bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of bolus tracking region-of-interest position within the descending aorta on luminal enhancement of coronary arteries in coronary computed tomography angiography
Authors: Kurokawa Ryo , Maeda Eriko , Mori Harushi , Amemiya Shiori , Sato Jiro , Ino Kenji , Torigoe Rumiko , Abe Osamu
Published: May 2019

To compare coronary artery luminal enhancement in coronary computed tomography angiography (CCTA) between ventral and dorsal region-of-interest (ROI) bolus tracking in the descending aorta.

The records of 165 consecutive patients who underwent CCTA with non-helical acquisition from July 2017 to March 2018 were retrospectively examined. We performed 320-row CCTA with bolus tracking [scan triggered at 260 HU in the descending aorta] and 133 patients were finally included. ROI was set in the ventral and dorsal halves of the descending aorta in 68 and 65 patients, respectively.

Contrast arrival time was significantly shorter in the dorsal group (ventral: 21.8 ± 0.372 s; dorsal: 20.7 ± 0.369; P = .0295). The mean density of the proximal and distal RCA was significantly higher in the ventral group (proximal: ventral, 428.1 ± 6.95 HU; dorsal, 405.5 ± 7.72 HU, P = .0318; distal: ventral, 418.0 ± 9.29 HU; dorsal, 393.2 ± 9.46 HU, P = .0133).

Dorsal bolus tracking ROI in the descending thoracic aorta significantly reduced preparation time and RCA CT values.
Concomitant severe influenza and cryptococcal infections
Authors: Huang Jinbao , Li Hongyan , Lan Changqing , Zou Shenghua , Zhang Hongying , Wang Xinhang , Weng Heng
Published: May 2019

Concomitant influenza and cryptococcal infections are rare. Herein, we describe an unusual case of an avian influenza A (H7N9) infection with several severe mixed bacterial infections and systemic super-infection with Cryptococcus neoformans presenting as ventilator-associated pneumonia (VAP) and bloodstream infection in a previously immunocompetent man during hospitalization.

A 58-year-old man was admitted to our hospital complaining of hyperpyrexia, dyspnoea, cough, and phlegm with blood. A chest computed tomography scan revealed multiple ground-glass opacities and consolidation in both lungs with right pleural effusion. An initial sputum test was positive for influenza A (H7N9) virus. After antiviral treatment and other supportive measures, the patient's condition improved. However, the patient's condition deteriorated again approximately 2 weeks after admission, and bronchoalveolar lavage fluid (BALF) and blood cultures were positive for C. neoformans. Therapy with intravenous liposomal amphotericin B and fluconazole was started. After a 2-week antifungal treatment, BALF and blood cultures were negative for C. neoformans. However, the patient had persistent lung infiltrates with severe pulmonary fibrosis with a prolonged course of disease. On hospital day 40, BALF and blood cultures were both positive for multidrug-resistant Stenotrophomonas maltophilia. Finally, the patient developed septic shock, disseminated intravascular coagulation and multi-organ failure and succumbed to treatment failure.

Cryptococcal infection can occur in patients with severe influenza during hospitalization with a more severe condition, and the clinician should be aware of this infection.
Bilateral idiopathic neuralgic amyotrophy involving selective branches of peripheral nerves with a stepwise progression
Authors: Kim Mee-Gang , Han Mi-Hyang , Kim Min-Wook , Lee Sang-Uk , Jang Dae-Hyun
Published: May 2019

Rationale:

This is a report about a rare case of idiopathic neuralgic amyotrophy (INA) involving selective peripheral nerve branches of bilateral upper extremities, which exhibited a stepwise progression.

Patient concern:

A 66-year-old woman presented with paresis of selective branches of bilateral median nerves, followed by paresis of bilateral posterior interosseous nerve (PIN) 8 weeks later.

Diagnoses:

We diagnosed it as INA involving the selective motor branches of bilateral median nerves and bilateral PINs. Forearm magnetic resonance imaging combined with electrodiagnostic testing helped accurately identify the affected regions, and ultrasonography demonstrated a severe constriction of the left PIN.

Interventions:

Intravenous methylprednisolone partially relieved the pain and paralysis. Surgical neurolysis of the constricted left PIN was done for persistent paralysis.

Outcomes:

The muscle power of the bilateral median nerve territories was recovered to nearly normal, but the muscle power of the left PIN territories remained at grade 1.

Lessons:

This case indicates that INA can manifest as a multiple mononeuropathy involving individual fascicular levels of peripheral nerve branches with focal constriction, and electrodiagnostic study combined with forearm MRI and ultrasonography can help in identifying affected lesion and predicting the prognosis.
Current trends in the features of male thyroid cancer
Authors: Kim Min Jhi , Lee Seul Gi , Kim Kwangsoon , Lee Cho Rok , Kang Sang-Wook , Lee Jandee , Nam Kee-Hyun , Chung Woong Youn , Jeong Jong Ju
Published: May 2019

This study aimed to compare the clinicopathologic characteristics and oncologic outcomes of papillary thyroid cancer (PTC) patients according to sex. Then, we validated prognostic variables to determine whether sex is a significant prognostic factor for PTC.

Between January 2007 and December 2010, 1232 men and 7276 women PTC patients underwent surgery. The patient characteristics and 5-year oncologic outcomes were compared. The stepwise Cox proportional hazards model determined the significance of survival variables.

Men PTC patients had more lymph node (LN) metastases than women, both in the total (P < .0001) and hemithyroidectomy (P < .0001) patients. Men and women showed similar 5-year recurrence-free survivals, both in total (P = .815) and hemithyroidectomy (P = .148) patients. The tumor size and the number of positive central nodes were associated with tumor recurrence, but not sex.

Sex was not an independent prognostic factor for tumor recurrence. Multicenter clinical studies with long-term follow-ups are needed to validate these results.
Examining determinants of sexual behavior among indigenous adolescents in Taiwan
Authors: Lin Li-Mei , Tung Tao-Hsin , Yeh Mei-Yu
Published: May 2019

A recent Taiwanese government report indicated that there were an increased number of sexual encounters among 15- to 17-year-old adolescents. Among them, indigenous Taiwanese had a higher rate of sexual encounters than did the rest of the population. However, no prior study has surveyed indigenous Taiwanese adolescents’ sexual behavior. Therefore, we examined the determinants of sexual behavior among indigenous adolescents in Taiwan.

In this cross-sectional study, the researchers chose 16 high schools as the target research population; after 2-stage random sampling, 4 of the 16 high schools were recruited to participate in the research. Data were collected through a self-report questionnaire from the participants, with a total of 521 valid responses.

Of the indigenous adolescents surveyed, 53% (N = 275) said they had touching, hugging, or kissing experiences, while 15.7% (N = 82) reported sexual behavior. The higher rate of sexual encounters among indigenous Taiwanese adolescents is associated with the gender, number of current or past romantic partners, drinking, and drug use before sexual intercourse. After adjustment for confounding factors, gender (male vs female, adjusted OR = 3.33, 95% CI: 1.83–6.07), number of heterosexual (≧1 vs no, OR = 1.67, 95% CI: 1.36–2.06), and heterosexual relationship (yes vs no, OR = 3.81, 95% CI: 1.94–7.48) appeared to be statistically significantly related sexual behaviors.

This study found that the occurrence rate of sexual behavior for indigenous adolescents was higher than the past research results, and having initiated sexual intercourse in earlier age. The results also showed the indigenous adolescents whose drinking alcohol and drug use are more experiences on sexual behaviors. The results could be applied on sexual education program in campus.
The tongue features associated with type 2 diabetes mellitus
Authors: Hsu Po-Chi , Wu Han-Kuei , Huang Yu-Chuen , Chang Hen-Hong , Lee Tsung-Chieh , Chen Yi-Ping , Chiang John Y. , Lo Lun-Chien
Published: May 2019

Diabetes mellitus (DM) is a public problem closely associated with numerous oral complications, such as coated tongue, xerostomia, salivary dysfunction, etc. Tongue diagnosis plays an important role in clinical prognosis and treatment of diabetes in the traditional Chinese medicine (TCM). This study investigated discriminating tongue features to distinguish between type 2 DM and non-DM individuals through non-invasive TCM tongue diagnosis.

The tongue features for 199 patients with type 2 DM, and 372 non-DM individuals, serving as control, are extracted by the automatic tongue diagnosis system (ATDS). A total of 9 tongue features, namely, tongue shape, tongue color, fur thickness, fur color, saliva, tongue fissure, ecchymosis, teeth mark, and red dot. The demography, laboratory, physical examination, and tongue manifestation data between 2 groups were compared.

Patients with type 2 DM possessed significantly larger covering area of yellow fur (58.5% vs 22.5%, P < .001), thick fur (50.8% vs 29.2%, P < .001), and bluish tongue (P < .001) than those of the control group. Also, a significantly higher portion (72.7% vs 55.2%, P < .05) of patients with long-term diabetics having yellow fur color than the short-term counterparts was observed.

The high prevalence of thick fur, yellow fur color, and bluish tongue in patient with type 2 DM revealed that TCM tongue diagnosis can serve as a preliminary screening procedure in the early detection of type 2 DM in light of its simple and non-invasive nature, followed by other more accurate testing process. To the best of our knowledge, this is the first attempt in applying non-invasive TCM tongue diagnosis to the discrimination of type 2 DM patients and non-DM individuals.
Extramedullary relapse of leukemia after allogeneic hematopoietic stem cell transplantation
Authors: Xie Ning , Zhou Jian , Zhang Yanli , Yu Fengkuan , Song Yongping
Published: May 2019

Extramedullary relapse (EMR) rarely occurs after allogeneic hematopoietic stem cell transplantation (HSCT) in leukemia. This study was to investigate the clinical characteristics of EMR.

We retrospectively investigated 316 consecutive patients undergoing HSCT for acute leukemia or chronic myeloid leukemia (CML) at 2 institutions between January 2012 and February 2017. Furthermore, we analyzed and compared the risk factors and outcomes between EMR and bone marrow relapse (BMR).

The 5-year cumulative incidence of EMR was 14.1%. The EMR incidence in acute myeloid leukemia, lymphoblastic leukemia, and CML was 17.5%, 18.9%, and 5.3%, respectively. CML had a lower EMR incidence rate. Compared to the BMR group, the EMR group had a longer median relapse-free time (10.5 months vs 5 months, P = .02), and the EMR group had a higher incidence rate of chronic graft-versus-host disease (50.0% vs 20.9%, P = .009). EMR had better estimated 3-year survival rates post-HSCT, and post-relapse, than did BMR (39.5% vs 9.5%, P < .001, and 21.9% vs 10.8%, P = .001). Multivariate analysis identified that adverse cytogenetics (hazard ratio [HR] = 9.034, P < .001) and extramedullary leukemia before HSCT (HR = 2.685, P = .027) were the independent risk factors for EMR after HSCT. In the EMR group, patients who achieved complete remission (CR) had a significantly better, estimated 3-year survival than did patients who did not achieve CR (38.4% vs 14.3%, P = .014).

EMR is a significant contributor to mortality after HSCT, which appears to be resistant to most of the current therapies. Establishing effective strategies for EMR is important in improving outcomes after HSCT.
Prognostic and clinicopathological significance of Gamma-Glutamyltransferase in patients with hepatocellular carcinoma
Authors: Sun Ping , Li Yanlong , Chang Lijun , Tian Xudong
Published: May 2019

Background:

Many studies explored the prognostic and clinicopathological significance of pretreatment serum Gamma-Glutamyltransferase (GGT) level in hepatocellular carcinoma (HCC). However, there are inconsistent results in the prognostic and clinicopathological significance of pretreatment serum GGT level in HCC. Thus, we conducted this meta-analysis to comprehensively assess the prognostic and clinicopathological significance of pretreatment serum GGT level in HCC patients.

Methods:

We systematically searched PubMed, EMBASE and Web of Science for relevant studies (up to June 14, 2018). The estimated hazard ratios (HRs) were used to assess the association between pretreatment serum GGT level and survival in HCC patients. The estimated odds ratios (ORs) were applied to evaluate the correlation between pretreatment serum GGT and clinicopathological features in HCC.

Results:

Our results showed that high pretreatment serum GGT level was significantly correlated with poor overall survival (OS) (HR = 1.70, 95% CI: 1.54–1.87; P < .01) and disease-free survival/relapse-free survival (DFS/RFS) (HR = 1.56, 95% CI: 1.42–1.71; P < .01). Additionally, our results also revealed that there was a close correlation between GGT level and several clinicopathological features in HCC patients, including vascular invasion, tumor size, tumor number and Alpha-fetoprotein (AFP) level.

Conclusions:

This meta-analysis shows that high pretreatment serum GGT level is significantly correlated with poor survival and unfavorable clinicopathological features in HCC patients, suggesting that pretreatment serum GGT may be an economical and effective prognostic biomarker for HCC patients. However, more high-quality studies are still warranted to further validate our findings, considering there are several limitations in this meta-analysis.
The relationship of CRP and cognition in cognitively normal older Mexican Americans
Authors: Vintimilla Raul , Hall James , Johnson Leigh , O’Bryant Sid
Published: May 2019

C-reactive protein (CRP) is a biomarker for cardiovascular events and also has been studied as a biomarker for cognitive decline. By the year 2050 the Hispanic population in the United States will reach 106 million, and 65% of those will be of Mexican heritage. The purpose of this study was to evaluate the association between CRP levels and cognitive functioning in a sample of Mexican American older adults. A cross-sectional analysis of data from 328 cognitive normal, Mexican American participants from the community-based Health and Aging Brain Among Latino Elders (HABLE) study were performed. Statistical methods included t-test, chi square, multiple linear regression, and logistic regression modeling. Cognitive performance was measured by the Mini Mental State Examination (MMSE), Logical Memory I and II, Digit Span, FAS, and Animal Naming tests. Age, years of education, gender, diagnostic of hypertension, diabetes, and dyslipidemia were entered in the model as covariates. High CRP levels significantly predicted FAS scores (B = −0.135, P = .01), even after adjusting for covariates. Education (B = 0.30, P < .05), and diagnosis of hypertension (B = −0.12, P = .02) were also independent predictors of FAS scores. Participants with higher CRP levels had greater adjusted odds of poorer performance in the FAS test (OR = 1.75, 95% CI = 1.13–2.72, P = .01) when compared to participants with lower CRP levels. This was also true for participants with hypertension (OR = 2.20, 95% CI = 1.34–3.60, P < .05). Higher CRP levels were not associated with MMSE, logical memory, digit span, and animal naming scores. In conclusion, our study showed a clear association between CRP levels and verbal fluency and executive function in a cognitively normal community-dwelling population of Mexican-Americans.
Efficacy and safety of apatinib in treatment of osteosarcoma after failed standard multimodal therapy
Authors: Tian Zhichao , Gu Zhiyuan , Wang Xin , Liu Zhiyong , Yao Weitao , Wang Jiaqiang , Zhang Peng , Cai Qiqing , Ge Hong
Published: May 2019

Recently, apatinib has been shown to be effective in treating sarcoma. This study aimed to assess the safety and efficacy of apatinib in the treatment of patients with osteosarcoma after failed of standard multimodal therapy and to compare the therapeutic effects of apatinib on osteosarcoma between high-dose group and low-dose group.

A total of 27 patients with osteosarcoma who received apatinib between January 2016 and August 2017 were retrospectively reviewed. Among the 27 patients, the objective response rate (ORR) and the disease control rate (DCR) were 25.93% and 66.67%, respectively. The median of progression-free survival (m-PFS) was 3.5 months (95% confidence interval [CI], 2.5–4.8 months), and the median of overall survival (m-OS) was 9.5 months (95% CI, 7.8–10.5 months). There was no statistically significant difference in ORR (36.36% vs 18.75%), DCR (63.64% vs 68.75%), m-PFS (4.3 months [95% CI, 1.8–7 months) vs 3.35 months (95% CI, 1.8–4 months]), and m-OS (9.5 months [95% CI, 7.8–10.5 months] vs 9.4 months [95% CI, 7.8–10.8 months]) (P > .05) between the high-dose group (the average dose was 659 mg/qd) and the low-dose group (the average dose was 516 mg/qd). Most of the adverse events (AEs) were in grade 1 or grade 2. The main AEs in grade 3 were hypertension, rash, weight loss, hand-foot syndrome, and diarrhea.

Apatinib is safe and effective in the treatment of advanced osteosarcoma. We recommend that the initial dose of apatinib should be 500 mg/qd in the treatment of osteosarcoma.
Failure of 3 different methods and biopsy sites to diagnose a patient with invasive colorectal cancer
Authors: Kim Daniel Dongiu , Litow Kyle Joseph , Lumbra Thomas James , Masri Mohammad Milhim
Published: May 2019

Rationale:

Colorectal cancer is one of the most commonly diagnosed cancers worldwide, and the majority arise from neoplastic adenomatous polyps. Bladder involvement in colorectal cancer is uncommon and found in approximately 3% of the cases, most commonly in sigmoid and rectal tumors and the diagnosis is classically based on biopsies of affected tissues.

Patient concerns:

A 68-year-old male with no significant past medical history underwent diagnostic colonoscopy for abdominal distension and constipation with positive fecal occult blood test ordered by the primary care physician.

Diagnosis:

Colonoscopy showed a sigmoid mass with biopsy finding of tubulovillous adenoma. Laparoscopy was performed for sigmoid colonic resection, but as the mass was large, a diverting loop colostomy and multiple biopsies were performed revealing tubulovillous adenoma again. Postoperative workup revealed right hydronephrosis, and cystoscopy was performed confirming bladder wall invasion with biopsies showing benign bladder wall tissue with no evidence of dysplasia or malignancy. Furthermore, computed tomography (CT)-guided core-needle biopsies of the colonic mass were performed but revealed adenomatous colonic mucosa without evidence of carcinoma.

Intervention:

Definitive surgical en bloc excision of the tumor and anterior bladder wall was performed with urology team until grossly free margins were attained. Final pathology revealed well-differentiated mucinous adenocarcinoma arising from a preexisting tubulovillous adenoma with direct invasion of the bladder wall.

Outcomes:

The patient's postoperative recovery was uneventful, and he was discharged 2 weeks postoperatively with planned adjuvant chemotherapy.

Lessons:

This case represents a classical presentation of invasive colorectal cancer. Perioperative workup, however, was confounded by failure of open, cystoscopic, and CT-guided biopsies to establish a tissue diagnosis for directed therapy. Upon literature review, evidence exists to support our approach to this unique dilemma.
Proximal versus total gastrectomy for proximal early gastric cancer
Authors: Xu Yixin , Tan Yulin , Wang Yibo , Xi Cheng , Ye Nianyuan , Xu Xuezhong
Published: May 2019

Background:

Recently, the incidence of proximal early gastric cancer (EGC) has been rising rapidly. Prevalent surgical methods are proximal gastrectomy (PG) and total gastrectomy (TG); however, which method is superior remains controversial. We conducted a systematic review and meta-analysis of original articles to compare the short- and long-term clinical outcomes of PG with TG for proximal EGC.

Methods:

Databases, including PubMed, Embase, Web of Science, and Cochrane Library were searched up to October 2018. The Newcastle-Ottawa scale was utilized to conduct quality assessments, and publication bias was evaluated using Egger test. STATA version 14.0 was used to perform the meta-analysis.

Results:

A total of 2036 patients with proximal EGC in 18 studies were included in the meta-analysis. The results showed that PG was potentially superior to TG regarding operation time, intraoperative blood loss volume, and long-term nutritional status. Overall survival between the PG and TG groups was not significantly different. PG was associated with a high incidence of 2 kinds of postoperative complications: anastomotic stenosis and reflux esophagitis. However, the incidence of these complications associated with esophagojejunostomy with double-tract reconstruction (DTR) was comparable with that of TG.

Conclusions:

PG has several advantages over TG for the treatment of proximal EGC, including surgical outcomes and long-term nutritional status. However, anastomotic stenosis and reflux esophagitis frequently occurred in patients undergoing PG. Esophagojejunostomy with DTR could offer a solution to reducing the incidence of these complications.
Intravenous iron versus oral iron or observation for gastrointestinal malignancies: a systematic review
Authors: Tang Grace H. , Dhir Vinita , Scheer Adena S. , Tricco Andrea C. , Sholzberg Michelle , Brezden-Masley Christine
Published: May 2019

Background

Anemia is a common condition in patients with gastrointestinal cancer. Current evidence for the use of intravenous compared with oral iron in this clinical setting is inconclusive. A systematic review was performed to assess evidence on the efficacy of intravenous iron versus oral/observation in gastrointestinal cancer patients in the preoperative and postoperative setting.

Materials and methods

We searched Medline and Embase from inception until December 2017 with no language restrictions. Outcomes included hemoglobin response, red blood cell transfusion, and adverse events. Screening, data abstraction, and risk of bias appraisal were performed by two independent reviewers. The risk of bias was assessed using the Cochrane tools for randomized and nonrandomized studies.

Results

A total of 10 studies (three randomized-controlled trials and seven nonrandomized studies) were included. Of the six preoperative studies, five reported that hemoglobin was significantly higher in the intravenous group compared with oral iron/observation. Among the four postoperative studies, three studies suggested that hemoglobin was significantly higher in the intravenous group compared with oral iron/observation. The overall risk of bias for all randomized-controlled trials was low. Quality assessments for nonrandomized studies found the risk of bias to be moderate for four studies and critical for three studies.

Conclusion

Despite the limitations of the current body of evidence, there is a likely benefit to the use of intravenous iron in this patient population. Further confirmatory research is needed to draw empirical conclusions.
Association of Maternal First-Trimester Ondansetron Use With Cardiac Malformations and Oral Clefts in Offspring
Authors: Huybrechts Krista F. , Hernández-Díaz Sonia , Straub Loreen , Gray Kathryn J. , Zhu Yanmin , Patorno Elisabetta , Desai Rishi J. , Mogun Helen , Bateman Brian T.
Published: May 2019

(Abstracted from JAMA 2018;320(23):2429–2437)

Nausea and vomiting is common in pregnancy and is reported to occur in up to 80% of women. About one-third of women with nausea and vomiting during pregnancy have symptoms that are clinically significant, and a small percentage develop hyperemesis gravidarum, which is the most common indication for hospital admission during the first part of pregnancy.
Association of Brain-Derived Neurotrophic Factor With Cognitive Function: An Investigation of Sex Differences in Patients With Type 2 Diabetes
Authors: Zhen Yan-Feng , Liu Xing-Yu , Li Yu-Kai , Fang Hui , Cassidy Ryan M. , Zhang Xiang Yang
Published: May 2019

Objective

Although a reduction in brain-derived neurotrophic factor (BDNF) has been implicated as a cause of cognitive impairment in type 2 diabetes mellitus (T2DM), the role of sex in moderating this effect has not been explored.

Methods

We compared the difference in serum BDNF and performance on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) between 96 men and 134 women with T2DM. We compared this with the difference in serum BDNF and performance in the control group (104 men, 144 women).

Results

Patients with T2DM performed worse on most RBANS indices (η2 = 0.372, all p < .05); within T2DM patients, men performed worse than women on the delayed memory score (74.1 (12.1) versus 79.9 (11.5), p = .002) and on the total score (71.4 (11.5) versus 76.5 (10.8), p = .025). Serum BDNF was lower in patients with T2DM versus controls (7.5 (2.7) ng/ml versus 11.5 (2.7) ng/ml, p < .001), and in men compared with women (6.9 (2.4) versus 7.9 (2.8), p = .024). Serum BDNF levels positively correlated with delayed memory score in patients with T2DM (β = 0.19, p = .007). However, this association was only observed in women, not in men (p
interaction = 0.04). Among healthy controls, no sex differences were noted in either RBANS or BDNF levels (η2 = 0.04, Cohen's d < 0.163, all p > .05).

Conclusions

Our results show sex differences in poorer cognitive performance, lower BDNF concentration, and their relationship in T2DM patients, suggesting that female sex may be a protective factor for cognitive decline in T2DM patients. However, the findings should be regarded as preliminary because of the cross-sectional design and chronicity of the diabetes.
Associations Between Objective Sleep and Ambulatory Blood Pressure in a Community Sample
Authors: Doyle Caroline Y. , Ruiz John M. , Taylor Daniel J. , Smyth Joshua W. , Flores Melissa , Dietch Jessica R. , Ahn Chul , Allison Matthew , Smith Timothy W. , Uchino Bert N.
Published: May 2019

Objective

Epidemiologic data increasingly support sleep as a determinant of cardiovascular disease risk. Fewer studies have investigated the mechanisms underlying this relationship using objective sleep assessment approaches. Therefore, the aim of this study was to examine associations between daily blood pressure (BP) and both objectively assessed sleep duration and efficiency.

Methods

A diverse community sample of 300 men and women aged 21 to 70 years, enrolled in the North Texas Heart Study, participated in the study. Actigraphy-assessed sleep was monitored for two consecutive nights with ambulatory BP sampled randomly within 45-minute blocks on the first and second day as well as the second night.

Results

Overall, sleep duration results paralleled those of sleep efficiency. Individuals with lower sleep efficiency had higher daytime systolic (B= −0.35, SE = 0.11,p= .0018,R2= 0.26) but not diastolic BP (B= −0.043, SE = 0.068,p= .52,R2= 0.17) and higher nighttime BP (systolic:B= −0.37, SE = 0.10,p< .001,R2= .15; diastolic:B= −0.20, SE = 0.059,p< .001,R2= .14). Moreover, lower sleep efficiency on one night was associated with higher systolic (B= −0.51, SE = 0.11,p< .001,R2= 0.23) and diastolic BP (B= −0.17, SE = 0.065,p= .012,R2= .16) the following day. When "asleep" BP was taken into account instead of nighttime BP, the associations between sleep and BP disappeared. When both sleep duration and efficiency were assessed together, sleep efficiency was associated with daytime systolic BP, whereas sleep duration was associated with nighttime BP.

Conclusions

Lower sleep duration and efficiency are associated with higher daytime systolic BP and higher nighttime BP when assessed separately. When assessed together, sleep duration and efficiency diverge in their associations with BP at different times of day. These results warrant further investigation of these possible pathways to disease.
Computed Tomography Angiography and Magnetic Resonance Angiography of Congenital Anomalies of Pulmonary Veins
Authors: Abdel Razek Ahmed Abdel Khalek , Al-Marsafawy Hala , Elmansy Maha , El-Latif Mahmoud Abd , Sobh Donia
Published: May 2019

We aimed to review computed tomography and magnetic resonance angiography of congenital anomalies of pulmonary veins. Total anomalous pulmonary venous return shows all pulmonary veins drain abnormally in another site rather than left atrium. Imaging can detect anomalous veins either supracardiac, infracardiac, or mixed. Partial anomalous pulmonary venous return shows some pulmonary vein have abnormal drainage that well delineated with computed tomography angiography. Scimitar syndrome is a type of partial anomalous pulmonary venous return where the pulmonary veins of the right lung drain infracardiac and is associated with right lung hypoplasia and dextrocardia. Pseudoscimitar show anomalous vein that takes a tortuous course and drains into the left atrium producing a false-positive scimitar sign. Cor triatriatum shows septum divide left atrium with proximal chamber receives blood flow from the pulmonary veins. Levoatriocardinal vein is an anomalous connection between the left atrium and anomalous vein from systemic venous system that is embryo logically derived from the cardinal veins. Computed tomography angiography can detect pulmonary vein stenosis, atresia, hypoplasia, and varix. Imaging is important for intimal diagnosis and detects the anomalous vessels and its connection, presence of stenosis, and associated other congenital cardiac anomalies. Also, it is a great role in assessment of patients after surgery.
Long-Term Characterization of Cranial Defects After Surgical Correction for Single-Suture Craniosynostosis
Authors: Skolnick Gary B. , Murthy Sindhoora , Patel Kamlesh B. , Huang Zhiyang , Naidoo Sybill D. , Ju Tao , Smyth Matthew D. , Woo Albert S.
Published: May 2019

Introduction

Craniosynostosis is typically corrected surgically within the first year of life through cranial vault reconstruction. These procedures often leave open calvarial defects at the time of surgery, which are anticipated to close over time in a large proportion of cases. However, residual calvarial defects may result as long-term sequelae from cranial vault remodeling. When larger defects are present, they may necessitate further reconstruction for closure.

Better understanding of the calvarial osseous healing process may help to identify which defects will resolve or shrink to acceptable size and which will require further surgery. Our study aims to assess the long-term changes in defect size after cranial vault reconstruction for craniosynostosis.

Methods

One-year postoperative and long-term computed tomography scans were retrieved from the craniofacial anomalies archive. Analysis used custom software. All defects above the size of 1 cm2 were analyzed and tracked for calvarial location, surface area, and circularity. Monte Carlo simulation was performed to model the effect of initial defect size on the rate of defect closure.

Results

We analyzed a total of 74 defects. The mean ± SD initial defect surface area was 3.27 ± 3.40 cm2. The mean ± SD final defect surface area was 1.71 ± 2.54 cm2. The mean ± SD percent decrease was 55.06% ± 28.99%. There was a significant difference in the percentage decrease of defects in the parietal and frontoparietal locations: 68.4% and 43.7%, respectively (P = 0.001). Monte Carlo simulation results suggest that less than 10% of defects above the size of 9 cm2 will close to the size of 2.5 cm2 or less.

Conclusions

We describe and make available a novel validated method of measuring cranial defects. We find that the large majority of initial defects greater than 9 cm2 remain at least 1 in2 in size (2.5 cm2) 1 year postoperatively. In addition, there appear to be regional differences in closure rates across the cranium, with frontoparietal defects closing more slowly than those in the parietal region. This information will aid surgeons in the decision-making process regarding cranioplasty after craniosynostosis correction.
Pressure Injury Prevention: Outcomes and Challenges to Use of Resident Monitoring Technology in a Nursing Home
Authors: Yap Tracey L. , Kennerly Susan M. , Ly Kao
Published: May 2019

PURPOSE:

We examined the usability, user perceptions, and nursing occupational subculture associated with introduction of a patient monitoring system to facilitate nursing staff implementation of standard care for pressure ulcer/injury prevention in the nursing home setting.

DESIGN:

Mixed methods, pre-/posttest design.

SUBJECTS AND SETTING:

Resident (n = 44) and staff (n = 38) participants were recruited from a 120-bed nursing home in the Southeast United States.

METHODS:

Digital data on frequency and position of residents were transmitted wirelessly from sensors worn on each resident's anterior chest to estimate nursing staff compliance with repositioning standard of care before and after visual monitors were activated to cue staff. The validated Nursing Culture Assessment Tool was used to determine changes in nursing culture. Benefits and challenges of implementation were assessed by 2 focus groups composed of 8 and 5 female members of the nursing staff (RN, LPN, CNA), respectively, and led by the three authors. Descriptive statistics were used for all quantitative variables, and inferential statistics were applied to categorical variables (χ2 test or Fisher exact test) and continuous variables (analyses of variance or equivalent nonparametric tests), respectively, where a 2-sided P value of <.05 was considered statistically significant.

RESULTS:

System use significantly (P = .0003) improved compliance with every 2-hour repositioning standards. The nursing culture normative ranking percentage increased from 30.9% to 58.2%; this difference was not statistically significant. Focus groups expressed satisfaction with the monitoring system and recommended improvements to support adaptation and use of technology.

CONCLUSIONS:

Study findings support the usability of the patient monitoring system to facilitate repositioning. Implementation of multiple strategies for training, supplies, and communication may enhance uptake and effectiveness.
Impact of Pressure Injuries on Patient Outcomes in a Korean Hospital
Authors: Han Yina , Jin Yinji , Jin Taixian , Lee Sun-Mi , Lee Ju-Young
Published: May 2019

PURPOSE:

The purpose of this study was to compare the effect of pressure injuries on mortality, hospital length of stay, healthcare costs, and readmission rates in hospitalized patients.

DESIGN:

A case-control study.

SUBJECTS AND SETTING:

The sample comprised 5000 patients admitted to a tertiary hospital located in Seoul Korea; 1000 patients with pressure injuries (cases) were compared to 4000 patients who acted as controls.

METHODS:

We retrospectively extracted clinical data from electronic health records. Study outcomes were mortality, hospital length of stay, healthcare costs, and readmission rates. The impact of pressure injuries on death and readmission was analyzed via multiple logistic regression, hospital deaths within 30 days were analyzed using the survival analysis and Cox proportional hazards regression, and impact on the length of hospitalization and medical costs were analyzed through a multiple linear regression.

RESULTS:

Developing a pressure injury was significantly associated with an increased risk of in-hospital mortality (odds ratio [OR], 3.94; 95% confidence interval [CI], 2.91-5.33), 30-days in-hospital mortality (OR, 2.18; 95% CI, 1.59-3.00), and healthcare cost (β = 11,937,333;P< .001). Pressure injuries were significantly associated with an extended length of hospitalization (β = 20.84;P< .001) and length of intensive care unit (ICU) stay (β = 8.16;P< .001). Having a pressure injury was significantly associated with an increased risk of not being discharged home (OR, 5.55; 95% CI, 4.35-7.08), along with increased risks of readmission (OR, 1.30; 95% CI, 1.05-1.62) and emergency department visits after discharge (OR, 1.70; 95% CI, 1.29-2.23).

CONCLUSIONS:

Development of pressure injuries influenced mortality, healthcare costs, ICU and hospital length of stay, and healthcare utilization following discharge (ie, readmission or emergency department visits). Hospital-level efforts and interdisciplinary approaches should be prioritized to develop interventions and protocols for pressure injury prevention.
Adaptive laboratory evolution reveals general and specific chemical tolerance mechanisms and enhances biochemical production
Authors: Lennen Rebecca M. , Jensen Kristian , Mohammed Elsayed T. , Malla Sailesh , Börner Rosa A. , Chekina Ksenia , Özdemir Emre , Bonde Ida , Koza Anna , Maury Jérôme , Pedersen Lasse E. , Schöning Lars Y. , Sonnenschein Nikolaus , Palsson Bernhard O. , Sommer Morten O.A. , Feist Adam M. , Nielsen Alex T. , Herrgård Markus J.
Published: May 2019

Tolerance to high product concentrations is a major barrier to achieving economically viable processes for bio-based chemical production. Chemical tolerance mechanisms are often unknown, thus their rational design is not achievable. To reveal unknown tolerance mechanisms we used an automated platform to evolveEscherichia colito grow in previously toxic concentrations of 11 chemicals that have applications as polymer precursors, chemical intermediates, or biofuels. Re-sequencing of isolates from 88 independently evolved populations, reconstruction of mutations, and cross-compound tolerance profiling was employed to uncover general and specific tolerance mechanisms. We found that: 1) the broad tolerance of strains towards chemicals varied significantly depending on the chemical stress condition under which the strain was evolved; 2) the strains that acquired high levels of NaCl tolerance also became broadly tolerant to most chemicals; 3) genetic tolerance mechanisms included alterations in regulatory, cell wall, transcriptional and translational functions, as well as more chemical-specific mechanisms related to transport and metabolism; 4) using pre-tolerized starting strains can significantly enhance subsequent production of chemicals when a production pathway is inserted; and 5) only a subset of the evolved isolates showed improved production indicating that this approach is especially useful when a large number of independently evolved isolates are screened for production. We provide a comprehensive genotype-phenotype map based on identified mutations and growth phenotypes for 224 chemical tolerant strains.
Logomaker: Beautiful sequence logos in python
Authors: Tareen Ammar , Kinney Justin B.
Published: May 2019

Sequence logos are visually compelling ways of illustrating the biological properties of DNA, RNA, and protein sequences, yet it is currently difficult to generate such logos within the Python programming environment. Here we introduce Logomaker, a Python API for creating publication-quality sequence logos. Logomaker can produce both standard and highly customized logos from any matrix-like array of numbers. Logos are rendered as vector graphics that are easy to stylize using standard matplotlib functions. Methods for creating logos from multiple-sequence alignments are also included.

Availability and Implementation

Logomaker can be installed using the pip package manager and is compatible with both Python 2.7 and Python 3.6. Source code is available athttp://github.com/jbkinney/logomaker.

Supplemental Information

Documentation is provided athttp://logomaker.readthedocs.io.

Contact

jkinney@cshl.edu.
Precise tuning of cortical contractility regulates cell shape during cytokinesis
Authors: Taneja Nilay , Bersi Matthew R. , Baillargeon Sophie , Fenix Aidan M. , Cooper James A. , Ohi Ryoma , Gama Vivian , Merryman W. David , Burnette Dylan T.
Published: May 2019

The mechanical properties of the cellular cortex regulate shape changes during cell division, cell migration and tissue morphogenesis. During cell division, contractile force generated by the molecular motor myosin II (MII) at the equatorial cortex drives cleavage furrow ingression. Cleavage furrow ingression in turn increases stresses at the polar cortex, where contractility must be regulated to maintain cell shape during cytokinesis. How polar cortex contractility controls cell shape is poorly understood. We show a balance between MII paralogs allows a fine-tuning of cortex tension at the polar cortex to maintain cell shape during cytokinesis, with MIIA driving cleavage furrow ingression and bleb formation, and MIIB serving as a stabilizing motor and mediating completion of cytokinesis. As the majority of non-muscle contractile systems are cortical, this tuning mechanism will likely be applicable to numerous processes driven by MII contractility.
Determining sufficient sequencing depth in RNA-Seq differential expression studies
Authors: Bass Andrew J. , Robinson David G. , Storey John D.
Published: May 2019

RNA-Seq studies require a sufficient read depth to detect biologically important genes. Sequencing below this threshold will reduce statistical power while sequencing above will provide only marginal improvements in power and incur unnecessary sequencing costs. Although existing methodologies can help assess whether there is sufficient read depth, they are unable to guide how many additional reads should be sequenced to reach this threshold. We provide a new method called superSeq that models the relationship between statistical power and read depth. We apply the superSeq framework to 393 RNA-Seq experiments (1,021 total contrasts) in the Expression Atlas and find the model accurately predicts the increase in statistical power gained by increasing the read depth. Based on our analysis, we find that most published studies (> 70%) are undersequenced, i.e., their statistical power can be improved by increasing the sequencing read depth. In addition, the extent of saturation is highly dependent on statistical methodology: only 9.5%, 29.5%, and 26.6% of contrasts are saturated when using DESeq2, edgeR, and limma, respectively. Finally, we also find that there is no clear minimum per-transcript read depth to guarantee saturation for an entire technology. Therefore, our framework not only delineates key differences among methods and their impact on determining saturation, but will also be needed even as technology improves and the read depth of experiments increases. Researchers can thus use superSeq to calculate the read depth to achieve required statistical power while avoiding unnecessary sequencing costs.
Stable Species Boundaries Despite Ten Million Years of Hybridization in Tropical Eels
Authors: Barth Julia M. I. , Gubili Chrysoula , Matschiner Michael , Tørresen Ole K. , Watanabe Shun , Egger Bernd , Han Yu-San , Feunteun Eric , Sommaruga Ruben , Jehle Robert , Schabetsberger Robert
Published: May 2019

Genomic evidence is increasingly underpinning that hybridization between taxa is commonplace, challenging our views on the mechanisms that maintain their boundaries. Here, we focus on seven catadromous eel species (genusAnguilla), and use genome-wide sequence data from more than 450 individuals sampled across the tropical Indo-Pacific, morphological information, and three newly assembled draft genomes to compare contemporary patterns of hybridization with signatures of past gene flow across a time-calibrated phylogeny. We show that the seven species have remained distinct entities for up to 10 million years, despite a dynamic scenario of incomplete isolation whereby the current frequencies of hybridization across species pairs (over 5% of all individuals were either F1 hybrids or backcrosses) contrast remarkably with patterns of past introgression. Based on near-complete asymmetry in the directionality of hybridization and decreasing frequencies of later-generation hybrids, we identify cytonuclear incompatibilities and hybrid breakdown as two powerful mechanisms that can support species cohesion even when hybridization has been pervasive throughout the evolutionary history of entire clades.
An early phase of instructive plasticity in visual cortex before the typical onset of sensory experience
Authors: Roy Arani , Wang Shen , Meschede-Krasa Benyamin , Breffle Jordan , Van Hooser Stephen D.
Published: May 2019

While early experience with moving stimuli is necessary for the development of direction selectivity in visual cortex of carnivores, it is unclear whether experience exerts a permissive or instructive influence. To test if the specific parameters of the experienced stimuli could instructively sculpt the emergent responses, visually naive ferrets were exposed to several hours of experience with unusual spatiotemporal patterns. In the most immature ferrets, cortical neurons developed selectivity to these patterns, indicating an instructive influence. In animals that were 1-10 days more mature, exposure to the same patterns led to a developmentally-typical increase in direction selectivity. We conclude that visual development progresses via an early phase of instructive plasticity, when the specific patterns of neural activity shape the specific parameters of the emerging response properties, followed by a late phase of permissive maturation, when sensory-driven activity merely serves to enhance the response properties already seeded in cortical circuits.
Electrocorticographic dissociation of alpha and beta rhythmic activity in the human sensorimotor system
Authors: Stolk Arjen , Brinkman Loek , Vansteensel Mariska J. , Aarnoutse Erik , Leijten Frans S. S. , Dijkerman Chris H. , Knight Robert T. , de Lange Floris P. , Toni Ivan
Published: May 2019

This study uses electrocorticography in humans to assess how alpha- and beta-band rhythms modulate excitability of the sensorimotor cortex during movement selection, as indexed through a psychophysically-controlled movement imagery task. Both rhythms displayed effector-specific modulations, tracked spectral markers of action potentials in the local neuronal population, and showed spatially systematic phase relationships (traveling waves). Yet, alpha- and beta-band rhythms differed in their anatomical and functional properties, were weakly correlated, and traveled along opposite directions across the sensorimotor cortex. Increased alpha-band power in the somatosensory cortex ipsilateral to the selected arm was associated with spatially-unspecific inhibition. Decreased beta-band power over contralateral motor cortex was associated with a focal shift from relative inhibition to excitation. These observations indicate the relevance of both inhibition and disinhibition mechanisms for precise spatiotemporal coordination of neuronal populations during movement selection. Those mechanisms are implemented through the substantially different neurophysiological properties of sensorimotor alpha- and beta-band rhythms.
An Open-Hardware sample mounting solution for inverted light-sheet microscopes with large detection objective lenses
Authors: Russell Craig T. , Rees Eric J.
Published: May 2019

Implementations of light-sheet microscopes are often incompatible with standard methods of sample mounting. Light-sheet microscopy uses orthogonal illumination and detection to create a thin sheet of light which does not illuminate the sample outside of the depth of field of the detection axis. Typically, this configuration involves a pair of orthogonal objectives which constrains the positioning of a length of coverslips or microscopes in range of the detection objective. We present an open-hardware (1, 2) sample mounting system for light-sheet microscopes using large detection objectives.