bluuebunny/crossref_metadata_2025 huggingface dataset:
Inaccurate Diagnosis Of Pulmonary Embolism
Authors: Dismuke S E
Published: July 2018

The likelihood and implications of making a false positive or false negative diagnosis of pulmonary embolism (PE) were studied at a large private hospital in 1980. Predictive accuracy (PreAc) of various lung scan patterns have been determined by McNeil and Biello using patients undergoing both lung scanning and pulmonary angiography. Using their criteria, 162 consecutive patients undergoing initial perfusion lung scan (ordered by 81 physicians) were studied. Cases were categorized by PreAc of the lung scan.

Conclusion: So far this study, where 250 patients are to be included, has not revealed any difference in follow-up venous function between legs with and without postoperative thrombosis as diagnosed with FUT.

In all groups many therapeutic decisions were made based on only medium probability for PE, increasing the possibilities of false positive and false negative diagnoses. It is therefore suggested that physicians be better educated about utilizing principles of probability and decision theory in order to help them maximize PreAc in PE. In patients with medium probability (10-90%) for PE the risks of an invasive procedure are low compared to the risks resulting from a false negative or false positive diagnosis. Therefore, more frequent use of venograms and angiograms would be indicated in this population to minimize errors in clinical decision making.
The Effect of a Tourniquet on the Kinin-Kininogen System in Blood and Muscle
Authors: Nakahara M
Published: July 2018

Dogs had tourniquet applied to their hind limbs for 4 h. Plasma kinin, plasma kininase, plasma kininogen, erythrocyte kininase, sarcoplasm kininase, sarcoplasm kinin forming enzymes, kininase from mitochondrial and lysosomal fractions, and kinin forming enzyme in mitochondrial and lysosomal fractions were examined for relationships between muscle and plasma kinins, before and after application of the tourniquet. The characteristics of kininase and kinin forming enzymes in extracts of mitochondrial and lysosomal fractions were stable to acid-heating. However, sarcoplasm kininase was unstable. A kinin forming enzyme which is stable to acid-heating was found in the plasma obtained after release of the tourniquet. A substance which acts as an accelerator of plasma kininase was present also in extracts from mitochondrial and lysosomal fractions. An increase in plasma kinin after release of the tourniquet was followed by a decrease in plasma kininogen content and by an increase in the activities of plasma kininase and erythrocyte kininase. From the results obtained, it appears that kinin forming enzymes may be released from ischemic muscle into the circulating blood after the release of the tourniquet, along with accelerators of plasma kininase. A mechanism to explain the increase in plasma kinin content is discussed.
Blood Coagulation
Authors: Seegers Walter H. , Grammens Gary L. , McCoy Lowell E.
Published: July 2018

Preparations of platelet factor 3 accelerated the conversion of purified autoprothrombin III (F-X) to autoprothrombin C (F-X?). The reaction was slow and the yields were low. Purified Hageman factor or purified autoprothrombin II (F-IX?) functioned as platelet cofactors. Each increased the yield of autoprothrombin C from purified autoprothrombin III above that obtained with platelet factor 3 alone. Hageman protein thus has a role in the direct acceleration of the first basic reaction in blood coagulation. Purified prothrombin was made refractory to the two-stage analytical reagents with Hageman factor.
The Biological Disappearance Rate of Prothrombin, Factors VII, IX and X from Plasma in Hypothyroidism, Hyperthyroidism, and During Fever
Authors: Loeliger E. A , van der Esch B , Mattern Mieke J , Hemker H. C
Published: July 2018

The biological disappearance rate of coagulation factors II, VIT, IX and X from plasma is decreased in myxoedema and increased in thyreotoxicosis. In patients with elevated body temperatures, an increase of up to three times the normal rate was observed. The clinical implications of these findings are briefly discussed.
Basic Enzymology of Blood Coagulation*
Authors: Seegers W. H
Published: July 2018

I have considered the accuracy of the “enzyme cascade” sequence or “waterfall sequence” for blood clotting proposed recently. My remarks are not intended to be exhaustive, but rather representative of a perspective. I regard these presentations as being at the speculative level of science, created with a wild use of the imagination. Some of the clotting factor precursors that are supposed to be converted in succession to active enzymes may not exist and certainly are not known to be enzymes. I find it against my sense of order to believe that six proteolytical enzymes are needed to get thrombin. That would require six special sites in proteins where each enzyme does its work. Each enzyme would not split the other five sites if located as single or multiple frequencies in the five other substrates. While creating hypothetical enzymes and assigning Roman numerals to them the well documented function of the best known enzyme; namely, thrombin is disregarded. The capacity of prothrombin to form derivatives is disregarded. This immediately places the superstructure on a false base. The sequence is definitely not in accurate order. There is no elaborate mobilization of chemical events on the periphery of prothrombin which leads to doing something to prothrombin. The second known enzyme, autoprothrombin C, is included in the plasma-platelet system (intrinsic) whereas its main, if not exclusive place, is in the conversion of prothrombin to thrombin when tissue-plasma-platelet mechanisms are in operation. What is meant by t he term prothrombin is not clarified, and the way in which the required phospholipid originates is not accounted for. If there is a factor XII it is not the exclusive way to create conditions that will initiate prothrombin activation in the plasma-platelet system. Most of the steps postulated could only be accurate if it were possible to deny important conclusions stated in papers which are not at all considered. Evidently refutation of facts in these papers was not possible and a parochial kind of authority was promoted1 ) on the basis of “consistent with most of the current investigations”. I like to recal11 ) the words of Henry David Thoreau: “Any man more right than his neighbor, constitutes a majority of one.” The advances in prothrombin chemistry are sufficiently substantial for the formulation of a conceptual theme consistent with principles of enzymology, and as I have indicated above, can also serve as a clarification of the proposed cascade or waterfall diagrams.
Possessive semantic relations and construction types in Kukama-Kukamiria
Authors: Vallejos Rosa
Published: July 2018

This study examines the correlations between possessive semantic relations and construction types in Kukama-Kukamiria (Amazon of Peru). The language does not have lexical verbs such as ‘have’, ‘belong,’ or a copula to predicate ownership. Yet possession can be inferred from other constructions, including: a predicate nominal construction with two juxtaposed NPs in which the possessor is encoded in the first NP, and the possessed in the second NP; an existential construction in which the possessor and possessed elements are expressed within an NP; and a combination of the existential and locative construction in which the possessor is expressed in the locative phrase, and the possessed in the NP. Heine (1997) predicts that the equative schema will encode physical possession; the existence schema, permanent and inalienable possession; whereas the location schema, physical and temporary possession. An examination of a text corpus reveals that Heine’s predictions are partially confirmed. Importantly, the equative construction encodes permanent ownership, which suggests that this is the most conventionalized linguistic expression of possession in Kukama-Kukamiria.
Evidence for the development of action nominals in Awetí towards ergatively-marked predicates
Authors: Reiter Sabine
Published: July 2018

Non-verbal predicates without any copula occur at a high frequency in Awetí discourse. Especially numerous are action nominals as heads of action nominal constructions (ANCs) with the structure of possessive NPs. There is evidence that in this Tupian language action nominals of a specific type have lost their pragmatic markedness and undergone a reanalysis as nuclei of main clause predicates. This tendency of a reanalysis of nominalizations has been observed in a variety of South American language families. As monoclausal constructions, ANCs have properties and possibilities which are absent in clauses with finite verbs. One of them is their consistent ergative person-marking and ordering of constituents, compared to Awetí finite verbs with their asymmetrical indexing pattern, and a constituent order in clauses with finite verbs which is motivated by discourse-pragmatic principles. Another is the possibility of a change in perspective in 3rd person arguments marked by an ‘antipassive’ on an action nominal, while 3rd person reference on finite verbs is determined by a person-animacy hierarchy.
Succeeding competently: towards an anti-luck condition for achievement
Authors: von Kriegstein Hasko
Published: July 2018

Achievements are among the things that make a life good. Assessing the plausibility of this intuitive claim requires an account of the nature of achievements. One necessary condition for achievement appears to be that the achieving agent acted competently, i.e. was not just lucky. I begin by critically assessing existing accounts of anti-luck conditions for achievements in both the ethics and epistemology literature. My own proposal is that a goal is reached competently (and thus an achievement), only if the actions of the would-be-achiever make success likely, and that this is the reason why she acts that way.
Proprotein-Convertase Subtilisin-Kexin Type 9 and Low-Density Lipoprotein Receptor Genotype Distribution and Statin Association in Filipino American Women
Authors: Gomez Joanne Michelle D. , Ancheta Irma B. , Volgman Annabelle S. , Battie Cynthia A. , Flores Rene , Palaniappan Latha
Published: July 2018

Filipino American women (FAW) have high incidence of coronary heart disease and high low-density lipoprotein cholesterol (LDL-C). The distribution of rs11206510 proprotein-convertase subtilisin-kexin type 9 (PCSK9) and rs1122608 low-density lipoprotein receptor (LDLR) single nucleotide polymorphisms (SNPs), known for genetic influences on LDL-C, is unknown in this population. The objective of this study was to examine the genetic determinants of LDL-C, their association with LDL-C, and effects of statins on LDL-C given the genetic determinants in this high-risk population. Data were obtained from the FAW Cardiovascular Study ( N = 338) of women ages 40 to 65 years from four major U.S. cities between 2011 and 2013. Roche Modular methodology and Luminex-oligonucleotide ligation assay procedure were used for allele frequency, genotype, LDL-C, and lipid analysis. Analysis of variance was used to determine differences between genotype groups. Genotype and statin effect on LDL-C were tested using the generalized linear model procedure of SAS. The distribution of rs11206510 PCSK9 genotypes was 88% TT, 11% TC, and 1% CC, and the rs1122608 LDLR genotype distribution was 83% GG, 17% GT, and 0% TT. These SNPs showed no association with mean LDL-C in this cohort. FAW on statin medications had lower LDL levels regardless of their PCSK9 or LDLR genotypes. Most FAW had a gain-of-function allele of PCSK9 and LDLR. This predominance in FAW cohort may account for the high percentage of subjects with elevated LDL-C. In a population at high risk for hypercholesterolemia, optimal treatment with statins should be considered where appropriate.
Afterword to the article “A brief history of the classification of the finite simple groups”
Authors: Solomon Ron
Published: July 2018

In this afterword the author discusses his previously published article “A brief history of the classification of the finite simple groups”, which appeared in Bull. Amer. Math. Soc. (N.S) 38 (2001), no. 3, 315–352.
Production Risks, Risk Preference and Contract Farming: Impact on Food Security in India
Authors: Mishra Ashok K , Kumar Anjani , Joshi Pramod K , D’Souza Alwin
Published: July 2018

This article reviews the literature on contract farming (CF) in India and assesses the impact of smallholders’ perceived production risks on the adoption of CF; the impact of CF on smallholders’ food security; and its impact on employment generation in their farming enterprises. We also show the impact of the outcome variables by risk preference of smallholders. Using farm‐level data and endogenous switching regression methods, this study presents three key findings. First, the perception of weather and pest risk, access to irrigation facilities, extension visits, and access to institutional credit are the main drivers of CF adoption. Second, CF adoption increases food security and varies with the revealed risk preference of smallholders, and risk‐seeking smallholders tend to gain higher food security. Third, regardless of revealed risk preferences, smallholders who did not adopt CF benefit from adoption by reducing their labor requirements, with no significant losses in yield.
Bone marrow cell response after injury and during early stage of regeneration is independent of the tissue‐of‐injury in 2 injury models
Authors: Leitão Luís , Alves Cecília J. , Alencastre Inês S. , Sousa Daniela M. , Neto Estrela , Conceiçâo Francisco , Leitão Catarina , Aguiar Paulo , Almeida-Porada Graça , Lamghari Meriem
Published: July 2018

Selectively recruiting bone marrow (BM)‐derived stem and progenitor cells to injury sites is a promising therapeutic approach. The coordinated action of soluble factors is thought to trigger the mobilization of stem cells from the BM and recruit them to lesions to contribute to tissue regeneration. Nevertheless, the temporal response profile of the major cellular players and soluble factors involved in priming the BM and recruiting BM‐derived cells to promote regeneration is unknown. We show that injury alters the BM cellular composition, introducing population‐specific fluctuations during tissue regeneration. We demonstrate that injury causes an immediate, transient response of mesenchymal stromal cells and endothelial cells followed by a nonoverlapping increase in hematopoietic stem and progenitor cells. Moreover, BM reaction is identical whether the injury is inflicted on skin and muscle or also involves a bone defect, but these 2 injury paradigms trigger distinct systemic cytokine responses. Together, our results indicate that the BM response to injury in the early stages of regeneration is independent of the tissue‐of‐injury based on the 2 models used, but the injured tissue dictates the systemic cytokine response.—Leitão, L., Alves, C. J., Alencastre, I. S., Sousa, D. M., Neto, E., Conceição, F., Leitão, C., Aguiar, P., Almeida‐Porada, G., Lamghari, M. Bone marrow cell response after injury and during early stage of regeneration is independent of the tissue‐of‐injury in 2 injury models. FASEB J. 33, 857–872 (2019). www.fasebj.org
Six versus 12 Months of Anti Tubercular Therapy in Patients With Biopsy Proven Spinal Tuberculosis
Authors: Nene Abhay M. , Patil Sanganagouda , Kathare Ambadas P. , Nagad Premik , Nene Amita , Kapadia Farhad
Published: July 2018

Study Design.

A single center pilot study, open labeled, prospective randomized clinical trial.

Objective.

To compare six versus 12 months of anti TB therapy in patients with biopsy proven spinal TB.

Summary of Background Data.

There is no clear consensus or evidence based guidelines for the duration of treatment of spinal tuberculosis. We studied if 6 and 12 months of anti tubercular therapy (ATT) had equivalent outcomes at 24 months from completion of therapy.

Methods.

A prospective randomized open labeled clinical trial of 6 versus 12 months ATT in patients with biopsy proven spinal-vertebral tuberculosis. The primary end point was absence of recurrence 24 months after completing therapy. Secondary end points were clinical cure at the end of therapy, significant adverse effect of ATT, need for delayed surgery, and residual neurological dysfunction.

Results.

Hundred patients, randomized to 6 or 12 months ATT, were followed up for a minimum of 24 months from completion of therapy. All patients completed scheduled duration of ATT, with one crossover from 6 months ATT group to 12 months. There were no recurrences of disease on the 24 months follow up following completion of ATT. All 100 patients met criteria for cure at time of stopping medicines. One patient (12 months group) had residual neurological dysfunction at the time of stopping treatment, which completely resolved over the next 12 months.

There were no patients with major drug induced hepatitis. One patient (12 months group) needed percutaneous drainage of an abscess. None needed surgical re-exploration for persistent infection of implant removal.

Conclusion.

This pilot study concludes that, in patients with biopsy proven spinal-vertebral, TB, 6 and 12 months of ATT give similar clinical outcomes at 24 months of completion of therapy.

Level of Evidence: 2
Exploring the State of the Science of the Nursing Hand-off Communication
Authors: Galatzan Benjamin J. , Carrington Jane M.
Published: July 2018

Miscommunication that occurs during the exchange of information between healthcare providers accounts for approximately 80% of adverse events in the healthcare setting. Nurses devote 10% to 15% of the workday to the nurse-to-nurse hand-off communication. The hand-off itself has remained virtually unchanged for the past 20 years, although the process is prone to errors. The introduction of the electronic health record and mandates to decrease errors and improve patient outcomes has led to an influx of research on the nurse-to-nurse hand-off communication. This article provides a comprehensive synopsis of the hand-off and the state of science on nurse-to-nurse communication using hand-offs. In general, the use and implementation of standardized tools and the nurse's perception of and satisfaction with the hand-off communication have been researched extensively. A standardized hand-off tool increases nurse satisfaction with the structure and consistency of the hand-off. While electronic health record–related forms and devices are not utilized by nurses, communication patterns and communication behaviors can also influence the effectiveness of the hand-off message. The areas of memory, cognition, and content of the hand-off affect the transfer and recall of hand-off information. Continued research on hand-off communication is essential to ensure patient safety.
Atrial Fibrillation and the Weekend Effect Regarding Cardioversion, Length of Stay, Readmission, and Mortality
Authors: Zaremski Lynn , Mazori Alon , Shulman Eric , Kargoli Faraj , Shah Tina , Chudow Jay Julius , Leiderman Ephraim , Di Biase Luigi , Fisher John , Ferrick Kevin , Krumerman Andrew
Published: July 2018

Background:

The weekend effect is a phenomenon in which worse outcomes have been found to occur over the weekend. This has been investigated in the context of stroke, ST-elevation myocardial infarction, and pulmonary embolism among others. Atrial fibrillation (AF) is the most common sustained arrhythmia, and admissions for AF have been increasing. However, few studies exist investigating the existence of a weekend effect regarding AF. Previous studies have been limited by a pragmatic but unrealistic definition of the weekend starting at midnight on Friday and ending midnight on Sunday. In addition, the studies that exist have conflicting data regarding outcomes of mortality and length of stay (LOS).

Methods:

Over a 5-year period, 3233 patients with a primary diagnosis of AF were admitted to an academic center. A retrospective analysis was performed to determine rates of cardioversion, 30-day readmission, 30-day mortality, LOS, and time to cardioversion among patients admitted over the weekend compared with those admitted during the work week. Weekend was defined as the 48-hour period, including Saturday and Sunday.

Results:

Baseline demographics and common risk factors were found to be equivalent in weekend admissions compared with weekday admissions. These characteristics were found to be equivalent in those who underwent cardioversion and those who did not. There was no statistically significant difference between groups in odds of cardioversion, 30-day readmission, or 30-day mortality. Difference in mean LOS and mean time to cardioversion was not statistically significant between groups.

Conclusion:

In conclusion, a weekend effect was not identified regarding AF in an academic hospital.
Role of Hypertension and Other Clinical Variables in Prognostication of Patients Presenting to the Emergency Department With Major Bleeding Events
Authors: Conti Alberto , Molesti Daniele , Bianchi Simone , Catarzi Stefania , Mazzucchelli Mariuccia , Covelli Antonella , Tognarelli Andrea , Perrotta Mafalda Ester , Pampana Alessandro , Orlandi Giovanni , Dell’Amico Iginio , Baratta Alberto , Arena Giuseppe , Torri Tito
Published: July 2018

Background:

Clinical variables including hypertension could be linked with major bleeding events and death beyond vitamin K antagonist (warfarin) or direct oral anti-coagulants (DOACs) treatment strategy.

Methods:

Subgroup analysis of major bleeding (primary endpoint) associated with clinical variables, site of bleeding, ongoing antithrombotics, reversal treatment or blood transfusion, outcomes (secondary endpoints) was performed in patients with bleeding events submitted to hard 5:1 propensity-score matching for hypertension.

Results:

Enrolled patients were 2,792 (mean age, 65.6 ± 19.9 years) during 2-year survey including 166,000 visits, of 200,000 inhabitants catchment area; 8,239 patients received warfarin and 3,797 DOACs. Hypertension account for 1,077 (39%) patients; major bleeding for 474 (17%); death for 29 (1%), and 72 (3%) on 1-month and 1-year, respectively. Hypertension, age, glucose, cancer, ischemic vascular disease, and CHA2D2VASc score were more likely to link with major bleeding. On multivariate analysis, only age (odds ratio [OR], 1.02; P < 0.001), CHA2DS2VASc score ≥ 2 (OR, 2.14; P = 0.001), and glucose (OR, 1.01; P = 0.005) were predictors of major bleeding. Kaplan–Meier analysis demonstrated patients with hypertension as compared with patients without showed 60% versus 20% death on 1-month (P < 0.001). Warfarin compared with DOACs was more likely to present with major bleeding (0.7% versus 0.2%; OR, 2.8; P = 0.005). Receiver operator characteristics analysis showed high value (0.61) of age and glucose over creatinine and systolic arterial pressure (P = NS).

Conclusions:

Four in 10 patients with major bleeding showed hypertension; of these 8 in 10 will die within 1 month. Warfarin compared with DOACs was more likely to present with major bleeding.
Serum Uric Acid and Atrial Fibrillation: Meta-analysis
Authors: Pak Stella , Yatsynovich Yan , Valencia Damian , Chen Tian
Published: July 2018

Hyperuricemia has been recently speculated to be associated with the development of atrial fibrillation (AF). A meta-analysis of observational studies was conducted to explore the relationship between serum uric acid (SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and performed extensive bibliography search to identify studies with mean SUA level for patients with and without AF. Key search terms were “atrial fibrillation” and “uric acid.” Under the random-effects model, the pooled standardized difference in means between patients with and without AF was calculated. A total of 24 studies with 30,609 patients were included for quantitative analyzation of the difference in SUA levels between the patients with and without AF. The SUA level of patients with atrial AF was found to be significantly higher compared with those without AF (standardized difference in means = 0.66; 95% confidence interval, 0.43–0.88;P< 0.0001). The mean SUA level of patients with AF significantly is higher than those without AF.
The Impact of Formal Training and Certification on the Relationship Between Volume and Outcomes in Percutaneous Coronary Interventions
Authors: Dakik Habib A. , Karowni Wassef , El-Sibai Katia , Kobrossi Semaan , Abdul-Ameer Karrar , Tamim Hani
Published: July 2018

Background:

Little data are available on the impact of formal training and certification on the relationship between volumes and outcome in percutaneous coronary interventions (PCIs).The objective of this report is to study the relationship between PCI volume and outcome for a formally trained interventional cardiologist who is certified by the American Board on Internal Medicine – Interventional Cardiology subspecialty board.

Methods:

The operator witnessed 3 different PCI volumes/yr over a 15-year practice period (2000–2014): <50 PCI/yr (years 2000–2006; n = 179), 50–100 PCI/yr (years 2007–2010; n = 256), and >100 PCI/yr (years 2011–2014; n = 427). Angiographic and procedural success rates were compared between the 3 volume groups, as well as in-hospital cardiovascular events (death, recurrent myocardial infarction, repeat PCI, stroke, or coronary artery bypass surgery).

Results:

The in-hospital mortality rate throughout the study period was 0.8% and was not statistically significant among the 3 volume groups. There was also no significant difference among the 3 groups with respect to recurrent myocardial infarction or repeat PCI. There was a slightly higher rate of same-stay elective coronary artery bypass grafting in the early low-volume period compared with the other 2 groups (2.2% vs. 0.8% vs. 0.2%; P = 0.04). The overall angiographic and procedural success rates were 97.3% and 96.5%, and they were not significantly different among the 3 groups.

Conclusions:

Our study shows that the angiographic and procedural success rates of PCI, as well as the in-hospital mortality, do not seem to be dependent on the annual volume for formally trained and certified interventional cardiologists.
The Effectiveness of Virtual Reality Interventions for Improvement of Neurocognitive Performance After Traumatic Brain Injury: A Systematic Review
Authors: Manivannan Susruta , Al-Amri Mohammad , Postans Mark , Westacott Laura Jayne , Gray William , Zaben Malik
Published: July 2018

Objective:

To evaluate current evidence for the effectiveness of virtual reality (VR) interventions in improving neurocognitive performance in individuals who have sustained a traumatic brain injury (TBI).

Methods:

A systematic literature search across multiple databases (PubMed, EMBASE, Web of Science) for articles of relevance. Studies were evaluated according to study design, patient cohort, VR intervention, neurocognitive parameters assessed, and outcome. VR interventions were evaluated qualitatively with respect to methodology and extent of immersion and quantitatively with respect to intervention duration.

Outcomes:

Our search yielded 324 articles, of which only 13 studies including 132 patients with TBI met inclusion criteria. A wide range of VR interventions and cognitive outcome measures is reported. Cognitive measures included learning and memory, attention, executive function, community skills, problem solving, route learning, and attitudes about driving. Several studies (n = 10) reported statistically significant improvements in outcome, and 2 studies demonstrated successful translation to real-life performance.

Conclusions:

VR interventions hold significant potential for improving neurocognitive performance in patients with TBI. While there is some evidence for translation of gains to activities of daily living, further studies are required to confirm the validity of cognitive measures and reliable translation to real-life performance.
MULTIMODAL IMAGING OF CHOROIDAL AND OPTIC DISK VESSELS NEAR OPTIC DISK PITS
Authors: Adams Matthew K. , Cohen Salomon-Yves , Souied Eric H. , Goldenberg Dafna , Loewenstein Anat , Olsen Timothy W. , Pulido Jose S.
Published: July 2018

Purpose:

To describe modern multimodal imaging of the choroidal and optic disk vessels in optic disk pits.

Methods:

Case reports of four patients with optic disk pit who underwent multimodal imaging of the optic pit and surrounding structures. Patients included in this article were found to have optic disk pits and subsequently underwent multimodal imaging.

Results:

Cilioretinal arteries were present in two of the four cases (50%). SPECTRALIS optical coherence tomography showed intraretinal and subretinal fluid in all cases. Small vessels in the choroid and in the disk around the pit were also present in all cases through optical coherence tomographic angiography. Confocal fluorescein angiographic imaging in the first case showed leakage from the vessels adjacent to the optic disk pit.

Conclusion:

Modern multimodal imaging shows that there are anomalous vessels in and around an optic pit. Whether these vessels affect the development of optic pit, maculopathy needs to be further evaluated.
“HOURGLASS COLOBOMA”: A CASE REPORT AND REVIEW OF ETIOPATHOGENESIS
Authors: Kumar Madhu , Shanmugam Mahesh , Sagar Pradeep , Kumar Dilip , Konana Vinaya Kumar
Published: July 2018

Purpose:

To report a rare case of multiple fundal colobomata and to review the possible etiopathogenic factors involved in its genesis.

Method:

Case report.

Result:

A 21-year-old myopic lady was noted to have 2 fundal colobomata—one in the inferior and the other in superior hemisphere of globe in a mirror-image fashion resembling an “hourglass” in the right eye and a typical Type 3 coloboma in the left eye. The iris was normal in both the eye. Multiple fundal colobomata have not been described in the literature. The presence of “accessory embryonic fissure” in the developing eyeball is the only probable mechanism that can explain this presentation. This case is an evidence for the possibility of presence of accessory embryonic fissure in developing eyeball in human. The eponym “hourglass coloboma” or “mirror-image colobomata” best describes this condition.

Conclusion:

This report of multiple fundal colobomata is the first of its kind. This case is an evidence for possibility of presence of accessory embryonic fissure in developing eyeball in human.
Prevalence, Risk Factors, and Outcome of Chikungunya Encephalitis in Hospitalized Patients at a Tertiary Care Center in Gujarat, India, During the 2016 Outbreak
Authors: Gohel Swati , Modi Rohan , Patel Ketan K. , Kumar Ambuj , Patel Atul K.
Published: July 2018

Background

India has experienced 2 major chikungunya viral (CHIKV) fever outbreaks over the last decade, with reportedly higher mortality during the 2006 outbreak.

Methods

This was a retrospective observational study conducted at a tertiary care center over a period of 4 months involving 110 hospitalized patients confirmed with CHIKV fever during the 2016 outbreak. Data on the proportion of patients with CHIK viral encephalitis (CHIK VE) and possible attributable risk factors were obtained from a retrospective chart review and data analysis using SPSS.

Results

Of 110 patients with confirmed CHIKV fever, 16 (14.6%) developed CHIK VE; 62.5% of the hospitalized patients with CHIK VE were older than 60 years. Patients with CHIK VE presented late to the hospital (4.9 ± 2.7 vs 2.9 ± 1.5, respectively, P = 0.00031) as opposed to those without encephalitis; 87.5% patients in the CHIK VE group required intensive care unit admission and had a prolonged hospital stay (9.2 ± 6.7 days vs 5.1 ± 4.2 days; odds ratio, 0.034; P = 0.001) compared with those in the nonencephalitis group. Patients in the extreme age groups were more vulnerable to CHIK VE compared with adults aged between 30 and 60 years, without a statistically significant difference. There was no statistically significant difference in the mean absolute lymphocyte count, globulin levels, total leukocyte counts, and underlying comorbidities between the 2 groups. Overall mortality with CHIK VE was 18.75%.

Conclusions

Large-scale studies are needed to validate the association of CHIK VE patients with probable risk factors, as it is associated with high mortality, based on the findings of the present study.
Autoimmune and Allergic Disorders are More Common in People With Celiac Disease or on a Gluten-free Diet in the United States
Authors: Kim Hyun-seok , Unalp-Arida Aynur , Ruhl Constance E. , Choung Rok Seon , Murray Joseph A.
Published: July 2018

Goals:

We analyzed demographics, lifestyle patterns, and clinical characteristics of people with celiac disease (CD) and people without CD avoiding gluten (PWAG) to better understand associations with medical conditions and consumer behavior.

Background:

Clinical significance of CD and gluten avoidance in the general population is incompletely understood. Recently, a high incidence of CD in adolescents with susceptibility genotypes, similar to other autoimmune or allergic disorders, and regional differences in consumer practices of gluten avoidance were reported.

Methods:

Among 22,277 participants in the National Health and Nutrition Examination Survey 2009-2014, we identified persons with CD by testing CD serology or by both a health care provider diagnosis and adherence to a gluten-free diet. Similarly, PWAG were defined as adherent to a gluten-free diet without a CD diagnosis. Consumer behavior and characteristics of both groups, CD and PWAG were compared with those without these conditions, using survey-weighted generalized logistic regression.

Results:

Participants with CD considered nutrition very important when grocery shopping and tended to have more constipation and thyroid disease. PWAG tended to spend more money on groceries, purchase organic foods, and check food labels more frequently during grocery shopping. They also reported having more food allergies, asthma, and thyroid disease.

Conclusions:

Our study confirms that CD and PWAG share comorbidities of autoimmune nature. PWAG had more autoimmune/allergy-related disorders that may be associated with non-celiac gluten sensitivity a self-justifiable reason to be on the diet.
Endoscopic band ligation versus endoscopic hemoclip placement for Dieulafoy’s lesion: a meta-analysis
Authors: Barakat Mohamed , Hamed Ahmed , Shady Ahmed , Homsi Maher , Eskaros Saphwat
Published: July 2018

Dieulafoy lesions (DL) are abnormally large arterial lesions that fail to decrease in size as they emerge from the submucosa to the mucosal surface. Endoscopic treatment has become the mainstay of therapy for actively bleeding DL lesions. In this meta-analysis, we aim to assess the efficacy of both techniques in achieving primary hemostasis of actively bleeding DL lesions and their rates of rebleeding. Our search included the Pubmed, Scopus and CINAHL electronic databases. The initial search yielded 440 articles and after appropriate review by 2 individual reviewers, 5 studies met inclusion criteria. Review manager version 5.3 was used for statistical analysis. There were 75 patients treated with EBL and 87 patients treated with EHC. The success rate of primary hemostasis of EBL for bleeding DL lesions was 0.96 [95% confidence interval (CI): 0.88–0.99]. The success rate of primary hemostasis of EHC for bleeding DL lesions was 0.91 (95% CI: 0.83–0.96). The recurrence of bleeding for patients treated with EBL was 0.06 (95% CI: 0.02–0.15). The recurrence of bleeding for patients treated with EHC was 0.17 (95% CI: 0.10–0.28). There was no statistical significance in primary hemostasis or rebleeding in patients treated with EBL or EHC. There was no significant heterogeneity between studies included in the analysis. Endoscopic band ligation and endoscopic hemoclip placement are efficacious procedures for the treatment of NVUGIB secondary to DL with similar rates of primary hemostasis and rebleeding.
Psychometric Properties of a Modified Version of the Faces Pain Scale-Revised (Modified FPS-R) to Evaluate Worst Pain in Children and Adolescents With Sickle Cell Anemia
Authors: Naegeli April N. , Heath Lori , Zhou Chunmei , Gupta Neehar , Dampier Carlton
Published: July 2018

We evaluated psychometric properties (validity, reliability, and responsiveness) of a modified Faces Pain Scale-Revised (FPS-R) in 257 patients with sickle cell anemia (SCA) 7 to below 18 years old in a randomized, multinational clinical study. The modified FPS-R asks patients to report, by daily diary, their worst intraday SCA-related pain. Intraclass correlation coefficient assessed test-retest reliability between month 1 and month 2. Pearson correlations between monthly mean SCA-related pain intensity, activity interference score, analgesic use, and opioid use assessed convergent validity. Responsiveness was assessed with correlations of changes of monthly pain rate or intensity and changes in analgesic use or activity interference score from month 1 to month 9. Intraclass correlation coefficients for pain intensity and pain rate were 0.777 and 0.820, respectively, indicating agreement among stable patients. Moderate associations were shown between mean pain intensity and analgesic use (r=0.39) and opioid use (r=0.44), and between monthly pain rate and analgesic use (r=0.38). Moderate-to-large associations were observed between change in mean pain rate or intensity and changes in analgesic use (r=0.38 to 0.39, bothP<0.001) and in activity interference scores (r=0.82 to 0.92, bothP<0.001). These results support use of the modified FPS-R across cultures in children and adolescents aged 7 to below 18 years with SCA.
Uterine Inversion: A Review of a Life-Threatening Obstetrical Emergency
Authors: Wendel Michael P. , Shnaekel Kelsey L. , Magann Everett F.
Published: July 2018

Importance

Uterine inversion is frequently accompanied by postpartum hemorrhage and hypovolemic shock. Morbidity and mortality occur in as many as 41% of cases. Prompt recognition and management are of utmost importance.

Objective

The aim of this review is to describe risk factors, clinical and radiographic diagnostic criteria, and management of this rare but potentially life-threatening complication of pregnancy.

Evidence Acquisition

A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched.

Results

There were 86 articles identified, with 25 being the basis of review. Multiple risk factors for a uterine inversion have been suggested including a morbidly adherent placenta, short umbilical cord, congenital weakness of the uterine wall or cervix, weakening of the uterine wall at the placental implantation site, fundal implantation of the placenta, uterine tumors, uterine atony, sudden uterine emptying, fetal macrosomia, manual removal of the placenta, inappropriate fundal pressure, excessive cord traction, and the use of uterotonic agents prior to placental removal. The diagnosis is almost exclusively clinical, and successful treatment depends on prompt recognition of the uterine inversion. Treatment options include manual and surgical replacement of the inverted uterus. There is no consensus regarding mode of delivery in subsequent pregnancies as reinversion in a subsequent pregnancy is unpredictable. However, if surgical replacement was required in the index pregnancy and involved an incision into the contractile portion of the uterus, cesarean delivery is a reasonable management option similar to that offered for a prior classic cesarean section.

Conclusions

Successful treatment is dependent on prompt recognition. Management should include resuscitation of maternal hypovolemic shock, as well as repositioning of the inverted uterine fundus.

Relevance

Uterine inversion is a rare but potentially life-threatening obstetrical emergency.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to evaluate published literature regarding puerperal uterine inversion, assess its associated comorbidities and risk factors, define clinical and radiographic diagnostic criteria to assist in prompt recognition and management of this obstetrical emergency, and propose management options for future pregnancies.
Gonococcal Conjunctivitis in Adults: Case Report and Retrospective Review of Cases in Alberta, Canada, 2000–2016
Authors: Belga Sara , Gratrix Jennifer , Smyczek Petra , Bertholet Lindsay , Read Ron , Roelofs Kelsey , Singh Ameeta E.
Published: July 2018

Background

A case of gonococcal conjunctivitis (GC) prompted us to review the reported cases and treatment regimens of GC in Alberta, Canada.

Methods

Gonococcal cases reported from 2000 to 2016 were extracted from the provincial sexually transmitted infection reporting database. The diagnosis of GC was based on a positive culture and/or nucleic acid amplification test from the eye.

Results

A total of 45 cases of GC were reported in adults. Three quarters (75.6%; n = 34) of the cases were diagnosed using culture, 57.8% (n = 26) of cases were among men, and 55.5% (n = 25) were diagnosed since 2014. Very few (13.3%; n = 6) of the cases were treated according to current Canadian Guidelines on Sexually Transmitted Infections, using 2 g of ceftriaxone in combination with azithromycin or doxycycline. Results of test of cures were available for 15.6% (n = 7) of the cases and occurred within 10 to 79 days (median = 26 days) after treatment; all were negative.

Conclusions

Gonococcal conjunctivitis was relatively uncommon in our region, but given its potential for severe manifestations and sequelae coupled with the rising rates of gonorrhea; it remains important to consider this diagnosis in sexually active individuals presenting with purulent conjunctivitis. Additional studies are needed to inform treatment recommendations and to evaluate outcomes of infection.
Failure-to-rescue in Patients Undergoing Pancreatectomy
Authors: El Amrani Mehdi , Clement Guillaume , Lenne Xavier , Farges Olivier , Delpero Jean-Robert , Theis Didier , Pruvot François-René , Truant Stéphanie
Published: July 2018

Objective:

To evaluate the influence of hospital volume on failure-to-rescue (FTR) after pancreatectomy in France.

Background:

There are growing evidences that FTR is an important source of postoperative mortality (POM) after pancreatectomy. However, few studies have analyzed the volume-FTR relationship following pancreatic surgery.

Methods:

All patients undergoing pancreatectomy between 2012 and 2015 were included. FTR is defined as the 90-day POM rate among patients with major complications. According to the spline model, the critical cutoff was 20 resections per year and hospitals were divided into low (<10 resections/an), intermediate (11–19 resections/yr), and high volume centers (≥20 resections/yr).

Results:

Overall, 12,333 patients who underwent pancreatectomy were identified. The POM was 6.9% and decreased significantly with increased hospital volume. The rate of FTR was 14.5% and varied significantly with hospital volume (18.3% in low hospital volume vs 11.9% in high hospital volume, P < 0.001), age (P < 0.001) and ChCl (CCl0-2: 11.5%, ChCl3: 13%, CCl ≥4:18.6%; P < 0.001). FTR for renal failure was the highest of all complications (40.2%), followed by postoperative shock (36.4%) and cardiac complications (35.1%). The FTR was significantly higher in low and intermediate compared with high volume hospitals for shock, digestive, and thromboembolic complications and reoperation. In multivariable analysis, intermediate (OR = 1.265, CI95%[1.103–1.701], P = 0.045) and low volume centers (OR = 1.536, CI95%[1.165–2.025], P = 0.002) were independently associated with increased FTR rates.

Conclusion:

FTR after pancreatectomy is high and directly correlated to hospital volume, highlighting variability in the management of postoperative complications. Measurement of the FTR rate should become a standard for quality improvement programs.
β-Blockade in Rectal Cancer Surgery
Authors: Ahl Rebecka , Matthiessen Peter , Fang Xin , Cao Yang , Sjolin Gabriel , Lindgren Rickard , Ljungqvist Olle , Mohseni Shahin
Published: July 2018

Objective:

To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.

Background:

Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking.

Methods:

All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model.

Results:

A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03–0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37–0.52, P < 0.001).

Conclusions:

Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.
Cardiac myocyte microtissue aggregates broadcast local field potentials
Authors: Serruya Mijail D. , Das Suradip , Katiyar Kritika S. , Struzyna Laura A. , Burrell Justin C. , Cullen D. Kacy
Published: July 2018

Muscle tissue has been exploited as a living biopotential amplifier to facilitate transduction of peripheral nerve signals into prosthetic control in patients with limb amputation. Here we sought to address the question of whether microscopically small volumes of muscle tissue could effectively broadcast field potentials to electrodes not immediately in contact with that tissue. Cardiac myocytes were grown as three-dimensional aggregates containing 105 cells comprising a volume of approximately 0.065 mm3 (~500 μm in diameter) atop multi-electrode arrays. In addition to the expected spontaneous contraction potentials detected using electrodes in direct contact with the myocytes, potentials could also be detected on distant electrodes not contacting the aggregates. Specifically, while both dissociated and aggregated cardiac myocyte cultures generated spontaneous contractions that could easily be recorded from underlying multi-electrode arrays, only aggregated myocyte cultures generated signals detectable several millimeters away by the electrode grid floating in media. This confirmed the ability of micro-volumes of aggregated muscle tissue to broadcast readily detectible signals. The amplitude of the potentials generated by the aggregates decreased exponentially with distance. The aggregates were sensitive to pharmacologic modification with isoproterenol increasing contraction rate. Simultaneous recordings with electrodes in physical contact to the aggregate and with electrodes several millimeters away revealed that the aggregates function as amplifiers and low-pass filters. This study lays the groundwork for forging myocyte aggregates as “living amplifiers” for long-term neural recording in brain-computer interfaces to treat neurological disease and injury.