bluuebunny/crossref_metadata_2025 huggingface dataset:
Antiangiogenic Activity and Cytotoxicity of Triterpenoids and Homoisoflavonoids from Massonia pustulata and Massonia bifolia
Authors: Schwikkard Sianne , Whitmore Hannah , Corson Timothy , Sishtla Kamakshi , Langat Moses , Carew Mark , Mulholland Dulcie
Published: February 2018

The Hyacinthaceae family (sensu APGII), with approximately 900 species in around 70 genera, plays a significant role in traditional medicine in Africa as well as across Europe and the Middle and Far East. The dichloromethane extract of the bulbs of Massonia pustulata (Hyacinthaceae sensu APGII) yielded two known homoisoflavonoids, (R)-5-hydroxy-3-(4-hydroxybenzyl)-7-methoxy-4-chromanone 1 and 5-hydroxy-3-(4-hydroxybenzyl)-7-methoxy-4-chromone 2 and four spirocyclic nortriterpenoids, eucosterol 3, 28-hydroxyeucosterol 4 and two previously unreported triterpenoid derivatives, (17S,23S)-17α,23-epoxy-3β,22β,29-trihydroxylanost-8-en-27,23-olide 5, and (17S, 23S)-17α,23-epoxy-28,29-dihydroxylanost-8-en-3-on-27,23-olide 6. Compounds 1, 2, 3, and 5 were assessed for cytotoxicity against CaCo-2 cells using a neutral red uptake assay. Compounds 1, 2, and 5 reduced cell viability by 70% at concentrations of 30, 100, and 100 µM, respectively. Massonia bifolia yielded three known homoisoflavonoids, (R)-(4′-hydroxy)-5-hydroxy-7-methoxy-4-chromanone 1, (R)-(4′-hydroxy)-5,7-dihydroxy-4-chromanone 7 and (R)-(3′-hydroxy-4′-methoxy)-5,7-dihydroxy-4-chromanone 9, two previously unreported homoisoflavonoids, (E)-3-benzylidene-(3′,4′-dihydroxy)-5-hydroxy-7-methoxy-4-chromanone 8 and (R)-(3′,4′-dihydroxy)-5-hydroxy-7-methoxy-4-chromanone 10, and a spirocyclic nortriterpenoid, 15-deoxoeucosterol 11. Compounds 1, 1Ac, 7, 8, 9, and 10 were screened for antiangiogenic activity against human retinal microvascular endothelial cells. Some compounds showed dose-dependent antiproliferative activity and blocked endothelial tube formation, suggestive of antiangiogenic activity.
Nonoperative Treatment of Appendicitis during Pregnancy in a Remote Area
Authors: Carstens Anne-Kathrine , Fensby Lise , Penninga Luit
Published: February 2018

Appendicitis is the most common nonobstetric surgical disease during pregnancy. Appendicitis during pregnancy is associated with an increased risk of morbidity and perforation compared with the general population. Furthermore, it may cause preterm birth and fetal loss, and quick surgical intervention is the established treatment option in pregnant women with appendicitis. In Greenland, geographical distances are very large, and weather conditions can be extreme, and surgical care is not always immediately available. Hence, antibiotic treatment is often initiated as a bridge-to-surgery. We report on a pregnant Greenlandic Inuit woman with appendicitis who was treated with intravenous antibiotics. Antibiotic treatment was successful before surgical care became available and the patient was not operated. No complications occurred, and further pregnancy was uneventful. Our case suggests that antibiotic treatment of appendicitis during pregnancy as a bridge-to-surgery may be a sensible treatment option in remote areas, where no surgical care is immediately available. In some cases, antibiotic treatment may turn out to be definitive treatment.
Compressive Neuropathy of the Ulnar Nerve in the Hypothenar Region by Lipoma: Case Report
Authors: de Magalhães Marcelo José Silva , Oliva Henrique Nunes Pereira , Nunes Bruno Lopes
Published: February 2018

Lipomas are well-defined tumors of the adipose tissue that often occur in the torso or the extremities of adult patients. These tumors usually develop painlessly and insidiously, but they may compress adjacent structures. The objective of the present study is to describe the case of a 68-year-old female patient with a giant lipoma located at the hypothenar region, with manifestation of compression of the common palmar digital nerves, the ulnar nerve, and the abductor muscle of the V finger. Regarding the symptoms, the patient felt moderate pain in the hypothenar region, with no Tinel sign, and no changes in the motor function or sensibility of the digits innervated by the ulnar nerve. Lipomas may present a varied range of histological characteristics, and malignant tumors may be a differential diagnosis. An imaging exam may aid in the diagnosis, which is confirmed by a histopathological study. For the present case, as recommended in the literature, a surgical procedure was performed for the resection of the tumor, which resulted in the control of the symptoms.
Nonmodal Clinical Decision Support and Antimicrobial Restriction Effects on Rates of Fluoroquinolone Use in Uncomplicated Infections
Authors: Gunn Lundy , Tunney Robert , Kelly Kimberly
Published: February 2018

Background Medication alert overrides remain persistently high over the past decade, influenced by factors such as “alert fatigue” and lack of provider acceptance.

Objective We compared the aggregate rate of fluoroquinolone (FQ) prescribing for the treatment of acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections (UTIs) in adult inpatients prior to (historical control group) and after (prospective intervention group) implementation of a program requiring indication when ordering FQ antibiotics in combination with a nonmodal best-practice alert regarding the latest U.S. Food and Drug Administration (FDA) recommendations. We then compared rates of prescribing among provider type, severity of infection, and patient age.

Methods Qualified orders were defined as new FQ orders for acute sinusitis, acute bronchitis, and uncomplicated UTI for adult inpatients between July 2016 through September 2016 (control) or November 2016 through January 2017 (intervention). The primary endpoint was a provider-initiated FQ order for a target indication. Secondary endpoints included FQ orders by provider type and patient age. Rates of FQ use among the target indications were compared between groups by chi-square test of independence with Yates' correction in the analysis of the primary endpoint and Fisher's exact test for secondary endpoints.

Results FQ prescribing for acute bronchitis, and uncomplicated UTI occurred at a rate of 86/350 (24.6%) and 62/394 (15.7%) in the control and experimental groups, respectively (p = 0.0035). No patients receiving FQ qualified for a diagnosis of acute sinusitis.

Conclusion A program combining FQ restriction in combination with nonmodal messaging may have decreased the rate of prescribing for acute bronchitis and uncomplicated UTI, although the contributions of each individual element could not be rigorously assessed.
VTE-Prophylaxe bei Niereninsuffizienz
Authors: Kretzschmar Alexander
Published: March 2018

Durch die immer kürzere Krankenhausverweildauer sieht der Arzt in der ambulanten Weiterversorgung vermehrt Patienten mit anhaltend erhöhtem Risiko für venöse Thromboembolien (VTE), so Professor Rupert Bauersachs, Darmstadt. Auf dem Internistenkongress 2017 diskutierte er die Risikobewertung bei der VTE-Prophylaxe und ging hierbei besonders auf älteren Patienten mit eingeschränkter Nierenfunktion ein. Das niedermolekulare Heparin Certoparin kann auch bei schwerer Niereninsuffizienz eingesetzt werden.
Radionuklidtherapie mit 223Ra-Dichlorid – Strahlenschutz und Dosimetrie
Authors: Wanke Carsten , Szermerski Bastian , Geworski Lilli
Published: March 2018

Für die Behandlung von Patienten mit symptomatischen Knochenmetastasen bei kastrationsresistentem Prostatakarzinom (mCPRC) ohne bekannte viszerale Metastasen wird ein Medikament mit dem Wirkstoff 223Ra-Dichlorid eingesetzt. Diese Therapie stellt den derzeit einzigen Einsatz eines Alphastrahlers in der klinischen Routinetherapie dar. Dieser Artikel geht auf die Durchführung der 223Ra-Dichlorid-Therapie nebst Dosimetrie ein und beschreibt Anforderungen an den Strahlenschutz, die sich bei der Anwendung von 223Ra-Dichlorid ergeben.
Was ist neu in der 2017 ESC/EACTS-Leitlinie zum Management von Klappenerkrankungen?
Authors: Baumgartner Helmut
Published: February 2018

Die neue gemeinsame Leitlinie der European Society of Cardiology (ESC) und European Association for Cardio-Thoracic Surgery (EACTS) für das Management von Klappenerkrankungen löst die letzte Version von 2012 ab. Neuerungen haben sich insbesondere im Bereich der katheterinterventionellen Klappenbehandlung, bei den Indikationen zur Intervention bei asymptomatischen Patienten, bei der antithrombotischen Therapie von Patienten mit Vorhofflimmern und nach Klappenintervention sowie für die Versorgungsstruktur ergeben. Der Beitrag listet im Vergleich zur Version von 2012 die 2017 veränderten und neu hinzugefügten Empfehlungen.
Ernährung und Sarkopenie
Authors: Kiesswetter Eva
Published: February 2018

Aufgrund zahlreicher Aufgaben verschiedener Ernährungsfaktoren im Muskelstoffwechsel spielt die Ernährung eine wesentliche Rolle bei der Entstehung der Sarkopenie, einem geriatrischen Syndrom, welches durch eine niedrige Muskelmasse in Kombination mit Funktionseinschränkungen gekennzeichnet ist. Eine bedarfsdeckende Energiezufuhr bildet die Grundlage für den Erhalt von Muskelmasse. Hinsichtlich der Optimierung der Muskelproteinsynthese ist besonders die Proteinzufuhr (Menge, Verteilung, Qualität) relevant. In Interaktion mit körperlichem Training ergeben sich weitere Ansatzpunkte, die anabole Resistenz des gealterten Muskels zu minimieren und Supplementationseffekte zu optimieren. Für weitere Ernährungsfaktoren wie β-Hydroxy-β-Methylbutyrat, Omega-3-Fettsäuren, Vitamin D und Antioxidanzien, die ebenfalls im Muskelstoffwechsel involviert sind, deuten Studien ein präventives und therapeutisches Potenzial bei Sarkopenie an. Die Komplexität der Ernährung und der damit verbundene Untersuchungsaufwand bedingen allerdings, dass es in vielen Bereichen noch an hochwertigen, randomisiert kontrollierten Studien fehlt und daher häufig keine spezifischen Empfehlungen für die Zufuhr der einzelnen Stoffe abgeleitet werden können.
Terahertz generation via laser coupling to anharmonic carbon nanotube array
Authors: Sharma Soni , Vijay A.
Published: February 2018

A scheme of terahertz radiation generation employing a matrix of anharmonic carbon nanotubes (CNTs) embedded in silica is proposed. The matrix is irradiated by two collinear laser beams that induce large excursions on CNT electrons and exert a nonlinear force at the beat frequency ω = ω1−ω2. The force derives a nonlinear current producing THz radiation. The THz field is resonantly enhanced at the plasmon resource, ω=ωp(1+β)/2, where ωp is the plasma frequency and β is a characteristic parameter. Collisions are a limiting factor, suppressing the plasmon resonance. For typical values of plasma parameters, we obtain power conversion efficiency of the order of 10−6.
Existence domain of electrostatic solitary waves in the lunar wake
Authors: Rubia R. , Singh S. V. , Lakhina G. S.
Published: March 2018

Electrostatic solitary waves (ESWs) and double layers are explored in a four-component plasma consisting of hot protons, hot heavier ions (He++), electron beam, and suprathermal electrons having κ-distribution using the Sagdeev pseudopotential method. Three modes exist: slow and fast ion-acoustic modes and electron-acoustic mode. The occurrence of ESWs and their existence domain as a function of various plasma parameters, such as the number densities of ions and electron beam, the spectral index, κ, the electron beam velocity, the temperatures of ions, and electron beam, are analyzed. It is observed that both the slow and fast ion-acoustic modes support both positive and negative potential solitons as well as their coexistence. Further, they support a “forbidden gap,” the region in which the soliton ceases to propagate. In addition, slow ion-acoustic solitons support the existence of both positive and negative potential double layers. The electron-acoustic mode is only found to support negative potential solitons for parameters relevant to the lunar wake plasma. Fast Fourier transform of a soliton electric field produces a broadband frequency spectrum. It is suggested that all three soliton types taken together can provide a good explanation for the observed electrostatic waves in the lunar wake.
Physics in Cuba
Authors: Feder Toni
Published: March 2018

Passion and creativity drive physics despite difficult circumstances.
Corrigendum to: Synthesis and Characterization of a New Group of Exo-Coordinating O2N2-Donor Macrocycles
Authors: Ghanbari Bahram , Safarkoopayeh (Agheli) Barzin , Kia Reze , Raithby Paul R.
Published: February 2018

The reaction of 15–18 membered benzodiazacrown ethers with salicylaldehyde afforded n-membered O2N2-donor macrocyclic ligands mounted with 1,3-diazacyclohexane subrings (1–4) in high yields. The products were characterized by FT-IR, 1H, 13C NMR spectroscopy, elemental analyses, and single crystal X-ray studies. The solid state structures revealed strong intramolecular hydrogen bonding between the pendant phenolic group and the tertiary nitrogen of the corresponding macroring.
Outreach immunisation services in NewZealand: a review of service delivery models
Authors: Roberts Loretta , Turner Nikki , McArdle Barbara , Nowlan Mary , Taylor Lynn , Webber Rachel , Rouse Paul
Published: February 2018

ABSTRACT INTRODUCTION Outreach Immunisation Services (OIS) enable children who have not been immunised on time at general practice to be immunised in the community, thereby improving immunisation coverage and reducing equity gaps. AIM To identify the most effective service delivery models and make recommendations for more effective and cost-efficient OIS delivery in New Zealand. METHODS Data collection and thematic analysis through a detailed review of OIS contracts and service specifications, an online survey and in-depth interviews with stakeholders and providers, and an analysis of cost data was conducted. RESULTS In total, 28 OIS providers completed survey questionnaires, 28 OIS staff were interviewed, and cost effectiveness data were obtained from 11 providers. The surveys and interviews identified key themes around identifying clients with the highest needs, effective engagement strategies, staffing requirements, and service challenges. On average, each OIS referral costs NZ$361 (median NZ$257), and each vaccination event costs NZ$636, ranging from NZ$145 to NZ$2403. Characteristics for two separate models of service delivery were identified based on provider size. CONCLUSION There is considerable range in costs and style of OIS delivery, and efficiencies can be gained. Models need to fit with locality needs and include adequate resourcing, staff with good local knowledge, close relationships with other key child health services and preferably co-location, sustainable funding, and regular service reviews. OIS are part of an effective integrated service that relies on accurate data, positive relationships and a rapid response when children fail to present for vaccination in a timely fashion.
Exploring access to vasectomy services: a case study of funding in Counties Manukau
Authors: Filoche Sara K. , Snook Simon , Lawton Beverley A.
Published: February 2018

ABSTRACT

INTRODUCTION
Although vasectomy rates in New Zealand have been reported as among the highest worldwide, there is limited information about who is receiving these services and how they are being accessed. This information is needed to develop equitable access to vasectomy services.

AIM
To describe the ethnicity and socioeconomic status of men accessing District Health Board-funded and self-funded vasectomies in Counties Manukau.

METHODS
A retrospective cohort analysis of provider data linked to ethnicity and area deprivation as an indicator of socioeconomic status.

RESULTS
Of 332 vasectomies, 66% were for New Zealand European men. Socioeconomic status was not associated with the number of procedures for New Zealand European men, but of the Māori and Pacific men who underwent vasectomies, most lived in the greatest areas of deprivation; 58% (18/31) and 50% (12/24), respectively. When vasectomies were funded, the number of procedures doubled for men from areas of high deprivation. The number of procedures was low for men of other ethnicities.

DISCUSSION
Our findings indicate differential access to vasectomies by ethnicity and socioeconomic status. Funding vasectomies may provide community benefits in terms of improving equity in access and alleviating a financial burden for many families living in areas of high deprivation.
Measuring doctor appointment availability in Northland general practice
Authors: Eggleton Kyle , Penney Liane , Moore Jenni
Published: February 2018

ABSTRACT INTRODUCTION Primary care access is associated with improved patient outcomes. Availability of appointments in general practice is one measure of access. Northland’s demographics and high ambulatory sensitive hospitalisation rates may indicate constrained appointment availability. Our study aims were to determine appointment availability and establish the feasibility of measuring appointment availability through an automated process. METHODS An automated electronic query was created, run through a third party software programme that interrogated Northland general practice patient management systems. The time to third next available appointment (TNAA) was calculated for each general practitioner (GP) and a mean calculated for each practice and across the region. A research assistant telephone request for an urgent GP appointment captured the time to the urgent appointment and type of urgent appointment used to fit patients in. Regression analysis was used to determine the relationships between deprivation, patients per GP, and the use of walk-in clinics. RESULTS The mean TNAA was 2.5 days. 12% of practices offered walk-in clinics. There was a significant relationship between TNAA and increasing number of walk-in clinics. CONCLUSION The TNAA of 2.5 days indicates the possibility that routine appointments are constrained in Northland. However, TNAA may not give a reliable measure of urgent appointment availability and the measure needs to be interpreted by taking into account practice characteristics. Walk-in clinics, although increasing the availability of urgent appointments, may lead to more pressure on routine appointments. Using an electronic query is a feasible way to measure routine GP appointment availability.
Species limits and taxonomic revision of the bracteate-prostrate group of southern hemisphere forget-me-nots (Myosotis, Boraginaceae), including description of three new species endemic to New Zealand
Authors: Meudt Heidi M. , Prebble Jessica M.
Published: February 2018

A taxonomic revision of southern hemisphere bracteate-prostrate forget-me-nots (Myosotis L., Boraginaceae) is presented here. The group comprises mostly species endemic to New Zealand plus the South American Myosotis antarctica Hook.f. (also Campbell Island) and M. albiflora Hook.f. The statistical analyses of morphological data from herbarium specimens reported here support recognition of five main subgroups on the basis of habit. Excluding the M. pygmaea Colenso species group (M. antarctica, M. brevis de Lange & Barkla, M. drucei (L.B.Moore) de Lange & Barkla, M. glauca (G.Simpson & J.S.Thomson) de Lange & Barkla, and M. pygmaea), which is being treated elsewhere, 14 species are recognised in the following four remaining subgroups: (1) creeping-species group: M. matthewsii L.B.Moore, M. chaffeyorum Lehnebach, M. spatulata G.Forst., M. tenericaulis Petrie, and M. albiflora; (2) cushion-species group: M. uniflora Hook.f., M. pulvinaris Hook.f., and M. glabrescens L.B.Moore; (3) M. cheesemanii + M. colensoi species group: M. cheesemanii Petrie and M. colensoi J.F.Macbr.; and (4) M. lyallii species group: M. lyallii Hook.f. and new species M. retrorsa Meudt, Prebble & Hindmarsh-Walls. New species Myosotis umbrosa Meudt, Prebble & Thorsen and M. bryonoma Meudt, Prebble & Thorsen do not fit comfortably within these subgroups. Myosotis elderi L.B.Moore is treated as M. lyallii subsp. elderi (L.B.Moore) Meudt & Prebble. For each of the 14 species revised here, a key to species, descriptions, phenology, distributions, maps, illustrations, specimens examined and notes are provided. Some specimens examined do not fit within these species and require additional comparative studies, including with certain ebracteate-erect species, before taxonomic decisions can be made. Future research on these and other southern hemisphere Myosotis should incorporate the morphological data presented here, with additional genetic, cytological, pollen, and other data in an integrative systematic framework.
Theaflavin-3-gallate specifically interacts with phosphatidylcholine, forming a precipitate resistant against the detergent action of bile salt
Authors: Narai-Kanayama Asako , Saruwatari Kosuke , Mori Natsumi , Nakayama Tsutomu
Published: February 2018

Black tea is a highly popular beverage, and its pigments, polymerized catechins such as theaflavins (TFs), are attracting attention due to their beneficial health effects. In this study, to test the inhibitory activities of TFs on the intestinal absorption of cholesterol, we investigated their effects on phosphatidylcholine (PC) vesicles in the absence or presence of a bile salt. (−)-Epicatechin gallate, (−)-epigallocatechin gallate, and TFs formed insoluble complexes with PC vesicles. Galloylated TFs such as TF2A, TF2B, and TF3 precipitated far more than other polyphenols. The subsequent addition of taurocholate redispersed the polyphenol-PC complexes, except that a large amount of TF2A remained insoluble. After incubation with taurocholate-PC micelles, TF2A elevated the turbidity of the micelle solution, providing red sediments. The TF2A-specific effect was dependent on the PC concentration. These results suggest that TF2A interacts with PC and aggregates in a specific manner different from catechins and other TFs.
College English teaching in China: opportunities, challenges and directions in the context of educational internationalization
Authors: Li Cuiying , Fang Zhihui
Published: March 2018

This essay, based on an interview with an internationally renowned scholar of language and literacy education, addresses a range of issues that is of current interest and significance to English teachers in China’s higher education context.
Working Memory Load Modulates Neuronal Coupling
Authors: Pinotsis Dimitris A , Buschman Timothy J , Miller Earl K
Published: February 2018

There is a severe limitation in the number of items that can be held in working memory. However, the neurophysiological limits remain unknown. We asked whether the capacity limit might be explained by differences in neuronal coupling. We developed a theoretical model based on Predictive Coding and used it to analyze Cross Spectral Density data from the prefrontal cortex (PFC), frontal eye fields (FEF), and lateral intraparietal area (LIP). Monkeys performed a change detection task. The number of objects that had to be remembered (memory load) was varied (1–3 objects in the same visual hemifield). Changes in memory load changed the connectivity in the PFC–FEF–LIP network. Feedback (top-down) coupling broke down when the number of objects exceeded cognitive capacity. Thus, impaired behavioral performance coincided with a break-down of Prediction signals. This provides new insights into the neuronal underpinnings of cognitive capacity and how coupling in a distributed working memory network is affected by memory load.
Filipino nurses in the United States
Authors: Jurado Leo-Felix M. , Saria Marlon Garzo
Published: February 2018

Demographic profile and job satisfaction
A Lack of Continuity in Education, Training, and Practice Violates the “Do No Harm” Principle
Authors: Englander Robert , Carraccio Carol
Published: February 2018

The paradigm shift to competency-based medical education (CBME) is under way, but incomplete implementation is blunting the potential impact on learning and patient outcomes. The fundamental principles of CBME call for standardizing outcomes addressing population health needs, then allowing time-variable progression to achieving them. Operationalizing CBME principles requires continuity within and across phases of the education, training, and practice continuum. However, the piecemeal origin of the phases of the “continuum” has resulted in a sequence of undergraduate to graduate medical education to practice that may be continuous temporally but bears none of the integration of a true continuum.

With these timed interruptions during phase transitions, learning is not reinforced because of a failure to integrate experiences. Brief block rotations for learners and ever-shorter supervisory assignments for faculty preclude the development of relationships. Without these relationships, feedback falls on deaf ears. Block rotations also disrupt learners’ relationships with patients. The harms resulting from such a system include decreases in patient satisfaction with their care and learner satisfaction with their work. Learners in this block system also demonstrate an erosion of empathy compared with those in innovative longitudinal training models. In addition, higher patient mortality during intern transitions has been demonstrated.

The current medical education system is violating the first principle of medicine: “Do no harm.” Full implementation of competency-based, time-variable education and training, with fixed outcomes aligned with population health needs, continuity in learning and relationships, and support from a developmental program of assessment, holds great potential to stop this harm.
Using Technologies in Nursing Research Education
Authors: Luo Shuhong , Yang Harrison Hao
Published: February 2018

To better prepare nurses for the new and expanding roles required in healthcare, faculty are expected to integrate emerging technology into educational processes. Using a mixed methods research design, this study aimed to examine nursing student reactions and learning based on their participation in an online research course through two technology-enhanced assignments: (1) annotation of the structure of a research article and (2) reflection on the content of a research article. Quantitative analysis examined students' questionnaire responses, and qualitative analysis explored students' reflective learning journals and the instructor's notes. These two separate strands of data were then integrated using a joint display. The discussion was guided by two components of the New World Kirkpatrick model, reaction and learning. Our findings suggest that the use of technology in the design of assignments is a way to engage students in learning and can be used to enhance nursing students' research learning online.
Pharmacologic Reversal of Direct Oral Anticoagulants
Authors: Farina Nicholas , Miller James T.
Published: February 2018

Direct oral anticoagulants are becoming increasingly popular in outpatient use. These medications have lacked specific reversal agents. However, this is changing. The Federal Food and Drug Administration approved idarucizumab for reversal of dabigatran in 2016, and another agent, andexanet alfa, is currently in clinical trials for reversal of rivaroxaban and apixaban. This article examines the efficacy and safety of these emerging reversal agents, as well as other historical agents for reversal of direct oral anticoagulants.
First Case of Lymphaticovenular Anastomosis for Treatment of Secondary Lymphedema in Costa Rica: Japanese Contribution to Microsurgery Development
Authors: Centeno-Rodriguez Madelein , Koshima Isao
Published: February 2018

Although a large number of treatments have been developed for lymphedema, definitive management still remains a challenge for plastic surgery, because not all surgical techniques have a positive effect on every patient, and good results are difficult to reproduce. However, it is important to recognize the efforts that Professor Isao Koshima and his colleagues together with the Government of Japan are carrying out to spread information to the different countries on the newest surgical techniques available in current plastic surgery and to motivate young doctors in developing countries to create a microsurgery unit in their home country, providing them with the necessary knowledge and skills to deliver real solutions to complex problems that were previously unanswered. As a result of this program, the authors present the first case of secondary lymphedema successfully treated with lymphaticovenular anastomosis in Costa Rica, Central America.
Single‐Cell Sequencing in Normal and Malignant Hematopoiesis
Authors: Wilson Nicola K. , Göttgens Berthold
Published: March 2018

Hematopoiesis is one of the best studied adult stem‐cell systems, with a differentiation hierarchy progressing from immature hematopoietic stem cells to over 10 distinct mature cell types. Recent technological breakthroughs now make it possible to define transcriptional profiles in thousands of individual cells. Facilitated by the wealth of prior data on cell purification and analysis strategies, hematopoiesis has been one of the earliest experimental systems to which many of these new single‐cell sequencing technologies have been applied. In this review, the authors focus on recent studies, which have shed light on heterogeneity within individual populations as well as the relationships between populations, and also attempt to characterize the differences between normal and disease/perturbed states.
BILATERAL ENTEROCOCCUS FAECALIS ENDOPHTHALMITIS WITH MULTIPLE RECURRENCES
Authors: Aderman Christopher M. , Chao Daniel L. , Obeid Anthony , Schwartz Daniel M. , Bhisitkul Robert B. , Chiu Cynthia S.
Published: February 2018

Purpose:

To describe the first case report of a bilateral recurrent Enterococcus faecalis endophthalmitis postcataract surgery.

Methods:

Case report with a description of the timeline, diagnosis, and management of a patient with bilateral recurrent E. faecalis endophthalmitis.

Results:

An 89-year-old man presented 6 weeks' postcataract surgery with pain, tearing, and blurred vision in the left eye. B-scan ultrasonography revealed vitritis and cultures postvitrectomy grew E. faecalis. There was gradual improvement in vision postintravitreal vancomycin administration. Four years later, the patient experienced another episode of E. faecalis endophthalmitis in the right eye postcataract extraction, followed by several additional episodes in both eyes posttreatment.

Conclusion:

Enterococcus faecalis is a rare but highly virulent cause of endophthalmitis that may remain sequestered in the capsular bag, despite aggressive treatment. Even after recurrent episodes, early vitrectomy and aggressive antibiotic therapy may prove to be effective in preventing vision loss.
In Vivo Confocal Microscopic Study of Hard Contact Lens–Induced Lipid Keratopathy Secondary to Corneal Neovascularization in a Rabbit Hypercholesterolemic Model
Authors: Sun Yi-Chen , Yang Li-Chuan , Hu Fung-Rong , Lin Chung-Tien , Chen Yan-Ming , Chen Wei-Li
Published: February 2018

Objectives:

In vivo confocal microscopy was used to observe the morphological presentations and anatomical correlations between corneal neovascularization (NV) and intracorneal lipid deposition in a rabbit model of contact lens (CL)–induced lipid keratopathy secondary to corneal NV.

Methods:

Rabbits were divided into 3 groups: (1) 8-week normal diet, (2) 8-week high-cholesterol diet, and (3) 4-week normal diet followed by 4-week high-cholesterol diet. Corneal NV was induced by closed-eye CL. The formation and maturation of corneal NV were shown by immunohistochemical staining against CD31 and high-molecular-weight melanoma-associated antigen. In vivo confocal microscopy identified corneal NV and lipid deposition. Acquired images for each eye were arranged and mapped into subconfluent montages.

Results:

In group 1, corneal NV sprouting formed from the peripheral to the central cornea by the end of week 4. Pericytes around vessels were shown after 2 weeks of CL wear. In group 2, lipid deposition started from the peripheral cornea and progressively covered the whole cornea. In group 3, lipid deposition was found first in the central cornea after 2 weeks of high-cholesterol diet and progressed to cover the peripheral cornea. In vivo confocal microscopy demonstrated four different patterns of intracorneal lipid deposition: spindle shapes arranged randomly or in parallel, amorphous shapes, multiangular shapes, and mixed types. Intracorneal lipid deposition was distributed from basal corneal epithelium to deep stroma.

Conclusions:

Intracorneal lipids tend to accumulate around newly formed corneal NV but can extend to the area covered with mature NV. In vivo confocal microscopy can demonstrate various shapes and depths of intracorneal lipid deposition.
Tablet-based Screening for Hearing Loss: Feasibility of Testing in Nonspecialty Locations
Authors: Kelly Elizabeth A. , Stadler Michael E. , Nelson Steven , Runge Christina L. , Friedland David R.
Published: February 2018

Objective:

To determine the feasibility of audiometric screening with tablet-based applications in typical clinic locations: examination room and clinic waiting area.

Study Design:

A randomized prospective study.

Setting:

Tertiary referral center.

Patients:

Participants included 107 adult patients referred for audiometric testing to assess hearing loss.

Intervention:

Each patient completed standard audiometry testing and one of three tablet-based audiometric applications that included pure-tone air conduction testing. The tablet-based audiometric testing was completed in a quiet examination room and a clinic waiting area using noise-cancellation headphones. A 5-question patient satisfaction survey was completed at the end of the testing.

Main Outcome Measure:

Thresholds at each frequency were compared with those obtained from tablet-based audiometric applications in a quiet examination room and clinic waiting area. Sensitivity and specificity of each tablet-based audiogram in detecting a hearing loss at each frequency was determined.

Results:

All three tablet-based audiometric applications were user-friendly for hearing screening. However, one application was shown to be feasible and the most accurate of the three tested with 92% of thresholds within 10 dB of conventional audiometry across all test conditions. This application had a sensitivity of 96 to 100% and specificity of 72 to 85% for identifying a hearing loss in each frequency tested. Variability was noted among applications between testing in a quiet clinic room and testing in the clinic waiting area. Patients showed no preference for either conventional audiometry or the tablet-based device.

Conclusion:

Tablet-based audiometric applications can be used to screen for hearing loss in typical clinic locations. This tool does not replace standard audiometry testing but allows for screening for hearing disorders when appropriate and in settings without access to audiometric equipment.
Frequency of and Factors Associated With Obstructive Sleep Apnea and Periodic Limb Movements in Stroke and TIA Patients
Authors: Gadodia Gaurav , Rangaraju Srikant , Raza Syed A. , Razzak Ammar , Marmarchi Labib , Davis Brittaine , Henriquez Laura , Trotti Lynn M. , Rye David , Nahab Fadi
Published: February 2018

Introduction:

Obstructive sleep apnea (OSA) and periodic limb movements (PLMs) have been associated with an increased risk of cardiovascular disease. There is limited data on the relationship between OSA and PLMs with atrial fibrillation and resistant hypertension in stroke and transient ischemic attack (TIA) patients.

Methods:

Consecutive stroke and TIA patients referred by a vascular neurologist for diagnostic polysomnography (PSG) from September 1, 2012 to August 31, 2015 were included in a retrospective analysis. Baseline clinical characteristics, PSG results and outcomes were collected to identify the frequency of and factors associated with PLMs (mild 5 to 10/h; severe ≥15/h), PLM arousals (≥5/h) and moderate-severe OSA (apna-hypopnea Index ≥15) including atrial fibrillation and resistant hypertension.

Results:

Among 103 patients (mean age, 60±15 y; 50% female; 61% nonwhites; 77% ischemic stroke; 23% resistant hypertension) who underwent PSG, 20% had mild PLMs, 28% had severe PLMs, 14% had PLM arousals, and 22% had moderate-severe OSA. Factors associated with moderate-severe OSA included older age (odds ratio, 1.06; 95% confidence interval, 1.02-1.11) and presence of atrial fibrillation (odds ratio, 4.26; 95% confidence interval, 1.17-15.44). Nonwhite race was associated with lower likelihood of mild and severe PLMs, whereas female sex was associated with lower likelihood of PLM arousals. OSA and PLMs were not associated with resistant hypertension.

Conclusions:

A significant number of stroke and TIA patients who underwent PSG have PLMs and moderate-severe OSA. Stroke and TIA patients with atrial fibrillation are more likely to have moderate-severe OSA and may benefit from PSG evaluation.
Intravenous Paracetamol Overdose
Authors: Aslan Nagehan , Yildizdas Dincer , Arslan Didar , Horoz Ozden Ozgur , Yilmaz Hayri Levent , Bilen Sevcan
Published: February 2018

Paracetamol is a common antipyretic often used to treat children with fever and pain. With the increasing administration of intravenous (IV) paracetamol, there will be the associated risk of medication dosing errors. We report a case of IV paracetamol overdose in a child with fever during hospital admission. A IV paracetamol dosing error occurred, with delayed recognition resulting in transient hepatotoxicity, with a peak alanine transaminase of 1946 IU/L and aspartate transaminase of 1633 IU/L.
The Not-So-Soft Spot
Authors: Cristoforo Thomas , Le Nicole K. , Rye-Buckingham Summer , Hudson William B. , Carroll Leslie F.
Published: February 2018

Roseola infantum is a clinical syndrome characterized by high fever followed by the emergence of a rash. Case reports have documented an association between bulging fontanelles and roseola. We propose a novel mechanism for the development of intracranial hypertension caused by human herpesvirus 6–induced cytokine elevation leading to increased cerebrospinal fluid production.
Removal of Maxillary Sinus Antrolith and Concomitant Intrasinus Augmentation
Authors: Rahpeyma Amin , Khajehahmadi Saeedeh
Published: March 2018

Maxillary sinus antrolithisis is a rare finding. Conservative surgical removal recommended. In the patients that need to maxillary intrasinus augmentation and antrolith is observed in preoperative radiography, 2 options remain. First, doing Caldwell-luc surgery to remove antrolith and delayed open sinus lift. Second way is removing antrolith and concomitant intrasinus augmentation.

The first way has 2 disadvantages: prolonged waiting period and difficulty of open sinus lift in sinuses with scar and fibrosis. Coupling these 2 surgeries and using corticocancellous bone block as grafting material are recommended by us. Buccal fat pad is a good option to isolate this graft from maxillary sinus.
A Comparison of the Nutritional Risk Screening 2002 Tool With the Subjective Global Assessment Tool to Detect Nutritional Status in Chinese Patients Undergoing Surgery With Gastrointestinal Cancer
Authors: Chi Juntao , Yin Shaohua , Zhu Yongjian , Gao Fengli , Song Xinna , Song Zhenlan , Lv Junying , Li Miaomiao
Published: February 2018

The objectives of this study were to describe the nutritional status of Chinese patients with gastrointestinal cancer undergoing surgery and to compare the ease of use, diversity, and concordance of the Nutritional Risk Screening 2002 with the Subjective Global Assessment in the same patients. A total of 280 gastrointestinal cancer patients admitted for elective surgery were evaluated by the Nutritional Risk Screening 2002 (NRS 2002) and Subjective Global Assessment (SGA) tools within 48 hours of admission from April to October 2012. Related opinions about ease of using the tools were obtained from 10 nurses. The prevalence of patients at nutritional risk with the SGA and NRS 2002 was 33.9% and 53.2% on admission. In the total group, ≤70 age group, and >70 age group, respectively, consistency was observed in 214 (76.4%), 175 (91.1%), and 39 (44.3%); and kappa values were 0.54 (p < .001), 0.81 (p < .001), and 0.085 (p = .096). McNemar paired chi-square test showed a significant difference between the NRS 2002 and SGA in the total group and >70 age group (p < .001); however, no difference was observed in the ≤70 age group (p = .14). Nurses reported ease of use of the NRS 2002 as a “very easy” or “easy” to complete (3–5 minutes) and the SGA as an “easy” or “fair” tool to complete (5–10 minutes). The diversity and concordance between the SGA and NRS 2002 were varied in different age groups. The NRS 2002 is more suitable in nursing practice than the SGA to identify the nutritional status of patients with gastrointestinal cancer undergoing surgery, but it appeared to detect more patients at nutritional risk in the >70 age group.
Multidepartmental Response to a Duodenoscope Used on a CRE Patient
Authors: Bruns Mark A. , Gibbs Elizabeth R.
Published: February 2018

Transmission of carbapenem-resistant Enterobacteriaceae (CRE) via duodenoscopes, specialized endoscopes used during endoscopic retrograde cholangiopancreatography (ERCP) procedures, has attracted media attention since early 2015. This attention has placed increasing focus on the reprocessing of duodenoscopes. Current reprocessing recommendations for these endoscopes require either high-level disinfection or ethylene oxide sterilization. While reprocessing duodenoscopes, staff at endoscopy locations within the Mercy health system perform a single high-level disinfection cycle that is preceded by two cycles of manual cleaning. The Mercy system has 37 locations for gastrointestinal endoscopic procedures and nine that can accommodate patients requiring ERCP. In early 2016, the Mercy Oklahoma City location performed an ERCP on a patient known prior to the case to be a carrier of CRE. After the case, multiple departments located in both the Oklahoma City and St. Louis facilities partnered to culture and sterilize the duodenoscope used in that case to ensure its safety for use on subsequent patients. This case study presents the situation and discusses culturing of endoscopes. In light of the evidence presented, the importance of enhanced communication and cooperation to achieve patient safety should be paramount to all other factors.
Evaluation of Smartphone Pelvic Floor Exercise Applications Using Standardized Scoring System
Authors: Barnes Kara Lauren , Dunivan Gena , Jaramillo-Huff Ashley , Krantz Tessa , Thompson Jennifer , Jeppson Peter
Published: February 2018

Objective

The aim of this study was to identify smartphone Kegel and pelvic floor exercise applications (apps) and identify those with superior functionality, features, and accuracy.

Methods

We identified a complete list of Kegel and pelvic floor exercise applications by searching iTunes and Google Play stores for “pelvic floor,” “pelvic floor exercises,” “Kegel,” and “Kegel exercises.” We used a modified APPLICATIONS scoring system to evaluate all identified apps.

Results

We identified 120 apps related to Kegel exercises. Apps unrelated to the pelvic floor, unavailable in English, or duplicated on a separate platform were excluded from the analysis, leaving 90 unique apps. After a preliminary review, we excluded an additional 58 apps that were nonfunctional, required a biofeedback device, or intended for pregnant women. The final 32 apps included 15 paid and 17 free apps. Paid apps had higher rates of privacy features than free apps (80% vs 53%), used more images and figures (53% vs 41%), and were more likely to cite primary literature in their descriptions (33% vs 29%). Paid apps were also more likely to have tech support available (73% vs 53%). Overall score, however, was almost identical between the groups, with paid apps averaging 9.93 and free apps 9.41. The highest rated free and paid app both received a score of 12, consisting of Kegel Trainer and Kegel Trainer Pro, respectively.

Conclusion

The quality of the apps is markedly variable in both the paid and unpaid applications. Using the APPLICATIONS scoring system, the apps were very similar in overall quality and value.
Human axial progenitors generate trunk neural crest cells
Authors: Frith Thomas J. R. , Granata Ilaria , Stout Erin , Wind Matthew , Thompson Oliver , Neumann Katrin , Stavish Dylan , Heath Paul R. , Hackland James O.S. , Anastassiadis Konstantinos , Gouti Mina , Briscoe James , Wilson Val , Guarracino Mario R. , Andrews Peter W. , Tsakiridis Anestis
Published: February 2018

The neural crest (NC) is a multipotent embryonic cell population generating distinct cell types in an axial position-dependent manner. The production of NC cells from human pluripotent stem cells (hPSCs) is a valuable approach to study human NC biology. However, the origin of human trunk NC remains undefined and therefore current in vitro differentiation strategies induce only a modest yield of trunk NC cells. Here we show that hPSC-derived axial progenitors, the posteriorly-located drivers of embryonic axis elongation, give rise to trunk NC cells and their derivatives. Moreover, we define the molecular signatures associated with the emergence of human NC cells of distinct axial identities in vitro. Collectively, our findings indicate that there are two routes toward a human post-cranial NC state: the birth of cardiac and vagal NC is facilitated by retinoic acid-induced posteriorisation of an anterior precursor whereas trunk NC arises within a pool of posterior axial progenitors.
Group IIA secreted phospholipase A2in human serum kills commensal but not clinicalEnterococcus faeciumisolates
Authors: Paganelli Fernanda L. , Leavis Helen L. , He Samantha , van Sorge Nina M. , Payré Christine , Lambeau Gérard , Willems Rob J.L. , Rooijakkers Suzan H.M.
Published: February 2018

Human innate immunity employs cellular and humoral mechanisms to facilitate rapid killing of invading bacteria. The direct killing of bacteria by human serum is mainly attributed to the activity of the complement system that forms pores in Gram-negative bacteria. Although Gram-positive bacteria are considered resistant to serum killing, we here uncover that normal human serum effectively killsEnterococcus faecium.Comparison of a well-characterized collection of commensal and clinicalE. faeciumisolates revealed that human serum specifically kills commensalE. faeciumstrains isolated from normal gut microbiota, but not clinical isolates. Inhibitor studies show that the human group IIA secreted phospholipase A2 (hGIIA), but not complement, is responsible for killing of commensalE. faeciumstrains in human normal serum. This is remarkable since hGIIA concentrations in ‘non-inflamed’ serum were considered too low to be bactericidal against Gram-positive bacteria. Mechanistic studies showed that serum hGIIA specifically causes permeabilization of commensalE. faeciummembranes. Altogether, we find that a normal serum concentration of hGIIA effectively kills commensalE. faeciumand that hGIIA resistance of clinicalE. faeciumcould have contributed to the ability of these strains to become opportunistic pathogens in hospitalized patients.

Importance

Human normal serum contains antimicrobial components that effective kill invading Gram-negative bacteria. Although Gram-positive bacteria are generally considered resistant to serum killing, here we show that normal human effectively kills the Gram-positiveEnterococcus faeciumstrains that live as commensals in the gut of humans. In contrast, clinicalE. faeciumstrains that are responsible for opportunistic infections in debilitated patients are resistant against human serum. The key factor in serum responsible for killing is group IIA secreted phospholipase A2 (hGIIA) that effectively destabilizes commensalE. faeciummembranes. We believe that hGIIA resistance by clinicalE. faeciumcould have contributed to the ability of these strains to cause opportunistic infections in hospitalized patients. Altogether, understanding mechanisms of immune defense and bacterial resistance could aid in further development of novel anti-infective strategies against medically important multidrug resistant Gram-positive pathogens.