2020

Background:

This study evaluated whether obese male mice exposed to di-(2-ethylhexyl) phthalate (DEHP) showed synergistic effects on testosterone levels and the potential underlying mechanism.

Methods:

Forty-eight male mice were assigned to six groups for 12-week treatments as follows: normal, DEHP100, diet-induced obesity (DIO), DIO + DEHP30, DIO + DEHP100, and DIO + DEHP300. Serum hormone levels, including testosterone (T), luteinizing hormone (LH), and leptin, were detected by ELISA. The levels of Ob-R, kisspeptin, and GPR54 protein expression in hypothalamus and testicular tissues were measured by western blot.

Results:

There were significantly lower levels of serum T and LH, higher levels of serum leptin and Ob-R, and kisspeptin and GPR54 protein expression were reduced in hypothalamus and testicular tissues in the DIO and DEHP groups compared with controls. Moreover, serum T and leptin levels were more severe in the combined DIO and DEHP exposure group than in the single exposure groups. Serum LH levels and GPR54 expression in the testis were significantly decreased in DIO + DEHP300 mice compared with DIO mice (p< 0.05).

Conclusion:

Obesity- and DEHP-only exposure had adverse effects on testosterone levels in mice, which may be due to high leptin levels and decreased Ob-R, kisspeptin, and GPR54 expression. Obesity combined with DEHP exposure had an additive adverse effect on testosterone levels in mice. One of the potential mechanisms is higher leptin levels and decreased GPR54 expression in the testes.
The Average Effect of Emergency Department Admission on Readmission and Mortality for Older Adults With Chest Pain
Authors: Alvarez Avendaño Sebastian A. , Cochran Amy L. , Patterson Brian , Shah Manish , Smith Maureen , Zayas-Cabán Gabriel
Published: July 2020

Background:

Many older adults (65+) present to the Emergency Department (ED) with chest pain, but do not have otherwise clear clinical indication of whether they should be admitted or discharged. This uncertainty leads to decisions that are highly variable—in addition to already being costly—which could have adverse consequences, since older adults are particularly vulnerable from hospitalization.

Objective:

The objective of this study was to determine whether admitting versus discharging an older adult presenting to the ED with chest pain reduces risk of mortality and readmission.

Study Design:

Electronic health records were curated from an academic hospital system between January 1, 2014, and September 27, 2018. Average effects of admission on 30-day readmission and mortality were estimated using a new causal inference approach based on a latent-variable model of the admission process. Additional analyses assessed moderators and robustness of estimates.

Subjects:

Older patients (n=3090) presenting to University of Wisconsin Hospital ED.

Measures:

Readmission and mortality within 25, 30, and 35 days of discharge from the ED for discharged patients or the hospital for admitted patients

Results:

For older chest pain patients, admission is estimated to lower the 30-day risk of readmission by 42.8% (95% confidence interval: 41.0%–44.6%) but increase the 30-day risk of mortality by 0.8% (95% confidence interval: 0.4%–1.2%). Individuals with higher hierarchical conditional category scores or diabetes with complications have both lower 30-day risk of readmission and higher 30-day risk of mortality compared with their counterparts (P≤0.02).

Conclusions:

Our findings suggest ED admission may prevent readmission at the cost of increasing mortality risk for older chest pain patients, especially those with comorbidity. Additional studies are needed to validate these findings.
Health Care Costs of Alzheimer’s and Related Dementias Within a Medicare Managed Care Provider
Authors: Fishman Paul A. , White Lindsay , Ingraham Bailey , Park Sungchul , Larson Eric B. , Crane Paul , Coe Norma B.
Published: July 2020

Background:

Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings.

Objective:

The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan.

Research Design:

A retrospective cohort design was used to estimate direct total, outpatient, inpatient, ambulatory pharmacy, and nursing home costs for 3 years before and after an incident ADRD diagnosis for 927 individuals diagnosed with ADRD relative to a sex-matched and birth year-matched set of 2945 controls.

Subject:

Adults 65 years of age and older enrolled in the Kaiser Permanente Washington MA plan and the Adult Changes in Thought (ACT) Study, a prospective longitudinal cohort study of ADRD and brain aging.

Measures:

Data on monthly health service use obtained from health system electronic medical records for the period 1992–2012.

Results:

Total monthly health care costs for individuals with ADRD are statistically greater (P<0.05) than controls beginning in the third month before diagnosis and remain significantly greater through the eighth month following diagnosis. Greater total health costs are driven by significantly (P<0.05) greater nursing home costs among individuals diagnosed with ADRD beginning in the third month prediagnosis. Although total costs were no longer significantly greater at 8 months following diagnosis, nursing home costs remained higher for the people with dementia through the 3 years postdiagnosis we analyzed.

Conclusion:

Greater total health care costs among individuals with ADRD are primarily driven by nursing home costs.
Does 68Ga-DOTA-NOC-PET/CT impact staging and therapeutic decision making in pulmonary carcinoid tumors?
Authors: Purandare Nilendu C. , Puranik Ameya , Agrawal Archi , Shah Sneha , Kumar Rajiv , Jiwnani Sabita , Karimundackal George , Pramesh C.S. , Rangarajan Venkatesh
Published: July 2020

Objective

Purpose of this study was to assess the utility of 68Ga-DOTA-NOC-PET/computed tomography (CT) (Ga-NOC-PET) in tumor detection, pathological differentiation and baseline staging of pulmonary carcinoids as well as to study its impact on therapeutic decision making.

Patients and methods

Patients who underwent a Ga-NOC-PET for initial evaluation of bronchopulmonary carcinoid tumors from August 2014 to December 2019 were included. Detection rate of Ga-NOC-PET for the primary lesion was calculated by visual estimation of tracer uptake as per Krenning score. SUVmax of typical and atypical carcinoid tumors was measured and difference compared using nonparametric statistical tests. Proportion of patients with distant metastases was also calculated and its impact on intended treatment was assessed.

Results

Imaging, histopathology and treatment details of 119 patients were available for analysis. Majority of tumors had an endobronchial location (74.7%) and showed histopathologic features of typical carcinoid (82.3%). Ga-NOC-PET showed a detection rate/sensitivity of 92.4%. Oncocytic variant on histopathology and smaller tumor size accounted for majority of negative results. Typical carcinoids showed significantly higher SUVmax than atypical tumors (median SUVmax 38.4 vs. 15.7, P = 0.002). Metastases to distant sites outside the thorax were seen in 14 patients (11.7%), primarily in liver and bones changing the intent of treatment from surgery to systemic therapy.

Conclusion

Ga-NOC-PET detects asymptomatic distant metastatic disease in a sizeable number of patients (11.7%) with pulmonary carcinoid and thus contribute to clinical management by precluding futile surgeries. It shows a high sensitivity for tumor detection and can help differentiate between typical and atypical carcinoid variants by virtue of their variable tracer uptake. PET/CT using Ga-labeled DOTA peptides should be an integral part of diagnostic workup of patients with lung carcinoid.
Nutritional Assessment and Malnutrition in Patients With Cirrhosis
Authors: Chaney Amanda , Rawal Bhupendra , Harnois Denise , Keaveny Andrew
Published: July 2020

We sought to determine the incidence and outcomes of malnutrition in patients with cirrhosis. We performed a retrospective chart review of 134 patients listed for liver transplant (LT) to assess the presence and degree of malnutrition identified by the Subjective Global Assessment score at the time of initial transplant evaluation, follow-up nutrition visits, and at the time of transplant. Number of admissions/readmissions to the hospital, reason for hospitalization(s), and length of stay were determined. Malnutrition was prevalent at initial nutrition visit (51.9%) and underdiagnosed. By the time of transplant, 61% of the patients were identified as malnourished. Most patients (52%) were awaiting LT for more than 180 days. The change in Subjective Global Assessment score after the initial nutrition assessment was statistically significant (p ≤ .007), with worsening malnutrition severity. Seventy-one patients (53%) required hospitalization while awaiting transplant, with a median hospital stay of 9 days. Nutrition expertise is required for prompt and accurate diagnosis of malnutrition in patients with cirrhosis. Nurses caring for patients with advanced liver disease are in a prime position to provide guidance to optimize patient outcomes.