bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Lumbar Spine Sagittal Alignment and L4-L5 Disc Degeneration Among Asymptomatic Young Adults
Authors: Menezes-Reis Rafael , Bonugli Gustavo Perazzoli , Dalto Vitor Faeda , da Silva Herrero Carlos Fernando Pereira , Defino Helton Luiz Aparecido , Nogueira-Barbosa Marcello Henrique
Published: March 2016

Study Design.

Cross-sectional observational study on the relationship between the degrees of disc degeneration and sagittal alignment in asymptomatic healthy individuals.

Objective.

This study sought to determine whether the sagittal spine alignment subtype is related to the prevalence of lumbar disc degeneration.

Summary and Background Data.

Sagittal balance and spinopelvic parameters might be risk factors for disc degeneration.

Methods.

A total of 70 asymptomatic participants (36 women and 34 men) without regular physical activity were categorized according to the four subtypes of sagittal alignment proposed by Roussouly. All participants underwent magnetic resonance imaging of the lumbar spine (1.5T) and panoramic radiography of the spine. The degree of disc degeneration was graded using T2-weighted images according to the Pfirrmann classification. Spinopelvic parameters and vertebral curvatures were measured on digital panoramic radiographs using Surgimap software. Interobserver analyses for the Pfirrmann classification and spinopelvic parameters were assessed using the weighted Kappa and intraclass correlation coefficient (ICC), respectively.

Results.

The Kappa associated with disc degeneration classification was 0.79 (95% confidence intervals 0.72–0.87). The ICCs were excellent, with small confidence intervals for all spinopelvic parameters. The type II group (flat lordosis) showed a higher frequency of degenerated discs at L4-L5 (P = 0.03) than the type IV group (long and curved lumbar spine). No significant differences in disc degeneration were observed among the four subtypes at the other disc levels. We found a negative, moderate correlation between the spinopelvic parameters and the occurrence of disc degeneration in the type II group.

Conclusion.

The Roussouly subtype II sagittal alignment is significantly associated with disc degeneration at L4-L5 in asymptomatic young adults. Our results support the hypothesis that spinal sagittal alignment plays a role in early disc degeneration.

Level of Evidence: 3
Outcome Measurement in ICU Survivorship Research From 1970 to 2013: A Scoping Review of 425 Publications*
Authors: Turnbull Alison E. , Rabiee Anahita , Davis Wesley E. , Nasser Mohamed Farhan , Venna Venkat Reddy , Lolitha Rohini , Hopkins Ramona O. , Bienvenu O. Joseph , Robinson Karen A. , Needham Dale M.
Published: March 2016

Objectives:

To evaluate the study designs and measurement instruments used to assess physical, cognitive, mental health, and quality of life outcomes of survivors of critical illness over more than 40 years old as a first step toward developing a core outcome set of measures for future trials to improve outcomes in ICU survivors.

Design:

Scoping review.

Setting:

Published articles that included greater than or equal to one postdischarge measure of a physical, cognitive, mental health, or quality of life outcome in more than or equal to 20 survivors of critical illness published between 1970 and 2013. Instruments were classified using the World Health Organization’s International Classification of Functioning, Disability, and Health framework.

Subjects:

ICU survivors.

Interventions:

None.

Measurements and Main Results:

We reviewed 15,464 abstracts, and identified 425 eligible articles, including 31 randomized trials (7%), 116 cross-sectional studies (27%), and 278 cohort studies (65%). Cohort studies had a median (interquartile range) sample size of 96 survivors (52–209), with 38% not fully reporting loss to follow-up. A total of 250 different measurement instruments were used in these 425 articles. Among eligible articles, 25 measured physical activity limitations (6%), 40 measured cognitive activity limitations (9%), 114 measured mental health impairment (27%), 196 measured participation restriction (46%), and 276 measured quality of life (65%).

Conclusions:

Peer-reviewed publications reporting patient outcomes after hospital discharge for ICU survivors have grown from 3 in the 1970s to more than 300 since 2000. Although there is evidence of consolidation in the instruments used for measuring participation restriction and quality of life, the ability to compare results across studies remains impaired by the 250 different instruments used. Most articles described cohort studies of modest size with a single follow-up assessment using patient-reported measures of participation restriction and quality of life. Development of a core outcome set of valid, reliable, and feasible measures is essential to improving the outcomes of critical illness survivors.
Skin self-examination and long-term melanoma survival
Authors: Paddock Lisa E. , Lu Shou En , Bandera Elisa V. , Rhoads George G. , Fine Judith , Paine Susan , Barnhill Raymond , Berwick Marianne
Published: March 2016

To evaluate the effect of skin self-examination (SSE) on melanoma mortality, we estimated the survival for individuals performing SSE compared with those who did not. Participants were from a previously carried out case–control study, who were newly diagnosed melanoma cases in 1987–1989. A 20-year survival analysis was carried out using death (event) and other causes of death (competing). Cumulative incidence functions were evaluated using Gray’s test and proportional subdistribution hazards regression models were fitted to study the effect of SSE and other covariates on melanoma survival. Forty-five percent of patients died, with 48.4% melanoma deaths. Individuals who did not perform SSE experienced a continuous increase in the risk of melanoma death trending toward significance for nearly 20 years after diagnosis, whereas melanoma deaths in skin self-examiners plateaued before 10 years after diagnosis (P=0.32). Univariate analyses suggested a 25% lower risk of melanoma death for those who performed SSE [hazard ratio (HR)=0.75, 95% confidence interval (CI)=0.43–1.32, P=0.32]. After adjusting for competing risks, the multivariate risk estimate was above one (HR=1.12, 95% CI=0.61–2.06, P=0.71). Skin awareness (HR=0.46, 95% CI=0.28–0.75, P≤0.01) was associated independently with a decreased risk of melanoma death. Although we did not find a significant association between melanoma mortality and SSE when adjusting for competing mortality and other covariates, we extended previous findings that increased skin awareness and tumor thickness are strongly inversely related to survival. Research is needed to continue developing best practices for melanoma screening and to further explore the components of SSE and long-term melanoma survival.
Mast Cell Inhibition Attenuates Cardiac Remodeling and Diastolic Dysfunction in Middle-aged, Ovariectomized Fischer 344 × Brown Norway Rats
Authors: Wang Hao , da Silva Jaqueline , Alencar Allan , Zapata-Sudo Gisele , Lin Marina R. , Sun Xuming , Ahmad Sarfaraz , Ferrario Carlos M. , Groban Leanne
Published: March 2016

The incidence of left ventricular diastolic dysfunction (LVDD) increases in women after menopause, yet the mechanisms are unclear. Because mast cells participate in the pathological processes of various cardiac diseases, we hypothesized that mast cell inhibition would protect against estrogen loss-induced LVDD. The mast cell stabilizer, cromolyn sodium (30 mg·kg−1·d−1), or vehicle was administered subcutaneously by osmotic minipump to ovariectomized (OVX) female Fischer 344 × Brown Norway (F344BN) rats starting at 4 weeks after surgery. Eight weeks after OVX, systolic blood pressure increased by 20% in OVX versus sham rats, and this effect was attenuated after 4 weeks of cromolyn treatment. Also, cromolyn mitigated the adverse reductions in myocardial relaxation (e′) and increases in left ventricle (LV) filling pressures (E/e′), LV mass, wall thicknesses, and interstitial fibrosis from OVX. Although cardiac mast cell number was increased after OVX, cardiac chymase activity was not overtly altered by estrogen status and tended to decrease by cromolyn. Contrariwise, Ang II content was greater in hearts of OVX versus sham rats, and cromolyn attenuated this effect. Taken together, mast cell inhibition with cromolyn attenuates LV remodeling and LVDD in OVX-Fischer 344 × Brown Norway rats possibly through actions on the heart level and/or through vasodilatory effects at the vascular level.
Magnetic Resonance Imaging of the Breast
Authors: HOLBROOK ANNA I. , NEWELL MARY S.
Published: March 2016

Magnetic resonance imaging (MRI) is an imaging modality that is complementary to mammography and ultrasound in the evaluation of breast disease. It has demonstrated utility in many clinical scenarios, and shows promise in others. In this chapter, we discuss the indications and contraindications to MRI. We include information that is essential for the clinician to understand when considering a breast MRI for his patient.
Use of Cervical Pessary in the Management of Cervical Insufficiency
Authors: TIMOFEEV JULIA
Published: March 2016

Prevention of spontaneous preterm birth is an important public health priority. Pessary may be a potential therapy in cases of cervical insufficiency, in singleton and multiple gestations. Availability of transvaginal sonography for accurate assessment of cervical length is allowing for the tailoring of therapy to a more specific subset of patients who may benefit from this treatment. Pessary therapy is attractive given the favorable side effect profile, low cost, and ease of placement and removal. Large randomized trials are ongoing to validate initial favorable findings.
A NEW TECHNIQUE WITH AUTOLOGOUS FIBRIN FOR THE TREATMENT OF PERSISTENT OPTIC PIT MACULOPATHY
Authors: Ozdek Sengul , Ozdemir Huseyin Baran
Published: March 2016

Purpose:

To report the use of autologous fibrin for the treatment of persistent optic pit maculopathy.

Methods:

The authors report two patients with an optic pit–related serous macular detachment, which persisted after vitrectomy and internal limiting membrane peeling. Autologous fibrin was prepared from the patients' whole blood and injected over the optic disk pit area to seal the pit/coloboma area followed by fluid–air–gas exchange.

Results:

Retina stayed attached starting from the first postoperative visit till the last visit at 27 (Case 1) and 14 (Case 2) months after surgery.

Conclusion:

The use of autologous fibrin for the treatment of optic disk pit–related serous macular detachment seems a worthy contribution to the treatment of persistent cases.
A Study on Comparative In Vitro Activity of Carbapenem Sparers Against Extended-Spectrum Beta Lactamase–Producing Enterobacteriaceae
Authors: Jessani Laxman G. , Devarajan Vidyalakshmi , Ghafur Abdul
Published: March 2016

Background

In the era of increasing carbapenem resistance, there is an urgent need to explore alternative options (carbapenem sparers) such as various betalactam/beta-lactamase (BL/BLI) agents, aminoglycosides, fosfomycin, and chloramphenicol to treat infections due to extended-spectrum beta lactamase (ESBL)-producing Enterobacteriaceae. We evaluated the in vitro activities of these agents in comparison to carbapenem against ESBL-producing Enterobacteriaceae blood culture isolates.

Methods

A retrospective analysis on the comparative susceptibility of ESBL-producing Escherichia coli and Klebsiella blood culture isolates against various antibiotics such as cefoperazone-sulbactam, piperacillin-tazobactam, cefepime-tazobactam (C/T), colistin, tigecyline, aminoglycosides, ciprofloxacin, and chloramphenicol was carried out in a tertiary care oncology setting over a span of 18 months (January 2013 to June 2014). Identification of the isolates and susceptibility testing were done using VITEK 2 compact autoanalyzer. Colistin sensitivity was done using Etest, as per Clinical and Laboratory Standards Institute (CLSI) 2013 guidelines.

Results

A total of 125 ESBL E coli and Klebsiella isolates were analyzed, (E coli, 67; Klebsiella, 58). Cefepime-tazobactam and carbapenem sensitivities were similar against E coli as well as Klebsiella isolates. E coli had good sensitivity to amikacin (70%) and chloramphenicol (88.5%). Among all BL/BLI agents, C/T had the highest sensitivity.

Conclusions

Betalactam/beta-lactamase agents and carbapenem had similar susceptibility against ESBL Enterobacteriaceae. Among the BL/BLI combinations, C/T had the highest susceptibility, followed by cefoperazone-sulbactam. Betalactam/beta-lactamase agents may have significant potential as carbapenem sparers.
Detection of Virulence Genes in Enterococci Isolated From the Human Normal Flora by Multiplex-Polymerase Chain Reaction
Authors: Khanmohammadian Shirin , Enayati Mohsen , Sadeghi Javad , Irajian Gholamreza , Amirmozafari Nour , Talebi Malihe
Published: March 2016

Background

Enterococcus species recently evolved from a common avirulent normal flora into a multidrug–resistant, health care–associated pathogen causing difficult-to-treat diseases. The aim of the current study was the detection of aggregation substance (asa), hyaluronidase (hyl), cytolysin (cyl), enterococcal surface protein (esp), collagen-binding protein (acm), gelatinase (gelE), and Enterococcus faecalis endocarditis antigen genes in Enterococcus faecium isolated from healthy volunteers by the Multiplex-polymerase chain reaction (PCR) method.

Methods

Stool samples were obtained from 24 healthy volunteers. After biochemical and microbiological tests, all isolates were tested for the presence of the virulence genes by Multiplex-PCR.

Results

In total, 91 E. faecium strains were collected from 54 different REP-PCR patterns. The distribution of the virulence genes showed that 33 (36%), 14 (15%), 3 (3%), 1 (1.1%), and 0 isolates were positive for acm, asa, esp, cylA, hyl, and gelE genes, respectively.

Conclusions

Despite the fact that E. faecium isolated from normal human intestines usually shows low incidence of virulence genes, they may act as harbors of virulence factors, allowing the distribution of these genes to the human normal flora through the food chain.
Incremental health care costs for chronic pain in Ontario, Canada: a population-based matched cohort study of adolescents and adults using administrative data
Authors: Hogan Mary-Ellen , Taddio Anna , Katz Joel , Shah Vibhuti , Krahn Murray
Published: March 2016

Little is known about the economic burden of chronic pain and how chronic pain affects health care utilization. We aimed to estimate the annual per-person incremental medical cost and health care utilization for chronic pain in the Ontario population from the perspective of the public payer. We performed a retrospective cohort study using Ontario health care databases and the electronically linked Canadian Community Health Survey (CCHS) from 2000 to 2011. We identified subjects aged ≥12 years from the CCHS with chronic pain and closely matched them to individuals without pain using propensity score matching methods. We used linked data to determine mean 1-year per-person health care costs and utilization for each group and mean incremental cost for chronic pain. All costs are reported in 2014 Canadian dollars. After matching, we had 19,138 pairs of CCHS respondents with and without chronic pain. The average age was 55 years (SD = 18) and 61% were female. The incremental cost to manage chronic pain was $1742 per person (95% confidence interval [CI], $1488-$2020), 51% more than the control group. The largest contributor to the incremental cost was hospitalization ($514; 95% CI, $364-$683). Incremental costs were the highest in those with severe pain ($3960; 95% CI, $3186-$4680) and in those with most activity limitation ($4365; 95% CI, $3631-$5147). The per-person cost to manage chronic pain is substantial and more than 50% higher than a comparable patient without chronic pain. Costs are higher in people with more severe pain and activity limitations.
Food Costs Are Higher in Counties With Poor Health Rankings
Authors: Hardin-Fanning Frances , Wiggins Amanda T.
Published: March 2016

Background:

Poor dietary habits are associated with higher rates of cardiovascular disease. However, the cost of foods associated with lower risk of cardiovascular disease can be a significant barrier to healthy eating.

Objective:

The aim of this study is to determine whether food prices per serving differed across Kentucky counties based on health ranking and overall nutritional quality.

Methods:

Fifteen counties were randomly selected based on County Health Ranking. Overall Nutritional Quality Index and cost of 75 foods were assessed in all 15 counties in the same week. A generalized estimating equations model and post hoc analyses were used to assess differences in food cost by nutritional quality and health ranking.

Results:

Food prices were significantly less in the most healthy counties compared with the least healthy (Z = 3.8; P < .001; $0.08 per serving). Prices were also significantly higher in least healthy counties (tertile 3) compared with moderately healthy counties (tertile 2) (Z = 2.3; P = .024; $0.05 per serving).

Conclusions:

Disproportionately higher food costs are associated with poor health outcomes in Kentucky counties. Community-based interventions can potentially improve access to affordable healthy foods. Current supplemental nutritional policies do not address disparate food costs. Health professionals should advocate for policy changes that are reflective of these food cost disparities.
Full-Support LVAD Implantation in a C-Pulse Heart Assist System Recipient with Deteriorating Chronic Heart Failure: Is It Feasible and Safe?
Authors: Zeriouh Mohamed , Sabashnikov Anton , Bowles Christopher T. , Weymann Alexander , Ghodsizad Ali , Mohite Prashant N. , Patil Nikhil P. , Simon André R. , Popov Aron-Frederik
Published: March 2016

Heart failure is a progressive disease with limited treatment options. The C-Pulse Heart Assist System (Eden Prairie, MN) is an extravascular, diastolic counterpulsation circulatory support device for patients with refractory NHYA Class III/ambulatory class IV heart failure. It comprises a balloon-cuff which is implanted around the ascending aorta that is synchronised to inflate during ventricular diastole. The system eliminates the need for systemic anticoagulation and significantly reduces the risk of bleeding and overcomes the problem of device thrombosis. However, clinical efficacy is dependent on maintenance of residual myocardial function. We describe a case of a patient who presented with ischemic cardiomyopathy in end-stage heart failure and received the C-Pulse System. Due to deterioration in cardiac function, the system had to be upgraded to a full-support left ventricular assist device (LVAD) after 4 months. However, the aorta ascendens was short and the outflow graft of the HeartWare LVAD had to be anastomosed to the cuff balloon region of the aorta. Our experience showed in this case that the inflatable cuff action did not compromise the structural integrity of the aortic wall.
Exertional Angina Due To Fused Aortic Bioprosthesis During Left Ventricular Assist Device Support: Two Cases and Review of the Literature
Authors: Bonios Michael J. , Selzman Craig H. , Gilbert Edward M. , McKellar Stephen H. , Koliopoulou Antigoni , Strege Jennifer L. , Nativi Jose N. , Fang James C. , Stehlik Josef , Drakos Stavros G.
Published: March 2016

We present the case of two patients with idiopathic dilated cardiomyopathy and moderate aortic valve regurgitation that were treated with a bioprosthetic valve at the time of the left ventricular assist device (LVAD) implantation. A few months later, patients revealed partial recovery in the left ventricle systolic function. Both patients, during the LVAD turndown protocol, reported the onset of chest pain. The transthoracic echocardiography revealed the presence of a new transaortic pressure gradient. We confirmed the presence of a fused bioprosthetic valve by further performing a transesophageal echocardiogram and a left and right heart catheterization. Replacement of aortic valve at the time of an LVAD implantation constitutes a challenging case. Although a mechanical valve is contraindicated due to the increased thromboembolic risk, selecting a bioprosthetic valve increases the risk of valve leaflets fusion. The consequences of this phenomenon should be acknowledged in LVAD patients undergoing aortic valve replacement with a bioprosthetic, especially under the view of LVAD explantation for those revealing myocardial recovery under mechanical unloading.
Environmental Enteric Dysfunction in Children
Authors: Syed Sana , Ali Asad , Duggan Christopher
Published: March 2016

Diarrheal diseases are a major cause of childhood death in resource‐poor countries, killing approximately 760,000 children younger than 5 years each year. Although deaths due to diarrhea have declined dramatically, high rates of stunting and malnutrition have persisted. Environmental enteric dysfunction (EED) is a subclinical condition caused by constant fecal‐oral contamination with resultant intestinal inflammation and villous blunting. These histological changes were first described in the 1960s, but the clinical effect of EED is only just being recognized in the context of failure of nutritional interventions and oral vaccines in resource‐poor countries. We review the existing literature regarding the underlying causes of and potential interventions for EED in children, highlighting the epidemiology, clinical and histologic classification of the entity, and discussing novel biomarkers and possible therapies. Future research priorities are also discussed.
Use of Indirect Calorimetry to Detect Overfeeding in Critically Ill Children
Authors: Kerklaan Dorian , Hulst Jessie M. , Verhoeven Jennifer J. , Verbruggen Sascha C.A.T. , Joosten Koen F.M.
Published: March 2016

Objectives:

Overfeeding during critical illness is associated with adverse effects such as metabolic disturbances and increased risk of infection. Because of the lack of sound studies with clinical endpoints, overfeeding is arbitrarily defined as the ratio caloric intake/measured resting energy expenditure (mREE) or alternatively as a comparison of measured respiratory quotient (RQ) to the predicted RQ based on the macronutrient intake (RQmacr). We aimed to compare definitions of overfeeding in critically ill mechanically ventilated children based on mREE, RQ, and caloric intake to find an appropriate definition.

Methods:

Indirect calorimetry measurements were performed in 78 mechanically ventilated children, median age 6.3 months. Enteral and/or parenteral nutrition was provided according to the local guidelines. Definitions used to indicate overfeeding were the ratio caloric intake/mREE of >110% and >120% and by the measured RQ > RQmacr + 0.05.

Results:

The proportion of patients identified as overfed varied widely depending on the definition used, ranging from 22% (RQ > RQmacr + 0.05), to 40% and 50% (caloric intake/mREE of >120% and >110%, respectively). Linear regression analysis showed that all patients would be identified as overfed with the definition RQ > RQmacr + 0.05 when the ratio caloric intake/mREE exceeded 165%. Caloric intake was higher in children with a standard deviation‐score weight for age <−2.

Conclusions:

The proportion of mechanically ventilated patients identified as overfed ranged widely depending on the definition applied. These currently used definitions fail to take into account several relevant factors affecting metabolism during critical illness and are therefore not generally applicable to the pediatric intensive care unit population.
Integration of VEGF and α-SMA Expression Improves the Prediction Accuracy of Fibrosis in Chronic Hepatitis C Liver Biopsy
Authors: Elzamly Shaimaa , Agina Hala A. , Elbalshy Abd El-Latif , Abuhashim Maha , Saad Eman , Abd Elmageed Zakaria Y.
Published: March 2016

Introduction:

The progression of fibrosis in chronic hepatitis C (CHC) is a multifactorial process. The high adverse effects and the cost of standard health care increase the demand to discover new predictors for the progression of fibrosis in CHC patients. Our study aims to establish the relation between the angiogenic marker [vascular endothelial growth factor (VEGF)] and activated hepatic stellate cells (HSCs) represented by the expression of α-smooth muscle actin (α-SMA) and whether these 2 markers can be used as predictors for the progression of fibrosis in patients with CHC.

Materials and Methods:

Histopathologic and immunohistochemical analyses were used for examining the morphology and the expression of VEGF and α-SMA in 60 CHC biopsies procured from CHC patients. Multivariate analysis was used to correlate the protein expression with staging and grading of liver fibrosis. Cutoff values of α-SMA and VEGF were determined by the receiver operating characteristics curve.

Results:

There was a positive correlation between VEGF and HSCs expressing α-SMA (ρ=0.287, P=0.026) and both factors were correlated with the stage of fibrosis (P<0.001). Using the receiver operating characteristics curve, both VEGF (area under the curve=0.71, P<0.006) and α-SMA (area under the curve=0.82, P<0.001) were positive predictors for moderate and severe fibrosis.

Conclusions:

This study demonstrates the relation between VEGF expression and the activated HSCs denoted by the expression of α-SMA in CHC biopsies and together can be used as a predictor for the progression of fibrosis.
The Natural History of Vulvar Intraepithelial Neoplasia, Differentiated Type: Evidence for Progression and Diagnostic Challenges
Authors: Bigby Susan M. , Eva Lois J. , Fong Kah Leng , Jones Ronald W.
Published: March 2016

Squamous cell carcinoma of the vulva (SCCV) develops through either human papillomavirus (HPV)-dependent or HPV-independent pathways. Approximately 60% of SCCV arise independently of HPV, commonly in a background of an inflammatory dermatosis, particularly lichen sclerosus. The likely direct precursor to most of these lesions is vulvar intraepithelial neoplasia (VIN), differentiated type (dVIN), although the evidence is largely circumstantial. There are few reports of progression to carcinoma, and the natural history of this pathway is not well understood. Nevertheless, dVIN is widely regarded as a potentially aggressive lesion. We identified dVIN adjacent to SCCV in 97 of 212 women (45.8%). Twenty-four of the 97 women (24.7%) had biopsies performed at least 6 mo before presentation with SCCV; slides for 47 biopsies from 21 women were available for review. dVIN was identified in 18 biopsies from 8 women (38.1%), which in 14 biopsies had been previously unrecognized. The subsequent cancer developed in the same region as the previous biopsy showing dVIN in 6 of the 8 women. The median interval between biopsy and invasive cancer was 43.5 mo (range, 8–102 mo). dVIN-associated SCCV was strongly associated with both lichen sclerosus, and HPV-negative status compared with usual type VIN (relative risk=38.35 (9.755–150.8) and 0.06485 (0.02764–0.1522), respectively). This study adds to the evidence linking dVIN with SCCV, and indicates that both clinical and histologic underrecognition contribute to the apparent rarity of dVIN as a solitary diagnosis. The morphologic spectrum of dVIN is likely to be wider than commonly appreciated; however, histologically defining the lower threshold is difficult and controversial.
Brief Report: Apparent Antiretroviral Overadherence by Pill Count is Associated With HIV Treatment Failure in Adolescents
Authors: Okatch Harriet , Beiter Kaylin , Eby Jessica , Chapman Jennifer , Marukutira Tafireyi , Tshume Ontibile , Matshaba Mogomotsi , Anabwani Gabriel M. , Gross Robert , Lowenthal Elizabeth
Published: March 2016

Pill counts with calculated adherence percentages are used in many settings to monitor adherence, but can be undermined by patients discarding pills to hide nonadherence. Pill counts suggesting that >100% of prescribed doses were taken can signal “pill dumping.” We defined “overadherence” among a cohort of 300 HIV-infected adolescents as having greater than one-third of pill counts with >100% adherence during a year of follow-up. Apparent overadherence was more common in those with virologic failure than in those with suppressed viral loads (33% vs 13%, χ2
P = 0.001). Pill count adherence repeatedly >100% may identify HIV-infected adolescents at increased risk of treatment failure.
A mathematical model of non-photochemical quenching to study short-term light memory in plants
Authors: Matuszyńska Anna , Heidari Somayyeh , Jahns Peter , Ebenhöh Oliver
Published: March 2016

Plants are permanently exposed to rapidly changing environments, therefore it is evident that they had to evolve mechanisms enabling them to dynamically adapt to such fluctuations. Here we study how plants can be trained to enhance their photoprotection and elaborate on the concept of the short-term illumination memory inArabidopsis thaliana. By monitoring fluorescence emission dynamics we systematically observe the extent of non-photochemical quenching (NPQ) after previous light exposure to recognise and quantify the memory effect. We propose a simplified mathematical model of photosynthesis that includes the key components required for NPQ activation, which allows us to quantify the contribution to photoprotection by those components. Due to its reduced complexity, our model can be easily applied to study similar behavioural changes in other species, which we demonstrate by adapting it to the shadow-tolerant plantEpipremnum aureum. Our results indicate that a basic mechanism of short-term light memory is preserved. The slow component, accumulation of zeaxanthin, accounts for the amount of memory remaining after relaxation in darkness, while the fast one, antenna protonation, increases quenching efficiency. With our combined theoretical and experimental approach we provide a unifying framework describing common principles of key photoprotective mechanisms across species in general, mathematical terms.
Pemetrexed‐induced scleroderma‐like conditions in the lower legs of a patient with non‐small cell lung carcinoma
Authors: Ishikawa Kazushi , Sakai Takashi , Saito‐Shono Tomoko , Miyawaki Michiyo , Osoegawa Atsushi , Sugio Kenji , Ono Asami , Mori Hiromu , Nishida Haruto , Yokoyama Shigeo , Okamoto Osamu , Fujiwara Sakuhei , Hatano Yutaka
Published: March 2016

Pemetrexed, which is used for the treatment of non‐small cell lung carcinoma and malignant mesothelioma, induces cutaneous adverse reactions in approximately 20% of patients. There are also reports of the induction of fibrosing disorders. We describe a case of pemetrexed‐induced scleroderma‐like conditions in the lower legs of a patient whose pulmonary carcinoma has been relatively well controlled, with prolongation of the dose interval, in spite of the discomfort in both his legs. Skin biopsy revealed dermal fibrosis and dilated lymph vessels in the dermis, but lymphocytic infiltration around the lymph vessels, in contrast to the blood vessels, was minimal. Immunohistochemical staining revealed that the major subsets of T cells that had infiltrated around blood vessels were CD3 and CD45Ro, but no B cells were detected. High serum levels of interleukin (IL)‐4 and IL‐6 suggested that T cells, which secrete these cytokines, may be involved in the pathogenesis of this condition. Magnetic resonance imaging of the lower extremities revealed muscular and fascial involvement. Several chemotherapeutic agents, such as taxanes, gemcitabine and bleomycin, are known to induce scleroderma‐like changes, and we should also keep the side‐effects of pemetrexed in mind when we encounter patients with fibrosing conditions.
Myoepithelial carcinoma on the right shoulder: Case report with published work review
Authors: Yokose Chiharu , Asai Jun , Kan Saori , Nomiyama Tomoko , Takenaka Hideya , Konishi Eiichi , Goto Keisuke , Ansai Shin‐ichi , Katoh Norito
Published: March 2016

Myoepithelial carcinoma is a malignant tumor that can differentiate towards myoepithelial cells and commonly occur in the salivary glands. There have been only a few reports of primary cutaneous myoepithelial carcinoma; however, most cases showed subcutaneous involvement and could also be diagnosed as soft tissue myoepithelial carcinoma arising from the subcutis with dermal involvement. It may thus be impossible to distinguish a primary cutaneous from a soft tissue myoepithelial carcinoma. Herein, we describe a case of myoepithelial carcinoma on the shoulder in an 85‐year‐old Japanese woman. The tumor was located in the whole dermis and subcutis; therefore, it could be diagnosed as either a cutaneous or soft tissue myoepithelial carcinoma. We reviewed previous cases of primary cutaneous and soft tissue myoepithelial carcinomas and compared their clinical and immunohistological features. We found no obvious differences in anatomical distribution or immunohistochemical findings. However, the recurrence rate of cutaneous myoepithelial carcinomas seems to be lower than that of soft tissue carcinomas. Such a difference may be attributable to the adequate surgical margin in cutaneous carcinomas compared with the deep‐seated soft tissue carcinomas. The metastatic frequency did not significantly differ between the two types. Although we could summarize from only a small number of cases, these results indicate the difficulty in distinguishing between cutaneous and soft tissue myoepithelial carcinomas; furthermore, it may not be suitable to distinguish them on the basis of aggressive behavior.
Economic Conditions Affect Support for Prime Minister Parties in Scandinavia
Authors: Vinæs Larsen Martin
Published: March 2016

Previous research has not been able to identify a relationship between objective economic indicators and support for governing parties in the Scandinavian countries. This is potentially problematic, as it suggests that political leaders are not held electorally accountable for the economic conditions they provide for their electorates. In this article, it is suggested that this null‐finding is a result of the particularities of the Scandinavian electoral context, which makes it difficult to identify the effects of the economy on electoral support. To bolster this argument, the relationship between unemployment, economic growth and support for prime minister parties is re‐examined in two datasets. The first is a dataset of Scandinavian elections, and the second is a yearly Danish vote function, which was constructed using election polls. Across both datasets, it is found that if one simply correlates support for the prime minister's party with economic conditions, there is no relationship; however, if one specifies a statistical model, which takes the Scandinavian context into account, it is possible to identify a statistically significant effect of economic conditions on electoral support. Based on this finding, the article concludes that economic conditions do shape electoral support for prime minister parties in Scandinavia.
Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates
Authors: Bitler Marianne P. , Carpenter Christopher S.
Published: March 2016

Objective

To evaluate the effects of state insurance mandates requiring insurance plans to cover Pap tests, the standard screening for cervical cancer that is recommended for nearly all adult women.

Data Sources

Individual‐level data on 600,000 women age 19–64 from the CDC's Behavioral Risk Factor Surveillance System.

Study Design

Twenty‐four states adopted state mandates requiring private insurers in the state to cover Pap tests from 1988 to 2000. We performed a difference‐in‐differences analysis comparing within‐state changes in Pap test rates before and after adoption of a mandate, controlling for the associated changes in other states that did not adopt a mandate.

Principal Findings

Difference‐in‐differences estimates indicated that the Pap test mandates significantly increased past 2‐year cervical cancer screenings by 1.3 percentage points, with larger effects for Hispanic and non‐Hispanic white women. These effects are plausibly concentrated among insured women.

Conclusions

Mandating more generous insurance coverage for even inexpensive, routine services with already high utilization rates such as Pap tests can significantly further increase utilization.
Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care
Authors: Kelley Amy S. , Covinsky Kenneth E. , Gorges Rebecca J. , McKendrick Karen , Bollens‐Lund Evan , Morrison R. Sean , Ritchie Christine S.
Published: March 2016

Objective

To create and test three prospective, increasingly restrictive definitions of serious illness.

Data Sources

Health and Retirement Study, 2000–2012.

Study Design

We evaluated subjects’ 1‐year outcomes from the interview date when they first met each definition: (A) one or more severe medical conditions (Condition) and/or receiving assistance with activities of daily living (Functional Limitation); (B) Condition and/or Functional Limitation and hospital admission in the last 12 months and/or residing in a nursing home (Utilization); and (C) Condition and Functional Limitation and Utilization. Definitions are increasingly restrictive, but not mutually exclusive.

Data Collection

Of 11,577 eligible subjects, 5,297 met definition A; 3,151 definition B; and 1,447 definition C.

Principal Findings

One‐year outcomes were as follows: hospitalization 33 percent (A), 44 percent (B), 47 percent (C); total average Medicare costs $20,566 (A), $26,349 (B), and $30,828 (C); and mortality 13 percent (A), 19 percent (B), 28 percent (C). In comparison, among those meeting no definition, 12 percent had hospitalizations, total Medicare costs averaged $7,789, and 2 percent died.

Conclusions

Prospective identification of older adults with serious illness is feasible using clinically accessible criteria and may be a critical step toward improving health care value. These definitions may aid clinicians and health systems in targeting patients who could benefit from additional services.
Double‐dorsal versus single‐volar digital subcutaneous anaesthetic injection for finger injuries in the emergency department: A randomised controlled trial
Authors: Martin Shane P , Chu Kevin H , Mahmoud Ibrahim , Greenslade Jaimi H , Brown Anthony FT
Published: March 2016

Objective

The objective of this present study is to compare pain associated with the double‐dorsal versus a single‐volar subcutaneous injection in the provision of digital anaesthesia for finger injuries presenting to the ED.

Methods

A randomised controlled trial from November 2012 to January 2014 at a single adult tertiary‐referral hospital. ED patients with finger injuries requiring digital anaesthesia was randomised to either the double‐dorsal or a single‐volar subcutaneous injection technique. The primary outcome was patient reported injection pain measured on a 100 mm visual analogue scale with the assessor blinded to the injection technique. The secondary outcome was success of anaesthesia defined as ability to perform the assessment and treatment without further anaesthetic supplementation after 5 min.

Results

Eighty‐six patients were enrolled. Median (IQR) age was 34 (24–47) years and 79% were men. The majority (66.3%) had distal phalanx injuries. Forty patients were randomised to the double‐dorsal and 46 to a single‐volar subcutaneous injection technique. The mean (standard deviation) pain score of the double‐dorsal injection was 39.1 (24.2) and a single‐volar injection was 37.3 (24.5) with a difference of 1.8 (95% CI –8.8 to 12.3). Digital anaesthesia was successful in 64.9% of the double‐dorsal and 71.7% of the single‐volar subcutaneous injections, a difference of 6.8% (95% CI –12.7 to 26.3).

Conclusion

In ED patients with finger injuries requiring digital anaesthesia, both the double‐dorsal or single‐volar subcutaneous injection techniques have similar pain of injection and success rates of anaesthesia. Single‐volar injection appears suitable alternative to the commonly performed double‐dorsal injection in the ED.
Utility of Ultrasonography of the Median Nerve With a High‐Frequency Probe for the Diagnosis of Dialysis‐Related Carpal Tunnel Syndrome
Authors: Yamazaki Tadashi , Kawahara Naomi , Arai Kazunori , Oyoshi Koji , Oshima Masami , Koike Sachiko , Miyauchi Akiko , Hayasaka Tokie , Saito Tetsuo , Tsuruoka Shuichi
Published: March 2016

This cross‐sectional study aimed to determine the utility of ultrasonography with improved resolution using a high‐frequency probe for dialysis‐related carpal tunnel syndrome (CTS). This study targeted 125 hemodialysis patients at our hospital. A 12 MHz probe was placed on the carpal tunnel area to identify the median nerve. The compression rate of the nerve was calculated by measuring the smallest diameter of the compressed nerve and largest diameter of the unaffected part. To quantify CTS symptoms, we determined the presence of Tinel's sign, measured pinch strength, and used questionnaires to assess numbness and pain. The association of these clinical data with the compression rate was examined. Mean compression rate was 12.1 ± 1.1%. The compression rate cutoff value for those positive with Tinel's sign was 25%, (sensitivity and specificity were 0.80 and 0.91, respectively), and that for those with a history of CTS surgery was 25% (sensitivity and specificity were 0.67 and 0.89, respectively). Multiple regression analysis identified duration of dialysis, β2‐microglobulin(β2‐Mg) concentration, positivity for Tinel's sign, history of CTS surgery, and pinch strength as independent compression rate determinants. Notably, compression rates were significantly higher in patients with a ≥4‐year duration of dialysis and a β2‐Mg level of 20 mg/L or more. The compression rate of the median nerve measured by an improved ultrasound device significantly correlated with clinical symptoms, medical history, and serological features associated with dialysis‐related CTS. Because ultrasonography is non‐invasive, the examination might be a simple method especially for early diagnosis of dialysis‐related CTS.
Evaluation of an electronic tool to assess food label literacy in adult Australians: A pilot study
Authors: Ringland Emma M. , Gifford Janelle A. , Denyer Gareth S. , Thai Danny , Franklin Janet L. , Stevenson Marie M. , Prvan Tania , O'connor Helen T.
Published: March 2016

Aim

This pilot study aimed to evaluate the food label literacy component of an electronic‐Nutrition Literacy Tool (e‐NutLiT) designed to assess nutrition literacy in adult Australians, and explore the influence of demographic factors.

Methods

Obese participants (OP) from an Australian obesity clinic and a criterion group of dietetic students (DS) from two Australian dietetic programs were recruited to complete the e‐NutLit; OP also completed the ‘Newest Vital Sign’ (NVS), a health literacy screening tool. Construct validity was assessed by comparing scores from the two groups. Associations between demographic factors and e‐NutLit scores were also explored.

Results

Sixty‐one participants (OP: n = 32; DS: n = 29) completed the study. The total e‐NutLit scores for OP was significantly lower than that of DS (71.9 ± 17.9%; 94.5 ± 5.6%, respectively: P = 0.01). Items requiring calculation of nutrient intake from the nutrition information panel (NIP) and interpreting endorsement logos were the worst performing sections on the e‐NutLit in both OP (35.9%; 71.9%) and DS (86.2%; 75.8%). Adequate health literacy, indicated by an NVS ≥ 4, was strongly associated with higher scores on the e‐NutLit in OP (P = 0.01). Level of education (≤year 10) and lack of engagement in food shopping were significantly associated with poorer competency on the e‐NutLit (P < 0.05).

Conclusions

Comparison of scores indicated that construct validity was established on most items for participants with lower literacy. The e‐NutLit identified specific weaknesses, such as nutrient calculations and interpretation of endorsement logos. This pilot study will help inform further development of the e‐NutLit.
Longitudinal association of obesity, metabolic syndrome and diabetes with risk of elevated aminotransferase levels in a cohort of Mexican health workers
Authors: Flores Yvonne N. , Auslander Allyn , Crespi Catherine M. , Rodriguez Michael , Zhang Zuo‐Feng , Durazo Francisco , Salmerón Jorge
Published: March 2016

Objective

In Mexico, chronic liver disease have been increasingly found along with the rapidly growing prevalence of obesity, diabetes and metabolic syndrome (MS). We aimed to investigate the longitudinal association between these three factors and risk of elevated alanine aminotransferase (ALT) levels (>40 U/L), a marker for liver damage, in a cohort of Mexican adults.

Methods

Data were obtained from two separate waves of the Mexican Health Worker Cohort Study: Wave 1 (2004–2006) and Wave 2 (2011–2013). Unconditional logistic regression models were employed to determine the cross‐sectional and longitudinal association between these risk factors and elevated ALT levels.

Results

The prevalence of elevated ALT was significantly higher among men, individuals aged under 60 years, those who were overweight or obese, diabetic, with MS or heavy/binge drinkers. The longitudinal results indicated that weight gain between waves that resulted in a change in body mass index, along with remaining overweight or obese, were significantly associated with an increased risk of elevated ALT levels. A significantly increased risk of developing elevated ALT was also observed among those who acquired diabetes or MS from Wave 1 to Wave 2.

Conclusions

Weight gain and acquiring diabetes or MS are associated with a significant risk of having elevated ALT. These results, within the context of the rapid increase in global obesity rates, call urgently for programs to help to prevent chronic liver disease.
Testing the potential ofDNAbarcoding in vertebrate radiations: the case of the littoral cichlids (Pisces, Perciformes, Cichlidae) from Lake Tanganyika
Authors: Breman Floris C. , Loix Sara , Jordaens Kurt , Snoeks Jos , Van Steenberge Maarten
Published: March 2016

We obtained 398 cytochromecoxidase subunit I barcodes of 96 morphospecies of Lake Tanganyika (LT) cichlids from the littoral zone. The potential ofDNAbarcoding in these fishes was tested using both species identification and species delineation methods. The best match (BM) and best close match (BCM) methods were used to evaluate the overall identification success. For this, three libraries were analysed in which the specimens were categorized into Operational Taxonomic Units (OTU) in three alternative ways: (A) morphologically distinct, including undescribed, species, (B) valid species and (C) complexes of morphologically similar or closely related species. For libraries A, B and C, 73, 73 and 96% (BM) and 72, 70 and 94% (BCM) of the specimens were correctly identified. Additionally, the potential of two species delineation methods was tested. The General Mixed Yule Coalescent (GMYC) analysis suggested 70 hypothetical species, while the Automatic Barcode Gap Discovery (ABGD) method revealed 115 putative species. Although theABGDmethod had a tendency to oversplit, it outperformed theGMYCanalysis in retrieving the species. In most cases whereABGDsuggested oversplitting, this was due to intraspecific geographical variation. The failure of theGMYCmethod to retrieve many species could be attributed to discrepancies between mitochondrial gene trees and the evolutionary histories ofLTcichlid species. LittoralLTcichlids have complex evolutionary histories that include instances of hybridization, introgression and rapid speciation. Nevertheless, although the utility ofDNAbarcoding in identification is restricted to the level of complexes, it has potential for species discovery in cichlid radiations.