bluuebunny/crossref_metadata_2025 huggingface dataset:
The ELR-SOBIR1 Complex Functions as a Two-Component Receptor-Like Kinase to Mount Defense Against Phytophthora infestans
Authors: Domazakis Emmanouil , Wouters Doret , Visser Richard G. F. , Kamoun Sophien , Joosten Matthieu H. A. J. , Vleeshouwers Vivianne G. A. A.
Published: February 2018

The ELICITIN RESPONSE protein (ELR) from Solanum microdontum can recognize INF1 elicitin of Phytophthora infestans and trigger defense responses. ELR is a receptor-like protein (RLP) that lacks a cytoplasmic signaling domain and is anticipated to require interaction with a signaling-competent receptor-like kinase. SUPPRESSOR OF BIR1-1 (SOBIR1) has been proposed as a general interactor for RLPs involved in immunity and, as such, is a potential interactor for ELR. Here, we investigate whether SOBIR1 is required for response to INF1 and resistance to P. infestans and whether it associates with ELR. Our results show that virus-induced gene silencing of SOBIR1 in Nicotiana benthamiana leads to loss of INF1-triggered cell death and increased susceptibility to P. infestans. Using genetic complementation, we found that the kinase activity of SOBIR1 is required for INF1-triggered cell death. Coimmunoprecipitation experiments showed that ELR constitutively associates with potato SOBIR1 in planta, forming a bipartite receptor complex. Upon INF1 elicitation, this ELR-SOBIR1 complex recruits SERK3 (SOMATIC EMBRYOGENESIS RECEPTOR KINASE 3) leading to downstream signaling activation. Overall, our study shows that SOBIR1 is required for basal resistance to P. infestans and for INF1-triggered cell death and functions as an adaptor kinase for ELR.
Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline
Authors: Gilligan Timothy , Coyle Nessa , Frankel Richard M. , Berry Donna L. , Bohlke Kari , Epstein Ronald M. , Finlay Esme , Jackson Vicki A. , Lathan Christopher S. , Loprinzi Charles L. , Nguyen Lynne H. , Seigel Carole , Baile Walter F.
Published: February 2018

(Abstracted from J Clin Oncol 2017;35(31):3618–3632)

Clinicians who treat cancer are faced with many challenges when communicating diagnostic, treatment, and prognostic information to patients and their families. The limited training of many oncologists does not prepare them to deliver effective information.
Tendon rehabilitation: factors affecting outcomes and current concepts
Authors: Lewis Don
Published: February 2018

Tendon rehabilitation is a complex aspect of rehabilitation and requires the coordinated efforts of surgeons, hand therapists, and patients in order to achieve desired outcomes. Typically, postoperative management of tendon repairs falls into one of three categories: immobilization, early passive protocols, or early active protocols. Immobilization is used on rare occasions such as in young children or in adults in whom compliance is expected to negatively affect patient outcomes. The industry is moving more toward early active protocols with advances in suture techniques and tendon repairs, but early passive protocols remain a staple in the rehabilitation process. General concerns for factors affecting patient outcomes have revolved around maintaining the integrity or strength of repair and limiting adhesions. This paper also discusses some less known and often overlooked aspects that have both a direct or indirect effect on patient outcomes to include a team-based approach to care, psychosocial factors, socioeconomic factors, and timing of both the tendon repair and therapy referral.
Understanding the Epidemiology of Pediatric Supracondylar Humeral Fractures in the United States: Identifying Opportunities for Intervention
Authors: Holt Joshua B. , Glass Natalie A. , Shah Apurva S.
Published: February 2018

Background:

Supracondylar humeral fractures (SCHF) are the most common elbow fractures in children. The epidemiology of these injuries in the United States is described.

Methods:

The Nationwide Emergency Department Sample database was queried for all children (age, below 18 y) with SCHF treated in the emergency department (ED) from 2006 to 2011, and weighted estimates were extracted.

Results:

A total of 63,348 ED visits for SCHF were identified. The weighted estimate of ED visits remained stable over the study period, ranging from 60.3 to 71.8 per 100,000 children annually. There was no significant difference in fracture rate (52% male) by sex. The mean age of closed injury was 5.5±3.1 years, with 53.6% of fractures occurring in children 3 to 6 years. Open injuries accounted for 1.0% of fractures. Children with open injuries were significantly older (mean, 9.1±4.4 y; P<0.0001) and more often male (OR, 1.43; P<0.001). Neurovascular injury occurred in significantly older children (mean, 7.6±3.1 y; P<0.0001) and was documented in 11.4% of open fractures and 3.6% of operative fractures. Although the South had the greatest number of total SCHF-related ED visits, children in the West had significantly more SCHF-related ED visits per 100,000 children annually (77.9) than all other regions (P<0.05). Average fracture rates were approximately 60% higher in April to September than October to March (P<0.001). Mean total charges for patients treated and discharged from the ED were $2965, compared with $17,865 in children admitted for surgery (P<0.05). Mean charges were significantly higher in the West compared with all other regions (P<0.0001).

Conclusions:

The incidence of pediatric SCHF-related ED visits remained stable from 2006 to 2011 and occurred most frequently in children aged 3 to 6 years. Open injuries are rare and are more likely to occur in older boys. There are significant differences in the injury rates and charges across geographic regions, identifying opportunities for injury prevention, cost reduction, and value improvement. The indications for operative management should be clearly delineated given the high cost of surgical treatment.

Level of Evidence:

Therapeutic Level IV.
Arthroscopically Assisted Percutaneous Fixation of a Talar Neck Fracture Via Posterior Approach: A Case Study
Authors: Pyle Casey , Harris Thomas G.
Published: February 2018

Talus fractures are the second most common tarsal fracture after the calcaneus. Traditional treatment methodology includes open reduction and internal fixation; however, there has been increased interest and literature in arthroscopically assisted fixation of talus fractures. We present a case study of a patient with a type 1 talar neck fracture that was successfully treated with arthroscopically guided percutaneous screw fixation from a posterior arthroscopic approach.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
The Evolution of Total Knee Component Design Follows Anatomic Morphology
Authors: Gold Christopher A. , Scuderi Giles R.
Published: February 2018

Over the years, the total knee arthroplasty (TKA) has become a common procedure for patients of various ages, ethnicities, and sex. Early prosthetic designs were limited in size and shape, leaving the surgeon to subjectively decide which component to use and sometimes having to compromise on the surgical technique to achieve a secure and stable construct. As studies began to investigate differences in tibial and femoral dimensions of the knee between specific populations, TKA implants incorporated these findings to become more anatomically accurate. When considering the global TKA patient population and the anthropometric differences between sexes and ethnicities, using anatomically proportioned femoral or tibial components with accurate trends in size and shape increases surgical accuracy to the measured anatomy, and ultimately influences clinical performance. This review will highlight the important clinical differences regarding knee anatomy between certain populations, along with the corresponding improvements in total knee component design.
Bicruciate Retaining Designs: Where Have We Been and Where are We Going?
Authors: Preston Jared Scott , Bateman Dexter K. , Tria Alfred J.
Published: February 2018

Bicruciate retaining total knee arthroplasty dates back to the 1980s. The earliest of the prostheses saved all of the ligaments but included constraint in the surface design that led to a kinematic conflict and early failures. Townley and Cloutier developed successful designs that had good midterm results but they did not develop a significant following among the orthopedic surgeons of their time. With the introduction of minimally invasive surgery for total knee arthroplasty, the concept of sparing the anatomy brought surgeons back to the concept of saving all of the ligaments. In the past 5 years at least 2 new designs for the bicruciate ligament retaining TKA have been introduced. The new prostheses have improved anatomy and more sophisticated instrumentation for the surgical procedure. The clinical results are short-term, but they are encouraging. The operation can be performed routinely, the prosthesis is reliable, and patients are reporting improved KOOS scores. The future will show added technology for the operation with robotic assistance, pressure sensing devices for balancing, and smart instruments to assist in alignment. Hopefully, the more anatomic design will help the 15% of patients who are not satisfied with their TKA.
Robotics and the Modern Total Knee Arthroplasty
Authors: Buza John A. , Vigdorchik Jonathan , Schwarzkopf Ran
Published: February 2018

Robotic-assisted knee arthroplasty has been clinically available for the past 2 decades, but is still in the early stages of adoption for use in total knee arthroplasty (TKA). The purpose of this technology is to improve the precision, accuracy, and reproducibility of TKA. Robotic-assisted systems may be passive, semiactive, or active. Although robotic-assisted systems have been used extensively in unicondylar knee arthroplasty, there are relatively few studies of using this technology in TKA. These early studies have shown that robot-assisted technology may lead to improvements in both mechanical axis and component alignment. No studies have demonstrated that these radiographic improvements have translated into any clinical benefit, however. The purpose of this review is to introduce robotic-assisted systems for use in knee arthroplasty, describe the potential advantages and limitations associated with this technology, and review several of the systems that are currently available.
The Bicruciate Substituting Knee Design and Initial Experience
Authors: Nodzo Scott R. , Carroll Kaitlin M. , Mayman David J.
Published: February 2018

Total knee arthroplasty (TKA) is an excellent treatment option for patients with end-stage osteoarthritis; however, a significant number of patients are not satisfied postoperatively. Much of this dissatisfaction comes from persistent pain and difficulty regaining range of motion. We retrospectively reviewed 200 patients who underwent a primary unilateral TKA by a single surgeon from 2013 to 2014 at a single institution. All surgery was performed with computer-navigated guides to minimize surgical alignment error. In total, 100 patients underwent a TKA using a standard posterior stabilized (PS) prosthesis and the other 100 patients underwent TKA with an asymmetric bicruciate stabilized (BCS) prosthesis. There was no significant difference between groups in preoperative range of motion (P=0.07). Postoperatively, in the BCS group, average flexion was 119 degrees (range, 95 to 125 degrees) and in the standard PS group average flexion was 96 degrees (range, 85 to 116 degrees). There was a significant and clinically relevant improvement in flexion at 6 weeks in patients who underwent a TKA with a BCS implant (P<0.0001). There was no significant difference in preoperative and postoperative Knee Society Scores between groups (P=0.30) at 6 weeks postoperatively. At 1-year follow-up, patients in the BCS group had significantly better Knee Society Scores compared with patients in the standard PS prosthesis (P<0.001). Our study suggests that an implant design that more closely replicates the normal anatomic joint line and knee kinematic patterns may help reduce some of the dissatisfaction following TKA.
Effects of the active constituents of Crocus sativus L. crocins and their combination with memantine on recognition memory in rats
Authors: Pitsikas Nikolaos , Tarantilis Petros A.
Published: February 2018

Crocus sativus L., is a plant cultivated in many countries of the world. Crocins are among the active constituents of C. sativus and their implication in cognition has been proposed. The present study was designed to investigate in the rat the effects of crocins on distinct recognition memory components (encoding, storage and retrieval). Subsequently, the potential use of crocins as adjunctive agents for the treatment of memory disorders was examined. Thus, the effects exerted by a combination of subthreshold doses of crocins and memantine on recognition memory were evaluated. To assess the effects of compounds on memory, the novel object-recognition task (NORT) was used. In a preliminary study, the influence of the retention time (the delay between the two trials) on the performance of rats was assessed. Rats’ recognition memory abilities remained intact up to 6 h, but were extinguished when a delay of 24 h was utilized. Crocins, at any dose tested (5, 15, and 30 mg/kg), did not affect rats’ performance, whereas administration of higher doses (15 and 30 mg/kg) reversed delay-dependent deficits in the NORT. The combination of subthreshold doses of crocins (5 mg/kg) and memantine (3 mg/kg) did not influence the performance, but counteracted delay-dependent deficits in the NORT. These findings suggest that crocins counteract natural forgetting and may modulate different aspects of recognition memory, and that the combined use of crocins and memantine might represent a novel strategy to treat memory disorders.
The Effects of a Health Promotion Program on Rural, West Virginia Adults
Authors: Spurrier Amy E. , Suttle Catherine , Matheson Linda , Baker-Watson Ann
Published: February 2018

This health promotion project is a 12-week program for adults in a rural West Virginia community with a body mass index (BMI) of 25 or greater. The goals of this project were to facilitate learning through modules focusing on activity and nutrition, increase knowledge of healthy activity and nutrition, and improve weight and BMI. Each 12-week session provided evidenced-based information regarding obesity, physical activity, and nutrition. Participants completed pre- and postprogram and 1-month follow-up survey/questionnaire. Results were compared for changes in activity, nutrition, and BMI. The program resulted in positive changes: increase in activity and nutritional consumption and a decrease in BMI.
Looking For Food
Authors: Hossfeld Leslie H. , Rico Mendez Gina
Published: February 2018

Mississippi has the highest food insecurity rate in the nation, and while the overall pattern of food insecurity has declined in the United States, for Mississippians it has plateaued, remaining significantly higher than prerecession rates. In addition, the food environment of the state is characterized by low healthy food access, high persistent poverty, and a primarily rural landscape. This translational research seeks to bridge thinking on agriculture policy, nutrition, food access/food insecurity in seeking to understand the paradox between obesity and poverty in rural Mississippi. Examining food system opportunities as potential solutions to food access and healthy outcomes is explored.
Health and Health Care From the Perspective of Intimate Partner Violence Adult Female Victims in Shelters
Authors: Wadsworth Pamela , Kothari Catherine , Lubwama Grace , Brown Cathy L. , Frank Benton Jennifer
Published: February 2018

Intimate partner violence (IPV) predicts poor health for victims and their children, but little is known about the perspective of victims. This study reports the perspectives of adult female IPV victims about the impact of IPV on their health and barriers of health care access for themselves and their children. The majority rated their health as good to excellent (69%). However, 83.5% indicated that IPV negatively affected their health; 53.5% had unmet health care needs. Mental health care was the most common unmet need for women; children's unmet needs were immunizations and preventive care. Transportation difficulties posed the biggest barrier to health care access.
Patterns of menopausal hormone therapy use and hyperkyphosis in older women
Authors: Woods Gina N. , Huang Mei-Hua , Cawthon Peggy M. , McDaniels-Davidson Corinne , Fink Howard A. , Kado Deborah M.
Published: February 2018

Objective:

Hyperkyphosis, an exaggerated anterior curvature of the thoracic spine, is associated with poor physical function, falls, fractures, and earlier mortality. Low bone mineral density, bone loss, and vertebral fractures are strong risk factors for hyperkyphosis. Menopausal hormone therapy (HT) reverses bone loss, prevents vertebral fractures, and, therefore, we hypothesize, may reduce the risk for developing hyperkyphosis.

Methods:

We evaluated the cross-sectional association between Cobb angle of kyphosis from lateral spine radiographs and pattern of self-reported HT use during the prior 15-year period in 1,063 women from the Study of Osteoporotic Fractures.

Results:

Participants had a mean age of 83.7 ± 3.3 years and a mean Cobb angle of 51.3 ± 14.6°. Forty-six per cent of women were characterized as never-users of HT, 24% as remote past users, 17% as intermittent users, and 12% as continuous users. In minimally adjusted models, the mean Cobb angle was 4.0° less in continuous HT users compared with never-users (P = 0.01); however, in fully adjusted models, this association was attenuated to 2.8° (P = 0.06). Remote past HT users had 3.0° less kyphosis compared with never-users in minimally adjusted models (P = 0.01), attenuated to 2.8° less in fully adjusted models (P = 0.02). Intermittent users did not differ from never-users in degree of kyphosis.

Conclusions:

Women reporting continuous or remote past HT use had less pronounced kyphosis than never-users by their mid-eighties, suggesting a possible role for HT in the prevention of age-related hyperkyphosis.
Technology's Role in Quality Improvement and Operational Efficiency
Authors: Blauwet Judy , Bell Mandy
Published: February 2018

Technology for technology's sake is never a good idea. There must be a purpose behind it. It must help us do our jobs better. Technology allows healthcare to remain affordable and, as such, accessible. Technology must increase access to care, improve safety, make test results more reliable, and help teams communicate better for a seamless care experience.

Avera Health, a health system based in Sioux Falls, South Dakota, comprises 330 facilities in 100 communities in five states. Sponsored by the Benedictine and Presentation Sisters, Avera is a healthcare ministry whose employees deliver high-quality care with compassion. We have been early innovators in using technology to deliver a high standard of service.

Avera has been nationally recognized for its innovation. For 18 of the past 19 years, the system has been named to Hospitals & Health Networks magazine's list of Health Care's Most Wired and has been designated as “advanced” for reasons that include the development of the most extensive telehealth network serving rural healthcare facilities. Avera also won the Most Wired Innovator Award in 2011 and 2012. Avera's flagship 545-bed tertiary facility, Avera McKennan Hospital & University Health Center, has received Stage 7 recognition from HIMSS Analytics.

Avera leaders have developed a spirit of inquiry and a culture of innovation. We have fostered change by aligning our care into service lines that help ensure that wherever people walk in our doors, they will receive the same quality care. In several cases, we have innovated through strategic partnerships. In this article, we describe how technology helps sustain our culture of innovation.
Reliability of Blotting Techniques to Assess Contact Lens Water Content
Authors: Cañadas Pilar , López-Miguel Alberto , Gómez Alba , López-de la Rosa Alberto , Fernández Itziar , González-García María J.
Published: February 2018

Objectives:

To determine the reliability of wet and modified dry blotting techniques used in the gravimetric method to assess contact lens (CL) water content (WC), the accuracy of both techniques in comparison with the nominal WC, and also their agreement.

Methods:

We evaluated hydrated and dry CL mass values and WC using the gravimetric method in 440 daily disposable CLs. Samples assessed corresponded to Dailies Total 1, Dailies AquaComfort Plus, 1-Day Acuvue TruEye, and Biotrue ONEday. Back vertex power ranged from +3.00 diopters (D) to −6.00 D. Within-subject coefficient of variation (CVw) and intraclass correlation coefficients were calculated. Bland-Altman analysis was also performed.

Results:

The modified dry blotting technique yielded significantly (P≤0.0001) higher hydrated CL mass values. The wet blotting technique provided significantly (P≤0.04) better consistency than the modified dry one. Values of CVw for wet and modified dry blotting techniques ranged from 1.2% to 2.1% and from 3.7% to 5.4%, respectively. As for dry CL mass values, CVw values were not significantly different (P≥0.05) between wet (range: 1.1%–1.9%) and dry (range: 1.0%–5.1%) blotting techniques, except for Dailies AquaComfort Plus (P=0.03). Bland-Altman analysis showed poor agreement between the techniques. The wet blotting technique yielded WC values close (around 1%) to nominal ones, in contrast to modified dry blotting technique (≥2.5%).

Conclusions:

The wet blotting technique is not only more reliable than the modified dry one when obtaining hydrated CL mass but also provides more accurate nominal WC measurements. Agreement between the techniques was poor.
Extravaginal Gardnerella vaginalis Infection—An Uncommon Variable
Authors: Booher Katelyn J. , Czachor John S.
Published: February 2018

Extravaginal infections due to Gardnerella vaginalis are rare and likely underappreciated. We present a case of G. vaginalis pyelonephritis and bacteremia due to an obstructing nephrolith. It is important for healthcare providers to be aware of such infections, including genitourinary or bloodstream infections, which may follow local anatomic disruption.
Kawasaki Disease After Streptococcal Pneumonia
Authors: Argyri Ioanna , Soldatou Alexandra , Grigoriadou Georgia , Vougiouka Olga , Tsolia Maria
Published: February 2018

A 4.5-year-old girl presented to the emergency department with a 5-day history of high fever, fatigue, and rash. Because of pneumonia with pleural empyema and sepsis caused by Streptococcus pyogenes, she was admitted to the pediatric intensive care unit. After initial improvement and on the eighth day, she became febrile again and also developed conjunctivitis, rash, cervical lymphadenopathy, periungual desquamation, and elevated inflammatory markers. A cardiac echo revealed a limited dilatation of the left main coronary artery. Because of suspicion of secondary Kawasaki disease, she received intravenous immunoglobulin and acetylsalicylic acid. There was an immediate clinical response with improvement of all clinical manifestations and laboratory findings. During follow-up examination 1 month later, the diameter of the left main coronary artery was within normal limits. A high index of suspicion of Kawasaki disease in children is required upon development of fever and compatible signs and symptoms in patients with serious streptococcal disease.
Long-Term Safety of Tedizolid in a Patient With Spondilodiscitis After Switch From Linezolid Due to Toxicity
Authors: Martínez Álvarez Rosa Maria , Navarro Pardo Irene , Moreno García Estela , Huarte Lacunza Rafael
Published: February 2018

The patient is a 57-year-old man with liver cirrhosis, Bricker anastomosis after a radical cystoprostatectomy and, a history of bacteremias caused by extended-spectrum β-lactamase–positive Escherichia coli, Enterococcus faecium, and Candida albicans. He presented with persistent low back pain and was diagnosed with vertebral osteomyelitis, for which he received ertapenem-linezolid treatment. However, after 20 days, linezolid had to be discontinued because of myelotoxicity and metabolic acidosis. The patient was switched to tedizolid, which, in combination with ertapenem, was successfully given for 114 days until biopsy showed no growth of gram-positive cocci. We conclude that tedizolid can be an alternative to linezolid in case of toxicity, especially in long-term treatments.
Retracting Locking-Pin Mechanism That Allows Partial Prosthetic Socket Doffing during Sitting
Authors: Goldstein Mark D. , Cagle John C. , Hafner Brian J. , Allyn Katheryn J. , Sanders Joan E.
Published: February 2018

Introduction

The purpose of this research was to develop a retractable tethered pin system to facilitate partial doffing and redonning of prosthetic sockets with locking-pin suspension.

Materials and Methods

The system included a tethered cord that extended from a retracting mechanism on the pylon through the shuttle lock to a clip at the bottom of the locking pin. The mechanism operated similarly to a seatbelt retractor, applying low-level tension unless the user made a rapid pull on the tether to lock the mechanism.

Results

Evaluation tests on four people with limb loss demonstrated that users liked the retracting mechanism and its capability to facilitate partial doffing and redonning. However, participants reported that the clip used to connect the mechanism to the locking pin worsened initial donning and final doffing of the socket.

Conclusions

Modifications to the retractable tethered pin system design may overcome limitations and result in an easy and effective accommodation technology for people with transtibial amputation.
Individualized Antithrombotic Therapy in Heartware HVAD Recipients
Authors: Sorensen Erik N. , Voorhees Hannah J. , Dees Lynn M. , Pham Si M. , Kon Zachary N. , Griffith Bartley P. , Feller Erika D.
Published: February 2018

There are no evidence-based guidelines for antithrombotic therapy in left ventricular assist device patients. We evaluated the efficacy of a multi-agent, test-guided protocol, which remained consistent throughout our use of the Heartware HVAD. Thrombelastography and platelet function analyzer (PFA)-100 guide antiplatelet titration. Goals are normal kaolin thrombelastography maximum amplitude and prolonged PFA-100. We analyzed incidence and rates of nonprocedural bleeding, stroke, and pump thrombosis for all 81 primary Heartware left ventricular assist devices implanted since 2011. For each event, we examined whether each test was within goal range. We also compared medication burden and dosage between patients with and without events. Pump thrombosis and hemorrhagic stroke each occurred in two patients (2.5%; 0.03 events/patient-year [EPPY]), and ischemic stroke in six (7.4%; 0.10 EPPY). Nonprocedural bleeding occurred 75 times in 34 patients (42%; 1.24 EPPY), primarily gastrointestinal (28%; 0.66 EPPY). Subtherapeutic international normalized ratio (INR) was the most common at thrombotic events; supratherapeutic partial thromboplastin time, international normalized ratio (INR), and PFA-adenosine diphosphate (ADP) were common at bleeding events. Medication burden and dosage were lower in patients with events than in stable patients. Protocol-guided antithrombotic therapy resulted in low rates of pump thrombosis and hemorrhagic stroke. Ischemic stroke and gastrointestinal bleeding rates were higher than in a comparable HVAD population. Optimization of our protocol to decrease its complexity and to reduce bleeding is underway.
From dysmotility to virulent pathogens: implications of opioid use in the ICU
Authors: Chapple Lee-anne , Deane Adam
Published: February 2018

Purpose of review

Gastrointestinal dysmotility occurs frequently in the critically ill. Although the causes underlying dysmotility are multifactorial, both pain and its treatment with exogenous opioids are likely causative factors. The purpose of this review is to describe the effects of pain and opioids on gastrointestinal motility; outline the rationale for and evidence supporting the administration of opioid antagonists to improve dysmotility; and describe the potential influence opioids drugs have on the intestinal microbiome and infectious complications.

Recent findings

Opioid drugs are frequently prescribed in the critically ill to alleviate pain. In health, opioids cause gastric dysmotility, yet the evidence for this in critical illness is inconsistent and limited to observational studies. Administration of opioid antagonists may improve gastrointestinal motility, but data are sparse, and these agents cannot be recommended outside of clinical trials. Although critical illness is associated with alterations in the microbiome, the extent to which opioid administration influences these changes, and the subsequent development of infection, remains uncertain.

Replication of clinical studies from ambulant populations in critical care is required to ascertain the independent influence of opioid administration on gastrointestinal motility and infectious complications.
Lessons Learned From Domestic and International Human Papillomavirus Vaccination Programs: A Review
Authors: Miller Kathryn , Dilley Sarah E. , Huh Warner K.
Published: February 2018

(Abstracted from Am J Obstet Gynecol 2017; http://dx.doi.org/10.1016/j.ajog.2017.08.109)

Persistent infection with oncogenic human papillomavirus (HPV) leads to the development of many cervical cancers, as well as cancers of other anatomic locations. Among the more than 150 types of HPV, 13 have been identified as carcinogenic; types 16 and 18 are responsible for 70% of invasive cervical cancer.
Surgeons' Views on Sling Tensioning During Surgery for Female Stress Urinary Incontinence
Authors: Borazjani Ali , Pizarro-Berdichevsky Javier , Li Jianbo , Goldman Howard B.
Published: February 2018

(Abstracted from Int Urogynecol J 2017;28:1489–1495)

Over the past 2 decades, synthetic midurethral slings (MUSs) have become the criterion standard treatment for female stress urinary incontinence (SUI). Rates of MUS far exceed those of other operations for female incontinence.
Nutrient Deficiency and Obstetrical Outcomes in Pregnant Women Following Roux-en-Y Gastric Bypass: A Retrospective Danish Cohort Study With a Matched Comparison Group
Authors: Hammeken Lianna Hede , Betsagoo Ramsina , Jensen Ann Nygaard , Sørensen Anne Nødgaard , Overgaard Charlotte
Published: February 2018

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2017;216:56–60)

Roux-en-Y gastric bypass (RYGB) is among the most common types of bariatric surgery for inducing weight loss by restricting the gastric volume and promoting malabsorption of nutrients. Often RYGB is performed in women of childbearing potential.
Pelvic Packing for Intractable Obstetric Hemorrhage After Emergency Peripartum Hysterectomy: A Review
Authors: Touhami Omar , Bouzid Arij , Ben Marzouk Sofiene , Kehila Mahdi , Channoufi Mohamed Badis , El Magherbi Hayen
Published: February 2018

Importance

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Even after emergency peripartum hysterectomy (EPH), bleeding may occur in the setting of acquired coagulopathy. This type of bleeding resistant to clipping, ligating, or suturing could be successfully controlled with a pelvic packing.

Objective

This review provides an overview of the different pelvic packing techniques used after the failure of an EPH to control severe PPH. It aims to highlight the outcome of patients after packing, the morbidity and complications of packing, the timing and indications of packing, and finally the optimal duration of packing.

Evidence Acquisition

Literature relating to pelvic packing after EPH in a PPH setting was reviewed.

Results

Packing techniques can be divided into 2 types: pads or roller gauze and balloon pack. The overall success rate was as high as 78.8% with a mortality rate of 12.5%. No major morbidity related to the pelvic packing was documented. The optimal duration of packing is in the range of 36 to 72 hours.

Conclusions

Pelvic packing should be part of the armamentarium available to the obstetrician whenever intractable pelvic hemorrhage is encountered. It is quite simple and quick to perform and requires no special medical materials, the rate of complications is very low, and the success rate is high.

Relevance

The pelvic packing should be particularly useful in developing countries where more advanced technologies such as selective arterial embolization are not always available. In developed countries, the pelvic packing may be a valuable temporary measure pending transport to a tertiary care facility.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to identify the situations were pelvic packing could be used as a lifesaving procedure; compare the different techniques of pelvic packing, highlighting the potential advantages and disadvantages of each technique; and evaluate the success rate of the procedure and the potential morbidity.
Prescription of Preexposure Prophylaxis to Men Who Have Sex With Men Diagnosed and Reported With Gonorrhea, STD Surveillance Network, 2016
Authors: Ramirez Viani , Han Emily , Stoltey Julie , Nguyen Trang Q. , Pathela Preeti , Tourdot Laura , Walters Jaime , Bell Teal , Torrone Elizabeth , Stenger Mark
Published: February 2018

Using a representative sample of gonorrhea cases in select jurisdictions, we estimated the proportion of eligible men who have sex with men reporting being prescribed preexposure prophylaxis (PrEP) to prevent HIV infection. In 2016, half (51.3%) of the estimated 33,165 eligible men who have sex with men reported being prescribed PrEP by their health care provider.
Brimonidine Ophthalmic Solution 0.025% for Reduction of Ocular Redness: A Randomized Clinical Trial
Authors: McLaurin Eugene , Cavet Megan E. , Gomes Paul J. , Ciolino Joseph B.
Published: February 2018

SIGNIFICANCE

The α2-adrenergic receptor agonist brimonidine has been reported to induce conjunctival blanching in cataract, strabismus, laser refractive, and filtration procedures. Clinicians are often faced with red eyes with no apparent underlying pathology. Low-dose brimonidine reduced ocular redness in such subjects with efficacy maintained over 1 month and negligible rebound redness.

PURPOSE

The aim of this study was to evaluate the safety and efficacy of brimonidine tartrate ophthalmic solution 0.025% for the treatment of ocular redness.

METHODS

In this single-center, double-masked, phase 3 clinical trial, adult subjects with baseline redness of more than 1 unit in both eyes (0- to 4-unit scale) were randomized 2:1 to brimonidine 0.025% or vehicle. A single dose was administered in-office (day 1); thereafter subjects instilled treatment four times a day for 4 weeks, with clinic visits on days 15, 29, and 36 (7 days post-treatment). Efficacy end points included investigator-evaluated redness 5 to 240 minutes post-instillation on day 1 (primary); investigator-evaluated change from baseline 1, 360, and 480 minutes post-instillation on day 1, and 1 and 5 minutes post-instillation on days 15 and 29; total clearance of redness, and subject-assessed redness. Safety/tolerability measures included adverse events, rebound redness, and drop comfort.

RESULTS

Sixty subjects were randomized (n = 40 brimonidine, n = 20 vehicle). Investigator-assessed redness was lower with brimonidine versus vehicle over the 5- to 240-minute post-instillation period (mean [SE], 0.62 [0.076] vs. 1.49 [0.108]; P < .0001) and at each time point within that period (P < .0001). At 1, 360, and 480 minutes post-instillation, respectively, the mean differences (95% confidence interval) between treatments were −0.73 (−1.05 to −0.41), −0.57 (−0.84 to −0.29), and −0.39 (−0.67 to −0.10), respectively. No tachyphylaxis was evident with brimonidine on days 15 and 29, and minimal rebound redness was observed following discontinuation. Adverse events were infrequent, and brimonidine was rated as very comfortable.

CONCLUSIONS

Brimonidine 0.025% appeared safe and effective for reduction of ocular redness, with an 8-hour duration of action, no evidence of tachyphylaxis, and negligible rebound redness.
The HEAAL Project: Applying Community-Based Participatory Research (CBPR) Methodology in a Health and Mental Health Needs Assessment With an African Immigrant and Refugee Faith Community in Lowell, Massachusetts
Authors: Oppenheim Claire E. , Axelrod Kathleen , Menyongai Jeremiah , Chukwuezi Bernadette , Tam Alison , Henderson David C. , Borba Christina P. C.
Published: February 2018

Community-based participatory research methodology is driven by community interests and rooted in community involvement throughout the research process. This article describes the use of community-based participatory research methodology in the HEAAL project (Health and Mental Health Education and Awareness for Africans in Lowell), a research collaboration between Christ Jubilee International Ministries—a nondenominational Christian church in Lowell, Massachusetts, that serves an African immigrant and refugee congregation—and the Massachusetts General Hospital Department of Psychiatry. The objective of the HEAAL project was to better understand the nature, characteristics, scope, and magnitude of health and mental health issues in this faith community. The experience of using community-based participatory research in the HEAAL project has implications for research practice and policy as it ensured that research questions were relevant and meaningful to the community; facilitated successful recruitment and navigation through challenges; and can expedite the translation of data to practice and improved care.
A Practice Report From the Northern Dental Access Center: Offering Wraparound Services at a Community Dental Access Clinic to Improve Treatment Outcomes Among Rural Populations in Poverty
Authors: Larson Jeanne E. , Leider Jonathon P. , Knudson Alana
Published: February 2018

Context:

Rural populations suffer significant adverse health outcomes without reliable access to dental care, including increased emergency department use for oral health. The Northern Dental Access Program (Northern Dental) serves more than 20 counties in Greater Minnesota and bordering states. Its population is generally poor and less healthy than the rest of the state, with high rates of Medicaid.

Approach:

Evaluation of Northern Dental focused primarily on utilization of dental and nondental wraparound/support services. First, descriptive analyses were conducted, including assessing the patient population, visit, and client counts over time. Measures include procedures performed, visits, unique clients, active client base (based on previous visits in 12, 18, or 24 months), treatment plan completion, and use of wraparound services.

Results:

Between 2009 and 2016, Northern Dental saw 20 367 unique clients. The staff performed more than 307 000 prevention and screening procedures, more than 55 000 fillings and restorations, and 20 000 oral surgery/endodontic procedures. Overall, 32% of patients (n = 6 626) completed their treatment plans. Bivariate comparisons suggested that those who were provided transportation assistance (5% of all patients) were more likely to complete their treatment than the overall patient population. Overall, in 2016, a total of 1 748 unduplicated clients worked with the staff more than 3 800 times to receive referrals and wraparound services. This represented about 27% of all clients seen in 2016 who had at least 1 clinical visit.

Discussion:

Evaluation of Northern Dental's practice and approach shows sustained growth over time in service provision to the Medicaid population in Greater Minnesota, high need for transportation assistance, and significant interest in wraparound services. Transportation assistance involved substantial outlays from Northern Dental but resulted in substantially higher reimbursement, billing, and treatment completion for patients.

Implications for Practice:

Wraparound services are typically supported through grants and charitable giving. Evidence like this can inform policy makers and insurance companies, making the case for reimbursing nonprofits that provide them.
Antibodies and the brain: antiribosomal P protein antibody and the clinical effects in patients with systemic lupus erythematosus
Authors: González Alfonso , Massardo Loreto
Published: February 2018

Purpose of review

Analysis of antiribosomal P protein autoantibodies (anti-P) pathogenicity in diffuse brain manifestations of neuropsychiatric lupus, emphasizing cognitive dysfunction and the recently emerged role of cross-reacting neuronal surface P antigen (NSPA) in α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid and N-Methyl-d-Aspartate receptor glutamatergic transmission.

Recent findings

Circulating anti-P antibodies associate with executive planning dysfunction and attention impairments in lupus patients and perturb glutamatergic transmission through NSPA in mice hippocampus, translating into impaired synaptic plasticity and spatial memory. Planning impairment impacts quality of life.

In addition to the known association with lupus psychosis, new clinical and experimental evidence reveal a pathogenic role of anti-P antibodies in cognitive dysfunction, mechanistically explained by the anti-P interaction with NSPA as a target involved in glutamatergic synaptic plasticity.
AZIP1Separation-of-Function Allele Reveals that Meiotic Centromere Pairing Drives Meiotic Segregation of Achiasmate Chromosomes in Budding Yeast
Authors: Kurdzo Emily L. , Chuong Hoa H , Dawson Dean S.
Published: February 2018

In meiosis I, homologous chromosomes segregate away from each other - the first of two rounds of chromosome segregation that allow the formation of haploid gametes. In prophase I, homologous partners become joined along their length by the synaptonemal complex (SC) and crossovers form between the homologs to generate links called chiasmata. The chiasmata allow the homologs to act as a single unit, called a bivalent, as the chromosomes attach to the microtubules that will ultimately pull them away from each other at anaphase I. Recent studies, in several organisms, have shown that when the SC disassembles at the end of prophase, residual SC proteins remain at the homologous centromeres providing an additional link between the homologs. In budding yeast, this centromere pairing is correlated with improved segregation of the paired partners in anaphase. However, the causal relationship of prophase centromere pairing and subsequent disjunction in anaphase has been difficult to demonstrate as has been the relationship between SC assembly and the assembly of the centromere pairing apparatus. Here, a series of in-frame deletion mutants of the SC component Zip1 were used to address these questions. The identification of separation-of-function alleles that disrupt centromere pairing, but not SC assembly, have made it possible to demonstrate that centromere pairing and SC assembly have mechanistically distinct features and that prophase centromere pairing function of Zip1 drives disjunction of the paired partners in anaphase I.

AUTHOR SUMMARY

The generation of gametes requires the completion of a specialized cell división called meiosis. This division is unique in that it produces cells (gametes) with half the normal number of chromosomes (such that when two gametes fuse the normal chromosome number is restored). Chromosome number is reduced in meiosis by following a single round of chromosome duplication with two rounds of segregation. In the first round, meiosis I, homologous chromosomes first pair with each other, then attach to cellular cables, called microtubules, that pull them to opposite sides of the cell. It has long been known that the homologous partners become linked to each other by genetic recombination in a way that helps them behave as a single unit when they attach to the microtubules that will ultimately pull them apart. Recently, it was shown, in budding yeast and other organisms, that homologous partners can also pair at their centromeres. Here we show that this centromere pairing also contributes to proper segregation of the partners away from each other at meiosis I, and demonstrate that one protein involved in this process is able to participate in multiple mechanisms that help homologous chromosomes to pair with each other before being segregated in meiosis I.
Escherichia colican survive stress by noisy growth modulation
Authors: Patange Om , Schwall Christian , Jones Matt , Griffith Douglas , Phillips Andrew , Locke James C.W.
Published: February 2018

Gene expression can be noisy1,2, as can the growth of single cells3,4. Such cell-to-cell variation has been implicated in survival strategies for bacterial populations5–7. However, it remains unclear how single cells couple gene expression with growth to implement these survival strategies. Here we show how noisy expression of a key stress response regulator,rpoS8, allows E. coli to modulate its growth dynamics to survive future adverse environments. First, we demonstrate thatrpoShas a long-tailed distribution of expression in an unstressed population of cells. We next reveal how a dynamic positive feedback loop betweenrpoSand growth rate produces multi-generationrpoSpulses, which are responsible for therpoSheterogeneity. We do so experimentally with single-cell, time-lapse microscopy9and microfluidics10and theoretically with a stochastic model11,22. Finally, we demonstrate the function of the coupling of heterogeneousrpoSactivity and growth. It enablesE. colito survive oxidative attack by causing prolonged periods of slow growth. This dynamic phenotype is captured by therpoS-growth feedback model. Our synthesis of noisy gene expression, growth, and survival paves the way for further exploration of functional phenotypic variability.
Immune evasion and immunotherapy resistance via TGF-beta activation of extracellular matrix genes in cancer associated fibroblasts
Authors: Chakravarthy Ankur , Khan Lubaba , Bensler Nathan Peter , Bose Pinaki , Carvalho Daniel D. De
Published: February 2018

The ability to disseminate, invade and successfully colonise other tissues is a critical hallmark of cancer that involves remodelling of the extracellular matrix (ECM) laid down by fibroblasts 1. Moreover, Cancer-Associated-Fibroblasts (CAFs) produce key growth factors and cytokines as components of the ECM that fuel tumour growth, metastasis and chemoresistance, and immune response 2-4. ECM changes also predict prognosis in pancreatic 5 and colorectal cancers 6,7. Here, we examine the landscape of ECM-gene dysregulation pan-cancer and find that a subset of ECM genes is (i) dysregulated specifically in cancer, (ii) adversely prognostic, (iii) linked to TGF-beta signalling and transcription in Cancer-Associated-Fibroblasts, (iv) enriched in immunologically active cancers, and (v) predicts responses to Immune checkpoint blockade better than mutation burden, cytolytic activity, or an interferon signature, thus identifying a novel mechanism of immune evasion for patient stratification in precision immunotherapy and pharmacological modulation.