bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimism may moderate screening mammogram frequency in Medicare
Authors: Progovac Ana M. , Pettinger Mary , Donohue Julie M. , Chang Chung-Chou H. (Joyce) , Matthews Karen A. , Habermann Elizabeth B. , Kuller Lewis H. , Rosal Milagros C. , Li Wenjun , Garcia Lorena , Tindle Hilary A.
Published: June 2019

Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005–2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.
Hepatosplenic brucella abscesses on computed tomography and magnetic resonance imaging
Authors: Guo Hui , Wang Yan , Yang Yuxin , Liu Wenya
Published: June 2019

Introduction:

Because of its infrequent and the lack of clinical data and image finding, the management of acute infections with the hepatosplenic brucella abscesses is challenging.

Methods: There were 10 serologically diagnosed cases with this brucella infection. All patients had fever, 50% patients had upper abdominal pain. Ninety percent patients lived in an urban environment. The localization of lesions included: 30% hepatosplenic, 30% liver, and 40% spleen.

Results:

Abdominal computed tomography (CT) scans and magnetic resonance imaging (MRI) demonstrated hepatosplenomegaly, with multiple small abscess lesions of various sizes in the acute stage of brucellosis, with the largest diameter of 1.5 cm in the liver. After contrast-enhanced CT and MRI findings, the arterial phase in which the enhancing area of lesions was thick, revealed multifocal hypodense or hypointense lesions of various sizes. These lesions manifested distinct boundary, which was intensified obviously in portal venous phase.

Conclusion:

Our results indicate that early CT or MRI dynamic contrast enhancement of suspected cases could improve rapid diagnosis. However, diagnostic criteria remain problematic and diagnosis is mostly based on a combination of clinical suspicion, serologic markers, and radiologic findings.
Severe bradycardia caused by the deviation of the laryngeal mask airway Supreme
Authors: Zhao Zhuang , Pan Shu , Yan Na , Wang Dunwei , Li Zhiwen
Published: June 2019

Rationale:

Classic laryngeal mask airway (LMA) has long been used for airway management. The LMA Supreme is a modified single-use version of the LMA Proseal, but it still remains some deficits such as the instable positioning that lead to easily sliding and the mask bowl full of air might lead to the reduced blood flow of the internal carotid artery. The carotid sinus is a baroreceptor that responds to the stretching of the arterial wall. Manual pressure of the carotid artery at the upper margin of the sternocleidomastoid muscle provoked bradycardia and hypotension.

Patient concerns:

A previously fit and well 42-year-old woman presented with breast fibroma on the left side. No other disease history could be recorded. Her family history was negative for neuromuscular and autoimmune disease.

Diagnoses:

The patient suffered from a severe bradycardia and hypotension when the LMA showed a shift. We presented with a hypothetical that the dislocated LMA may cause carotid sinus syndrome (CSS).

Interventions:

The patient's heart rate (HR) gradually rosed up as soon as the LMA adjusted back to the normal position.

Outcomes:

The patient was comfortable in the post anesthesia care unit (PACU) and had no adverse sequelae.

Lessons:

The position of LMA Supreme should be confirmed throughout the surgery especially for the ones who has changed the position and the head was covered by surgical drapes.
Incidence of recurrent fungal keratitis after primary keratoplasty and visual outcome and prognosis after intervention for the recurrence
Authors: Gong Yuerong , Xin Meng
Published: June 2019

There are no standardized protocols or guidelines for the treatment of recurrent fungal keratitis after therapeutic keratoplasty. This study aimed to investigate the incidence of recurrent fungal keratitis after the primary keratoplasty and the visual outcome and prognosis after intervention for the recurrence.

This was a retrospective study. Patients with recurrent fungal keratitis after lamellar keratoplasty (LK) or penetrating keratoplasty (PK) were treated with different antifungal regimens at Shandong Eye Hospital and Qingdao Eye Hospital between Januray 2004 and December 2015. The operative techniques included PK, focal excision, tectonic keratoplasty with a patch graft, lensectomy and vitrectomy, and combined operation. Patients were followed at 1, 2, and 3 months, and then every 6 months after surgery for 2 years. Best corrected visual acuity was assessed and recurrence was recorded. Good prognosis was defined as the presence of visual acuity.

Fungal keratitis recurred in 112 of 1448 patients (112/1448, 7.7%) treated initially with PK or LK. The good prognosis rates for different sites of recurrent fungal keratitis were: overall, 93 of 112 (83.0%); recipient bed, 64 of 69 (92.8%); anterior chamber, 14 of 14 (100%); posterior segment, 10 of 16 (62.5%); and atypical, 5 of 13 (38.5%). There was no significant difference in the timing of recurrence between the good and poor prognosis groups (P = .518). Recurrence rates were similar between patients with PK (8.6%) and those with LK (6.0%; P > .05), but the good prognosis rate in patients with post-LK recurrence (96.8%) was higher than that in patients with post-PK recurrence (77.8%, P = .017).

Individualized treatment according to recurrent sites of fungal keratitis can achieve a good prognosis in most patients.
Antibiotic resistance profiles and multidrug resistance patterns of Streptococcus pneumoniae in pediatrics
Authors: Wang Cai-yun , Chen Ying-Hu , Fang Chao , Zhou Ming-ming , Xu Hong-mei , Jing Chun-mei , Deng Hui-ling , Cai Hui-jun , Jia Kai , Han Shu-zhen , Yu Hui , Wang Ai-min , Yin Dan-dan , Wang Chuan-qing , Wang Wei , Huang Wei-chun , Deng Ji-kui , Zhao Rui-zhen , Chen Yi-ping , Yang Ji-Hong , Wang Chun , Che Yan-ran , Nie Xiu-zhen , Wang Shi-fu , Hao Jian-hua , Zhang Cong-hui
Published: June 2019

Emergent resistance to antibiotics among Streptococcus pneumoniae isolates is a severe problem worldwide. Antibiotic resistance profiles for S pneumoniae isolates identified from pediatric patients in mainland China remains to be established.

The clinical features, antimicrobial resistance, and multidrug resistance patterns of S pneumoniae were retrospectively analyzed at 10 children's hospitals in mainland China in 2016.

Among the collected 6132 S pneumoniae isolates, pneumococcal diseases mainly occurred in children younger than 5 years old (85.1%). The resistance rate of S pneumoniae to clindamycin, erythromycin, tetracycline, and trimethoprim/sulfamethoxazole was 95.8%, 95.2%, 93.6%, and 66.7%, respectively. The resistance rates of S pneumoniae to penicillin were 86.9% and 1.4% in non-meningitis and meningitis isolates, while the proportions of ceftriaxone resistance were 8.2% and 18.1%, respectively. Pneumococcal conjugate vaccine was administered to only 4.1% of patients. Penicillin and ceftriaxone resistance, underling diseases, antibiotic resistant risk factors, and poor prognosis appeared more frequently in invasive pneumococcal diseases. The incidence of multidrug resistance (MDR) was 46.1% in patients with invasive pneumococcal disease which was more than in patients with non-invasive pneumococcal disease (18.3%). Patients with invasive pneumococcal disease usually have several MDR coexistence.

S pneumoniae isolates showed high resistance to common antibiotics in mainland China. Penicillin and ceftriaxone resistance rate of invasive streptococcal pneumonia patients were significantly higher than that of non-invasive S pneumoniae patients. Alarmingly, 46.1% of invasive clinical isolates were multidrug resistant, so it is important to continued monitor the resistance of S pneumoniae when protein conjugate vaccine (PCV13) is coming in mainland China.
Case report: right-sided native endocarditis presenting with multiple abscess formations [care compliant]
Authors: Chan Tsung-Yu , Hsieh Chih-Chia , Chen Chien-Liang , Huang Yao-Yi , Chuang Chia-Chang
Published: June 2019

Introduction:

Right-sided native endocarditis is a difficult case with fewer cardiac symptoms and fewer classic signs of cutaneous vascular lesions compared with left-sided endocarditis.

Patient concerns:

A 68-year-old Taiwanese man with a history of gouty arthritis, hyperlipidemia, and adrenal insufficiency presented to our ED and complained dyspnea and low back pain for 1 month.

Diagnosis assessment:

The PE showed bilateral crackles on chest auscultation and a palpable fluctuant mass over the anterior chest wall. The chest and abdominal CT scan showed multiple abscess formations involving pulmonary, sternal, and paraspinal areas. The TEE being performed and an oscillating mass over the anterior and septal leaflets of the tricuspid valve and moderate tricuspid regurgitation.

Interventions:

Only pharmacologic treatment without surgical interventions.

Outcomes:

Deceased, patient expired on day 4 after ED visit.

Conclusion:

This case arose as a sequela of staphylococcal endocarditis associated with persistent bacteremia and immunological dysregulation. The diagnosis of right-sided endocarditis is easily missing, multidisciplinary approach should be triggered as soon as possible, which might lead to a better outcome. Right-sided IE is still an important public health issue in southern Taiwan.
Uni-center, patient-blinded, randomized, 12-month, parallel group, noninferiority study to compare outcomes of 3-row vs 2-row circular staplers for colorectal anastomosis formation after low anterior resection for rectal cancer
Authors: Nekliudov Nikita A. , Tsarkov Petr V. , Tulina Inna A.
Published: June 2019

Background:

Colorectal anastomotic leakage (AL) is one of the most serious complications in rectal cancer surgery due to its negative impact on the overall as well as cancer-specific survival. Two-row stapling technique has become standard in low anterior resections (LARs), but has neither alleviated the morbidity, nor reduced the incidence of AL. This is the 1st study that aims to compare the success rate of new 3-row circular staplers compared to that of conventional 2-row staplers in a prospective, randomized clinical trial.

Methods:

The THREESTAPLER trial (Clinical Trials NCT03910699) is a prospective, noninferiority, 2-armed, parallel-group, patient and outcomes assessor blinded study with a 1:1 allocation ratio. Colorectal anastomosis will be formed using Ethicon 29 mm Curved Intraluminal Stapler (CDH29A) in the active comparator group, and using Mirus Disposable Circular Stapler 3 Row 29 (MCS-29R3) in the experimental group. The hypothesis states that the incidence of AL in the 3-row stapler group is at least not higher than in the 2-row stapler group. Assuming there is a difference in success rate of 12% and noninferiority margin Δ = 5%, 154 patients will be required to achieve statistical significance. An interim analysis will be performed after recruitment of 20 patients per group to assess safety profile of 3-row circular staplers. The primary endpoint is the rate of AL, documented by imaging studies, assessed with Pearson Chi-squared test and Fisher exact test. The secondary outcomes include severity of AL (A, B, or C), anastomotic bleeding, postoperative complication rate graded with the Clavien–Dindo classification, reintervention rate, stapler dysfunction rate, complications of defunctioning stoma, overall and cancer-specific quality of life, assessed with short form (36) and quality-of-life questionnaire core 30 questionnaires, respectively, fecal incontinence assessed with Cleveland clinic incontinence score form, and manifestation of LAR syndrome. All patients will be monitored for 12 months following the LAR.

Discussion:

This is the 1st prospective randomized trial to assess the safety profile of 3-row staplers for colorectal anastomosis after LAR for rectal cancer. It may provide evidence of feasibility of 3-row circular staplers in LAR with respect to short-term and long-term patient outcomes.

Trial registration: NCT03910699 on 10 April 2019
Clinical efficacy and safety of percutaneous coronary intervention for acute myocardial infarction complicated with chronic renal insufficiency
Authors: Luo Liang , Xu Wen-Qing , Zhong Ri-Xiang , Chen Feng , Fu You-Lin , Zhang Peng , Xiao Shi-Hui
Published: June 2019

Background:

The aim of this research is to further evaluate the efficacy and safety of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) complicated with chronic renal insufficiency (CRI) by meta-analysis, to provide scientific and effective medical evidence for PCI in patients with AMI complicated with CRI, and to support the clinical application of PCI.

Methods:

Electronic databases will be searched, including PubMed, Cochrane Library, Embase, CNKI, CBM, VIP, and Wanfang Data. Patients with AMI complicated by renal insufficiency treated with PCI will be included. The retrieval time is from inception to January 2019. The inclusion and exclusion criteria are formulated to search only the relevant literature. Endnote software management for literature will be adopted. The literature will be independently screened by 2 researchers. Excel 2016 will be applied to extract literature data with the “Research Information Registration Form.” The final selected literature will be assessed for bias risk. Stata 12.0 software will be used for the meta-analysis.

Results:

The systematic evaluation and meta-analysis will be carried out strictly in accordance with the requirements of the Cochrane System Evaluator Manual 5.3 on meta-analyses, which will provide a high-quality evaluation of the clinical efficacy and safety of PCI in patients with AMI and CRI.

Ethics and dissemination:

This study belongs to the category of systematic reviews, not clinical trials. Therefore, it does not require ethical approval. The results of this study will be published in influential international academic journals related to this topic.

Conclusion:

PCI is an effective and safe treatment for patients with AMI and CRI. This study will provide a definite evidence-based medical conclusion and provide a scientific basis for the clinical treatment of patients with AMI and CRI.

PROSPERO registration number:

CRD42019131367.
Integrative bioinformatics analysis of miRNA and mRNA expression profiles and identification of associated miRNA-mRNA network in aortic dissection
Authors: Su Yiming , Li Qiyi , Zheng Zhiyong , Wei Xiaomin , Hou Peiyong
Published: June 2019

Background:

Aortic dissection (AD) is one of the most lethal cardiovascular diseases. The aim of this study was to identify core genes and pathways revealing pathogenesis in AD.

Methods:

We screened differentially expressed mRNAs and miRNAs using mRNA and miRNA expression profile data of AD from Gene Expression Omnibus. Then functional and pathway enrichment analyses of differential expression genes (DEGs) was performed utilizing the database for annotation, visualization, and integrated discovery (DAVID). Target genes with differential expression miRNAs (DEMIs) were predicted using the miRWalk database, and the intersection between these predictions and DEGs was selected as differentially expressed miRNA-target genes. In addition, a protein–protein interaction (PPI) network and miRNA-mRNA regulatory network were constructed.

Results:

In total, 130 DEGs and 47 DEMIs were identified from mRNA and miRNA microarray, respectively, and 45 DEGs were DEMI-target genes. The PPI and miRNA-mRNA network included 79 node genes and 74 node genes, respectively, while 23 hub genes and 2 hub miRNAs were identified. The DEGs, PPI and modules differential expression miRNA-target genes were all mainly enriched in cell cycle, cell proliferation and cell apoptosis signaling pathways.

Conclusion:

Taken above, the study reveals some candidate genes and pathways potentially involving molecular mechanisms of AD. These findings provide a new insight for research and treatment of AD.
Community-acquired respiratory viruses
Authors: Dominguez Fernando , Blodget Emily
Published: June 2019

Purpose of review

Community-acquired respiratory viruses (CARV) have been historically linked to upper respiratory tract infections; however, new data has emerged in recent years that has provided new insight into their role as causative pathogens for lower respiratory tract infections. We aim to discuss the importance of recognition of viruses both epidemiologically and clinically as causes of lower respiratory tract infection.

Recent findings

With advances of molecular testing it is now possible to identify viruses from clinical specimens which have many implications that range from therapeutics to antibiotic stewardship. Recent studies suggest that most of the cases of community-acquired pneumonia are caused by viruses, which corresponds to a paradigm shift for most clinicians.

As community-acquired lower respiratory infections are the most common cause of ICU admission in the USA, it is important for medical providers to be aware of the association with viruses, especially in patients with immunosuppression because of solid organ transplant and hematologic malignancies when sometimes diagnosis can be challenging and patients can be exposed to unnecessary antibiotics.
Relationship Between Impulsivity and Clinical and Sociodemographic Variables Among Lebanese Patients With Bipolar Disorder
Authors: Azzam Patrick , Obeid Sahar , Haddad Chadia , Kazour Francois , Nabbout Rita , Hallit Souheil , Azar Jocelyne
Published: June 2019

Impulsivity is a psychiatric symptom that seems to be more prevalent in some mental disorders such as bipolar disorders (BDs). It is a trait that seems to be influenced by many clinical and sociodemographic variables across BD. To examine the relationship between impulsivity and these variables, we performed a cross-sectional study on 50 patients diagnosed with BD and 50 healthy subjects. Both groups were administered the Barratt Impulsiveness Scale; the Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, for borderline personality disorder; the Beirut District Scale; and the Athens Insomnia Scale to assess impulsivity, borderline personality disorder, psychological distress, and sleep disturbances, respectively. A significantly higher nonplanning impulsivity (p = 0.001), motor impulsivity (p < 0.0001), total impulsivity (p < 0.0001), body mass index (p < 0.0001), and insomnia (p = 0.002) were found in subjects with BDs compared with healthy ones. Exposure to violence (odds ratio [OR] = 7.63), the loss of a parent (OR = 3.83), being a current smoker (OR = 14.56), and a higher motor impulsivity score (OR = 1.27) were all significantly associated with the presence of BD. Impulsivity was shown to be strongly associated with the presence of a diagnosis of BD, and further studies are warranted to fully characterize it through the course of the illness.
Presenting to the Emergency Department Versus Clinic-Based Sexually Transmitted Disease Care Locations for Testing for Chlamydia and Gonorrhea: A Spatial Exploration
Authors: Bergquist Eleanor Peters , Trolard Anne , Fox Branson , Sebert Kuhlmann Anne , Loux Travis , Liang Stephen Y. , Stoner Bradley P. , Reno Hilary
Published: June 2019

Background

Rates of sexually transmitted diseases (STDs) including chlamydia and gonorrhea are increasing in the United States while public health funding for STD services is decreasing. Individuals seek care in various locations including the emergency department (ED). The objective of this study is to investigate whether there are more physically proximal clinic-based STD care locations available to individuals who present to the ED in a major metropolitan area.

Methods

Addresses of EDs, clinics, and patients 13 years or older in St. Louis City or County given a nucleic acid amplification test and assigned an STD diagnosis (n = 6100) were geocoded. R was used to analyze clinics within 5 radii from the patients' home address and assess missed clinic opportunities (open, no charge, with walk-in availability) for those living in an urban versus suburban area.

Results

In urban areas, 99.1% of individuals lived closer to a clinic than the ED where they sought STD services; in suburban areas, 82.2% lived closer to a clinic than the ED where they presented. In the region, 50.6% lived closer to the health department-based STD care location than the hospital where they presented. Up to a third of ED patient visits for STD care could have occurred at a clinic that was closer to the patient's home address, open, no charge, and available for walk-in appointments.

Conclusions

Clinic availability is present for most of the individuals in our study. Clinics providing STD services can increase advertising efforts to increase public awareness of the services which they provide.
Clinicopathologic Features and Calcium Deposition Patterns in Calciphylaxis
Authors: McMullen Emily R. , Harms Paul W. , Lowe Lori , Fullen Douglas R. , Chan May P.
Published: June 2019

Diagnosis of calciphylaxis is crucial, yet its distinction from other vascular diseases can be challenging. Although vascular calcification and thrombosis are hallmarks of calciphylaxis, the incidence and patterns of these features in other vascular diseases have not been well characterized. The specificity of fine calcium deposits in vessel walls (identifiable on von Kossa [VK] stain only) and other extravascular calcifications is not entirely clear. We retrospectively examined the clinicopathologic features in calciphylaxis (n=27), gangrene and viable skin at amputation margin (n=20 each), chronic stasis (n=22), and thrombotic vasculopathy (n=19) to identify useful discriminators. Calcification of subcutaneous small vessels appreciable on hematoxylin and eosin stain was relatively specific for calciphylaxis, although sensitivity was low (56%). VK detected fine calcium deposits in vessel walls not appreciable on hematoxylin and eosin, however, specificity was limited by frequent finding of similar deposits in peripheral artery disease. Combining calcium deposits detected by VK and thrombosis of subcutaneous small vessels resulted in optimal sensitivity (85%) and specificity (88%) for calciphylaxis. Similar observations applied to medium-sized vessel calcification. Calcification of eccrine gland basement membranes, elastic fibers, and perineurium did not effectively distinguish calciphylaxis from other groups. Diffuse dermal angiomatosis was exclusively found in calciphylaxis in this study. In conclusion, VK is useful in enhancing the detection of vascular calcification and avoiding the false-negative diagnosis, but this finding requires concomitant subcutaneous small vessel thrombosis to support a diagnosis of calciphylaxis. Diffuse dermal angiomatosis should increase suspicion for underlying calciphylaxis and prompt deeper sampling in the appropriate clinical setting.
HIV Seroconversion in the Era of Pharmacologic Prevention: A Case–Control Study at a San Francisco STD Clinic
Authors: Johnson Kelly A. , Hessol Nancy A. , Kohn Robert , Nguyen Trang Q. , Mara Elise S. , Hsu Ling , Scheer Susan , Cohen Stephanie E.
Published: June 2019

Background:

The comparative effectiveness of pre- and post-exposure prophylaxis (PrEP and PEP) for men who have sex with men (MSM) is unclear.

Setting:

We conducted a case–control study of MSM who were initially HIV-uninfected during September 1, 2012–June 30, 2016 at San Francisco's only municipal sexually transmitted diseases (STDs) clinic.

Methods:

Each case was matched with up to 3 controls based on age, baseline visit date, and follow-up time. The primary dependent variable was HIV seroconversion; the primary independent variable was exposure to PrEP, PEP, or neither. Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals.

Results:

Of 638 MSM (161 cases and 477 controls), 137 reported ever taking PrEP, 98 reported taking PEP-only, and 403 took neither. PrEP takers had more non-HIV sexually transmitted diseases during the analysis (72.3% vs. 55.1% vs. 42.4% P < 0.01) and were more likely to report receptive anal sex in the past 3 months (86.5% vs. 80.4% vs. 73.0%; P < 0.01). In the adjusted model, PrEP was associated with lower odds of HIV seroconversion (odds ratio 0.24; 95% confidence interval: 0.13 to 0.46) while PEP use had no effect on HIV acquisition compared with taking neither.

Conclusions:

MSM who ever used PrEP demonstrated equal or higher sexual risk compared with those using neither PrEP nor PEP but had 76% lower odds of HIV seroconversion. MSM who used PEP but never PrEP were no less likely to seroconvert than those using neither. MSM should be offered PrEP. PEP users with ongoing risk of HIV infection should be connected to PrEP after PEP.
Quantitative Assessment of Bone Metastasis in Prostate Cancer Using Synthetic Magnetic Resonance Imaging
Authors: Arita Yuki , Takahara Taro , Yoshida Soichiro , Kwee Thomas C. , Yajima Shugo , Ishii Chikako , Ishii Ryota , Okuda Shigeo , Jinzaki Masahiro , Fujii Yasuhisa
Published: June 2019

Objectives

The aims of this study were to evaluate the feasibility of quantitative synthetic magnetic resonance imaging (SyMRI) for characterizing bone lesions in prostate cancer and to discriminate viable progressive osteoblastic bone metastasis from nonviable bone metastases with treatment-induced sclerosis during the treatment course.

Materials and Methods

This institutional review board–approved prospective study included 96 consecutive prostate cancer patients who underwent whole-body MRI including diffusion-weighted imaging at the time of staging at diagnosis or starting a new line of anticancer treatment. Additional synthetic MRI of the lumbosacral spine, pelvis, and proximal femurs was performed. A region of interest of 1.0 cm in diameter was set in each bone lesion by 2 independent readers who were blinded to bone lesions' diagnosis. Differences in SyMRI variables between the different bone lesions were compared with the Wilcoxon rank sum test, and associations of SyMRI variables with active disease were analyzed with logistic regression analysis. Performance of T1, T2, and proton density (PD) for diagnosing active disease was assessed using the area under the receiver operating characteristic curve.

Results

Ninety-three bone lesions were eligible for analysis. The PD values of active (viable) bone metastatic lesions were significantly higher than those of inactive (nonviable) bone metastatic lesions without sclerosis and those of red bone marrow (P < 0.001 for both readers). The PD values of inactive bone metastatic lesions with sclerosis were significantly lower than those of inactive bone metastatic lesions without sclerosis and red bone marrow (P < 0.001 for both readers). The PD value proved to be an independent significant indicator (P < 0.001) for differentiating bone lesions. The areas under the curve of T1/T2/PD for identifying active disease were 0.81/0.69/0.93 for reader 1 and 0.78/0.70/0.92 for reader 2, respectively.

Conclusions

Signal quantification on SyMRI provides objective assessment of bone lesions in the lower trunk. The PD value can be useful to determine the viability of bone metastases in prostate cancer.
Pediatric Toxic Shock Syndrome After a 7% Burn
Authors: Khajuria Ankur , Nadama Hauwa’u Hayat , Gallagher Michael , Jones Isabel , Atkins Joanne
Published: June 2019

Introduction

Toxic shock syndrome (TSS) is a life-threatening condition, which occurs in children after sustaining a burn. Often diagnosed retrospectively, many patients may not receive optimal treatment.

The primary objective of this study was to evaluate a severe and complex case of TSS at our unit and subsequently conduct a Preferred Reporting for Systematic Reviews and Meta-Analyses–compliant systematic literature review, to identify cases of postthermal injury TSS and evaluate their presentation and management.

Case Report

A 9-year-old boy with Down syndrome presented with a 7% total body surface area scald to his back and posterior head. Four days after discharge, he developed a fever. The following day, he deteriorated, becoming stridulous and unresponsive. A working diagnosis of TSS was made. The patient's intensive care stay was arduous with multiple complications, including 2 cardiac arrests.

Methods

A Preferred Reporting for Systematic Reviews and Meta-Analyses–compliant systematic literature review was conducted. MEDLINE, PubMed, and Web of Science were searched using key terms “burns, thermal injury, scalds, paediatric, child, infant, neonate, toxic shock syndrome” to identify cases. Two authors independently checked each study against inclusion criteria.

Results

The systematic literature search yielded 9 articles, identifying 40 cases. Ages ranged between 9 months and 8 years. The mean number of days' postburn patients presented with symptoms of TSS was 2.5 days (1–7 days). The most common presenting symptoms were fever (75%), rash (70%), and diarrhea, and/or vomiting (52.5%). Intravenous immunoglobulins were administered in 11 (27.5%) cases.

Discussion

We have highlighted a case where a possible delayed diagnosis along with the immunodeficiency seen in Down syndrome may have impacted the severity of TSS. The literature review highlighted that a significant proportion of patients do not meet diagnostic criteria.

Conclusions

It is fundamental that appropriate diagnostic and management guidelines are developed. Furthermore, this case highlights the importance of educating patient's carers and health professionals of key symptoms to be wary of postburn.
Subcutaneous Administration of Carbidopa Enhances Oral Levodopa Pharmacokinetics: A Series of Studies Conducted in Pigs, Mice, and Healthy Volunteers
Authors: Shaltiel-Karyo Ronit , Caraco Yoseph , Zawaznik Eduardo , Weinstock Irena , Nemas Mara , Oren Sheila , Yacoby-Zeevi Oron , LeWitt Peter A.
Published: June 2019

Objectives

Although commercially available levodopa (LD) formulations include carbidopa (CD) or benserazide for gastrointestinal l-aromatic amino acid decarboxylase inhibition, little is known how manipulating CD delivery affects the pharmacokinetics of LD. Our research systematically evaluated the peripheral and central pharmacokinetics of LD during continuous subcutaneous CD delivery.

Methods

We conducted pharmacokinetic experiments in pigs, mice, and humans to characterize effects of continuous subcutaneous CD delivery co-administered with LD as compared with oral LD/CD administration on LD pharmacokinetics. The porcine and human studies compared peripheral LD pharmacokinetic parameters (area under the curves [AUCs], peak plasma concentrations [C
max], and plasma elimination half-life [t
1/2]) and the mouse studies compared brain LD and dopamine concentrations.

Results

In the pig, supplementary subcutaneous CD delivery significantly increased the LD t
1/2 and AUC versus LD/CD alone and versus additional oral CD administration. In mice, administration of supplementary subcutaneous CD substantially increased mean plasma concentrations of both LD and CD versus oral LD/CD alone at all time points. These increases were mirrored by increased brain dopamine levels for at least the 7 hours of study. In healthy human subjects, continuous subcutaneous CD administration, 3.33 mg/h x24h, increased the plasma LD t
1/2, C
max, and AUC by 17.4%, 40.5%, and 22.3%, respectively (P < 0.003).

Conclusions

This series of studies demonstrates that small continuous dosing of subcutaneous CD has an unexpected effect on LD pharmacokinetics greater than the extent of decarboxylase inhibition achieved by additional oral CD administration.
A Measure to Assess Perceptions and Knowledge About Electroconvulsive Therapy
Authors: Tsai Jack , Huang Minda , Wilkinson Samuel T. , Edelen Carl , Rosenheck Robert A. , Holtzheimer Paul E.
Published: June 2019

Objectives

Although electroconvulsive therapy (ECT) has been found to be one of the most robust and rapid treatments for severe depression, it is widely underused partly because of negative perceptions and inaccurate knowledge about the treatment.

Methods

The 18-item ECT Perception and Knowledge (ECT-PK) measure was developed through a systematic review of the literature, subject matter expert ratings, and examination of content validity. The ECT-PK consists of Perception and Knowledge subscales, which were tested on a national sample of 1091 US adults who screened positive for depression in 2018 through Amazon's Mechanical Turk platform.

Results

Evaluation of the ECT-PK subscales found that both subscales demonstrated good construct validity, criterion validity, and internal consistency reliability. Participants who had higher Perception and Knowledge subscale scores were significantly more likely to report that they were willing to try ECT. The ECT-PK revealed that many participants reported fears about pain, brain damage, and memory loss resulting from ECT, and had inaccurate knowledge about ECT being outdated or lacking scientific evidence.

Conclusions

Together, these results showed that the ECT-PK is an efficient and effective contemporary tool to measure the perception and knowledge of ECT, and highlights areas in need of psychoeducation.
Assessing Public Attitudes to Electroconvulsive Therapy
Authors: Alexander Lauren , Malone Kevin , Counihan Eimear , Kennedy Jennifer , Roddy Darren , Delaney Liam
Published: June 2019

Introduction

Electroconvulsive therapy (ECT) is an established treatment for major depressive disorder, yet it remains controversial. Attitudes toward ECT have been studied in members of the public and service users, with diverse findings. There is no systematically validated scale to quantify attitudes.

Objectives

The aim of this study was to validate a scale measuring attitudes toward ECT using a systematic analysis.

Methods

Validation consisted of 3 stages: item generation, theoretical analysis, and psychometric analysis. A total of 196 members of the public were surveyed, and the findings were used to perform principal component analysis, Cronbach alpha (CA), and interitem correlation.

Results

The Modified ECT Attitudes Questionnaire (EAQ) is a 22-item participant-rated questionnaire (0–44) consisting of 2 principal components: “moral and ethical perceptions of ECT” and “ECT as a last resort treatment.” There was adequate reliability for the total EAQ (CA, 0.873) and each of the components (component 1 CA, 0.907; component 2 interitem correlation, 0.389). Among the 196 members of the public, the mean score was 20.4 (SD, 8.4), which equates to 46% positive responses. Component 1 elicited 39% positive responses; component 2 elicited 52% positive responses. The emotion components of attitudes elicited particularly negative responses.

Conclusions

The EAQ is a validated and reliable scale for the measurement of attitudes toward ECT. Application of this scale to 196 members of the public indicates that negative attitudes are rooted in individuals' moral and ethical objections to ECT, particularly the emotion components of such attitudes. This scale can be applied to other groups, including service users, to further characterize attitudes that underlie the stigma toward ECT.
Clinical Effectiveness of Maintenance Electroconvulsive Therapy in Patients with Schizophrenia
Authors: Isserles Moshe , Remington Jesse , Kaster Tyler S. , Daskalakis Zafiris J. , Blumberger Daniel M.
Published: June 2019

Objective

This study aimed to assess the clinical effectiveness and cognitive effects of maintenance electroconvulsive therapy (mECT) in patients with schizophrenia or schizoaffective disorder and explore factors associated with both outcomes.

Methods

In this retrospective cohort study, we examined clinical records of 47 patients with a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of schizophrenia or schizoaffective disorder treated with mECT at an academic mental health hospital between April 2010 and July 2016. Sixty-two mECT courses were reviewed. We assessed clinical effectiveness and cognitive effects as well as factors associated with response to treatment, including psychiatric diagnosis, concomitant pharmacological treatment, and previous treatment response.

Results

Maintenance electroconvulsive therapy was able to maintain clinical response in 48 (77%) treatment courses. Significant cognitive adverse effects were reported in 7 (11%) of the courses. Use of antipsychotic, antidepressant or benzodiazepine medications, psychiatric disorder, and sex were not associated with response.

Conclusion

This study shows meaningful clinical effectiveness and good tolerability of mECT in patients with resistant schizophrenia over extended periods.
Effect of Electroconvulsive Therapy on Health-Related Quality of Life in Older Depressed Patients
Authors: Arunachalam Arulmathy , Sarma Shanthi
Published: June 2019

Background

Research has shown large improvements in quality of life after a course of electroconvulsive therapy (ECT) for severe depressive disorder. The effect of ECT on health-related quality of life (HRQOL) in the Australian older population has not been explored.

Objectives

This study aimed to investigate the impact of ECT on HRQOL in older patients with severe major depression and confirm that ECT in these participants is associated with an improvement in depression and no change in cognition.

Methods

Data on 34 patients from a Public Older Persons Mental Health Service in Queensland were collected. The Quality of Life Enjoyment and Satisfaction Questionnaire Short Form, Montgomery-Asberg Depression Rating Scale (MADRS), and Montreal Cognitive Assessment (MoCA) were used pre- and post-ECT. The Wilcoxon signed rank test, Friedman test, and Kendall τ correlation coefficient were performed.

Results

A significant improvement in Quality of Life Enjoyment and Satisfaction Questionnaire Short Form was demonstrated post-ECT. Montgomery-Asberg Depression Rating Scale scores decreased significantly post-ECT. Montreal Cognitive Assessment score increased significantly post-ECT. Significant results were sustained at the 3-month time point.

Conclusions

An acute course of ECT for severe depressive disorder was associated with clinically and statistically significant improvement in HRQOL. There was also clinical and statistical improvement in depression and no significant decrease in global cognitive function, memory, or executive function domains after ECT compared with baseline. In fact, the cohort showed improvement on measures of cognition post-ECT.
Landscape heterogeneity of peasant-managed agricultural matrices
Authors: Urrutia Ana L. , González-González Cecilia , Van Cauwelaert Emilio Mora , Rosell Julieta A. , Barrios Luis García , Benítez Mariana
Published: June 2019

In agricultural landscapes, management practices and other environmental and social factors shape complex agroecological matrices. In turn, the structure of such matrices impacts both agricultural activities and biodiversity conservation, for instance, by mediating wildlife migration between agricultural and habitat patches. One way to characterize a matrix, its potential role in biodiversity conservation, and how its descriptors change across different spatial scales, is characterizing heterogeneity metrics and systematically examining how such metrics change with grain size and landscape extent. However, these methods have rarely been applied to tropical, peasant-managed landscapes, even though this type of landscape occupies most of the agricultural surface in or near biodiversity hotspots. We focus on a peasant-managed agricultural landscape in Oaxaca, Mexico, for which we mapped and quantified the land-use classes and evaluated heterogeneity metrics. We also examined the response of heterogeneity metrics to changes in grain and extent scales. This allowed us to further understand the structure and conservation potential of the agroecological matrix in this type of landscape, to broadly compare this landscape with other agricultural landscapes in North America, and to recommend specific landscape metrics for different types of studies involving agricultural matrices. We conclude that this type of agricultural matrix is ideal to pursue joint agricultural and conservation strategies in an integrated landscape.
Mitochondrial genomes ofColumbicolafeather lice are highly fragmented, indicating repeated evolution of minicircle-type genomes in parasitic lice
Authors: Sweet Andrew D. , Johnson Kevin P. , Cameron Stephen L.
Published: June 2019

Most animals have a conserved mitochondrial genome structure composed of a single chromosome. However, some organisms have their mitochondrial genes separated on several smaller circular or linear chromosomes. Highly fragmented circular chromosomes (“minicircles”) are especially prevalent in parasitic lice (Insecta: Phthiraptera), with 16 species known to have between 9 and 20 mitochondrial minicircles per genome. All of these species belong to the same clade (mammalian lice), suggesting a single origin of drastic fragmentation. Nevertheless, other work indicates a lesser degree of fragmentation (2-3 chromosomes/genome) is present in some avian feather lice (Ischnocera: Philopteridae). In this study, we tested for minicircles in four species of the feather louse genusColumbicola(Philopteridae). Using whole genome shotgun sequence data, we applied three different bioinformatic approaches for assembling theColumbicolamitochondrial genome. We further confirmed these approaches by assembling the mitochondrial genome ofPediculus humanusfrom shotgun sequencing reads, a species known to have minicircles. All three methods indicatedColumbicolaspp. genomes are highly fragmented into 15-17 minicircles between 1,119 and 3,173 bp in length, with 1-4 genes per minicircle. Subsequent annotation of the minicircles indicated that tRNA arrangements of minicircles varied substantially between species. These mitochondrial minicircles for species ofColumbicolarepresent the first feather lice (Philopteridae) for which minicircles have been found in a full mitochondrial genome assembly. Combined with recent phylogenetic studies of parasitic lice, our results provide strong evidence that highly fragmented mitochondrial genomes, which are otherwise rare across the Tree of Life, evolved multiple times within parasitic lice.
Full-featured, real-time database searching platform enables fast and accurate multiplexed quantitative proteomics
Authors: Schweppe Devin K. , Eng Jimmy K. , Bailey Derek , Rad Ramin , Yu Qing , Navarrete-Perea Jose , Huttlin Edward L. , Erickson Brian K. , Paulo Joao A. , Gygi Steven P.
Published: June 2019

Multiplexed quantitative analyses of complex proteomes enable deep biological insight. While a multitude of workflows have been developed for multiplexed analyses, the most quantitatively accurate method (SPS-MS3) suffers from long acquisition duty cycles. We built a new, real-time database search (RTS) platform, Orbiter, to combat the SPS-MS3 method’s longer duty cycles. RTS with Orbiter enables the elimination of SPS-MS3 scans if no peptide matches to a given spectrum. With Orbiter’s online proteomic analytical pipeline, which includes RTS and false discovery rate analysis, it was possible to process a single spectrum database search in less than 10 milliseconds. The result is a fast, functional means to identify peptide spectral matches using Comet, filter these matches, and more efficiently quantify proteins of interest. Importantly, the use of Comet for peptide spectral matching allowed for a fully featured search, including analysis of post-translational modifications, with well-known and extensively validated scoring. These data could then be used to trigger subsequent scans in an adaptive and flexible manner. In this work we tested the utility of this adaptive data acquisition platform to improve the efficiency and accuracy of multiplexed quantitative experiments. We found that RTS enabled a 2-fold increase in mass spectrometric data acquisition efficiency. Orbiter’s RTS was able to quantify more than 8000 proteins across 10 proteomes in half the time of an SPS-MS3 analysis (18 hours for RTS, 36 hours for SPS-MS3).