bluuebunny/crossref_metadata_2025 huggingface dataset:
Sagittal Alignment Profile Following Selective Thoracolumbar/Lumbar Fusion in Patients With Lenke Type 5C Adolescent Idiopathic Scoliosis
Authors: Tauchi Ryoji , Kawakami Noriaki , Ohara Tetsuya , Saito Toshiki , Tanabe Hironori , Morishita Kazuaki , Yamauchi Ippei
Published: March 2019

Study Design.

A retrospective case series.

Objective.

This study aimed to report the sagittal outcome measures in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS) undergoing thoracolumbar/lumbar (TL/L) fusion surgery.

Summary of Background Data.

Previous studies have demonstrated coronal correction of Lenke type 5C AIS by selective TL/L fusion surgery. However, little is known about the sagittal influence of selective TL/L curve correction in Lenke type 5C AIS.

Methods.

Thirty-nine patients with Lenke type 5C AIS underwent selective posterior TL/L curves fusion (mean age, 15.9 ± 2.1 yrs). Preoperative and postoperative radiographic and clinical parameters were analyzed at a minimum 2-year follow-up period. Radiographic parameters were compared between patients with Lenke sagittal modifier normal (Group N) to those with Lenke sagittal modifier minus (Group M).

Results.

The main TL/L Cobb angle was 46.3° ± 7.7° preoperatively and 20.7° ± 5.3° (P < 0.0001) at 2-year follow-up. Also, thoracic kyphosis (TK) (T1–12) angle was 29.0° ± 11.3° preoperatively and 36.4° ± 10.3° at follow-up (P < 0.001), and TK (T5–12) angle was 18.1° ± 10.2° preoperatively and 25.9° ± 8.9° at follow-up (P < 0.001). The cervical lordosis (CL) was 9.6° ± 11.6° preoperatively and 6.1° ± 10.9° at follow-up (P = 0.037). Compared with the Lenke sagittal modifier groups, preoperative TK (T1–12), TK (T5–12), thoracolumbar kyphosis (TLK), and CL were significantly different from both the groups; and after the surgery, no significant differences in these parameters were observed between the two groups.

Conclusion.

After the selective TL/L posterior fusion surgery in patients with Lenke type 5C AIS, the sagittal alignment profile, including TK, TLK, C7 sagittal vertical axis, T1 slope, and CL, was significantly changed. With regard to the sagittal aspect, selective TL/L surgery was more likely to affect Group M than Group N.

Level of Evidence: 4
Explaining variations in hospitals’ use of strategic human resource management: How environmental and organizational factors matter
Authors: Schneider Annika M. , Oppel Eva-Maria , Winter Vera
Published: March 2019

Background

Against the background of increasing workforce-related challenges such as staff shortages, strategic human resource management (SHRM) has gained importance in hospitals. Although the positive implications of SHRM for hospital performance are well known and commonly accepted in research and practice, hospitals still vary in its use. However, the sources of variations in hospitals’ use of SHRM are largely unknown.

Purpose

Various organizational and environmental factors were used in this study to explain the variations in hospitals’ use of SHRM for physicians and nurses.

Methodology

Data were obtained from a hospital survey (n = 172) on topics related to human resource management in hospitals and linked to different secondary data sets. We apply multiple linear regression modeling to investigate the association between organizational and environmental characteristics and hospitals’ use of SHRM for nurses and physicians.

Findings

Our results suggest that organizational factors such as private for-profit and nonprofit ownership (compared to public ownership), academic teaching status, and the strategic involvement of the human resource administration are positively associated with hospitals’ use of SHRM. None of the environmental factors investigated in this study was significantly related to hospitals’ use of SHRM.

Practical Implications

The study results increase our understanding of variations in hospitals’ use of SHRM. Although organizational characteristics were found to explain variations in SHRM, environmental factors seem unrelated with hospitals’ use of SHRM. Our results inform both hospital managers and policy makers about possible approaches to enhance SHRM use in hospitals. Furthermore, profound knowledge about factors associated with SHRM will help to enhance our understanding of anticipating changes in hospitals’ use of SHRM through organizational- and environmental-oriented interventions.
Noninferiority of Preservative-free Versus BAK-preserved Latanoprost-timolol Fixed Combination Eye Drops in Patients With Open-angle Glaucoma or Ocular Hypertension
Authors: Aptel Florent , Pfeiffer Norbert , Schmickler Stefanie , Clarke Jonathan , Lavín-Dapena Cosme , Moreno-Montañés Javier , Żarnowski Tomasz , Csutak Adrienne , Jugaste Tiia , Volksone Lāsma , Astakhov Yury S. , Coupier Laurent , Nordmann Jean-Philippe , Stalmans Ingeborg
Published: March 2019

Précis:

Noninferiority of efficacy was demonstrated for a preservative-free latanoprost-timolol fixed combination compared with a BAK-containing formulation at 84 days after treatment in patients with open-angle glaucoma or ocular hypertension.

Purpose:

The purpose of this study was to compare the effect on intraocular pressure and safety of preservative-free latanoprost-timolol fixed combination (T2347) to benzalkonium chloride-preserved latanoprost-timolol fixed combination in patients with open-angle glaucoma or ocular hypertension.

Methods:

Phase III, randomized, parallel-group, investigator-masked study in 10 countries. A total of 242 patients aged 18 years or older with open-angle glaucoma or ocular hypertension in both eyes controlled with a preserved latanoprost-timolol fixed combination (15.7±2.4 mm Hg overall before inclusion) were randomized at day 0 with no washout period to receive the preservative-free alternative T2347 (N=127) or remain on the preserved comparator (N=115) for 84 days. Intraocular pressure changes from day 0 were measured at 9:00 am (±1 hour) on day 42 and day 84, and noninferiority of T2347 to the preserved comparator was analyzed statistically at day 84. Safety parameters were also reported.

Results:

The mean change in intraocular pressure from baseline to day 84 was −0.49±1.80 mm Hg for preservative-free T2347 and −0.49±2.25 mm Hg for the preserved comparator. These results met the noninferiority limits. Similar results were observed at day 42. There was no difference between groups in the incidence of adverse events or ocular signs. The total ocular symptoms score was better for T2347 than BPLT upon instillation at day 84 (45.9%/44.3%/9.8% of patients with improvement/no change/worsening vs. 33.6%/47.3%/19.1%; P=0.021), reflecting improvements in individual symptoms such as irritation/burning/stinging (P<0.001), and itching (P<0.01) on day 84.

Conclusions:

Preservative-free latanoprost-timolol fixed combination T2347 showed noninferior efficacy compared with the preserved comparator and was well tolerated.
Questionnaires Designed to Assess Knowledge of Atrial Fibrillation
Authors: Tam Wilson , Woo Brigitte , Lim Toon Wei
Published: March 2019

Background:

Atrial fibrillation (AF) is associated with high mortality and morbidity. Approximately half of patients with AF and at risk of stroke do not receive oral anticoagulation, despite its demonstrable reduction of stroke risk. Low adherence to anticoagulation medications may be a result of limited knowledge of AF among patients; hence, a validated instrument to assess AF knowledge is warranted. Cross-sectional surveys evaluating AF knowledge revealed the availability of instruments in the literature, but no systematic review has hitherto been conducted to characterize them.

Objective:

The objective of this study is to collate all validated instruments assessing AF knowledge.

Methods:

A systematic review was conducted. CINAHL, EMBASE, MEDLINE, and PsycINFO were searched from inception to May 25, 2018. Study selection and data extraction were conducted by 2 reviewers, from which results are presented narratively.

Results:

Based on 407 records retrieved from the databases, 15 studies were included, from which 7 questionnaires assessing AF knowledge were identified. The number of items ranged from 8 to 58. All the questionnaires were content validated, and some also examined other validities and reliabilities.

Conclusion:

In the literature, 7 validated questionnaires are available for assessing AF knowledge, in which the items often cover knowledge of AF in general, symptoms, treatments, and complications.
Phenotypic heterogeneity of kyphoscoliosis with vertebral and rib defects: a case series
Authors: Panigrahi Inusha , Angurana Suresh Kumar , Varma Harish , Peyam Pandurangam Srinivasan , Williams Vijai , Thappa Surjeet , Kaur Anupriya , Khandelwal Niranjan
Published: March 2019

Disorders associated with multiple vertebral segmentation defects may have additional rib anomalies in form of absence or hypoplastic ribs, fanning of ribs, etc. Spondylocostal dysostosis is genetic disorder with abnormal vertebral segmentation and rib anomalies. Diagnosis is often delayed because of non-familiarity with the characteristic features. There are six genes identified for spondylocostal dysostosis, of which SCDO5 is responsible for autosomal dominant form of the disorder. Retrospective study was conducted in Genetic and Metabolic unit of a tertiary hospital in north India over a period of 9 years. Twenty patients with a clinical diagnosis of congenital scoliosis were identified, and reviewed. Three patients were discussed in an earlier report and 11 subsequent patients, are described in this case series here. The median age at presentation was 34 months. The patients showed hemivertebrae, vertebral fusion, fusion of ribs, fanning of ribs. Hydrocephalus/ventriculomegaly was found in three cases and diastematomyelia was identified in one case. Other associated anomalies included corpus callosal agenesis, club foot and capillary malformation. One parent showed rib/spinal defects in two cases. Further studies are needed to characterise the phenotype and genetic basis of scoliosis in Indian patients.
Novel variant in HDAC8 gene resulting in the severe Cornelia de Lange phenotype
Authors: Jezela-Stanek Aleksandra , Murcia Pienkowski Victor , Jurkiewicz Dorota , Iwanicka-Pronicka Katarzyna , Jędrzejowska Maria , Krajewska-Walasek Małgorzata , Płoski Rafał
Published: March 2019

Cornelia de Lange syndrome (CDLS) is a clinically and genetically heterogeneous developmental disorder characterized by multiple malformations. Primarily, affected individuals have unique and recognizable dysmorphic facial features, cleft palate, distal limb defects, growth retardation, and developmental delay. However, also milder, as well as slightly phenotypically different forms exist. We described herein a patient with CDLS5, an X-linked form, caused by mutations in the HDAC8 gene inherited form the mosaic mother. Analysis of results from whole exome sequencing identified two variants with possible impact on the phenotype. Of them, hemizygous variant (c.938G>A, p.Arg313Gln) inherited from the mosaic mother, was further proved to lead to disease in the proband. Our intention was to delineate this syndrome but also point out the clinical course of the disease, which only in combination with a facial phenotype allow for verification of exome sequencing result.
Contemporary systematic review and meta-analysis of exfoliative toxin-producing Staphylococcus aureus strains isolated from patients in Iran
Authors: Memariani Mojtaba , Memariani Hamed , Shahidi-Dadras Mohammad , Tehranchinia Zohreh , Ghalamkarpour Fariba , Moravvej Hamideh
Published: March 2019

Exfoliative toxins of Staphylococcus aureus have been associated with Staphylococcal scalded-skin syndrome (SSSS) and bullous impetigo. Despite many reports on the exfoliative toxin-producing S. aureus in Iran over the past years, a comprehensive analysis of these studies are still rare endeavors. This systematic review aimed to determine the overall prevalence of exfoliative toxin genes (i.e. eta, etb, and etd) among S. aureus isolated from patients in Iran. An electronic search was conducted in the MEDLINE/PubMed, Scopus, and Google scholar databases for all documents published from 1 January 2010 through 1 December 2018. Of the 735 records identified from the databases, 14 studies fulfilled the eligibility criteria. The overall prevalence of eta, etb, and etd genes among S. aureus strains were 13.057% (95% CI: 2.930–28.885%), 3.601% (95% CI: 0.901–8.002%), and 21.922% (95% CI: 3.012–83.237%), respectively. The most prevalent genotypes of eta-positive S. aureus in Iran were staphylococcal cassette chromosome mec (SCCmec) type IV, accessory gene regulator (agr) group I, S. aureus Protein A (spa) type t021, and sequence type 30 (ST30). Regarding etb, the most common genotypes were SCCmec III, spa t005, and ST22. In conclusion, the prevalence of S. aureus strains harboring exfoliative toxin genes varies throughout Iran and that these strains, especially those carrying eta, might be more prevalent in some Iranian provinces, such as Mazandaran and Zanjan. Further researches are encouraged to understand the transmission, burden, and risk factors associated with infections caused by exfoliative toxin-producing S. aureus.
An Innovative Virtual Reality Experience in the PICU: A Pilot Study*
Authors: Badke Colleen M. , Essner Bonnie S. , O’Connell Megan , Malakooti Marcelo R.
Published: March 2019

Objectives:

Patients in the PICU frequently have limitations that impede independent interactions with their environment. Virtual reality is an immersive experience that may improve outcomes in critically ill children. The objective of this study was to assess feasibility and satisfaction with virtual reality.

Design:

Cross-sectional, single-arm pilot study.

Setting:

PICU.

Patients:

Convenience sample of 3- to 17-year-old patients.

Interventions:

Three-hundred sixty degree immersions were delivered using a simple virtual reality headset and smartphone videos. Each participant was given a choice of developmentally appropriate virtual reality experiences. Following the short (< 15 min) virtual reality experience, participants, and parents completed a brief survey.

Measurements and Main Results:

One-hundred percent of participants enjoyed using virtual reality, and 84% reported preference to use virtual reality for a longer duration. One-hundred percent of parents agreed that their child enjoyed using virtual reality, and 100% enjoyed watching their child use virtual reality. Eighty-two percent of parents reported that virtual reality calmed their child.

Conclusions:

Virtual reality is an innovative, easily administered, and enjoyable tool that subjectively calms PICU patients in an otherwise chaotic environment.
Methods of assessing late radiotherapy effects on bowel function
Authors: Nelson Annmarie , Mann Mala , Staffurth John
Published: March 2019

Purpose of review

Pelvic radiation disease in the form of chronic radiation-induced consequences of treatment is under recognized by healthcare professionals and under reported by patients. Gastrointestinal symptoms are not routinely assessed, and may not be causally associated with previous radiotherapy. These symptoms are therefore often under treated.

Recent findings

A literature search was conducted in Ovid Medline, which included Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Ovid Embase for articles published between 2016 and April 2018. A total of 11 articles were selected for review. A wide range of patient reported outcome measure instruments are used in research and practice. Clinical symptom grading is restricted to a fewer number of tools but may not always capture issues, such as urgency, that are important to the patient. Clinician and patient concordance in the assessment of outcomes is limited. Initiatives to prompt communication of the relative risks of the late consequences of treatment and comparative effectiveness of treatments decisions are developing, as are new techniques to limit irradiation of healthy tissue.

Nonstandardized outcome measurement reduces the ability to aggregate toxicity and patient outcomes across clinical trials. The development of standardized screening and treatment algorithms for gastrointestinal symptoms can systematically locate and treat gastrointestinal late effects of treatment.
Pursuing the limits of child survival in the most and least developed countries
Authors: Mejía-Guevara Iván , Zuo Wenyun , Mortensen Laust H. , Tuljapurkar Shripad
Published: March 2019

Summary paragraph

The epidemiological transition from young to old deaths in high-income countries reduced mortality at all ages, but a major role was played by a decline of infant and child mortality from infectious diseases1,2that greatly increased life expectancy at birth2,3. Over time, declines in infectious disease continue but chronic and degenerative causes persist4,5, so we might expect under-5 deaths to be concentrated in the first month of life. However, little is known about the age-pattern of this transition in early mortality or its potential limits. Here we first describe the limit using detailed data on Denmark, Japan, France, and the USA— developed countries with low under-5 mortality. The limiting pattern of under-5 deaths concentrates in the first month, but is surprisingly dispersed over later ages: we call this the early rectangularization of mortality. Then we examine the progress towards this limit of 31 developing countries from sub-Saharan Africa (SSA)—the region with the highest under-5 mortality6. In these countries, we find that early deaths have large age-heterogeneities; and that the age patterns of death is an important marker of progress in the mortality transition at early ages. But a negative association between national income and under-5 mortality levels, confirmed here, does not help explain reductions in child mortality during the transition.
A sensitive period in the neural phenotype of language in blind individuals
Authors: Pant Rashi , Kanjlia Shipra , Bedny Marina
Published: March 2019

In congenital blindness, “visual” cortices respond to linguistic information, and fronto-temporal language networks are less left-lateralized. Does this plasticity follow a sensitive period? We tested this by comparing the neural basis of sentence processing in two experiments with adult-onset blind (AB,n=16), congenitally blind (CB,n=22) and blindfolded sighted controls (n=18). In Experiment 1, participants made semantic judgments for spoken sentences and solved math equations in a control condition. In Experiment 2, participants answered “who did what to whom” questions for grammatically complex (with syntactic movement) and grammatically simpler sentences. In a control condition, participants performed a memory task with lists of non-words. In both experiments, visual cortices of CB and AB but not sighted participants responded more to sentences than control conditions, but the effect was much larger in the CB group. Crucially, only the “visual” cortex of CB participants responded to grammatical complexity. Unlike the CB group, the AB group showed no reduction in left-lateralization of fronto-temporal language network relative to the sighted. These results suggest that blindness during development modifies the neural basis of language, and this effect follows a sensitive period.
Research grade marijuana supplied by the National Institute on Drug Abuse is genetically divergent from commercially availableCannabis
Authors: Schwabe Anna L. , Hansen Connor J. , Hyslop Richard M. , McGlaughlin Mitchell E.
Published: March 2019

Public comfort withCannabis(marijuana and hemp) has recently increased, resulting in previously strictCannabisregulations now allowing hemp cultivation, medical use, and in some states, recreational consumption. There is a growing interest in the potential medical benefits of the various chemical constituents produced by theCannabisplant. Currently, the University of Mississippi, funded through the National Institutes of Health/National Institute on Drug Abuse (NIH/NIDA), is the sole Drug Enforcement Agency (DEA) licensed facility to cultivateCannabisfor research purposes. Hence, most federally funded research where participants consumeCannabisfor medicinal purposes relies on NIDA-supplied product. Previous research found that cannabinoid levels in research grade marijuana supplied by NIDA did not align with commercially availableCannabisfrom Colorado, Washington and California. Given NIDA chemotypes were misaligned with commercialCannabis, we sought to investigate where NIDA’s research grade marijuana falls on the genetic spectrum ofCannabisgroups. NIDA research grade marijuana was found to genetically group with Hemp samples along with a small subset of commercial drug-typeCannabis. A majority of commercially available drug-typeCannabiswas genetically very distinct from NIDA samples. These results suggest that subjects consuming NIDA research grade marijuana may experience different effects than average consumers.
Structure-function analysis of ZAR1 immune receptor reveals key molecular interactions for activity
Authors: Baudin Maël , Schreiber Karl J. , Martin Eliza C. , Petrescu Andrei J. , Lewis Jennifer D.
Published: March 2019

NLR (Nucleotide-binding [NB] Leucine-rich repeat [LRR] Receptor) proteins are critical for inducing immune responses in response to pathogen proteins, and must be tightly regulated to prevent spurious activation in the absence of a pathogen. The ZAR1 NLR recognizes diverse effector proteins from Pseudomonas syringae, including HopZ1a, and Xanthomonas species. Receptor-like cytoplasmic kinases (RLCKs) such as ZED1, interact with ZAR1 and provide specificity for different effector proteins, such as HopZ1a. We previously developed a transient expression system in Nicotiana benthamiana, that allowed us to demonstrate ZAR1 function is conserved from the Brassicaceae to the Solanaceae. Here, we combined structural modeling of ZAR1, with molecular and functional assays in our transient system, to show that multiple intramolecular and intermolecular interactions regulate ZAR1 activity. We identified new determinants required for the formation of the ZARCC dimer and its activity. Lastly, we characterized new intramolecular interactions between ZAR1 subdomains that participate in keeping ZAR1 immune complexes inactive. This work identifies molecular constraints on immune receptor function and activation.

One sentence-summary

Structure-informed analyses reveal multiple finely-tuned intramolecular interactions that regulate the activity of the immune receptor ZAR1.

Funding

Research on plant immunity in the Lewis laboratory was supported by the USDA ARS 2030-21000-046-00D and 2030-21000-050-00D (JDL), and the NSF Directorate for Biological Sciences IOS-1557661 (JDL). ECM and AJP acknowledge financial support from UEFISCDI grant PN-III-ID-PCE-2016-0650 and the Romanian Academy programs 1 & 2 of IBAR.
A combined strategy of neuropeptide predictions and tandem mass spectrometry identifies evolutionarily conserved ancient neuropeptides in the sea anemoneNematostella vectensis
Authors: Hayakawa Eisuke , Watanabe Hiroshi , Menschaert Gerben , Holstein Thomas W. , Baggerman Geert , Schoofs Liliane
Published: March 2019

Neuropeptides are a class of bioactive peptides and are responsible for various physiological processes including metabolism, development and reproduction. Although accumulated genome and transcriptome data have reported a number of neuropeptide candidates, it still remains difficult to obtain a comprehensive view of neuropeptide repertoires due to their small and variable nature. Neuropeptide prediction tools usually work only for those peptides for which sequentially related homologs have previously been identified. Recent peptidomics technology has enabled systematic structural identification of neuropeptides by using the combination of liquid chromatography and tandem mass spectrometry. However, obtaining reliable identifications of endogenous peptides is still difficult using a conventional tandem mass spectrometry-based peptide identification approach using protein database because a large search space has to be scanned due to the absence of a cleavage enzyme specification. We developed a pipeline consisting of the prediction ofin silicocleaved endogenous neuropeptides followed by peptide-spectrum matching enabling highly sensitive and reliable neuropeptide identification. This approach effectively reduces the search space of peptide-spectrum matching, and thus increases search sensitivity. To identify neuropeptides inNematostella vectensis,a basal eumetazoan having one of the most primitive nervous systems, we scanned theNematostellaprotein database for sequences displaying structural hallmarks of metazoan neuropeptides, including C/N-terminal structures and modifications. Peptide-spectrum matching was performed against thein silicocleaved peptides and successfully identified dozens of neuropeptides at high confidence. The identification of Nematostella neuropeptides structurally related the tachykinin, GnRH/AKH, neuromedin-U/pyrokinin peptide families indicate that these peptides already originated in the eumetazoan ancestor of all animal species, most likely concomitantly with the development of a nervous system.
A cross-country evaluation of energy efficiency from the sustainable development perspective
Authors: Jalali Sepehr Mehrdad , Haeri Abdorrahman , Ghousi Rouzbeh
Published: March 2019

Purpose

The purpose of this paper is to estimate energy efficiency of 132 countries from 2007 to 2014 according to their performance, categorizing the nations into similar groups.

Design/methodology/approach

Data envelopment analysis model based on Goal Programming and then K-Means clustering algorithm are used to determine the efficiency and clustering the nations based on their efficiency performances.

Findings

The results of the study reveal that developing low-income countries could lead to high energy-efficiency scores, and countries with different development and income levels can become efficient in the field of energy consumption. Following the nations during a seven-year period also indicates that the changes in energy-related indicators such as renewable energy consumption and energy productivity are the main drivers to move a country between clusters.

Originality/value

The present study aimed to investigate whether similar nations with similar energy efficiency level in a cluster are similar in their development and income level, and changing the energy consumption pattern during the seven-year period could move the countries from a cluster to another one.
Robot‐assisted surgery for the management of apical prolapse: a bi‐centre prospective cohort study
Authors: van Zanten F , Schraffordt Koops SE , O'Sullivan OE , Lenters E , Broeders IAMJ , O'Reilly BA
Published: March 2019

Objective

Robot‐assisted surgery is a recognised treatment for pelvic‐organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data.

Design

Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot‐assisted apical prolapse surgery.

Setting

Two European tertiary referral hospitals.

Population

Consecutive patients undergoing robot‐assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS).

Methods

Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ‐7).

Main outcome measures

Primary outcome: anatomical and subjective cure. Secondary outcomes: surgical safety and intraoperative variables.

Results

A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow‐up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ‐7 scores improved from 76.7 ± 62.3 to 13.5 ± 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS [183.1 ± 38.2 versus 145.3 ± 29.8 (P < 0.0005)]. Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%).

Conclusions

This is the largest reported prospective cohort study on robot‐assisted apical prolapse surgery. Both procedures are safe, with durable results.

Tweetable abstract

European bi‐centre trial concludes that robot‐assisted surgery is a viable approach to managing apical prolapse.
Antibiotic exposure perturbs the bacterial community in the small brown planthopper Laodelphax striatellus
Authors: Zhang Xu , Li Tong‐Pu , Zhou Chun‐Ying , Zhao Dian‐Shu , Zhu Yu‐Xi , Bing Xiao‐Li , Huang Hai‐Jian , Hong Xiao‐Yue
Published: March 2019

Bacteria symbionts in herbivores play an important role in host biology and ecology, and are affected by environmental factors such as temperature, diet, habitat, antibiotics and so on. However, the effects of antibiotics on the microbiome of the small brown planthopper Laodelphax striatellus (SBPH) remain unclear. Here, we studied the effects of tetracycline on the diversity and composition of bacterial colonies in different tissues of SBPH using high throughput sequencing of 16S ribosomal RNA amplicons. Our results show that Proteobacteria, Firmicutes, Bacteroidetes, Actinobacteria were most abundant in SBPH, and the genera Asaia and Wolbachia were most abundant in all body parts of SBPH. Antibiotic treatment had persistent effects on the composition of the SBPH microbiome. Tetracycline depleted the population of Firmicutes, Bacteroidetes, Tenericutes and Fusobacteria, and nearly 100% eliminated Wolbachia, Bacteroides and Abiotrophia in SBPH. Together, these results suggest that antibiotic exposure affects the bacteria symbionts of different body parts in SBPH and will facilitate future studies of the bacterial symbionts of arthropod hosts.
Every flow has its ebb: The impact of flow on work–family conflict and adjustment in global careers
Authors: Ramsey Jase R. , Lorenz Melanie P.
Published: March 2019

Despite an increase in research in psychology on the mental state of flow, little is known within the area of organisational studies about its “dark side.” Although prior organisational studies literature suggests that flow leads to generally positive work outcomes, we use conservation of resources theory to argue that expatriates in the state of flow can accumulate resources that lead to work adjustment but at the same time may experience unintended negative work–family conflict consequences. Specifically, we argue that being in the state of flow can improve expatriates' work adjustment because they can concentrate on the task at hand in an unencumbered way. Yet the exclusive concentration on work tasks and the distortion of time while in the state of flow may reduce psychological and time resources available to the family, resulting in work–family conflict. We explore whether flow theory needs to be altered to discover potentially negative work–family conflict outcomes inherent in the complex work regimes associated with global careers. Structural equation modelling analyses based on a sample of 230 expatriates in the United States and 169 expatriates in Brazil revealed that flow increased both work–family conflict and work adjustment.
The combination of whole‐exome sequencing and clinical analysis allows better diagnosis of rare syndromic retinal dystrophies
Authors: Abu Diab Alaa , AlTalbishi Ala'a , Rosin Boris , Kanaan Moien , Kamal Lara , Swaroop Anand , Chowers Itay , Banin Eyal , Sharon Dror , Khateb Samer
Published: March 2019

Purpose

To identify the accurate clinical diagnosis of rare syndromic inherited retinal diseases (IRDs) based on the combination of clinical and genetic analyses.

Methods

Four unrelated families with various autosomal recessive syndromic inherited retinal diseases were genetically investigated using whole‐exome sequencing (WES).

Results

Two affected subjects in family MOL0760 presented with a distinctive combination of short stature, developmental delay, congenital mental retardation, microcephaly, facial dysmorphism and retinitis pigmentosa (RP). Subjects were clinically diagnosed with suspected Kabuki syndrome. WES revealed a homozygous nonsense mutation (c.5492dup, p.Asn1831Lysfs*8) in VPS13B that is known to cause Cohen syndrome. The index case of family MOL1514 presented with both RP and liver dysfunction, suspected initially to be related. WES identified a homozygous frameshift mutation (c.1787_1788del, p.His596Argfs*47) in AGBL5, associated with nonsyndromic RP. The MOL1592 family included three affected subjects with crystalline retinopathy, skin ichthyosis, short stature and congenital adrenal hypoplasia, and were found to harbour a homozygous nonsense mutation (c.682C>T, p.Arg228Cys) in ALDH3A2, reported to cause Sjögren‐Larsson syndrome (SLS). In the fourth family, SJ002, two siblings presented with hypotony, psychomotor delay, dysmorphic facial features, pathologic myopia, progressive external ophthalmoplegia and diffuse retinal atrophy. Probands were suspected to have atypical Kearns‐Sayre syndrome, but were diagnosed with combined oxidative phosphorylation deficiency‐20 due to a novel suspected missense variant (c.1691C>T, p.Ala564Val) in VARS2.

Conclusion

Our findings emphasize the important complement of WES and thorough clinical investigation in establishing precise clinical diagnosis. This approach constitutes the basis for personalized medicine in rare IRDs.
Validation of hospital discharge coding for neonatal abstinence syndrome
Authors: Yam Patricia , Lok Laverne , Eastwood John , Maher Catherine , Ward Meredith , Clews Sara , Falconer Janet , Oei Ju Lee
Published: March 2019

Aim

To validate the diagnostic discharge coding of neonatal abstinence syndrome (NAS) (International Classification of Diseases [ICD]‐10‐AM, P96.1).

Methods

Retrospective record review of infants diagnosed with NAS (P96.1) in a non‐tertiary Australian hospital between 2000 and 2016. NAS criteria were predetermined to include the following: (i) maternal opioid use; (ii) infant requiring NAS medication and (iii) at least one score of ≥8 on the Finnegan Neonatal Abstinence Scoring Tool (FNAST).

Results

Of the 253 infants coded with P96.1, 82/146 (56%) opioid‐exposed infants and 9/107(18%) infants exposed to non‐opioid drugs only received withdrawal medication: sensitivity 56.2 (95% confidence interval: 47.7–64.3), specificity 91.6 (84.2–95.8%), positive predictive value (PPV) 90.1 (81.6–95.1%) and negative predictive value (NPV) 60.5 (52.5–68.0%) for all three criteria. Using the criterion of ≥1 FNAST score ≥8 resulted in 58.0 (51.3–64.4%) sensitivity, 63.6 (40.8–82.0%) specificity, 94.4 (88.8–97.4%) PPV and 12.6 (7.3–20.6%) NPV for identifying need for NAS medications.

Conclusion

A diagnosis of P96.1 is highly specific and predictive but poorly sensitive for identifying opioid‐exposed infants requiring medications for withdrawal.
Indications for laparoscopic liver resection of mass‐forming intrahepatic cholangiocarcinoma
Authors: Kinoshita Masahiko , Kanazawa Akishige , Takemura Shigekazu , Tanaka Shogo , Kodai Shintaro , Shinkawa Hiroji , Shimizu Sadatoshi , Murata Akihiro , Nishio Kohei , Hamano Genya , Ito Tokuji , Tsukamoto Tadashi , Kubo Shoji
Published: March 2019

Introduction

We investigated the indications for laparoscopic liver resection (LLR) of mass‐forming intrahepatic cholangiocarcinoma (MF‐ICC), including the need for lymph node dissection for improved postoperative prognosis.

Methods

This study involved 36 patients who underwent surgery for solitary peripheral MF‐ICC. Fifteen patients underwent LLR, and 21 underwent open liver resection (OLR). Surgical outcomes and prognostic factors were investigated to determine the indications for LLR.

Results

No significant differences were observed in perioperative outcomes between patients who underwent LLR and OLR. A significantly worse disease‐free survival (DFS) rate was observed in patients who preoperatively had a tumor diameter ≥3 cm, vascular invasion on diagnostic imaging, and elevated serum carbohydrate antigen (CA) 19‐9 and carcinoembryonic antigen (CEA) levels. A significantly worse overall survival (OS) rate was observed in patients with a tumor diameter ≥3 cm, vascular invasion on diagnostic imaging, and elevated serum CA19‐9 levels. Therefore, a tumor diameter ≥3 cm, vascular invasion on diagnostic imaging, and elevated serum CA19‐9 and CEA levels were determined to be preoperative prognostic factors. DFS and OS rates were significantly better in patients without these factors. Moreover, in six patients without these factors who underwent LLR, neither lymph node metastasis nor postoperative recurrence was observed.

Conclusion

A tumor diameter ≥3 cm, vascular invasion on diagnostic imaging, and elevated serum CA19‐9 and CEA levels are preoperative prognostic factors for peripheral MF‐ICC. LLR is indicated for patients without these factors.
Altered accelerator pedal control in a driving simulator in people with diabetic peripheral neuropathy
Authors: Perazzolo M. , Reeves N. D. , Bowling F. L. , Boulton A. J. M. , Raffi M. , Marple‐Horvat D. E.
Published: March 2019

Aim

To investigate whether the sensory‐motor impairment attributable to diabetic peripheral neuropathy would affect control of the accelerator pedal during a driving simulator task.

Methods

A total of 32 active drivers, 11 with diabetic peripheral neuropathy (mean ± sd age 67±5.0 years), 10 with diabetes but no neuropathy (diabetes group; mean ± sd age 62±10 years), and 11 healthy individuals without diabetes (healthy group; mean ± sd age 60±11 years), undertook a test on a dynamometer to assess ankle plantar flexor muscle strength and ankle joint proprioception function of the right leg, in addition to a driving simulator task. The following variables were measured: maximal ankle plantar flexor muscle strength; speed of strength generation (Nm/s); and ankle joint proprioception (ankle repositioning error, degrees). In the driving simulator task, driving speed (mph), accelerator pedal signal (degrees) and the duration of specific ‘loss‐of‐control events’ (s) were measured during two drives (Drive 1, Drive 2).

Results

Participants with diabetic peripheral neuropathy had a lower speed of strength generation (P<0.001), lower maximal ankle plantar flexor muscle strength (P<0.001) and impaired ankle proprioception (P=0.034) compared to healthy participants. The diabetic peripheral neuropathy group drove more slowly compared with the healthy group (Drive 1 P=0.048; Drive 2 P=0.042) and showed marked differences in the use of the accelerator pedal compared to both the diabetes group (P=0.010) and the healthy group (P=0.002). Participants with diabetic peripheral neuropathy had the longest duration of loss‐of‐control events, but after one drive, this was greatly reduced (P=0.023).

Conclusions

Muscle function, ankle proprioception and accelerator pedal control are all affected in people with diabetic peripheral neuropathy, adversely influencing driving performance, but potential for improvement with targeted practice remains possible.
Reporting of hypoglycaemia in clinical trials of basal insulins: A need for consensus
Authors: Frier Brian M. , Ratzki‐Leewing Alexandria , Harris Stewart B.
Published: March 2019

Hypoglycaemia is a common side‐effect of diabetes therapies, particularly insulin, and imposes a substantial burden on individuals and healthcare systems. Consequently, regulatory approval of newer basal insulin (BI) therapies has relied on demonstration of a balance between achievement of good glycaemic control and less hypoglycaemia. Randomized controlled trials (RCTs) are the gold standard for assessing efficacy and safety, including hypoglycaemia risk, of BIs and are invaluable for obtaining regulatory approval. However, their highly selected patient populations and their conditions lead to results that may not be representative of real‐life situations. Real‐world evidence (RWE) studies are more representative of clinical practice, but they also have limitations. As such, data both from RCTs and RWE studies provide a fuller picture of the hypoglycaemia risk with BI therapies. However, substantial differences exist in the way hypoglycaemia is reported across these studies, which confounds comparisons of hypoglycaemia frequency among different BIs. This problem is ongoing and persists in recent trials of second‐generation BI analogues. Although they provide a lower risk of hypoglycaemia when compared with earlier BIs, they do not eliminate it. This review describes differences in the way hypoglycaemia is reported across RCTs and RWE studies of second‐generation BI analogues and examines potential reasons for these differences. For studies of BIs, there is a need to standardize aspects of design, analysis and methods of reporting to better enable interpretation of the efficacy and safety of such insulins among studies; such aspects include length of follow‐up, glycaemic targets, hypoglycaemia definitions and time intervals for determining nocturnal events.
Nutrient stoichiometry shapes microbial coevolution
Authors: Larsen Megan L. , Wilhelm Steven W. , Lennon Jay T.
Published: March 2019

Coevolution is a force contributing to the generation and maintenance of biodiversity. It is influenced by environmental conditions including the scarcity of essential resources, which can drive the evolution of defence and virulence traits. We conducted a long‐term chemostat experiment where the marine cyanobacterium Synechococcus was challenged with a lytic phage under nitrogen (N) or phosphorus (P) limitation. This manipulation of nutrient stoichiometry altered the stability of host–parasite interactions and the underlying mode of coevolution. By assessing the infectivity with > 18 000 pairwise challenges, we documented directional selection for increased phage resistance, consistent with arms‐race dynamics while phage infectivity fluctuated through time, as expected when coevolution is driven by negative frequency‐dependent selection. The resulting infection networks were 50% less modular under N‐ versus P‐limitation reflecting host‐range contraction and asymmetric coevolutionary trajectories. Nutrient stoichiometry affects eco‐evolutionary feedbacks in ways that may alter the dynamics and functioning of environmental and host‐associated microbial communities.
Symptom clusters of subjective cognitive decline amongst cognitively normal older persons and their utilities in predicting objective cognitive performance: structural equation modelling
Authors: Liew T. M. , Yap P. , Ng T.‐P. , Mahendran R. , Kua E.‐H. , Feng L.
Published: March 2019

Background and purpose

Prior literature on subjective cognitive decline (SCD) has mostly focused on memory complaints. It is uncertain whether the other non‐memory complaints are equally relevant and can be used, alongside memory complaints, to identify populations at high risk of cognitive impairment. How the memory and non‐memory complaints of SCD cluster with each other amongst community‐dwelling individuals was investigated, and the differential utility of the symptom clusters of SCD in predicting objective cognitive performance was evaluated.

Methods

This study included 736 participants who were ≥60 years and had normal cognition, using the baseline data of an ongoing cohort study. Participants completed baseline assessments which comprised an SCD scale, a global cognitive measure and neuropsychological tests. Symptom clusters of SCD – as identified from exploratory and confirmatory factor analyses – were included in structural equation models to predict baseline changes in neuropsychological tests.

Results

The symptoms of SCD were split into two distinct factors, of which factor 1 was reported much more frequently than factor 2. Each standard deviation (SD) increment in factor 1 led to a 0.16–0.50 SD increase in global cognition, immediate memory, visuospatial abilities, language, attention and delayed memory (P < 0.05). In contrast, each SD increment in factor 2 worsened some of the cognitive domains by 0.18–0.37 SD.

Conclusions

The various complaints of SCD can have different implications amongst cognitively normal older persons and may possibly be classified into age‐related symptoms and pathological symptoms. The findings highlight the need for caution when selecting SCD measures, and illustrate the potential utility of SCD subtypes to inform on the underlying neurobiology.
Application of critical distances to fatigue at pores
Authors: Sobotka James C. , Enright Michael P. , McClung R. Craig
Published: March 2019

This work applies Taylor's theory of critical distance to quantify the effect of defects on fatigue initiation in an additively manufactured metal. We focus on hollow pores that are ideal spherical, prolate, and oblate spheroids isolated in an otherwise homogeneous linear‐elastic material. These conditions support the development of exact solutions using the exterior Eshelby tensor for a pore in a remote, arbitrary stress field. For spheres, this solution process admits simple closed‐form solutions for principal stresses disturbed by the pore. For prolate and oblate spheroids, we present the solutions as graphical curves showing stress variations under uniaxial tension. This report then extends the analysis to determine the effect of defects on a parametric, power‐law stress range vs fatigue life model. By propagating the distributed stress fields through this model, this study demonstrates the effect of pore size, pore shape, stress, and parametric fatigue properties on the life reduction due to porosity. These results suggest several approaches to increasing fatigue lives in porous materials, eg, reducing the pore size, promoting spherical pores, and increasing the microstructural parameter (comparable to the El Haddad parameter). Results presented in this work may be useful to inform trends of fatigue strength and fatigue initiation lives in metallic alloys with limited porosity, eg, additively manufactured materials that have been HIP'ed.
Population‐based surveillance of haemophilia and patient outcomes in Indiana using multiple data sources
Authors: Okolo Amanda I. , Soucie John Michael , Grosse Scott D. , Roberson Christopher , Janson Isaac A. , Allen Martha , Shapiro Amy D.
Published: March 2019

Introduction

Epidemiological surveillance of haemophilia through linkage of medical records within a US state has not been conducted in 20 years.

Aim

The Indiana Haemophilia Surveillance Project aims to identify all persons with haemophilia who resided in Indiana in 2011‐2013 and to determine the percentage of patients in Indiana cared for at a federally recognized haemophilia treatment centre (HTC).

Methods

A retrospective review of medical charts was conducted to identify haemophilia cases during the surveillance years. Case‐finding methods involved a variety of medical care resources including hospitals, administrative claims data and haematology/oncology clinic reports.

Results

In Indiana, 704 unique haemophilia cases were identified. Of those cases, 456 (64.8%) had factor VIII and 248 (35.2%) had factor IX deficiency. Among those with known severity levels (n = 685), 233 (34%) were severe, 185 (27%) were moderate, and 267 (39%) were mild. Overall, 81.7% of the haemophilia patients identified visited an HTC at least once during the three‐year study period, which was the requirement for being considered an HTC patient. Age‐adjusted prevalence for 2013 was 19.4 haemophilia cases per 100 000 males, 12.7 per 100 000 for factor VIII and 6.7 per 100 000 for factor IX. Incidence of haemophilia over the 10 years prior to the surveillance years was 1:3688 live male births in Indiana. During the surveillance years, 24 cases (3.4%) died.

Conclusion

We observed higher incidence and prevalence of haemophilia in Indiana compared to previous national estimates, as well as higher HTC utilization among persons with haemophilia.