bluuebunny/crossref_metadata_2025 huggingface dataset:
Normal black holes in bulge-less galaxies: the largely quiescent, merger-free growth of black holes over cosmic time
Authors: Martin G , Kaviraj S , Volonteri M , Simmons B D , Devriendt J E G , Lintott C J , Smethurst R J , Dubois Y , Pichon C
Published: February 2018

Understanding the processes that drive the formation of black holes (BHs) is a key topic in observational cosmology. While the observed MBH–MBulge correlation in bulge-dominated galaxies is thought to be produced by major mergers, the existence of an MBH–M⋆ relation, across all galaxy morphological types, suggests that BHs may be largely built by secular processes. Recent evidence that bulge-less galaxies, which are unlikely to have had significant mergers, are offset from the MBH–MBulge relation, but lie on the MBH–M⋆ relation, has strengthened this hypothesis. Nevertheless, the small size and heterogeneity of current data sets, coupled with the difficulty in measuring precise BH masses, make it challenging to address this issue using empirical studies alone. Here, we use Horizon-AGN, a cosmological hydrodynamical simulation to probe the role of mergers in BH growth over cosmic time. We show that (1) as suggested by observations, simulated bulge-less galaxies lie offset from the main MBH–MBulge relation, but on the MBH–M⋆ relation, (2) the positions of galaxies on the MBH–M⋆ relation are not affected by their merger histories, and (3) only ∼35 per cent of the BH mass in today's massive galaxies is directly attributable to merging – the majority (∼65 per cent) of BH growth, therefore, takes place gradually, via secular processes, over cosmic time.
Nonawake vs Awake Placement of Spinal Cord Stimulators: A Prospective, Multicenter Study Comparing Safety and Efficacy
Authors: Falowski Steven M , Sharan Ashwini , McInerney James , Jacobs Darren , Venkatesan Lalit , Agnesi Filippo
Published: February 2018

BACKGROUND

Spinal cord stimulation (SCS) is a common intervention for managing intractable pain. Generally, leads are implanted in a minimally invasive procedure with verbal feedback regarding the location and nature of generated paresthesias by active stimulation; in this way their optimal location can be confirmed. However, lead placement under general anesthesia can have additional benefits.

OBJECTIVE

To investigate the outcomes of awake vs asleep lead placement procedures.

METHODS

In this prospective multicenter open label trial, subjects were assigned to undergo asleep (n = 19) or awake (n = 11) SCS implantations in a nonrandomized fashion. Subjects received paddle leads following laminotomy. The process for intraoperative programming differed between the groups: awake subjects participated by verbally reporting on pain-paresthesia overlap, while for asleep subjects, paresthesia location was inferred based on electromyographic monitoring.

RESULTS

Operative time was shorter for the asleep group compared to the awake group (88.9 ± 51.2 min vs 125.2 ± 37.9, respectively; P = .018), as well as 27% less total time spent in the operating room (95.4 ± 48.6 min vs 130.6 ± 39.9; P = .014). At 6 wk postimplant, subjects in the asleep group had better pain-paresthesia overlap than the awake group (83.5% ± 19.8 coverage vs 46.6% ± 44.5, respectively; P = .05) and fewer extraneous paresthesia (16.7% ± 23.1 vs 71.2% ± 30.3; P < .001). Both groups had equivalent levels of pain relief (more than 50%) after 6 and 24 wk of treatment. There were 2 adverse events in the asleep group compared to 6 in the awake group.

CONCLUSION

Electrophysiological monitoring during asleep SCS implantation is a robust tool becoming more frequently used. This comparative prospective series demonstrates that asleep placement allows for shorter procedure and operating room times with superior paresthesia coverage profiles, while maintaining lower adverse events and equal clinical outcomes for pain relief.
Quality Reporting in Neurological Surgery: Practice Adherence to Quality Payment Program Guidelines
Authors: Agarwal Nitin , Kashkoush Ahmed , Baucom Elizabeth T , Ratliff John K , Stroink Ann R ,   The Council of State Neurosurgical Societies
Published: February 2018

Recent legislation has changed quality reporting in neurological surgery. The present study summarizes the reporting of objectives and measures outlined by the Quality Payment Program (QPP) and assesses how practices are preparing to comply. In February 2017, 220 neurosurgical practices were surveyed regarding their adherence to quality reporting objectives and measures. Survey responders were asked to report infrastructure-level data including practice type and number of providers. Furthermore, we evaluated the reporting of quality and advancing care measures outlined by the QPP. Assessment of quality measures was focused on those related to neurosurgical patient management. A total of 27 responses were obtained. Practices consisted of 8 academic (30%), 16 physician-owned (59%), and 3 hospital-owned (11%) neurosurgical practices. Of the 27 total responders, 18 indicated their adherence to a host of quality and advancing care measures. Practice type was strongly associated with the number of quality measures performed (P = .020, Wilcoxon rank-sum test). Physician-owned practices reported performing a median of 5 quality measures (interquartile range, 4.5-9.5), while practices in academic and hospital-owned groups reported performing 12 quality measures (interquartile range, 9.5-13.5). Forty-five percent of physician-owned practices reported performing at least 6 quality measures, whereas 100% of academic and hospital-owned practices reported the same benchmark (P = .038, Fisher's exact test). Performance of advancing care measures was not associated with practice type. Compared to other practice types, the rate of quality reporting among physician-owned neurosurgical practices appears to be modest thus far, which may influence future reimbursement adjustments.
SNARE-Encoding Genes VdSec22 and VdSso1 Mediate Protein Secretion Required for Full Virulence in Verticillium dahliae
Authors: Wang Jie , Tian Li , Zhang Dan-Dan , Short Dylan P. G. , Zhou Lei , Song Shuang-Shuang , Liu Yan , Wang Dan , Kong Zhi-Qiang , Cui Wei-Ye , Ma Xue-Feng , Klosterman Steven J. , Subbarao Krishna V. , Chen Jie-Yin , Dai Xiao-Feng
Published: February 2018

Proteins that mediate cellular and subcellular membrane fusion are key factors in vesicular trafficking in all eukaryotic cells, including the secretion and transport of plant pathogen virulence factors. In this study, we identified vesicle-fusion components that included 22 soluble N-ethylmaleimide-sensitive factor attachment protein receptors (SNAREs), four Sec1/Munc18 (SM) family proteins, and 10 Rab GTPases encoded in the genome of the vascular wilt pathogen Verticillium dahliae Vd991. Targeted deletion of two SNARE-encoding genes in V. dahliae, VdSec22 and VdSso1, significantly reduced virulence of both mutants on cotton, relative to the wild-type Vd991 strain. Comparative analyses of the secreted protein content (exoproteome) revealed that many enzymes involved in carbohydrate hydrolysis were regulated by VdSec22 or VdSso1. Consistent with a role of these enzymes in plant cell–wall degradation, pectin, cellulose, and xylan utilization were reduced in the VdSec22 or VdSso1 mutant strains along with a loss of exoproteome cytotoxic activity on cotton leaves. Comparisons with a pathogenicity-related exoproteome revealed that several known virulence factors were not regulated by VdSec22 or VdSso1, but some of the proteins regulated by VdSec22 or VdSso1 displayed different characteristics, including the lack of a typical signal peptide, suggesting that V. dahliae employs more than one secretory route to transport proteins to extracellular sites during infection.
Relationship Between Drosophila suzukii and Postharvest Disorders of Sweet Cherry (Prunus avium)
Authors: Ayyanath M.-M. , Zurowski C. L. , Scott I. M. , Lowery D. T. , Watson M. C. , O’Gorman D. T. , MacKenzie K. E. , Úrbez-Torres J. R.
Published: February 2018

Spotted wing drosophila, Drosophila suzukii, utilizes intact ripe fruits for oviposition and larval development. Sweet cherry (Prunus avium) and D. suzukii share a saprophytic microbial community, or microbiome, that colonizes the interior and exterior of the fruit, which benefits the nutrition and development of the flies. Some of the microbes, specifically yeast species, are also reportedly associated with a newly described slip-skin-like disorder of sweet cherries. In British Columbia (BC), Canada, contact-based insecticides and fungicides are applied to sweet cherry to suppress D. suzukii populations and cherry diseases, respectively. To date, no resistance to the organophosphate insecticide, malathion, in D. suzukii field or laboratory populations has been reported. Laboratory bioassays with malathion-incorporated diet determined that when microorganisms associated with the D. suzukii microbiome were sterilized with potassium metabisulfite (KMS), survival of the flies was significantly affected. These findings led to speculation that malathion residues on cherry fruit may be degraded due to the greater presence of yeast species that are spared as a result of selective fungicide use patterns in cherry orchards. In orchard trials, KMS was shown to be effective in suppressing the surface yeast counts on cherry, but this did not impact symptoms of slip-skin-like disorder. Based on these findings, it is recommended that other products functioning as systemic biocides need to be investigated to address these two microbial-connected pest management concerns in sweet cherries.
Prolonged Catheter Use and Infection in Regional Anesthesia
Authors: Bomberg Hagen , Bayer Ina , Wagenpfeil Stefan , Kessler Paul , Wulf Hinnerk , Standl Thomas , Gottschalk André , Döffert Jens , Hering Werner , Birnbaum Jürgen , Spies Claudia , Kutter Bernd , Winckelmann Jörg , Liebl-Biereige Simone , Meissner Winfried , Vicent Oliver , Koch Thea , Sessler Daniel I. , Volk Thomas , Raddatz Alexander
Published: February 2018

Background

Prolonged catheter use is controversial because of the risk of catheter-related infection, but the extent to which the risk increases over time remains unknown. We thus assessed the time-dependence of catheter-related infection risk up to 15 days.

Methods

Our analysis was based on the German Network for Regional Anesthesia, which includes 25 centers. We considered 44,555 patients who had surgery between 2007 and 2014 and had continuous regional anesthesia as well as complete covariable details. Cox regression analysis was performed and adjusted for confounding covariables to examine the relationship between catheter duration and probability of infection-free catheter use.

Results

After adjustment for confounding factors, the probability of infection-free catheter use decreases with each day of peripheral and epidural catheter use. In peripheral catheters, it was 99% at day 4 of catheter duration, 96% at day 7, and 73% at day 15. In epidural catheters, it was 99% at day 4 of catheter duration, 95% at day 7, and 73% at day 15. Only 31 patients (0.07%) had severe infections that prompted surgical intervention. Among these were five catheters that initially had only mild or moderate signs of infection and were left in situ; all progressed to severe infections.

Conclusions

Infection risk in catheter use increases over time, especially after four days. Infected catheters should be removed as soon as practical.
Clinical Management of Endometriosis
Authors: Falcone Tommaso , Flyckt Rebecca
Published: February 2018

Endometriosis is a common and challenging condition of reproductive-aged women that carries a high individual and societal cost. The many molecular dissimilarities between endometriosis lesions and eutopic endometrium create difficulties in the development of new drug therapies and treatments. Surgery remains the gold standard for definitive diagnosis, but it must be weighed against the risks of surgical morbidity and potential decreases in ovarian reserve, especially in the case of endometriomas. Safe and effective surgical techniques are discussed within this article for various presentations of endometriosis. Medical therapy is suppressive rather than curative, and regimens that are long-term and affordable with minimal side effects are recommended. Recurrences are common and often rapid when medical therapy is discontinued. Endometriosis in the setting of infertility is reviewed and appropriate management is discussed, including when and whether surgery is warranted in this at-risk population. In patients with chronic pain, central sensitization and myofascial pain are integral components of a multidisciplinary approach. Endometriosis is associated with an increased risk of epithelial ovarian cancer; however, the risk is low and currently no preventive screening is recommended. Hormone therapy for symptomatic women with postsurgical menopause should not be delayed as a result of concerns for malignancy or recurrence of endometriosis.
Sliding Sign for Intra-abdominal Adhesion Prediction Before Repeat Cesarean Delivery
Authors: Drukker Lior , Sela Hen Y. , Reichman Orna , Rabinowitz Ron , Samueloff Arnon , Shen Ori
Published: February 2018

BACKGROUND:

The sliding sign (the relative motion between the abdominal and uterine wall as assessed by ultrasonography) may help identify severe intra-abdominal adhesions before repeat cesarean delivery.

METHODS:

We conducted a prospective observational study of scheduled repeat cesarean deliveries. Using transabdominal ultrasonography, while the parturient breathed deeply, the ultrasonographer recorded a video clip in a sagittal plane lateral to the umbilicus. These clips were assessed for the presence (sliding-positive) or absence (sliding-negative) of relative movement between the maternal abdominal and uterine wall. Surgeons blinded to ultrasonography results graded the severity of intraperitoneal adhesions intraoperatively. Study outcomes were the accuracy of the preoperative sliding sign for prediction of severe adhesions and its association with surgical times and bleeding.

EXPERIENCE:

We recruited 370 women. A negative sliding sign was associated with severe adhesions (sensitivity 56%, 95% CI 35–76; specificity 95%, 95% CI 93–97). A similar accuracy (sensitivity 64%, 95% CI 43–82; specificity 94%, 95% CI 92–97) was achieved by combining the sliding sign with a history of adhesions in the previous surgery. In multivariable models, a negative sliding sign was significantly correlated with a longer interval from skin incision to delivery and increased risk for bleeding.

CONCLUSION:

A negative sliding sign predicts severe intra-abdominal adhesions encountered during repeat cesarean delivery, longer time to delivery, and a higher chance of bleeding.
Maternal and Perinatal Outcomes After Laparoscopic Sleeve Gastrectomy
Authors: Rottenstreich Amihai , Elchalal Uriel , Kleinstern Geffen , Beglaibter Nahum , Khalaileh Abed , Elazary Ram
Published: February 2018

OBJECTIVE:

To examine associations of laparoscopic sleeve gastrectomy with maternal and perinatal outcomes.

METHODS:

We conducted a retrospective case–control study of deliveries that occurred from 2006 to 2016 at two university hospitals. The study group comprised all women who had undergone laparoscopic sleeve gastrectomy and who delivered during the study period. If a woman had more than one pregnancy during the study period, data from only her first pregnancy were used. A control group was established by matching preoperative body mass index (BMI), age, parity, delivery history, and delivery year.

RESULTS:

Data from 238 women were analyzed, 119 post–laparoscopic sleeve gastrectomy and 119 matched control parturients. Among the post–laparoscopic sleeve gastrectomy patients, the median preoperative BMI was 41.7 (interquartile range 39.9–44.4) and the median postoperative BMI was 28.9 (26.6–32.0). Compared with the control group, the study group had lower rates of gestational diabetes mellitus (3.4% vs 17.6%, P=.001), large-for-gestational-age neonates (1.7% vs 19.3%, P=.001), and birth weight greater than 4,000 g (0.8% vs 7.6%, P=.02) but higher proportions of small-for-gestational-age (SGA) neonates (14.3% vs 4.2%, P=.01) and low-birth-weight neonates (12.6% vs 4.2%, P=.03). Rates of gestational hypertensive disorders and prematurity were comparable between the groups. For the study group, hemoglobin levels were lower in early pregnancy (median 12.6 vs 13.2 g/dL, P=.001) and after delivery (10.5 vs 10.8 g/dL, P=.002), and a higher proportion of patients were treated with intravenous iron supplementation during pregnancy (14.3% vs 0.8%, P=.001). Cesarean delivery rates during labor were lower in the study group (10.1% vs 20.2%, P=.04).

CONCLUSION:

Laparoscopic sleeve gastrectomy was associated with reduced rates of gestational diabetes mellitus, excessive fetal growth, and cesarean delivery and an increased rate of SGA and low-birth-weight neonates.
Association Between Labor and Delivery Unit Census and Delays in Patient Management
Authors: Molina Rose L. , Gombolay Matthew , Jonas Jennifer , Modest Anna M. , Shah Julie , Golen Toni H. , Shah Neel T.
Published: February 2018

OBJECTIVE:

To demonstrate the association between increases in labor and delivery unit census and delays in patient care decisions using a computer simulation module.

METHODS:

This was an observational cohort study of labor and delivery unit nurse managers. We developed a computer module that simulates the physical layout and clinical activity of the labor and delivery unit at our tertiary care academic medical center, in which players act as clinical managers in dynamically allocating nursing staff and beds as patients arrive, progress in labor, and undergo procedures. We exposed nurse managers to variation in patient census and measured the delays in resource decisions over the course of a simulated shift. We used mixed logistic and linear regression models to analyze the associations between patient census and delays in patient care.

RESULTS:

Thirteen nurse managers participated in the study and completed 17 12-hour shifts, or 204 simulated hours of decision-making. All participants reported the simulation module reflected their real-life experiences at least somewhat well. We observed 1.47-increased odds (95% CI 1.18–1.82) of recommending a patient ambulate in early labor for every additional patient on the labor and delivery unit. For every additional patient on the labor and delivery unit, there was a 15.9-minute delay between delivery and transfer to the postpartum unit (95% CI 2.4–29.3). For every additional patient in the waiting room, we observed a 33.3-minute delay in the time patients spent in the waiting room (95% CI 23.2–43.5) and a 14.3-minute delay in moving a patient in need of a cesarean delivery to the operating room (95% CI 2.8–25.8).

CONCLUSION:

Increasing labor and delivery unit census is associated with patient care delays in a computer simulation. Computer simulation is a feasible and valid method of demonstrating the sensitivity of care decisions to shifts in patient volume.
Use of Long-Acting Reversible Contraception by Obstetrics and Gynecology Residents: An Examination of Access for All Women
Authors: Evans Megan L. , Espey Eve , Ogburn Tony , Zite Nikki B.
Published: February 2018

Although long-acting reversible contraception (LARC) use is increasing in the general female population, only 12% of all women who use contraception and 4.8% of nulliparous women in the United States use either the intrauterine device (IUD) or contraceptive implant. In several studies, however, female physicians prefer LARC for contraception. In 2016, an anonymous electronic survey was administered to all U.S. obstetrics and gynecology residents before the start of the annual in-training examination administered by the Council on Resident Education in Obstetrics and Gynecology. The survey included questions about LARC, including personal use. Fifty percent of female residents or the female partners of male residents used IUDs for contraception, 31.3% used combined oral contraceptives, and 3% used a contraceptive implant. Among nulliparous residents, 37.7% used IUDs. This rate of IUD use was five times the rate reported by the general female population and eight times the nulliparous rate in the United States. Obstetrics and gynecology residents understand the benefits of LARC, but have minimal barriers to access. When barriers and cost are removed and the full range of contraceptive options is offered, the majority of contracepting women and adolescents choose LARC. With the high rates of unintended pregnancy and maternal morbidity and mortality in the United States—especially among poor and minority women—all women, regardless of income, race–ethnicity, and career, should have awareness of and access to these effective contraceptive methods.
Surgical Outcomes After Apical Repair for Vault Compared With Uterovaginal Prolapse
Authors: Rogers Rebecca G. , Nolen Tracy L. , Weidner Alison C. , Richter Holly E. , Jelovsek J. Eric , Shepherd Jonathan P. , Harvie Heidi S. , Brubaker Linda , Menefee Shawn A. , Myers Deborah , Hsu Yvonne , Schaffer Joseph I. , Wallace Dennis , Meikle Susan F. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network
Published: February 2018

OBJECTIVE:

To retrospectively compare surgical success and complications between vaginal vault prolapse compared with uterovaginal prolapse in women who underwent apical prolapse repair for stage II–IV prolapse.

METHODS:

Women in one of three Pelvic Floor Disorders Network prolapse surgical trials were included. Absence of bothersome bulge symptoms, no prolapse beyond the hymen, and no subsequent prolapse treatment defined success and was our primary outcome. Secondary outcomes included comparison of quality-of-life measures, anatomic changes, and adverse events. Pelvic organ prolapse quantification (POP-Q) and quality-of-life measures were administered at baseline and 1–2 years postoperatively. Comparisons were controlled for study site, age, body mass index, baseline POP-Q, apical and anterior or posterior repair performed, and prior prolapse repair. Outcomes measured at multiple time points were analyzed using longitudinal models to assess whether differences existed across study follow-up.

RESULTS:

Four hundred twenty-one women underwent vault prolapse, and 601 underwent uterovaginal prolapse apical repair. The vault prolapse group was older, more likely to be white, and to have prior urinary incontinence or prolapse repair, stage IV prolapse, and more prolapse bother on a validated scale (all P≤.034). The vault prolapse group was more likely to undergo sacrocolpopexy (228/421 [54%] vs 93/601 [15%]); the uterovaginal prolapse group was more likely to undergo vaginal repair (508/601 [85%] vs 193/421 [46%] P<.001). There were no differences in success (odds ratio [OR] 0.76 for vault prolapse vs uterovaginal prolapse, 95% CI 0.51–1.15, P=.20), changes in Pelvic Organ Prolapse Distress Inventory scores (−79.4 vs −79.8, P=.89), postoperative POP-Q point C measurements (−7.0 vs −7.1 cm, P=.41), or serious adverse events (86/421 [20%] vs 90/601 [15%], P=.86) between groups. Among women who underwent a vaginal approach for repair of vault prolapse (n=193) or uterovaginal prolapse (n=508), there were no differences in success rates (OR 0.67, 95% CI 0.43–1.04, P=.09) at 1–2 years postoperatively.

CONCLUSION:

Surgical success of stage II–IV vault prolapse and uterovaginal prolapse apical repair was similar whether performed vaginally or abdominally at 1–2 years postoperatively.
Risk of Recurrent Disease and Surgery Following an Admission for Acute Diverticulitis
Authors: El-Sayed Charlotte , Radley Simon , Mytton Jemma , Evison Felicity , Ward Stephen T.
Published: February 2018

BACKGROUND:

Diverticular disease accounts for significant morbidity and mortality and may take the form of recurrent episodes of acute diverticulitis. The role of elective surgery is not clearly defined.

OBJECTIVE:

This study aimed to define the rate of hospital admission for recurrent acute diverticulitis and risk factors associated with recurrence and surgery.

DESIGN:

This is a retrospective population-based cohort study.

SETTINGS:

National Health Service hospital admissions for acute diverticulitis in England between April 2006 and March 2011 were reviewed.

PATIENTS:

Hospital Episode Statistics data identified adult patients with the first episode of acute diverticulitis (index admission), and then identified recurrent admissions and elective or emergency surgery for acute diverticulitis during a minimum follow-up period of 4 years. Exclusion criteria included previous diagnoses of acute diverticulitis, colorectal cancer, or GI bleeding, and prior colectomy or surgery or death during the index admission.

INTERVENTIONS:

There were no interventions.

MAIN OUTCOME MEASURES:

The primary outcomes measured were recurrent admissions for acute diverticulitis and patients requiring either elective or emergency surgery during the study period.

RESULTS:

Some 65,162 patients were identified with the first episode of acute diverticulitis. The rate of hospital admission for recurrent acute diverticulitis was 11.2%. A logistic regression model examined factors associated with recurrent acute diverticulitis and surgery: patient age, female sex, smoking, obesity, comorbidity score >20, dyslipidemia, and complicated acute diverticulitis increased the risk of recurrent acute diverticulitis. There was an inverse relationship between patient age and recurrence. Similar factors were associated with elective and emergency surgery.

LIMITATIONS:

The cases of acute diverticulitis required inpatient management and the use of Hospital Episode Statistics, relying on the accuracy of diagnostic coding.

CONCLUSIONS:

This is the largest study assessing the rates of hospital admission for recurrent acute diverticulitis. Knowledge of the rate and risk factors for recurrent acute diverticulitis is required to aid discussion and decision making with patients regarding the need and timing of elective surgery. Some factors associated with recurrence are modifiable; therefore, weight reduction and smoking cessation can be championed. See Video Abstract at http://links.lww.com/DCR/A449.
Prior Surgical Score: An Analysis of the Prognostic Significance of an Initial Nondefinitive Surgical Intervention in Patients With Peritoneal Carcinomatosis of a Colorectal Origin Undergoing Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy
Authors: Paul Bikram K. , Ihemelandu Chukwuemeka , Sugarbaker Paul H.
Published: February 2018

BACKGROUND:

The prior surgical score estimates the extent of previous surgical intervention by quantitating surgical dissection within 9 abdominopelvic regions.

OBJECTIVE:

Our aim was to analyze the prognostic significance of the prior surgical score in our cohort of patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of a colorectal origin.

DESIGN:

This was a retrospective analysis of a prospectively maintained database for all patients treated for peritoneal carcinomatosis of a colorectal origin.

SETTINGS:

The prospectively maintained surgical oncology tumor database was analyzed for the study period 1989–2014.

PATIENTS:

A total of 407 patients diagnosed with peritoneal carcinomatosis of a colorectal origin and treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy were included in this analysis.

MAIN OUTCOME MEASURES:

The prognostic significance and clinicopathologic factors associated with an initial nondefinitive surgical intervention in patients with peritoneal carcinomatosis of a colorectal origin undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy was evaluated.

RESULTS:

There were 210 men (51.6%) and 197 women (48.4%) in the study. Mean age at presentation was 53.7 years (range, 19.0–87.0 y). Data on prior surgical score for 69 patients were missing, leaving us with a study cohort of 338 patients. Grouped by prior surgical score, 46 (13.6%) had a prior surgical score of 0 versus 25 (7.4%), 122 (36.1%), and 145 (42.9%) who had a prior surgical score of 1, 2, or 3. Overall survival was 53.0%. Three- and 5-year survival rates were 75% and 75% for group prior surgical score 0 versus 26% and 13%, 39% and 37%, and 21% and 16% for group prior surgical scores 1, 2, and 3. Median survival time for the various prior surgical score groups were 180.0, 30.4, 30.5, and 21.3 months for prior surgical scores 0, 1, 2, and 3 (p = 0.000). A total of 87.2% of the prior surgical score 0 group had a completeness of cytoreduction score of 0/1 (no residual disease/tumor <0.25 cm) versus 68.0%, 68.1%, and 48.6% for prior surgical scores of 1, 2, or 3 (p = 0.000). Significant independent predictors of a shorter survival in multivariate analysis included a high cytoreduction score status (p < 0.000) and a high prior surgical score (p = 0.05).

LIMITATIONS:

This study was limited by its retrospective, population-based design.

CONCLUSIONS:

The extent of a previous nondefinitive surgical intervention contributes to the poor prognosis associated with peritoneal carcinomatosis of a colorectal origin. Independent predictors for an improved overall survival include completeness of cytoreduction and low prior surgical score. See Video Abstract at http://links.lww.com/DCR/A573.
Prevalence of Therapeutic Drug Monitoring for Lithium and the Impact of Regulatory Warnings: Analysis Using Japanese Claims Database
Authors: Ooba Nobuhiro , Tsutsumi Daisuke , Kobayashi Naoko , Hidaka Shinji , Hayashi Hiroyuki , Obara Taku , Satoh Michihiro , Kubota Kiyoshi , Fukuoka Noriyasu
Published: February 2018

Background:

Therapeutic drug monitoring (TDM) for lithium is recommended in guidelines; however, the prevalence of TDM for lithium is seldom reported. We have therefore investigated the prevalence of TDM for lithium and evaluated the impact of the regulatory warnings requiring routine TDM for lithium.

Methods:

Monthly claims data covering around 1.7 million persons aged 20–74 years old during the period January 1, 2005, and March 31, 2015, were evaluated. All patients who had at least one prescription for lithium were selected and included to calculate the annual prevalence of TDM for lithium. Also we assessed whether the 2 regulatory warnings requiring routine TDM for lithium and issued in April 2012 and September 2012 had an impact on TDM for lithium, using segmented regression analysis.

Results:

Between 2005 and 2014, 136,956 prescriptions of lithium were issued to 5823 patients, and the annual prevalence of TDM for lithium was 14.9% (95% confidence interval, 14.7%–15.1%). The analysis revealed that the mean prevalence increased abruptly by 6.9% (P= 0.001) after the regulatory warning in April 2012, whereas that the warning in September 2012 decreased by 1.2% (P= 0.47). There was no significant change in trends of period prevalence after the warning in April 2012 (April 2012–August 2012) compared with prevalence before the warning (April 2010–March 2012). Similarly, no significant change was observed in the trends before (April 2012–August 2012) and after (September 2012–March 2014) the subsequent warning in September 2012.

Conclusions:

Results showed that the prevalence of TDM for lithium was low, although TDM for lithium was strongly recommended by the guidelines. Regulatory warnings requiring compliance with the measurement of blood levels during treatment with lithium, issued twice during the five-month period, were associated with an increase in the prevalence of TDM for lithium. However, the impact of the second warning was not remarkable compared with the first warning.
Variation of Coma Aberration With Prismatic Soft Contact Lenses
Authors: Carpena-Torres Carlos , López-Alonso José Manuel , Burgos-Martínez Mercedes , Carracedo Gonzalo , Carballo-Álvarez Jesús
Published: February 2018

Purpose:

To analyze the variation in vertical coma and the rest of ocular aberrations before and after fitting prismatic soft contact lenses (PSCL).

Methods:

Thirty-seven eyes of 20 healthy subjects (24.30±2.03 years) were evaluated to analyze the variation in ocular wavefront aberrations before and after fitting PSCL of different base-down prism values (1.0, 1.5, and 2.0 prism diopters [PD]), designed to study its influence in the compensation of vertical coma aberration. A Hartmann–Shack sensor with a wavelength of 780 nm was used, considering a pupil size of 3 mm. In addition, the influence of PSCL in visual function under photopic conditions in terms of high-contrast visual acuity and contrast sensitivity was evaluated.

Results:

There was statistically significant differences (P<0.05) in ocular aberrations from first to seventh order after fitting PSCL, but only the differences in vertical tilt, horizontal tilt, defocus, vertical astigmatism, and vertical coma were clinically relevant (Strehl ratio <0.8). The mean of vertical coma (μm) was 0.022±0.030 for control, 0.045±0.064 for 1.0 PD (P=0.645), 0.048±0.053 for 1.5 PD (P=0.037), and 0.074±0.047 for 2.0 PD (P<0.001). The changes in visual function under photopic conditions were not clinically relevant.

Conclusions:

PSCL induce a magnitude of vertical coma aberration directly proportional to prism value without affecting the rest of ocular high-order aberrations.
Acetyl Cholinesterase Inhibitors and Cell-Derived Peripheral Inflammatory Cytokines in Early Stages of Alzheimer's Disease
Authors: Kokras Nikolaos , Stamouli Evangelia , Sotiropoulos Ioannis , Katirtzoglou Everina A. , Siarkos Kostas T. , Dalagiorgou Georgia , Alexandraki Krystallenia I. , Coulocheri Stavroula , Piperi Christina , Politis Antonios M.
Published: February 2018

Background

Clinical and preclinical studies firmly support the involvement of the inflammation in the pathogenesis of Alzheimer’s disease (AD). Despite acetylcholinesterase inhibitors (AChEI) being widely used in AD patients, there is no conclusive evidence about their impact on the inflammatory response.

Methods

This study investigates peripheral proinflammatory cytokines (interferon gamma [IFN-γ], tumor necrosis factor alpha [TNF-α], and interleukins 1β [IL-1β] and 6 [IL-6]) by firstly comparing peripheral blood mononuclear cell (PBMC)–derived secretion in drug-naïve and AChEI-treated AD patients versus healthy controls. A subset of those drug-naïve AD patients, who were prescribed the AChEI donepezil, was followed-up for 6 months to investigate if donepezil suppresses proinflammatory cell-derived cytokine secretion.

Results

Patients with AD showed higher levels of PBMC-derived proinflammatory cytokines (IFN-γ, TNF-α, IL-1β, and IL-6) in comparison with healthy controls. On reexamination, previously drug-naïve AD patients who received donepezil treatment for 6 months displayed a decrease in cell-derived IFN-γ, TNF-α, IL-1β, and IL-6.

Conclusions

Proinflammatory PBMC-derived cytokines were increased in patients with AD in comparison with healthy controls and donepezil-reduced proinflammatory cytokines when examining drug-naïve AD patients before and after AChEI treatment.
State Laws Related to Billing Third Parties for Health Care Services at Public Sexually Transmitted Disease Clinics in the United States
Authors: Cramer Ryan , Loosier Penny S. , Krasner Andee , Kawatu Jennifer
Published: February 2018

Background

Health departments (HDs) cite state laws as barriers to billing third parties for sexually transmitted disease (STD) services, but the association between legal/policy barriers and third-party HD billing has not been examined. This study investigates the relationship between laws that may limit HDs’ ability to bill, clinic perceptions of billing barriers, and billing practices.

Methods

Two surveys, (1) clinic managers (n = 246), (2) STD program managers (n = 63), conducted via a multiregional needs assessment of federally funded HD clinics’ capacity to bill for STD services, billing/reimbursement practices, and perceived barriers were combined with an analysis of state laws regarding third-party billing for STD services. Statistical analyses examined relationships between laws that may limit HDs’ ability to bill, clinic perceptions, and billing practices.

Results

Clinic managers reported clinics were less likely to bill Medicaid and other third parties in jurisdictions with a state law limiting their ability to bill compared with respondents who billed neither or 1 payer (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.10–0.97) and cited practical concerns as a primary barrier to billing (OR, 2.83; 95% CI, 1.50–5.37). The STD program managers report that the staff believed that STD services should be free (OR, 0.34; 95% CI, 0.13–0.90) was associated with not billing (not sure versus no resistance to billing); confidentiality concerns was not a reported barrier to billing among either sample.

Conclusions

Practical concerns and clinic staff beliefs that STD services should be free emerged as possible barriers to billing, as were laws to a lesser extent. Attempts to initiate HD billing for STD services may benefit from staff education as well as addressing perceived legal barriers and staff concerns.
Major Depressive Disorder: Longitudinal Analysis of Impact on Clinical and Behavioral Outcomes in Uganda
Authors: Kinyanda Eugene , Levin Jonathan , Nakasujja Noeline , Birabwa Harriet , Nakku Juliet , Mpango Richard , Grosskurth Heiner , Seedat Soraya , Araya Ricardo , Shahmanesh Maryam , Patel Vikram
Published: February 2018

Background:

There is still wide variability in HIV disease course and other HIV-related outcomes, attributable in part to psychosocial factors such as major depressive disorder (MDD), a subject that has received little attention in sub-Saharan Africa.

Methods:

Using a longitudinal cohort of 1099 HIV-positive antiretroviral therapy–naive persons, we investigated the impact of MDD on 4 HIV-related negative outcome domains in Uganda. MDD was assessed using a Diagnostic Statistical Manual IV–based tool. Also collected were data on surrogate measures of the HIV-related outcome domains. Data were collected at the 3 time points of baseline, 6, and 12 months. Multiple regression and discrete time survival models were used to investigate the relationship between MDD and indices of the HIV outcomes.

Results:

MDD was a significant predictor of “missed antiretroviral therapy doses” [adjusted odds ratio (aOR) = 4.75, 95% confidence interval (CI): 1.87 to 12.04, P = 0.001], “time to first visit to healthy facility” (aOR = 1.71; 95% CI: 1.07 to 2.73; P = 0.024), “time to first self-reported risky sexual activity” (aOR = 2.11, 95% CI: 1.27 to 3.49; P = 0.004) but not of “CD4 counts at months 6 and 12” (estimated effect 29.0; 95% CI: −7.8 to 65.7; P = 0.12), and “time to new WHO stage 3 or 4 clinical event” (aOR = 0.52, 95% CI: 0.12 to 2.20, P = 0.37).

Conclusions:

MDD significantly impacted 3 of the 4 investigated outcome domains. These results by demonstrating the adverse consequences of an untreated mental health disorder (MDD) on HIV-related outcomes further strengthen the need to urgently act on WHO's call to integrate mental health care in general HIV care.
Differences in Local and Systemic TFV PK Among Premenopausal Versus Postmenopausal Women Exposed to TFV 1% Vaginal Gel
Authors: Thurman Andrea Ries , Chandra Neelima , Yousefieh Nazita , Kimble Thomas , Anderson Sharon M. , Cottrell Mackenzie , Sykes Craig , Kashuba Angela , Schwartz Jill L. , Doncel Gustavo F.
Published: February 2018

Objective:

We describe and compare the local and systemic pharmacokinetics (PK) of tenofovir (TFV) and TFV-diphosphate (TFV-DP) in healthy premenopausal (PRE) and postmenopausal (POST) women using TFV 1% gel and correlate local PK with other mucosal end points.

Methods:

PRE (n = 20) and POST (n = 17) women used 2 doses of TFV 1% vaginal gel, separated by 2 hours. Blood and cervicovaginal samples were obtained 3 and 23 hours after the second dose. PRE women used gel in the follicular and luteal phases of the menstrual cycle. POST women used gel at baseline and again after approximately 2 months of treatment with 0.01% vaginal estradiol (E2) cream.

Results:

Median TFV concentrations in cervicovaginal aspirate (ng/mL) and vaginal tissue (ng/mg) were significantly higher in PRE (4.3E106, 49.8) versus POST women (2.6E106, 2.2). POST women had significantly higher median molecular ratios of TFV-DP to TFV (3.7%) compared with PRE (0.19%). After vaginal E2 treatment, the local and systemic PK end points in POST women were generally similar to PRE women (all P values > 0.05). Importantly, median vaginal tissue TFV-DP concentrations (fmol/mg) among PRE, POST, and POST women after E2 therapy were similar (292.5, 463.3, and 184.6, respectively). Vaginal tissue TFV concentrations were significantly positively correlated with vaginal epithelial thickness, whereas vaginal tissue TFV-DP concentrations were positively correlated with density of vaginal CD4+ and CD8+ immune cells.

Conclusions:

The state of the cervicovaginal mucosa has a significant impact on local and systemic PK of a topically applied microbicide.
Orthognathic Surgery and Implant-Supported Bridge in a Class III Patient Injured in a Motor Vehicle Accident
Authors: Honda Koji , Hirota Makoto , Iwai Toshinori , Fujita Koichi , Omura Susumu , Ono Takashi , Tohnai Iwai
Published: February 2018

Occlusal and esthetic rehabilitation of jaw deformities in patients with partially edentulous maxilla are challenging procedures. This article describes a patient involving a skeletal Class III, 36-year-old male patient with a single bilateral anterior partially edentulous maxilla resulting from injuries sustained in a motor vehicle accident; his anterior teeth had been lost for more than 10 years. His lip protruded from the lateral view due to the proclined upper incisors and mandibular protrusion.

Because of the facial deformity and inadequate prosthesis of the maxilla, the prosthesis had dropped out repeatedly. Bone deficiency was prominent in the area of the anterior maxillary region and required augmentation for implant restoration.

Consultation among the prosthodontist, orthodontist, and patient led to a decision to perform an orthognathic surgery and bone graft before implant treatment. After orthodontic treatment combined with orthognathic surgery, 3 dental implants were placed with simultaneous iliac bone graft for prosthetic rehabilitation. The treatment restored the maxillary dental arch, which supported the upper lip with appropriate occlusion, both esthetically and functionally. After a 2-year clinical follow-up, the orthoprosthesis of the maxilla remained stable, and the patient was satisfied with the outcome of treatment. The combination of orthodontic, surgical, and dental implant treatment could be an option for skeletal Class III patients with bone-deficient, edentulous jaws.
Primitive Squamous Cell Carcinoma of Pterygopalatine Fossa
Authors: Mauvais Olivier , Badet Cécile , Lestrade Laetitia , Tavernier Laurent
Published: February 2018

Primitive tumors of pterygopalatine fossa (PPF) are often benign tumors or extension of a malignant sinonasal tract. Primitive tumors may rarely occur in PPF.

The authors present a 71-year-old woman with a 6-month history of left cranial nerve palsy. Magnetic resonance imaging and positron emission tomography–computed tomography showed an enhancing isolated lesion at the PPF. A transmaxillary biopsy was performed, leading to diagnosis of primitive squamous cell carcinoma. The patient underwent radiotherapy treatment.

Primitive tumors of PPF are rare and diagnosis may be difficult. Endoscopic access for diagnosis can be performed. Squamous cell carcinoma occurring in PPF is associated with poor prognosis.
A Minimally Invasive Endoscopic Approach to Midcheek Mass: Showcase for Technical Description
Authors: Abbate Vincenzo , Dell’Aversana Orabona Giovanni , Romano Antonio , Maglitto Fabio , Iaconetta Giorgio , Califano Luigi
Published: February 2018

Background:

Surgical approaches to the midcheek area are challenging. This area is included between the lower eyelid above, and the upper lip below. The peculiar anatomical location makes it really important for attractiveness, thus the need to obtain a correct balance between the operation's safety and minimally invasive aspect. To the authors’ knowledge, this is the first showcase and technical description of a novel minimally invasive endoscopic approach for midcheek mass removal.

Methods:

Making 3 incisions in concealed area an endoscopically aided facial dissection was performed to remove a solitary venus malformation of the left midcheek region.

Results:

After the surgical procedure was performed, no hematoma, no edema, or facial nerve paralysis were observed. To date, during the follow-up period, no recurrence of the lesion has been observed, and the quality of life of the patient was good with a minimally scar outcome. Magnetic resonance imaging, performed 2 weeks postoperatively, demonstrated a complete removal of the mass

Conclusion:

The authors’ finding experience suggests that the minimally invasive approach provides an excellent surgical window that achieves greater exposure for the dissection of the midcheek area. Further clinical applications are required to assess advantages and/or limitations of this procedure.
Tacrolimus Optic Neuropathy
Authors: Rasool Nailyn , Boudreault Katherine , Lessell Simmons , Prasad Sashank , Cestari Dean M.
Published: February 2018

Background:

Tacrolimus (FK506, Prograf) is a potent immunosuppressant, which inhibits cytokine synthesis and blocks T-cell development. Optic neuropathy from tacrolimus toxicity is very uncommon but, when present, can result in severe vision loss.

Methods:

Case series and review of the literature.

Results:

We present 3 patients with tacrolimus optic neuropathy after bone marrow transplantation complicated by graft-vs-host disease and demonstrate the differing clinical and radiologic presentation of this presumed toxic optic neuropathy.

Conclusions:

Tacrolimus optic neuropathy can manifest in a multitude of clinical presentations and can have devastating visual consequences.
Synergistic effect of natural chickpea leaf exudates acids in heterocyclization: a greener protocol for benzopyran synthesis
Authors: Mali Snehali , Shinde Sachin , Damte Shashikant , Patil Suresh
Published: February 2018

Without using any toxic or hazardous reagent, ligand, acid, transition metal catalyst, additives/promoters and organic solvent, green Knoevenagel condensation and tandem Knoevenagel–Michael reactions have been successfully carried out by using
chickpea leaf exudates
as a naturally sourced Bronsted acid type bio-catalyst. The reaction proceeds in neat
chickpea leaf exudates
at room temperature in aqueous conditions in very short reaction times, and therefore, it is an evergreen and environmentally sound alternative to the existing protocols for benzopyran synthesis. In comparison to the conventional methods, this synthetic pathway complies with several key requirements of green chemistry principles such as the utilization of biodegradable catalyst obtained from renewable feedstock, auxiliary aqueous conditions, along with waste prevention. The same protocol was also extended to the synthesis of 2
H
-xanthene-1,8-diones by condensation of aromatic aldehydes with dimedone achieving excellent yields. Thus, the reported protocol offers an attractive option because of its ecological safety, environmental acceptance, sustainability, low-cost straightforward work-up procedure and with excellent values of green chemistry metrics as compared with other reported methods.