bluuebunny/crossref_metadata_2025 huggingface dataset:
Dramatic pressure-sensitive ion conduction in conical nanopores
Authors: Jubin Laetitia , Poggioli Anthony , Siria Alessandro , Bocquet Lydéric
Published: April 2018

Significance

The domain of nanofluidics, exploring fluid and ionic transport at the nanoscale, has made tremendous progress recently. However, transport in artificial systems remains as yet unable to reproduce the richness and complexity of the advanced functionalities exhibited in Nature, such as mechanosensitive channel activation, ionic pumps, etc. Here we demonstrate experimentally and theoretically a mechanosensitive ionic transistor effect in conical nanopores, in which the ionic conduction is found to be activated or inhibited by a mechanical stimulus. Such behavior is a fundamental building block for reproducing the advanced transport functionalities found in Nature.
Personality and Health
Authors: Hampson Sarah E.
Published: April 2018

Although the belief that personality is linked to health goes back at least to Greek and Roman times, the scientific study of these links began in earnest only during the last century. The field of psychosomatic medicine, which grew out of psychoanalysis, accepted that the body and the mind were closely connected. By the end of the 20th century, the widespread adoption of the five-factor model of personality and the availability of reliable and valid measures of personality traits transformed the study of personality and health. Of the five broad domains of personality (extraversion, agreeableness, conscientiousness, emotional stability, and intellect/openness), the most consistent findings in relation to health have been obtained for conscientiousness (i.e., hard-working, reliable, self-controlled). People who are more conscientious have better health and live longer lives than those who are less conscientious. These advantages are partly explained by the better health behaviors, good social relationships, and less stress that tend to characterize those who are more conscientious. The causal relation between personality and health may run in both directions; that is, personality influences health, and health influences personality. In addition to disease diagnoses and longevity, changes on biomarkers such as inflammation, cortisol activity, and cellular aging are increasingly used to chart health in relation to personality traits and to test explanatory models. Recognizing that both personality and health change over the life course has promoted longitudinal studies and a life-span approach to the study of personality and health.
Portuguese Colonialism in Africa
Authors: Bandeira Jerónimo Miguel
Published: April 2018

The Portuguese colonial empire was the first and the last European empire overseas, from the conquest of Ceuta (1415), in Morocco, North Africa, until the formal handover of Macau to the People’s Republic of China (1999). From the coastline excursions in Africa and the gradual establishment of trade routes in Asia and in the Indian Ocean and the related emergence of the Estado da Índia (the Portuguese empire east of the Cape of Good Hope), to the colonization projects in the Americas, namely, in Brazil, and, in the second half of the 19th century, in Africa, the Portuguese empire assumed diverse configurations. All of these entailed expansionist projects and motivations—political, missionary, military, commercial—with changing dynamics, strongly conditioned by local circumstances and powers. In Africa, actual colonization was a belated and convoluted process, which started and ended with violent conflicts, the so-called pacification campaigns of the 1890s, and the liberation wars of the 1960s and 1970s. In Angola, Guinea-Bissau, Mozambique, Cape Verde, and São Tomé and Príncipe, the Portuguese enacted numerous modalities of formalized rule, based on political, military, and religious apparatuses. These forms of control engaged with and impacted on local societies differently. However, until the very end, coercive labor and tax exactions, racial discrimination, authoritarian politics, and economic exploitation were the fundamental pillars of Portuguese colonialism in Africa.
Public Administrators in Natural Hazards Governance
Authors: Robinson Scott E. , Eller Warren S.
Published: April 2018

Natural hazards governance calls upon a diverse array of actors. The focus of most research—and most media coverage—has long been on governmental actors. Indeed, natural hazards governance relies on a complex arrangement of actors connected from the local, state, and national levels. Local organizations are the initial point of contact and face emerging threats. If the event exceeds the capacity of local organizations to respond, the governance system escalates the problem by expanding the participants to include state-level and, eventually, national-level actors. Natural hazards governance seeks to smooth and rationalize this process of escalation and expansion. Recent research has expanded this view to include nongovernmental actors like charitable organizations, religious institutions, and even private business. While charitable organizations have long been part of natural hazards governance, a broader range of charities, religious institutions, and private-sector companies has recently become more important to practice and scholarship. In many ways, the governance of these nongovernmental organizations resembles the structure of the governmental structure with its emphasis on escalation, expansion, and functional differentiation. Given the inclusion of so diverse a group of cooperating organizations, natural hazards governance faces notable challenges of communication, authority, and reliability.
Supporting Natural Hazards Management With Geospatial Technologies
Authors: Mitsova Diana
Published: April 2018

On a global scale, natural disasters continue to inflict a heavy toll on communities and to pose challenges that either persist or amplify in complexity and scale. There is a need for flexible and adaptive solutions that can bridge collaborative efforts among public agencies, private and nonprofit organizations, and communities. The ability to explore and analyze spatial data, solve problems, visualize, and communicate outcomes to support the collaborative efforts and decision-making processes of a broad range of stakeholders is critical in natural hazards and disaster management. The adoption of geospatial technologies has long been at the core of natural hazards risk assessment, linking existing technologies in GIS (geographic information system) with spatial analytical techniques and modeling. Practice and research have shown that though risk-reduction strategies and the mobilization of disaster-response resources depend on integrating governance into the process of building disaster resilience, the implementation of such strategies is best informed by accurate spatial data acquisition, fast processing, analysis, and integration with other informational resources. In recent years, new and accessible sources and types of data have greatly enhanced the ability of practitioners and researchers to develop approaches that support rapid and efficient disaster response, including forecasting, early warning systems, and damage assessments. Innovations in geospatial technologies, including remote sensing, real-time Web applications, and distributed Web-based GIS services, feature platforms for systematizing and sharing data, maps, applications, and analytics. Distributed GIS offers enormous opportunities to strengthen collaboration and improve communication and efficiency by enabling agencies and end users to connect and interact with remotely located information products, apps, and services. Newer developments in geospatial technologies include real-time data management and unmanned aircraft systems (UAS), which help organizations make rapid assessments and facilitate the decision-making process in disasters.
m6ASNP: a tool for annotating genetic variants by m6A function
Authors: Jiang Shuai , Xie Yubin , He Zhihao , Zhang Ya , Zhao Yuli , Chen Li , Zheng Yueyuan , Miao Yanyan , Zuo Zhixiang , Ren Jian
Published: April 2018

Background

Large-scale genome sequencing projects have identified many genetic variants for diverse diseases. A major goal of these projects is to characterize these genetic variants to provide insight into their function and roles in diseases. N6-methyladenosine (m6A) is one of the most abundant RNA modifications in eukaryotes. Recent studies have revealed that aberrant m6A modifications are involved in many diseases.

Findings

In this study, we present a user-friendly web server called “m6ASNP” that is dedicated to the identification of genetic variants that target m6A modification sites. A random forest model was implemented in m6ASNP to predict whether the methylation status of an m6A site is altered by the variants that surround the site. In m6ASNP, genetic variants in a standard variant call format (VCF) are accepted as the input data, and the output includes an interactive table that contains the genetic variants annotated by m6A function. In addition, statistical diagrams and a genome browser are provided to visualize the characteristics and to annotate the genetic variants.

Conclusions

We believe that m6ASNP is a very convenient tool that can be used to boost further functional studies investigating genetic variants. The web server “m6ASNP” is implemented in JAVA and PHP and is freely available at [60].
Acute Onset of Pneumococcal Pneumonia Following Instrumentation of the Respiratory Tract
Authors: Gardner Julianna G , Rueda Adriana M , Musher Daniel M
Published: April 2018

We describe 22 patients who developed pneumococcal pneumonia within 96 hours of respiratory tract instrumentation. In 59% of cases, the time to onset of symptoms was <24 hours. Instrumentation bypasses normal protective barriers and carries organisms directly to the lower airways, leading to the rapid development of pneumonia.
Isolate–Cultivar Interactions, In Vitro Growth, and Fungicide Sensitivity of Fusarium oxysporum Isolates Causing Seedling Disease on Soybean
Authors: Cruz Jimenez D. R. , Ellis M. L. , Munkvold G. P. , Leandro L. F. S.
Published: April 2018

Fusarium oxysporum is frequently associated with soybean root rot in the United States. Information about pathogenicity and other phenotypic characteristics of F. oxysporum populations is limited. The objective of the research described herein was to assess phenotypic characteristics of F. oxysporum isolates from soybean, including the interaction between isolates and soybean cultivars, fungal growth characteristics in culture, and sensitivity to fungicides commonly used as seed treatment products. The pathogenicity of 14 isolates was evaluated in rolled-towel and Petri-dish assays using 11 soybean cultivars. In the rolled-towel assay, seed were inoculated with a conidial suspension and disease severity was observed. In the Petri-dish assay, F. oxysporum isolates were grown on 2% water agar and seed were placed on the F. oxysporum colony to observe the symptoms that developed. Cultivars differed in susceptibility to F. oxysporum, and significant (P = 0.0140) isolate–cultivar interactions were observed. F. oxysporum isolates differed in radial growth on potato dextrose agar at 25°C. Pyraclostrobin and trifloxystrobin reduced conidial germination with average 50% effective concentration (EC50) of 0.15 and 0.20 µg active ingredient (a.i.)/ml, respectively. Ipconazole reduced fungal growth with average EC50 of 0.23 µg a.i./ml, whereas fludioxonil was ineffective. Our results illustrate soybean F. oxysporum isolate variability and the potential for their management through cultivar selection or seed treatment.
How to cope with food allergy symptoms?
Authors: Deschildre Antoine , Lejeune Stéphanie
Published: April 2018

Purpose of review

Food allergy symptoms may involve a wide variety of organs (skin, gastrointestinal tract, and eyes) and systems (respiratory, circulatory, and neurological). They are often associated. Their severity ranges from mild to potentially life-threatening reactions and the presentation from acute to chronic.

Recent findings

Food allergies have been the focus of multiple studies, position papers, and guidelines in recent years. They have defined an approach in classifying symptoms as mild to anaphylactic, distinguishing objective from subjective symptoms, and describing their heterogeneity, specific phenotypes or syndromes (e.g., lipid transfer protein syndrome or pollen food syndrome). Cofactors can also influence food allergy reactions. Symptoms of non-IgE-gastrointestinal food allergies, illustrated by eosinophilic esophagitis and food-protein-induced enterocolitis syndrome, are also now better understood and defined. Improvement in the knowledge of food allergy symptoms is crucial for correct diagnosis and a personalized treatment approach.

Through a better description and understanding of symptoms, the diversity of food allergies is now better known. The next step is to harmonize symptom assessment not only for clinicians but also for patients, researchers, and public health stakeholders, to describe food allergy phenotypes and their underlying mechanisms and endotypes, to develop targeted management.
Clinical Predictors of Survival and Functional Outcome of Stroke Patients Admitted to Critical Care*
Authors: van Valburg Mariëlle K. , Arbous M. Sesmu , Georgieva Milena , Brealey David A. , Singer Mervyn , Geerts Bart F.
Published: April 2018

Objectives:

To determine the predictive value of commonly used clinical variables upon ICU admission for long-term all-cause mortality and functional outcome of adult stroke patients admitted to the ICU.

Design:

Retrospective observational cohort study.

Setting:

General and neurosurgical ICUs of the University College London Hospitals in North Central London.

Patients:

All adult ICU patients with a clinical diagnosis of acute stroke admitted between February 2010 and May 2012.

Interventions:

None.

Measurements and Main Results:

Demographic and clinical data concerning the first 24 hours after ICU admission were obtained. Patients were followed until February 2016 to assess long-term survival. Functional outcome was determined using the modified Rankin Scale. We evaluated 131 critically ill stroke patients, with a median (interquartile range) age of 70 years (55–78 yr). One-year mortality rate was 52.7%. Surviving patients were followed up over a median (interquartile range) period of 4.3 years (4.0–4.8 yr). The multivariable model that best predicted long-term all-cause mortality indicated that mortality of critically ill stroke patients was predicted by high Acute Physiology and Chronic Health Evaluation II score, impaired consciousness (Glasgow Coma Scale score ≤ 8) as reason for ICU admission, low Glasgow Coma Scale sum score after 24 hours, and absence of brainstem reflexes. Long-term independent functional status occurred in 30.9% of surviving patients and was predicted by low Acute Physiology and Chronic Health Evaluation II score, high Glasgow Coma Scale sum score at ICU admission, and absence of mass effect on CT scan.

Conclusions:

Mortality in critically ill stroke patients is high and occurs most often shortly after the event. Less than one in three surviving patients is able to function independently after 1 year. This study has identified several clinical variables that predict long-term all-cause mortality and functional outcome among critically ill stroke patients and found that mainly acute physiologic disturbance and absolute values of neurologic clinical assessment are predictive.
Xenon
Authors: Roostan Mohammad , Frishman William H.
Published: April 2018

Xenon is an inert, highly polarizable noble gas with demonstrated safety and application in general anesthesia for over 50 years. A potent inhibitor of the N-methyl-d-aspartate subtype of glutamate receptors, xenon has a well-documented ameliorating effect on excitotoxic neuronal injury in numerous cellular and animal models of hypoxic-ischemic brain injury. The most important determinant of overall survival and morbidity in out-of-hospital cardiac arrest is the severity of neurological injury. The only approved neuroprotective strategy in this setting is mild therapeutic hypothermia, which has demonstrated significant, albeit modest, improvements in mortality. The combination therapy of therapeutic hypothermia and xenon in porcine models of cardiac arrest has shown a greater improvement in functional outcomes than either intervention alone, thereby prompting the study of combination therapy in randomized clinical trials. The treatment of postarrest patients with xenon and mild hypothermia is safe and demonstrates favorable cardiovascular features, including a reduced heart rate, a reduction in troponin elevations, and a decreased need for vasopressors. Combination therapy is superior in protecting white matter integrity than hypothermia alone, but did not significantly impact neurological outcomes at 6-month follow-up. Despite an abundance of preclinical evidence supporting xenon’s neuroprotective properties, its translational potential in postcardiac arrest care is indeterminate due to a lack of adequately-powered studies.
Sodium–Glucose Cotransporter-2 Inhibition in Type 2 Diabetes Mellitus
Authors: Dalan Rinkoo
Published: April 2018

Cardiovascular (CV) disease remains the leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). However, conventional antihyperglycemic medications seem to have minimal effect on lowering CV risk despite achieving excellent reductions in glycated hemoglobin A1c and associated reductions in microvascular risk. Sodium–glucose cotransporter 2 (SGLT2) inhibitors have emerged as noteworthy antihyperglycemic agents with concomitant CV and renal protection in T2DM patients. In this comprehensive review, we present the key CV findings from major large-scale outcome trials of SGLT2 inhibitors to date. We also review the mechanistic studies that might explain the CV benefits of SGLT2 inhibition in patients with T2DM.
The Physiological Rationale for Incorporating Pulsatility in Continuous-Flow Left Ventricular Assist Devices
Authors: Grosman-Rimon Liza , Billia Filio , Kobulnik Jeremy , Pollock Bar-Ziv Stacey , Cherney David Z. , Rao Vivek
Published: April 2018

Over the past few decades, left ventricular assist device (LVAD) support has extended the lives of many patients with end-stage heart failure. The most common devices are continuous-flow (CF) LVADs. The use of the CF-LVADs has required that clinicians learn the physiological and clinical consequences of long-term continuous blood flow. While this alteration in the normal physiology still offers advantages from mechanical circulatory support, the lack of pulsatility may also increase the likelihood of adverse events. However, it is currently unknown whether newly evolved devices should incorporate pulsatility. In this article, we discuss the possible benefits of incorporating pulsatility, while maintaining the benefits of the CF-LVAD, to maximize the treatment of patients.
Simultaneous Quantification of Adalimumab and Infliximab in Human Plasma by Liquid Chromatography–Tandem Mass Spectrometry
Authors: Jourdil Jean-François , Némoz Benjamin , Gautier-Veyret Elodie , Romero Charlotte , Stanke-Labesque Françoise
Published: April 2018

Background:

Adalimumab (ADA) and infliximab (IFX) are therapeutic monoclonal antibodies targeting tumor necrosis factor-alpha (TNFα). They are used to treat inflammatory diseases. Clinical trials have suggested that therapeutic drug monitoring for ADA or IFX could improve treatment response and cost effectiveness. However, ADA and IFX were quantified by ELISA in all these studies, and the discrepancies between the results obtained raise questions about their reliability. We describe here the validation of a liquid chromatography–tandem mass spectrometry (LC-MS/MS) method for the simultaneous quantification of ADA and IFX in human samples.

Methods:

Full-length antibodies labeled with stable isotopes were added to plasma samples as an internal standard. Samples were then prepared using Mass Spectrometry Immunoassay followed by trypsin digestion before ADA and IFX quantification by LC-MS/MS. ADA and IFX were quantified in serum from patients treated with ADA (n = 21) or IFX (n = 22), and the concentrations obtained were compared with those obtained with a commercial ELISA kit.

Results:

The chromatography run lasted 8.6 minutes, and the quantification range was 1–26 mg/L. The method was reproducible, repeatable, and accurate. For both levels of internal quality control, for ADA and IFX, interday and intraday coefficients of variation and accuracies were all within 15%, in accordance with FDA recommendations. No significant cross-contamination effect was noted. Good agreement was found between LC-MS/MS and ELISA results, for both ADA and IFX.

Conclusions:

This LC-MS/MS method can be used for the quantification of ADA and IFX in a single analytical run and for the optimization of LC-MS/MS resource use in clinical pharmacology laboratories.
Pressure-induced referred pain areas are more expansive in individuals with a recovered fracture
Authors: Doménech-García Víctor , Skuli Palsson Thorvaldur , Boudreau Shellie Ann , Herrero Pablo , Graven-Nielsen Thomas
Published: April 2018

Musculoskeletal trauma and pain can sensitize central pain mechanisms, but whether these normalize on recovery is unknown. This study compared the extent of pain referral in individuals recovered from a musculoskeletal trauma and healthy controls. Twenty pain-free participants recovered from a shoulder fracture and 20 age-/sex-matched controls participated in 2 experimental sessions (day-0 and day-1) separated by 24 hours. On both days, pressure pain thresholds were measured bilaterally at infraspinatus, supraspinatus, trapezius, and gastrocnemius muscles. Referred pain towards the shoulder region was induced by a 60-second pressure stimulation (pressure pain threshold + 20%) at the infraspinatus muscle and recorded on an electronic body chart. After day-0 assessments, delayed onset muscle soreness (DOMS) was induced to challenge the pain systems by exercising the external rotators of the recovered/dominant shoulder. The size of pressure-induced pain referral on day-0 did not differ between groups, although there was a tendency for a smaller referred pain area in recovered group. Pressure pain thresholds at the infraspinatus muscle on the DOMS side were reduced on day-1 in both groups (P = 0.03). An expansion of pressure-induced pain referral was found in both groups following the DOMS protocol on day-1 (P = 0.05) with a relatively larger expansion (P = 0.05) and higher frequency of pain in the shoulder (P = 0.04) in the recovered pain group. After complete recovery and absence of pain symptoms after a fracture, central pain mechanisms seem to normalize in the region of the trauma after recovery but when sensitized a heightened response can emerge. Such mechanisms could be important for recurrence of pain conditions.
Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale
Authors: Le May Sylvie , Ballard Ariane , Khadra Christelle , Gouin Serge , Plint Amy C. , Villeneuve Edith , Mâsse Benoit , Tsze Daniel S. , Neto Gina , Drendel Amy L. , Auclair Marie-Christine , McGrath Patrick J. , Ali Samina
Published: April 2018

Appropriate pain measurement relies on the use of valid, reliable tools. The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED). The inclusion criteria were children aged 6 to 17 years presenting to the ED with a musculoskeletal injury and self-reported pain scores ≥30 mm on the mechanical Visual Analogue Scale (VAS). Self-reported pain intensity was assessed using the mechanical VAS, Faces Pain Scale-Revised (FPS-R), and Colour Analogue Scale (CAS). Convergent validity was assessed by Pearson correlations and the Bland–Altman method; responsiveness to change was assessed using paired sample t tests and standardized mean responses; and reliability was estimated using relative and absolute indices. A total of 456 participants were included, with a mean age of 11.9 years ± 2.7 and a majority were boys (252/456, 55.3%). Correlations between each pair of scales were 0.78 (VAS/FPS-R), 0.92 (VAS/CAS), and 0.79 (CAS/FPS-R). Limits of agreement (95% confidence interval) were −3.77 to 2.33 (VAS/FPS-R), −1.74 to 1.75 (VAS/CAS), and −2.21 to 3.62 (CAS/FPS-R). Responsiveness to change was demonstrated by significant differences in mean pain scores among the scales (P < 0.0001). Intraclass correlation coefficient and coefficient of repeatability estimates suggested acceptable reliability for the 3 scales at, respectively, 0.79 and ±2.29 (VAS), 0.82 and ±2.07 (CAS), and 0.76 and ±2.82 (FPS-R). The scales demonstrated good psychometric properties for children with acute pain in the ED. The VAS and CAS showed a strong convergent validity, whereas FPS-R was not in agreement with the other scales.
Stretchable Electronic Wearable Motion Sensors Delineate Signatures of Human Motion Tasks
Authors: Garlant Jacob A. , Ammann Kaitlyn R. , Slepian Marvin J.
Published: April 2018

Digital tracking of human motion offers the potential to monitor a wide range of activities detecting normal versus abnormal performance of tasks. We examined the ability of a wearable, conformal sensor system, fabricated from stretchable electronics with contained accelerometers and gyroscopes, to specifically detect, monitor, and define motion signals and “signatures,” associated with tasks of daily living activities. The sensor system was affixed to the dominant hand of healthy volunteers (n = 4) who then completed four tasks. For all tasks examined, motion data could be captured, monitored continuously, uploaded to the digital cloud, and stored for further analysis. Acceleration and gyroscope data were collected in the x-, y-, and z-axes, yielding unique patterns of component motion signals for each task studied. Upon analysis, low-frequency (<10 Hz) tasks (walking, drinking from a mug, and opening a pill bottle) showed low intersubject variability (<0.3g difference) and low interrepetition variability (<0.1g difference) when comparing the acceleration of each axis for a single task. High-frequency (≥10 Hz) activity (brushing teeth) yielded low intersubject variability of peak frequencies in acceleration of each axis. Each motion task was readily distinguishable and identifiable (with ≥70% accuracy) by independent observers from motion signatures alone, without the need for direct visual observation. Stretchable electronic technologies offer the potential to provide wireless capture, tracking, and analysis of detailed directional components of motion for a wide range of individual activities and functional status.
Impact of Cardiac Resynchronization Therapy on Left Ventricular Unloading in Patients with Implanted Left Ventricular Assist Devices
Authors: Tehrani David M. , Adatya Sirtaz , Grinstein Jonathan , Rodgers Daniel , Sarswat Nitasha , Kim Gene H. , Raikhelkar Jayant , Sayer Gabriel , Uriel Nir
Published: April 2018

Cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVADs) are common heart failure therapies; however, little is known regarding the concomitant use of these devices. We aim to evaluate unloading differences in LVAD patients with and without active biventricular pacing. Left ventricular assist device patients with and without CRT prospectively underwent ramp hemodynamic/echocardiographic testing. Patients with >95% biventricular pacing comprised the active CRT pacing group; all others (no device, implantable cardioverter defibrillator only, CRT without biventricular pacing) were categorized into the non-CRT pacing group. Invasive hemodynamics and echocardiographic characteristics (left ventricular end-diastolic/systolic diameter and valvular regurgitation) were measured at baseline and at incremental speed changes. Unloading slopes were calculated using linear regression modeling for individual hemodynamics and echocardiographic characteristics across speeds. Among 62 LVAD patients (age 59.6 ± 11.4 years, 60% male), 25 had active CRT pacing. There was no significant difference in echocardiographic or hemodynamic characteristics at baseline or final set speeds between CRT groups. Similarly, no significant differences were noted in the unloading characteristics. In LVAD patients, active biventricular pacing is unlikely to improve echocardiographic or hemodynamic characteristics.
Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: How Long Is Too Long?
Authors: Menaker Jay , Rabinowitz Ronald P. , Tabatabai Ali , Tesoriero Ronald B. , Dolly Katelyn , Cornachione Christopher , Stene Edward , Buchner Jessica , Kufera Joseph , Kon Zachary N. , Deatrick Kristopher B. , Herr Daniel L. , O’Connor James V. , Scalea Thomas M.
Published: April 2018

The use of veno-venous extracorporeal membrane oxygenation (VV ECMO) in adults with respiratory failure has steadily increased during the past decade. Recent literature has demonstrated variable outcomes with the use of extended ECMO. The purpose of this study is to evaluate survival to hospital discharge in patients with extended ECMO runs compared with patients with short ECMO runs at a tertiary care ECMO referral center. We retrospectively reviewed all patients on VV ECMO for respiratory failure between August 2014 and February 2017. Bridge to lung transplant, post-lung transplant, and post-cardiac surgery patients were excluded. Patients were stratified by duration of ECMO: extended ECMO, defined as >504 hours; short ECMO as ≤504 hours. Demographics, pre-ECMO data, ECMO-specific data, and outcomes were analyzed. One hundred and thirty-nine patients with respiratory failure were treated with VV ECMO. Overall survival to discharge was 76%. Thirty-one (22%) patients had extended ECMO runs with an 87% survival to discharge. When compared with patients with short ECMO runs, there was no difference in median age, body mass index (BMI), body surface area (BSA), partial pressure of oxygen (PaO2)/ fraction of inspired oxygen (FiO2) (P/F), and survival to discharge. However, time from intubation to cannulation for ECMO was significantly longer in patients with extended ECMO runs. (p = 0.008). Our data demonstrate that patients with extended ECMO runs have equivalent outcomes to those with short ECMO runs. Although the decision to continue ECMO support in this patient population is multifactorial, we suggest that time on ECMO should not be the sole factor in this challenging decision.
Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when?
Authors: Tagami Takashi , Ong Marcus Eng Hock
Published: April 2018

Purpose of review

Increase in pulmonary vascular permeability accompanied with accumulation of excess extravascular lung water (EVLW) is the hallmark of acute respiratory distress syndrome (ARDS). Currently, EVLW and pulmonary vascular permeability index (PVPI) can be quantitatively measured using the transpulmonary thermodilution (TPTD) technique. We will clarify why, how, and when EVLW and PVPI measurements should be performed.

Recent findings

Although the Berlin criteria of ARDS are simple and widely used, several criticisms of them have been published. The last 2 decades have witnessed the introduction and evolution of the TPTD technique for measuring EVLW and PVPI. Several publications have recommended to evaluate EVLW and the PVPI during the treatment of critically ill patients. Accurate and objective diagnoses can be made for ARDS patients using EVLW and PVPI. EVLW more than 10 ml/kg is a reasonable criterion for pulmonary edema, and EVLW more than 15 ml/kg for a severe condition. In addition to EVLW more than 10 mL/kg, PVPI more than three suggests increased vascular permeability (i.e., ARDS), and PVPI less than 2 represent normal vascular permeability (i.e., cardiogenic pulmonary edema).

EVLW and PVPI measurement will open the door to future ARDS clinical practice and research, and have potential to be included in the future ARDS definition.
Barrett Esophagus Length, Nodularity, and Low-grade Dysplasia are Predictive of Progression to Esophageal Adenocarcinoma
Authors: Solanky Dipesh , Krishnamoorthi Rajesh , Crews Nicholas , Johnson Michele , Wang Kenneth , Wolfsen Herbert , Fleischer David , Ramirez Francisco C. , Katzka David , Buttar Navtej , Iyer Prasad G.
Published: April 2018

Goals:

To investigate factors predictive of progression from nondysplastic Barrett esophagus (NDBE) or low-grade dysplasia (LGD) to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) using a large, prospective cohort of patients, wherein all esophageal biopsies undergo expert gastrointestinal pathologist review.

Background:

Efficacy and cost-effectiveness of endoscopic surveillance to detect incident EAC in the setting of Barrett esophagus (BE), particularly in NDBE patients, is questioned. Previous studies have reported factors predictive of progression to EAC to guide surveillance intervals, but their strength is limited by small sample size and absence of expert gastrointestinal pathologist involvement in esophageal biopsy review.

Study:

NDBE and LGD subjects were identified from a prospective registry in a tertiary care center. “Progressors” were BE subjects who developed HGD/EAC>12 months after the initial NDBE or LGD diagnosis. Cox proportional hazards model were used to identify predictors of progression.

Results:

In total, 318 with NDBE and 301 with BE-LGD (mean age, 62.6 y, 85% male) were included. The mean follow-up was 5.3 years. The 7 NDBE and 21 LGD subjects progressed to HGD/EAC. BE length [hazards ratio (HR), 1.16; 95% confidence interval (CI), 1.03-1.29], presence of nodularity (HR, 4.98; 95% CI, 1.80-11.7), and baseline LGD (HR, 2.57; 95% CI, 1.13-6.57) were significant predictors of progression on multivariate analysis.

Conclusions:

In this well-defined cohort of NDBE and BE-LGD subjects, BE length, presence of LGD, and nodularity were independent predictors of progression to HGD/EAC. These factors may aid in identifying high-risk patients who may benefit from closer endoscopic surveillance/therapy.
Cognitive assessment of patients with nonalcoholic fatty liver disease
Authors: Celikbilek Asuman , Celikbilek Mehmet , Bozkurt Gurbet
Published: April 2018

Objective

The aim of this study was to investigate cognitive performance for the first time in participants with nonalcoholic fatty liver disease (NAFLD) using the Montreal Cognitive Assessment (MoCA).

Participants and methods

In total, 70 participants with NAFLD and 73 age-matched and sex-matched healthy participants were enrolled in this prospective cross-sectional study. The diagnosis of NAFLD was made on the basis of abdominal ultrasonography findings. Anthropometric indices were calculated, and routine laboratory analyses were carried out for each participant. All participants provided sociodemographic data and completed the Beck Depression Inventory-II. Cognitive functions were evaluated using the Turkish version of the MoCA, with a cut-off score for mild cognitive impairment of less than 21 points.

Results

The MoCA scores were significantly lower in participants with NAFLD than in the healthy group (P<0.05). In addition, more NAFLD participants than healthy participants presented with deficits in the visuospatial (P<0.05) and executive function domains (P<0.05). In the multivariate model, education level [2.79 (1.12–6.96); P<0.05] and area of residence [5.68 (2.24–14.38); P<0.001] were associated independently with cognitive dysfunction in both the NAFLD and the healthy groups. The MoCA scores were correlated negatively with fibrosis 4 scores in NAFLD participants (r=−0.359; P<0.05). However, hepatosteatosis grade and the presence of metabolic syndrome were not correlated with MoCA scores in the NAFLD group (P>0.05).

Conclusion

Our results show that NAFLD patients may have early or subtle cognitive dysfunction, including in the visuospatial and executive function domains, as indexed by scores on the MoCA test. Further targeted psychometric testing will be required to confirm the presence of cognitive impairment in this population.
Enhancing human cord blood hematopoietic stem cell engraftment by targeting nuclear hormone receptors
Authors: Guo Bin , Huang Xinxin , Broxmeyer Hal E.
Published: April 2018

Purpose of review

Allogeneic hematopoietic cell transplantation (HCT) is a life-saving therapy for hematological and nonhematological diseases. Cord blood is a source of transplantable hematopoietic stem cells (HSCs), but limited numbers of HSCs in single cord blood units, which may cause delayed neutrophil, platelet, and immune cell reconstitution, is a major problem for efficient transplantation. Ex-vivo expansion and enhanced homing of cord blood HSC may overcome this disadvantage and improve its long-term engraftment. Here, we discuss the role of nuclear hormone receptors signaling in human cord blood HSC engraftment.

Recent findings

Antagonizing retinoid acid receptor (RAR) signaling promotes human HSC expansion and increases myeloid cell production. Cord blood CD34+ cells expanded by SR1 promotes efficient myeloid recovery after transplantation compared with control groups, and leads to successful engraftment. Short-term treatment of glucocorticoids enhances homing and long-term engraftment of human HSCs and HPCs in NSG mice. Peroxisome proliferator-activated receptor-γ (PPARγ) antagonism expands human HSCs and HPCs by preventing differentiation and enhancing glucose metabolism. These findings demonstrate that nuclear hormone receptor signaling components might be promising targets for improving human cord blood HCT.

Better understanding of molecular mechanisms underlying human HSC expansion and homing mediated by nuclear hormone receptor signaling pathways will facilitate enhanced HCT efficacy.
Reassessment of the Risk-stratified GD-2008 ALL Protocol
Authors: Que Li-ping , Huang Ke , Fang Jian-pei , Xu Hong-gui , Zhou Dun-hua , Li Yang , Xu Lv-hong , Li Jian , Chen Hai-lei
Published: April 2018

Objective:

To explore the clinical features and outcomes of relapsed childhood acute lymphoblastic leukemia (ALL) at our center, achieve the early detection of risk factors for recurrence and assess the risk-stratified Guangdong (GD)-2008 ALL protocol.

Materials and Methods:

In total, 59 Chinese childhood ALL patients treated with the GD-2008 ALL protocol who relapsed between July 2008 and March 2015 were enrolled in this study. Their clinical features and outcomes were retrospectively analyzed and compared with those of 218 patients who achieved continuous complete remission.

Results:

Of the 285 study participants, 8 died of treatment-related infections or other complications before remission, 218 achieved continuous complete remission, and 59 patients relapsed, yielding a relapse rate of 20.7%. The number of relapsed patients in the standard-risk, intermediate-risk, and high-risk groups were 15 (17.0%), 27 (19.7%), and 17 (32.7%), respectively. Risk factors included age 10 years and above at first diagnosis, white blood cell (WBC) count ≥50×109/L, poor prednisone response, failure to achieve bone marrow complete remission at day 15 of induction chemotherapy. High-risk stratification and a high level (≥0.1%) of minimal residual disease at day 33 were the risk factors for relapse. Multivariate analysis showed that a high WBC at first diagnosis was an independent risk factor for relapse (P=0.000).

Conclusion:

For the GD-2008 ALL risk stratification based on age and initial WBC, 10 years of age and WBC 50×109/L can be used as cut-offs. Patients at high risk benefited from the GD-2008 ALL protocol. In addition, the impact of minimal residual disease on prognosis should be considered.
Clinical Study of Second Branchial Cleft Anomalies
Authors: Lee Dong Hoon , Yoon Tae Mi , Lee Joon Kyoo , Lim Sang Chul
Published: April 2018

Objective:

The objective of this study was to review the clinical characteristics and surgical treatment outcomes of second branchial cleft anomalies, and to evaluate the usefulness and accuracy of preoperative fine-needle aspiration cytology (FNAC) in the diagnosis of branchial cleft cysts.

Methods:

A retrospective chart review was performed at Chonnam National University Hwasun Hospital from January 2010 to December 2016.

Results:

Among 25 patients with second branchial cleft anomalies, in 23 patients (92.0%), these anomalies presented as cysts, and in the remaining 2 patients (8.0%), these anomalies presented as fistulas. Fine-needle aspiration cytology had a diagnostic sensitivity of 100%, a positive-predictive value of 100%, and accuracy of 100% for diagnosing second branchial cleft cyst. All patients of second branchial cleft anomalies were treated surgically under general anesthesia. No recurrence of second branchial cleft anomalies was observed.

Conclusion:

Branchial cleft cysts were the most common type of second branchial cleft anomalies. Preoperative FNAC is a useful and accurate method for preoperative evaluation of branchial cleft cysts. Surgical excision of second branchial cleft anomalies is the treatment of choice without any complications and with no recurrence.
Cleft Palate Repair Using Single Flap Palatoplasty in Patient With Associated Palatal Hemangioma
Authors: Kara Murat , Calis Mert , Akyuz Canan , Ozgur Figen
Published: April 2018

Hemangiomas are the most common tumors of childhood with an average incidence of 10%. It is unusual for hemangiomas, which are already rarely seen isolated on the palate, to coexist with cleft palate as in the authors’ patient. Four months old baby was admitted with isolated Veau 2 cleft palate and a red-purple colored raised lesion involving almost the whole right side of the hard palate. Magnetic resonance imaging revealed intensive contrasting solid nodule with a lobulated contour that was covering the right half of the hard palate, measuring 2.2×1.3 cm. To reduce the size of the vascular lesion 7 mg/d oral propranolol treatment was initiated. Following reduction in the size of hemangioma, the cleft palate was repaired at 11 months of age. Single mucoperiosteal flap from the left side of the palate preserving the major palatine artery was elevated whereas right mucoperisteal flap was minimally dissected not to interfere with the hemangioma. No intraoperative and postoperative complications in both the early and late term were experienced. As a result, since early palatal repair is important to obtain ideal speech outcomes in cleft patients, repair should be performed in similar patients with hemangiomas without delaying the timing.
Percutaneous Autologous Fat Injection Following 2-Layer Flap Lower Blepharoplasty for the Correction of Tear Trough Deformity
Authors: Kim Jeenam , Shin Hyojeong , Lee Myungchul , Shin Donghyeok , Kim Soonheum , Jo Dongin , Kim Cheolkeun , Kim Heonjoon , Choi Hyungon
Published: April 2018

Tear trough deformity has been an area that has received much attention in terms of esthetic improvements. Fat transposition has been commonly used for the treatment of tear trough deformity. As some patients have had minimal improvement by that method, we propose the use of fat grafting combined with open blepharoplasty to complement the sunken area, including some of anterior maxilla region, and evaluate and precisely remove the excessive tissue.

Lower blepharoplasty was performed by separating the skin and muscle flap. The excessive or laxed tissue was evaluated during the procedure and resected in each flap. Fat grafting was performed after completing a lower blepharoplasty, to ensure accurate placement on the spot where the surgeon originally intended. Overcorrection is not recommended.

No serious complications were reported during a period of 10 years. Only 4 patients required a secondary fat injection.

Patients who require structural correction of the lower eyelid area (eg, aggressive herniated fat, excessive skin laxity, or bulky orbicularis oculi muscle) and who need complementary material to fill the lower lid area (eg, deep, wide sunken area or relative exophthalmos) are good candidates for blepharoplasty with a fat grafting procedure.
Sex Difference in the Morphology of Pineal Gland in Adults Based on Brain Magnetic Resonance Imaging
Authors: Han Qing , Li Youqiong , Wang Jincheng , Zhao Xue
Published: April 2018

Purpose:

We aimed to figure out the anatomical features of pineal gland region on magnetic resonance imaging (MRI) and to explore the sex difference in pineal gland-related parameters with increasing age.

Methods:

We measured the pineal gland on MRI images from 198 healthy adults (96 males and 102 females). Included subjects were divided into 4 age groups. After 3-dimensional reconstruction, the anatomic features of pineal gland and its distances to superior colliculus and splenium of corpus callosum were analyzed in each group. The prevalence of cystic pineal gland was calculated. Moreover, we calculated the volume of pineal gland (PGV) and explored the differences of PGV in males and females across different age groups. Linear regression analysis was performed to detect the relationship between age and pineal gland-related parameters.

Results:

In 198 subjects, the mean length, width, and height of pineal gland were 7.58 ± 0.45 mm, 4.92 ± 0.40 mm, and 2.90 ± 0.20 mm. The distances between pineal gland and superior colliculus as well as splenium of corpus callosum were 3.96 ± 0.92 mm and 4.3 ± 1.89 mm, respectively. The PGV was 54.1 ± 7.02 mm3. Significant sex differences were found in pineal gland length (P < 0.001), cranial cavity diameter (P < 0.001), pineal gland index (P < 0.001) and PGV values (P = 0.02). The prevalence of cystic pineal gland was 36.4% in total subjects, 41.7% in males and 32.4% in females. No linear relationship was found between age and pineal gland parameters.

Conclusion:

We measured the pineal gland morphology based on MRI images. Significant influences on pineal gland parameters were found in subjects with different sex, whereas no effect was observed from age.
Orbital Fracture Reconstruction Using Prebent, Anatomic Titanium Plates: Technical Tips to Avoid Complications
Authors: Purnell Chad A. , Vaca Elbert E. , Ellis Marco F.
Published: April 2018

Orbital fractures are common. In patients where there is significant loss of the medial wall and orbital floor, anatomic prebent 3-dimensional plates allow efficacious restoration of orbital volume. However, the large size of these plates can result in technical difficulties with plate placement, especially in fractures with complete loss of 2 walls of the orbit. In this article, the authors review the pertinent anatomy of the bony orbit with respect to fracture and landmarks in fracture reduction. The authors also note the 3 most commonly encountered problems with the placement of anatomic plates: poor exposure, failure to identify the posterior ledge for the plate, and rotational issues with plate placement resulting in impingement. Technical tips are given to help overcome these issues intraoperatively.