bluuebunny/crossref_metadata_2025 huggingface dataset:
Corneal Configurations and High-order Aberrations in Primary Congenital Glaucoma
Authors: Hu Yin , Fang Lei , Guo Xinxing , Yang Xiao , Chen Weiyin , Ding Xiaohu , Liu Xing , He Mingguang
Published: August 2018

Purpose:

Corneal changes are prevalent in eyes with primary congenital glaucoma (PCG). This study aimed to describe corneal irregularity and high-order aberrations (HOAs) in PCG eyes.

Materials and Methods:

The study consecutively enrolled 61 PCG eyes (of 39 participants with PCG) and 61 age-matched control eyes (of 61 healthy participants). Participants underwent corneal topography, best spectacle–corrected visual acuity (BSCVA), and fundus photography. Corneal irregularity and HOAs were derived from topographic data and evaluated over central 4 and 6 mm diameter zones. Variables were compared between PCG and control eyes. Percentages of PCG eyes with abnormal corneal irregularity and HOAs were calculated.

Results:

The median ages of PCG and control participants were 8.8 and 8.6 years, respectively. Irregularity and total HOAs across both 4 and 6 mm zones were greater in PCG than in control eyes. The median irregularity of PCG eyes was 2 to 5 times that of the controls, whereas, their median total HOAs were approximately twice those of the controls. Thirty-nine (64%), 53 (87%), and 40 (66%) PCG eyes had abnormal (either 4 or 6 mm zone) anterior irregularity, posterior irregularity, and total HOAs. Similar percentages were observed among eyes with a cup-to-disc ratio <0.6 (n=28). Among 13 eyes with cup-to-disc ratio <0.6 but abnormal 4 mm total corneal HOAs, 9 (69%) had BSCVA<20/25, whereas only 1 of 7 (14%) had BSCVA<20/25 among eyes with normal HOAs.

Conclusions:

Abnormal corneal irregularity and HOAs are common in PCG eyes, even in those with limited optic nerve damage. These abnormalities relate to compromised visual outcomes.
Prospective administration of anti–nerve growth factor treatment effectively suppresses functional connectivity alterations after cancer-induced bone pain in mice
Authors: Buehlmann David , Ielacqua Giovanna Diletta , Xandry Jael , Rudin Markus
Published: August 2018

Cancer-induced bone pain is abundant among advanced-stage cancer patients and arises from a primary tumor in the bone or skeletal metastasis of common cancer types such as breast, lung, or prostate cancer. Recently, antibodies targeting nerve growth factor (NGF) have been shown to effectively relieve neuropathic and inflammatory pain states in mice and in humans. Although efficacy has been shown in mice on a behavioral level, effectiveness in preventing pain-induced functional rearrangements in the central nervous system has not been shown. Therefore, we assessed longitudinal whole-brain functional connectivity using resting-state functional magnetic resonance imaging in a mouse model of cancer-induced bone pain. We found functional connectivity between major hubs of ascending and descending pain pathways such as the periaqueductal gray, amygdala, thalamus, and cortical somatosensory regions to be affected by a developing cancer pain state. These changes could be successfully prevented through prospective administration of a monoclonal anti-NGF antibody (mAb911). This indicates efficacy of anti-NGF treatment to prevent pain-induced adaptations in brain functional networks after persistent nociceptive input from cancer-induced bone pain. In addition, it highlights the suitability of resting-state functional magnetic resonance imaging readouts as an indicator of treatment response on the basis of longitudinal functional network changes.
Analysis of 4 Years of Injury in Professional Rodeo
Authors: Sinclair Elder Amanda J. , Nilson Collin J. , Elder Craig L.
Published: August 2018

Objective:

To analyze injury frequency, density, location, type, mechanism of injury (MOI), activity phase of injury, and injury risk in professional rodeo.

Design:

Retrospective epidemiological review.

Setting:

Professional Rodeo Cowboys Association sanctioned rodeos from 2011 to 2014.

Participants:

Professional Rodeo Cowboys Association competitors competing in bull riding, bareback riding, saddle bronc riding, team roping, tie-down roping, and steer wrestling.

Main Outcome Measures:

Injury reports were documented by sports medicine personnel. Variables assessed include event, frequency, density, location, type, MOI, activity phase of injury, and injury density.

Results:

A total of 2305 injuries from 139,098 competitor exposures (CEs) were reported, demonstrating overall injury density of 16.6 injuries per 1000 CEs (95% confidence interval, 0.016-0.017) and overall risk of injury of 1.69%. Rough stock riders accounted for 88.7% of all injuries. Bull riders, bareback riders, and saddle bronc riders demonstrated injury densities of 48.2, 41.1, and 23.2 injuries per 1000 CEs, respectively. Most injuries (62.9%) were sustained by collisions with the ground or animal, or being stomped on by the animal. Contusions, sprains, and concussions were the most frequent injury types (23.1%, 13.6%, and 11.6%, respectively). Neurological components, knees, and shoulders were the most injured body parts (13.4%, 11.1%, and 11.0%, respectively). Most injuries (36.8%) occurred during or immediately after the dismount.

Conclusions:

Rough stock events have the greatest risk of injury in professional rodeo, whereas steer wrestling has the greatest risk of injury for timed event athletes. Medical professionals should use these findings to implement prevention programming where possible.
A Simplified Prediction Model for Lower Extremity Long Bone Stress Injuries in Male Endurance Running Athletes
Authors: Carbuhn Aaron F. , Sanchez Zack , Fry Andrew C. , Reynolds Matthew R. , Magee Lawrence M.
Published: August 2018

Objective:

Develop a prediction model for lower extremity long bone injuries (LBIs) in male endurance running athletes using dual-energy x-ray absorptiometry (DEXA).

Design:

Retrospective.

Setting:

Sports medicine department in a university athletic setting.

Participants:

National Collegiate Athletic Association (NCAA) Division 1 white male endurance athletes (n = 27).

Independent Variables:

Backward stepwise elimination was used to achieve a model that predicts LBI, by removing noncontributory variables (P > 0.10), using binary logistic regression. Independent prediction variables analyzed for model were as follows: (1) height (cm), body mass index (BMI) (kg/m−2), and total mass (kg); and (2) regional and total lean mass, fat mass, and bone density assessed using DEXA.

Main Outcome Measures:

Dichotomous dependent variable was LBI.

Results:

Final constructed model predicted 96.3% of athletes with and without LBI. Prediction model were as follows: predict lower extremity long bone stress injury = 23.465 − 0.896 BMI + 1.043 (total upper-body mass) TUB − 34.536 leg bone mineral density (BMD). Predict lower extremity long bone stress injury is the LBI prediction, and TUB (kg) is total fat, muscle, and bone weight in trunk and arms.

Conclusions:

These preliminary data suggest that Division 1 white male endurance running athletes are at risk of LBI with higher relative TUB and lower BMI in combination with a lower leg BMD.
Return to Competition After Surgery for Herniated Lumbar Disc in Professional Football Players
Authors: Tencone Fabrizio , Minetto Marco Alessandro , Tomaello Luca , Giannini Alessandro , Roi Giulio Sergio
Published: August 2018

Objective:

To investigate the prevalence and outcomes of surgery for lumbar disc herniation in professional football players.

Design:

Retrospective case series.

Setting:

Sports rehabilitation center.

Participants:

A period of 10 seasons of the Italian Football First League (Serie A) was retrospectively investigated. Thirty-three teams (for a total of 1960 players) took turns in the 10 seasons, and 42 team doctors were requested to provide information about the number of players who underwent surgery for lumbar disc herniation.

Intervention:

Survey distributed to team doctors.

Main Outcome Measures:

Prevalence and match incidence of the lumbar discectomy, proportion of players returning to competition after surgery, recovery time and preintervention and postintervention number of appearances in official matches were analyzed.

Results:

Eleven players underwent the surgical intervention during the considered period. The prevalence of the surgical treatment was 0.6%, whereas the match incidence was 0.09 cases/1000 match hours. All players returned to competitions 6.0 (3.5-7.7) months after surgery, with no significant difference between different roles. The number of appearances in official matches was comparable during the seasons before and after surgery.

Conclusions:

The lumbar discectomy must be considered a rare surgical procedure performed in professional football players. All players returned to competitions after surgery. The postintervention number of appearances in official matches was comparable with the preintervention one.
Prevalence of Anal Squamous Intraepithelial Lesions in HIV-1–Infected Young Men Who Have Sex With Men and Transwomen
Authors: Thompson Amelia B. , Gillespie Scott E. , Mosunjac Marina B. , Hussen Sophia A. , Flowers Lisa C. , Camacho-Gonzalez Andres F.
Published: August 2018

Objective

Anal cancer rates are increasing among HIV-infected persons. Although an efficacious human papillomavirus (HPV) vaccine is available, HPV vaccination rates remain low. Therefore, providers perform anal cancer screening, but there is no consensus on the optimal methods or timing of screening. This study was performed to determine the prevalence of and factors associated with anal squamous intraepithelial lesions in sexually active HIV-infected young men who have sex with men and transgender women.

Materials and Methods

We performed a single-center, retrospective study of sexually active HIV-infected young men who have sex with men and transgender women aged 13 to 24 years at an HIV clinic in Atlanta GA from 2009 to 2016. We used analysis of variance and χ2 tests of independence to evaluate bivariate associations and identify demographic, behavioral, and clinical risk factors.

Results

Of 314 subjects with a mean (SD) age of 20.4 (2.1) years at initial anal cytology testing, 5% had completed the HPV vaccine series at or before the time that cytology was obtained. Ninety-five percent of the anal cytology tests obtained were abnormal, and 72 (29%) of those subjects returned for diagnostic testing either by intraoperative biopsy or high-resolution anoscopy. Fifty-seven percent of those who underwent biopsy had histologic high-grade squamous intraepithelial lesions including 2 cases of carcinoma in situ. A history of greater than 20 lifetime sexual partners was associated with abnormal histology (probability < 0.001, p = .017).

Conclusions

Our study highlights the value of early, standardized screening to avoid missing anal dysplasia or cancer, particularly in unvaccinated persons with high numbers of sexual partners.
Cannabis in liver disorders: a friend or a foe?
Authors: Goyal Hemant , Rahman M. Rubayat , Perisetti Abhilash , Shah Nihar , Chhabra Rajiv
Published: August 2018

The recent legalization of recreational marijuana use in some parts of the world, the discovery of new indications for the clinical application of cannabis, and the acceptance of the use of cannabis in practice has been paralleled by extensive research on the active components of cannabis and the endocannabinoid system within the human body. In this review, we evaluate the available evidence on cannabis and its constituents and the application of this evidence in clinical practice, focusing particularly on the liver and liver diseases. Constituents of cannabis, such as cannabidiol and Δ9-tetrahydrocannabinol, have shown anti-inflammatory, antioxidant, and hepatoprotective effects both in in vitro and clinical studies, and appear to have potential in the symptom management and treatment of various liver diseases that were previously considered difficult to manage conservatively. In addition, the manipulation of the inherent endocannabinoid response system has found favor in many clinical fields and has generated considerable research and clinical interest. Moreover, evidence with regard to the adverse effects of marijuana use in liver diseases is weak, which has led to raise a question on the prior rules, with regard to a denial of liver transplantation to marijuana users. All in all, the recent trends in research, clinical experiences, as well as the legislature, has opened up new avenues towards the widespread clinical application of cannabis and its derivatives as well as modifiers of the components of the endocannabinoid system. More research is required to fully exploit these new evidences.
How People with Low Vision Achieve Magnification in Digital Reading
Authors: Granquist Christina , Wu Yueh-Hsun , Gage Rachel , Crossland Michael D. , Legge Gordon E.
Published: August 2018

SIGNIFICANCE

Digital reading displays provide opportunities for enhancing accessibility of text for low vision. How are these displays used by people in their daily lives?

PURPOSE

Subjects responded to an online survey concerning their vision history, reading technology, display preferences, and reading habits. Here, we report on findings concerning acuity and magnification.

METHODS

The survey asked subjects to arrange a text passage for typical reading and to report viewing distance, screen dimensions, and the number of characters per line. Seventy-five adult subjects (most with early-onset low vision, few with central field loss) completed all survey questions relevant to the analysis of acuity and magnification. Mean acuity was .92 logMAR (range, 0.1 to 1.6), and mean age was 44.8 years (range, 18 to 71 years). Twelve normally sighted controls reported the same information while viewing the passage on cell phones, tablets, and computers.

RESULTS

The controls had a mean viewing distance of 38.7 cm and a mean x-height of 1.38 mm. For all three types of devices, angular x-height was 0.21° (close to laboratory estimates of the critical print size for reading). Low vision subjects showed decreasing viewing distance and increasing print size with larger values of logMAR acuity. Most of the low vision subjects achieved their desirable magnification by a combination of reduced viewing distance and increased physical letter size. The majority (54 of 75) relied more on letter-size magnification. Relative to the controls, regression analysis revealed that a typical low vision subject with logMAR acuity of 1.0 reduced viewing distance by a factor of 2.8 and enlarged physical print size by a factor of 6.

CONCLUSIONS

Our survey shows that people with a wide range of acuities are engaged in digital reading. Our subjects achieved desirable magnification primarily by enlarging physical character size and to a lesser extent by reducing viewing distance.
Preliminary Evaluation of a Wearable Camera-based Collision Warning Device for Blind Individuals
Authors: Pundlik Shrinivas , Tomasi Matteo , Moharrer Mojtaba , Bowers Alex R. , Luo Gang
Published: August 2018

SIGNIFICANCE

This work describes a preliminary evaluation of a wearable collision warning device for blind individuals. The device was found to provide mobility benefit in subjects without (or deprived of) vision. This preliminary evaluation will facilitate further testing of this developmental stage device in more naturalistic conditions.

PURPOSE

We developed a wearable video camera–based device that provided tridirectional collision warnings (right, center, and left) via differential feedback of two vibrotactile wristbands. We evaluated its mobility benefit in blind and normally sighted (NS) blindfolded individuals in indoor mobility courses.

METHODS

Three evaluation experiments were conducted. First, the ability of the device to provide warnings for hanging objects not detected by a long cane was evaluated in eight NS and four blind subjects in an obstacle course with and without the device. Second, the accuracy of collision warning direction assignment was evaluated in 10 NS subjects as they walked toward a hanging object at random offsets and verbally reported the obstacle offset position with respect to their walking path based on the wristbands' vibrotactile feedback. Third, the mobility benefit of collision warning direction information was evaluated by 10 NS and 4 blind subjects when walking with and without differential wristband feedback.

RESULTS

In experiment 1, collisions reduced significantly from a median of 11.5 without to 4 with the device (P < .001). Percent preferred walking speed reduced only slightly from 41% without to 36% with the device (P = .04). In experiment 2, the most likely reported relative obstacle positions were consistent with the actual positions. In experiment 3, subjects made more correct navigational decisions with than without the collision warning direction information (91% vs. 69%, P < .001).

CONCLUSIONS

Substantial mobility benefit of the device was seen in detection of aboveground collision threats missed by a long cane and in enabling better navigational decision making based on the tridirectional collision warning information.
A Global Public Health Perspective: Facilitating Access to Assistive Technology
Authors: du Toit Rènée , Keeffe Jill , Jackson Jonathan , Bell Diane , Minto Hasan , Hoare Philip
Published: August 2018

SIGNIFICANCE

Clinicians should not overlook vulnerable populations with limited access to assistive technology (AT), the importance of collaboration in multidisciplinary teams, advocacy for enabling environments, and supportive health systems. Resources, a model of care, and recommendations can assist clinicians in contributing to changing attitudes, expanding knowledge, and improving the lives of many.

The increasing availability of innovative advances in AT can immeasurably enhance the quality of life of people with disabilities. Clinicians will undoubtedly welcome the prospect of having cutting-edge AT available to prescribe to individuals who consult them. Arguably, though, the development of innovative strategies to improve access to AT, especially to underserved people “left behind,” is equally urgent. Current efforts are inadequate, with millions of people with disabilities not being reached. Particularly at risk are women, children, and the elderly, as well as poorer people who live in resource-poor and remote areas, especially in low- and middle-income countries. Not only must physical access be facilitated, but also quality services must be available. Good-quality, affordable AT, which is appropriate and acceptable to the user, would ideally be provided by competent personnel, working in multidisciplinary teams, offering comprehensive, person-centered services, including rehabilitation, fully integrated into the various levels of the health system. Clinicians can contribute to improving access to quality services, participate in initiatives aiming to increase the knowledge of health personnel and the public, engage in advocacy to change attitudes, influence legislation, and raise awareness of universal health coverage—ultimately facilitating access to AT for all.
Recommendations on RBC Transfusion in Critically Ill Children With Nonlife-Threatening Bleeding or Hemorrhagic Shock From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Authors: Karam Oliver , Russell Robert T. , Stricker Paul , Vogel Adam M. , Bateman Scot T. , Valentine Stacey L. , Spinella Philip C.
Published: August 2018

Objectives:

To present the recommendations and supporting literature for RBC transfusions in critically ill children with bleeding developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.

Design:

Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children.

Methods:

The panel of 38 experts developed evidence-based and, when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The bleeding subgroup included five experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method.

Results:

Transfusion and Anemia Expertise Initiative Consensus Conference experts developed a total of six recommendations focused on transfusion in the critically ill child with acute bleeding. In critically ill children with nonlife-threatening bleeding, we recommend giving a RBC transfusion for a hemoglobin concentration less than 5 g/dL, and be considered for a hemoglobin concentration between 5 and 7 g/dL. In critically ill children with hemorrhagic shock, we suggest that RBCs, plasma and platelets transfusion ratio between 2:1:1 to 1:1:1 until the bleeding is no longer life-threatening. We recommend future studies to develop physiologic and laboratory measures to indicate the need for RBC transfusions, and to determine if goal directed hemostatic resuscitation improves survival. Finally, we recommend future studies to determine if low titer group O whole blood is more efficacious and safe compared with reconstituted whole blood in children with hemorrhagic shock.

Conclusions:

The Transfusion and Anemia Expertise Initiative Consensus Conference developed pediatric specific recommendations regarding RBC transfusion management in the critically ill child with acute bleeding, as well as recommendations to help guide future research priorities.
Recommendations on RBC Transfusions for Critically Ill Children With Nonhemorrhagic Shock From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Authors: Muszynski Jennifer A. , Guzzetta Nina A. , Hall Mark W. , Macrae Duncan , Valentine Stacey L. , Bateman Scot T. , Spinella Philip C.
Published: August 2018

Objectives:

To present the recommendations and supporting literature for RBC transfusions in critically ill children with nonhemorrhagic shock developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.

Design:

Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children.

Methods:

The panel of 38 experts developed evidence-based, and when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The nonhemorrhagic shock subgroup included five experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method.

Results:

Transfusion and Anemia Expertise Initiative Consensus Conference experts developed and voted on a total of four clinical and four research recommendations focused on RBC transfusion in the critically ill child with nonhemorrhagic shock. All recommendations reached agreement (> 80%). Of the four clinical recommendations, three were based on consensus panel expertise, whereas one was based on weak pediatric evidence. In hemodynamically stabilized critically ill children with a diagnosis of severe sepsis or septic shock, we recommend not administering a RBC transfusion if the hemoglobin concentration is greater than or equal to 7 g/dL. Future studies are needed to determine optimum transfusion thresholds for critically ill children with nonhemorrhagic shock undergoing acute resuscitation.

Conclusions:

The Transfusion and Anemia Expertise Initiative Consensus Conference developed pediatric-specific clinical and research recommendations regarding RBC transfusion in the critically ill child with nonhemorrhagic shock. Although agreement among experts was strong, available pediatric evidence was scant—revealing significant gaps in the existing literature.
Lactic Acidosis in a Critically Ill Patient
Authors: Schuh Abigail M. , Leger Kasey Joanne , Summers Corinne , Uspal Neil G.
Published: August 2018

Lactic acidosis in the emergency department and other hospital settings is typically due to tissue hypoxia with sepsis being the most common cause. However, in patients with persistently elevated lactate without evidence of inadequate oxygen delivery, type B lactic acidosis should be considered. We report the case of a 12-year-old boy with relapsed and refractory pre–B-cell acute lymphoblastic leukemia who presented in distress with tachycardia, history of fever, and diffuse abdominal tenderness. The patient had severe metabolic acidosis with elevated lactate upon arrival to the emergency department. Despite aggressive fluid resuscitation and intravenous antibiotics, the patient's acidosis worsened. Serial blood cultures were negative, and he was eventually diagnosed with type B lactic acidosis secondary to relapsed acute lymphoblastic leukemia.
Heterogeneous Knee Effusions on Point-of-Care Ultrasound in a Toddler Diagnosed With Juvenile Idiopathic Arthritis
Authors: Rizvi Munaza B. , Rabiner Joni E.
Published: August 2018

Point-of-care musculoskeletal ultrasound can provide information about joint effusions and the quality of the effusion. This case report describes the findings of a previously healthy pediatric patient with acute onset of knee swelling and abnormal gait. After point-of-care ultrasound demonstrated bilateral knee effusions with complex, heterogeneous material, subsequent workup revealed a diagnosis of juvenile idiopathic arthritis (JIA). We review the ultrasound technique, sonographic findings, and literature regarding point-of-care ultrasound for knee effusions and JIA.
Hepatic Portal Venous Gas
Authors: Liang Keng-Wei , Huang Hsin-Hui , Tyan Yeu-Sheng , Tsao Teng-Fu
Published: August 2018

Ultrasonography (US) is believed to be the most available method of detecting hepatic portal venous gas (HPVG) with real-time imaging capability. Hepatic portal venous gas has characteristic image appearances in various ultrasound modes such as bright mode, Doppler mode, and even motion (M) mode. In this article, we give a comprehensive review of the image appearances of HPVG among different modes of US with a special focus on the M mode US. Hepatic portal venous gas was recognized as linear echogenicities in various oblique directions (the meteor shower sign) on the M mode US. This specific sign may expand some potential of HPVG detection by US.
Fronto-naso-orbital Reconstructions
Authors: Chen Shih-Heng , Ko An-Ta , Chen Hung-Chi , Roan Tyng-Luen , Tang Yueh-Bih
Published: August 2018

Background

Significant defects at the fronto-naso-orbital area always present with severe facial disfigurement for the afflicted individuals. It may occur after tumor ablations, compound comminuted fractures, or craniofacial surgeries at this area.

Patients and Methods

Reconstructions of 11 patients with this problem had been performed by the authors, with follow-up for 3 to 25 years. The modes of reconstruction involved carved cartilage block with fascia grafts in 3 patients, split calvarial bone grafting covered with fascia grafts in 2 patients, drilled bone chips harvested from outer table of calvarial bone encased with fascia for smaller defects in 2 patients, 3-dimensional computed tomographic reconstruction and reformation of replica to replace the destroyed framework in 4 patients.

Results

Patients in this series all achieved good results, with symmetric face, acceptable facial contour, and being willing to attend social activities with deliberate evaluation and planning, selection of proper method, with proficient skills in reconstruction. One patient who received cartilage block grafting came back for refining facial contour 18 years later.

Conclusions

Midline fronto-naso-orbital defects could be reconstructed with carved cartilage graft or bone graft, overlaid with fascia graft, intricate asymmetric defects can be reconstructed with the aid of 3-dimensional computed tomographic image reconstruction and reformation of the defect replica to achieve symmetric esthetic result with individualized approaches.
How to Get Started Performing Supermicrosurgical Lymphaticovenular Anastomosis to Treat Lymphedema
Authors: Chen Wei F.
Published: August 2018

Recent advancements in microsurgery and supermicrosurgery have made effective lymphedema treatment a surgical reality. When comparing the 2 currently available procedures, lymphaticovenular anastomosis (LVA) and vascularized lymph node transfer, vascularized lymph node transfer is more frequently performed owing to technical unfamiliarity with supermicrosurgery and uncertainty in patient selection, technical execution, and procedural outcome. To date, the author has performed more than 250 cases of supermicrosurgical LVAs. In this article, the author shares his approach in technical acquisition, how to get over the learning curve using a simulation model, patient selection, LVA-specific technical pearls, outcome assessment, and finally how to team up with other lymphedema-related specialists. After reading this paper, the readers should have enough knowledge to get started building a surgical lymphedema program.
Could Nasal Surgery Affect Multilevel Surgery Results for Obstructive Sleep Apnea?
Authors: El-Anwar Mohammad Waheed , Amer Hazem S. , Askar Sherif M. , Elsobki Ahmed , Awad Ali
Published: August 2018

Objective:

To study the role of nasal surgery as a part of multilevel surgery for management of obstructive sleep apnea (OSA).

Methods:

All patients underwent multilevel surgery for relieving OSA symptoms and they were classified according to type of surgical intervention into: group A (20 patients), who underwent hyoid suspension (Hyoidthyroidpexy), tonsillectomy, suspension (El-Ahl and El-Anwar) sutures and nasal surgery (inferior turbinate surgery). Group B (20 patients), who underwent hyoid suspension (Hyoidthyroidpexy), tonsillectomy and suspension sutures. Pre and postoperative sleep study, Epworth sleepiness scale, snoring score were reported and compared.

Results:

Apnea hypoapnea index (AHI) dropped significantly in both groups. The mean preoperative AHI was significantly less in patients who had no nasal obstruction (P = 0.0367), while the difference in postoperative values was nonsignificant (P = 0.7358).

The mean Epworth sleepiness scale improved significantly in both groups, but the difference between pre and postoperative values in both groups was nonsignificant. The lowest oxygen saturation elevated significantly in both groups, but the difference between pre and postoperative values in both groups was nonsignificant. As regards snoring scores, they dropped significantly in both groups. The preoperative snoring score was reported to be significantly more in patients who had associated nasal obstruction (group A) (P = 0.0113). But after surgery the difference in postoperative values was nonsignificant (P = 0.1296).

Conclusion:

Treatment of nasal obstruction should be considered a crucial component in the comprehensive management plan for OSA patients as it has significant impact on the patients’ AHI and snoring.
A Public Database on Traumatic Brachial Plexus Injury
Authors: Patroclo Cristiane B , Ramalho Bia L , Maia Juliana S , Rangel Maria Luíza , Torres Fernanda F , Souza Lidiane , Braghetto Kelly R , Vargas Claudia D
Published: August 2018

We hereby present the first worldwide public digital database centred on adult Traumatic Brachial Plexus Injury (TBPI). This initiative aims at reducing distance between clinical and experimental practice and encouraging data sharing and reuse. Detailed electronic questionnaires made with the free software LimeSurvey were designed to collect patients’ epidemiological, physical and clinical data. The freely available software Neuroscience Experiments System (NES) was employed to support data storage and management. First results of this effort concern data collected from 109 Brazilian adult TBPI patients with varying degrees of functional impairment. The sample is composed by large majority of men (84.4%), mean age of 32.1 (11.3 SD) years old, victims of motorcycle accidents (67%). The similarity of this dataset basic descriptors with those from previous reports in TBPI validates the strategies employed herein. Managing data from diverse provenance in TBPI may allow identifying functional markers related to the patients’ clinical improvement and foster the development of new investigative tools to unveil its mechanisms.
New phylogenomic analysis of the enigmatic phylum Telonemia further resolves the eukaryote tree of life
Authors: Strassert Jürgen F. H. , Jamy Mahwash , Mylnikov Alexander P. , Tikhonenkov Denis V. , Burki Fabien
Published: August 2018

The broad-scale tree of eukaryotes is constantly improving, but the evolutionary origin of several major groups remains unknown. Resolving the phylogenetic position of these ‘orphan’ groups is important, especially those that originated early in evolution, because they represent missing evolutionary links between established groups. Telonemia is one such orphan taxon for which little is known. The group is composed of molecularly diverse biflagellated protists, often prevalent although not abundant in aquatic environments. Telonemia has been hypothesized to represent a deeply diverging eukaryotic phylum but no consensus exists as to where it is placed in the tree. Here, we established cultures and report the phylogenomic analyses of three new transcriptome datasets for divergent telonemid lineages. All our phylogenetic reconstructions, based on 248 genes and using site-heterogeneous mixture models, robustly resolve the evolutionary origin of Telonemia as sister to the Sar supergroup. This grouping remains well supported when as few as 60% of the genes are randomly subsampled, thus is not sensitive to the sets of genes used but requires a minimal alignment length to recover enough phylogenetic signal. Telonemia occupies a crucial position in the tree to examine the origin of Sar, one of the most lineage-rich eukaryote supergroups. We propose the moniker ‘TSAR’ to accommodate this new mega-assemblage in the phylogeny of eukaryotes.
Sparse network-based regularization for the analysis of patientomics high-dimensional survival data
Authors: Veríssimo André , Carrasquinha Eunice , Lopes Marta B. , Oliveira Arlindo L. , Sagot Marie-France , Vinga Susana
Published: August 2018

Data availability by modern sequencing technologies represents a major challenge in oncological survival analysis, as the increasing amount of molecular data hampers the generation of models that are both accurate and interpretable. To tackle this problem, this work evaluates the introduction of graph centrality measures in classical sparse survival models such as the elastic net.

We explore the use of network information as part of the regularization applied to the inverse problem, obtained both by external knowledge on the features evaluated and the data themselves. A sparse solution is obtained either promoting features that are isolated from the network or, alternatively, hubs,i.e., features that are highly connected within the network.

We show that introducing the degree information of the features when inferring survival models consistently improves the model predictive performance in breast invasive carcinoma (BRCA) transcriptomic TCGA data while enhancing model interpretability. Preliminary clinical validation is performed using the Cancer Hallmarks Analytics Tool API and the String database.

These case studies are included in the recently released glmSparseNet R package1, a flexible tool to explore the potential of sparse network-based regularizers in generalized linear models for the analysis of omics data.
Towards a decision support tool for intensive care discharge: machine learning algorithm development using electronic health care data from MIMIC-III and Bristol, UK.
Authors: McWilliams Christopher , Lawson Daniel J , Santos-Rodriguez Raul , Gilchrist Iain D , Champneys Alan , Gould Timothy H , Thomas Matthew J.C. , Bourdeaux Christopher P
Published: August 2018

Objective: The primary objective is to develop an automated method for detecting patients that are ready for discharge from intensive care.
Design: We used two datasets of routinely collected patient data to test and improve upon a set of previously proposed discharge criteria.
Setting: Bristol Royal Infirmary general intensive care unit (GICU).
Patients: Two cohorts derived from historical datasets: 1870 intensive care patients from GICU in Bristol, and 7592 from MIMIC-III (a publicly available intensive care dataset).
Results: In both cohorts few successfully discharged patients met all of the discharge criteria. Both a random forest and a logistic classifier, trained using multiple-source cross-validation, demonstrated improved performance over the original criteria and generalised well between the cohorts. The classifiers showed good agreement on which features were most predictive of readiness-for-discharge, and these were generally consistent with clinical experience. By weighting the discharge criteria according to feature importance from the logistic model we showed improved performance over the original criteria, while retaining good interpretability.
Conclusions: Our findings indicate the feasibility of the proposed approach to ready-for-discharge classification, which could complement other risk models of specific adverse outcomes in a future decision support system. Avenues for improvement to produce a clinically useful tool are identified.
Detection and Molecular Epidemiology of Human Bocavirus in Children with Acute Gastroenteritis from Brazil
Authors: Soares L.S. , Lima A. B. , Pantoja K.C. , Lobo P.S. , Cruz J.F. , Guerra S.F.S. , Bezerra D.A.M. , Bandeira R.S. , Mascarenhas J.D.P.
Published: August 2018

Human Bocavirus (HBoV) is a recently discovered virus and was first detected in the nasopharyngeal aspirate samples and after in stool samples, suggesting that HBoV may be a causative agent for human enteric infections. Due to absence of treatment options, there is a need to understand the disease-causing mechanism of these viruses. The aim of this was to demonstrate the prevalence of HBoV from children less than 10 years with acute gastroenteritis in Brazil, during November 2011 to November 2012. Stool samples from hospitalized children ≤ 10 years who presented symptoms of acute gastroenteritis were analyzed for the presence of HBoV DNA by nested-PCR. HBoV- positivity was detected in 24.0% (54/225) of samples. Two peaks of HBoV detection were observed, during November 2011 and July to September 2012. Co-infections between HBoV and rotavirus A were identified in 50.0% (27/54) of specimens. Phylogenetic analysis identified the presence of HBoV-1 (94.8%), HBoV-2 (2.6%) and HBoV-3 (2.6%) species, with only minor variations among them. Further investigations are necessary to improve the knowledge on the role of HBoV in gastrointestinal infections.
Characterization and mechanism of lead and zinc biosorption by growing Verticillium insectorum J3
Authors: Feng Chong-ling , Li Jin , Li Xue , Li Ke-lin , Luo Kun , Liao Xing-sheng , Liu Tao
Published: August 2018

Verticillium insectorum J3 was isolated from a local lead-zinc deposit tailing, and its biosorption characteristics and reaction to the toxicities of different Pb(II) and Zn(II) concentrations were investigated. SEM, FTIR, a pH test and a desorption experiment were carried out to identify a possible mechanism. The biosorption of J3 presented an inhibition trend at low concentrations (25-75 mg L-1) and promotion at high concentrations (100-300 mg L-1). J3 absorbed Pb(II) prior to Zn(II) and produced alkaline substances, while mycelial and pellet morphology modifications were important for the removal of Pb(II) and Zn(II) under different stressful conditions (SEM results). Both intracellular accumulation and extracellular absorption may contribute to the removal of Pb(II) at lower concentrations (25-50 mg L-1), although mainly extracellular biosorption occurred at higher concentrations (75-300 mg L-1). However, Zn(II) bioaccumulation occurred at all concentrations assayed. Verticillium insectorum J3 may have evolved active defenses to alleviate the toxicity of heavy metals and proved to be a highly efficient biosorbent, especially for Pb(II) at high concentrations. This study is a useful reference for the development of biotreatment technologies to mitigate heavy metal waste.
Life-cycle mediated effects of urbanization on parasite communities in the estuarine fish, Fundulus heteroclitus
Authors: Alfieri James M. , Anderson Tavis K.
Published: August 2018

This study examined the relationship between urbanization and parasite community structure in the estuarine fish, Fundulus heteroclitus. We measured landscape and physicochemical factors associated with urbanization at 6 sites from 4 collection periods. Concurrently, we quantified the metazoan parasite community in F. heteroclitus collected at those sites, with 105 fish studied per site during the 4 collection periods. Parasite community composition differed between sites. Variation in the prevalence and intensity of infection of two indirect life-cycle parasites, Lasiocotus minutus and Glossocercus caribaensis, were the primary parasite species that determined this pattern. Sediment potassium and aquatic osmium were the most important physicochemical factors in structuring parasite communities, and habitat dominance was the most important landscape factor. Our data supports the hypothesis that urbanization, acting at both landscape and physicochemical scales, can have a significant impact on parasite community structure. This, however, varied by parasite life history: there was little effect of urbanization on the prevalence and intensity of direct life-cycle parasites, but significant variation was dedicated for indirect life-cycle parasites. This study demonstrates how anthropogenically driven landscape change influences fine-scale parasite population dynamics.
Systematic characterization of genome editing in primary T cells reveals proximal genomic insertions and enables machine learning prediction of CRISPR-Cas9 DNA repair outcomes
Authors: Leenay Ryan T. , Aghazadeh Amirali , Hiatt Joseph , Tse David , Hultquist Judd F. , Krogan Nevan , Wu Zhenqin , Marson Alexander , May Andrew P. , Zou James
Published: August 2018

The Streptococcus pyogenes Cas9 (SpCas9) nuclease has become a ubiquitous genome editing tool due to its ability to target almost any location in DNA and create a double-stranded break1,2. After DNA cleavage, the break is fixed with endogenous DNA repair machinery, either by non-templated mechanisms (e.g. non-homologous end joining (NHEJ) or microhomology-mediated end joining (MMEJ)), or homology directed repair (HDR) using a complementary template sequence3,4. Previous work has shown that the distribution of repair outcomes within a cell population is non-random and dependent on the targeted sequence, and only recent efforts have begun to investigate this further5–11. However, no systematic work to date has been validated in primary human cells5,7. Here, we report DNA repair outcomes from 1,521 unique genomic locations edited with SpCas9 ribonucleoprotein complexes (RNPs) in primary human CD4+ T cells isolated from multiple healthy blood donors. We used targeted deep sequencing to measure the frequency distribution of repair outcomes for each guide RNA and discovered distinct features that drive individual repair outcomes after SpCas9 cleavage. Predictive features were combined into a new machine learning model, CRISPR Repair OUTcome (SPROUT), that predicts the length and probability of nucleotide insertions and deletions with R2 greater than 0.5. Surprisingly, we also observed large insertions at more than 90% of targeted loci, albeit at a low frequency. The inserted sequences aligned to diverse regions in the genome, and are enriched for sequences that are physically proximal to the break site due to chromatin interactions. This suggests a new mechanism where sequences from three-dimensionally neighboring regions of the genome can be inserted during DNA repair after Cas9-induced DNA breaks. Together, these findings provide powerful new predictive tools for Cas9-dependent genome editing and reveal new outcomes that can result from genome editing in primary T cells.
Cryogenically preserved RBCs support gametocytogenesis ofPlasmodium falciparuminvitroand gametogenesis in mosquitoes
Authors: Pathak Ashutosh K. , Shiau Justine C. , Thomas Matthew B. , Murdock Courtney
Published: August 2018

Background

The malaria Eradication Research Agenda (malERA) has identified human-to-mosquito transmission ofPlasmodium falciparumas a major target for eradication. The cornerstone for identifying and evaluating transmission in the laboratory is small membrane feeding assays (SMFAs) where mature gametocytes ofP. falciparumgeneratedin vitroare offered to mosquitoes as part of a blood-meal. However, propagation of “infectious” gametocytes requires 10-12 days with considerable physico-chemical demands imposed on host RBCs and thus, “fresh” RBCs that are ≤1-week old post-collection are generally recommended. However, in addition to the costs, physico-chemical characteristics unique to RBC donors may confound reproducibility and interpretation of SMFAs. Cryogenic storage of RBCs (cryo-preserved RBCs herein) is approved by the European and US FDAs as an alternative to refrigeration (4°C) for preserving RBC quality and while cryo-preserved RBCs have been used forin vitrocultures of otherPlasmodiaand the asexual stages ofP. falciparum, none of the studies required RBCs to support parasite development for >4 days.

Results

Using the standard laboratory strain,P. falciparumNF54, we first demonstrate that cryo-preserved RBCs preserved in the gaseous phase of liquid nitrogen and thawed after storage for 1, 4, 8 and 12 weeks, supported gametocytogenesisin vitroand subsequent gametogenesis inAnopheles stephensimosquitoes. Using data from 11 SMFAs and RBCs from 4 separate donors with 3 donors re-tested following various periods of cryo-preservation, we show that overall levels of sporogony in the mosquito, as measured by oocyst prevalence and burdens in the midguts and sporozoites in salivary glands, were similar or better than using ≤1-week old refrigerated RBCs. Additionally, the potential for cryo-preserved RBCs to serve as a universal substrate for SMFAs is shown for a Cambodian isolate ofP. falciparum.

Conclusions

Considering the suitability of cryo-preserved RBCs forP. falciparumSMFAs, we suggest guidelines for their use and how they can be integrated into an existing laboratory/insectary framework with the potential to significantly reduce running costs and provide greater reliability. Finally, we discuss scenarios where cryo-preserved RBCs may be especially useful in enhancing our understanding and/or providing novel insights into the patterns and process underlying human-to-mosquito transmission.
KymoButler, a Deep Learning software for automated kymograph analysis
Authors: Jakobs Maximilian A. H. , Dimitracopoulos Andrea , Franze Kristian
Published: August 2018

Kymographs are graphical representations of spatial position over time, which are often used in biology to visualise the motion of fluorescent particles, molecules, vesicles, or organelles moving along a predictable path. Although in kymographs tracks of individual particles are qualitatively easily distinguished, their automated quantitative analysis is much more challenging. Kymographs often exhibit low signal-to-noise-ratios (SNRs), and available tools that automate their analysis usually require manual supervision. Here we developed KymoButler, a Deep Learning-based software to automatically track dynamic processes in kymographs. We demonstrate that KymoButler performs as well as expert manual data analysis on kymographs with complex particle trajectories from a variety of different biological systems. The software was packaged in a web-based “one-click” application for use by the wider scientific community. Our approach significantly speeds up data analysis, avoids unconscious bias, and represents another step towards the widespread adaptation of Machine Learning techniques in biological data analysis.