bluuebunny/crossref_metadata_2025 huggingface dataset:
Predators catalyze an increase in chloroviruses by foraging on the symbiotic hosts of zoochlorellae
Authors: DeLong John P. , Al-Ameeli Zeina , Duncan Garry , Van Etten James L. , Dunigan David D.
Published: November 2016

Significance

Reproduction and growth of viruses depend on successful encounters with appropriate hosts. However, some hosts are difficult to encounter. In particular, chloroviruses cannot reach their target zoochlorellae hosts, because zoochlorellae are endosymbionts, living inside the cell of a protist that protects the zoochlorellae from the chlorovirus. The protist host is subject to predation, and we show that copepods foraging on zoochlorellae-bearing protists can disrupt the mutualism and pass endosymbiontic zoochlorellae through their guts, exposing them to chloroviruses. In this way, predators can catalyze the virus population growth by breaking down physical barriers between viruses and their endosymbiont hosts.
Distinct regions that control ion selectivity and calcium-dependent activation in the bestrophin ion channel
Authors: Vaisey George , Miller Alexandria N. , Long Stephen B.
Published: November 2016

Significance

BEST1 is a Ca
2+
-activated chloride channel found in a variety of cell types that allows chloride to traverse the plasma membrane. Mutations in BEST1 can cause macular degeneration. The mechanisms for anion selectivity and Ca
2+
-dependent activation of BEST1 are unknown. Here, we show that a hydrophobic “neck” region of the channel’s pore does not play a major role in ion selectivity but acts as an effective gate, responding to Ca
2+
binding at a cytosolic sensor. Mutation of a cytosolic “aperture” dramatically affects relative permeabilities among anions. These insights help rationalize how disease-causing mutations in BEST1 affect channel behavior and contribute to a broader understanding of ion channel gating and selectivity mechanisms.
Radiocarbon dating of seized ivory confirms rapid decline in African elephant populations and provides insight into illegal trade
Authors: Cerling Thure E. , Barnette Janet E. , Chesson Lesley A. , Douglas-Hamilton Iain , Gobush Kathleen S. , Uno Kevin T. , Wasser Samuel K. , Xu Xiaomei
Published: November 2016

Significance

C-14 dating methods can be used to determine the time of death of wildlife products. We evaluate poaching patterns of elephants in Africa by using
14
C to determine lag time between elephant death and recovery of ivory by law enforcement officials. Most ivory in recent seizures has lag times of less than 3 y. Lag times for ivory originating in East Africa are shorter, on average, than the lag times for ivory originating in the Tridom region (Cameroon–Gabon–Congo). The
14
C data show little or no evidence that large-scale ivory shipments contained ivory stockpiled over long time periods. Little, if any, “old” ivory (i.e., >10 y) seems to contribute to large ivory shipments.
Mastering the interface for advanced all-solid-state lithium rechargeable batteries
Authors: Li Yutao , Zhou Weidong , Chen Xi , Lü Xujie , Cui Zhiming , Xin Sen , Xue Leigang , Jia Quanxi , Goodenough John B.
Published: November 2016

Significance

Realization of a safe, low-cost rechargeable lithium battery of high energy density and long cycle life is needed for powering an electric road vehicle and for storing electric power generated by solar or wind energy. This urgent need has prompted efforts to develop a solid electrolyte with an alkali metal anode. Only now is it recognized that the key requirement is wetting of the electrolyte surface by the alkali-metal anode. We report a full rechargeable cell with a solid electrolyte that, although it is reduced by metallic lithium, forms a thin lithium–electrolyte interface that is wet by the anode and wets the electrolyte to give a small Li
+
transfer resistance across the interface.
Systematic autoantigen analysis identifies a distinct subtype of scleroderma with coincident cancer
Authors: Xu George J. , Shah Ami A. , Li Mamie Z. , Xu Qikai , Rosen Antony , Casciola-Rosen Livia , Elledge Stephen J.
Published: November 2016

Significance

In this study, we created a barcoded whole-genome ORF mRNA display library and combined it with phage-immunoprecipitation sequencing to look for autoantibodies in sera from patients with scleroderma who also had coincident cancer without a known autoantibody biomarker. Using these two technologies, we found that 25% of these patients had autoantibodies to RNA Binding Region Containing 3 (RNPC3) and multiple other components of the minor spliceosome. There was evidence of intra- and intermolecular epitope spreading within RNPC3 and the complex. These combined technologies are highly effective for rapidly discovering autoantibodies in patient subgroups, which will be useful tools for patient stratification and discovery of pathogenic pathways.
Ligand-induced and small-molecule control of substrate loading in a hexameric helicase
Authors: Lawson Michael R. , Dyer Kevin , Berger James M.
Published: November 2016

Significance

Many processive, ring-ATPase motor proteins rely on substrate-dependent conformational changes to assist with the loading of client substrates into the central pore of the enzyme and subsequent translocation. Using the
Escherichia coli
Rho transcription terminator as a model hexameric helicase, we show that two distinct ligands—the antibiotic bicyclomycin and pyrimidine-rich nucleic acids—respectively repress or promote the transition of Rho from an open RNA-loading configuration to a closed-ring active helicase. Our findings explain several mechanisms by which Rho activity is controlled and provide a general illustration of how intrinsic and extrinsic factors can regulate ring-type ATPase dynamics through diverse mechanisms.
Reduced high-frequency motor neuron firing, EMG fractionation, and gait variability in awake walking ALS mice
Authors: Hadzipasic Muhamed , Ni Weiming , Nagy Maria , Steenrod Natalie , McGinley Matthew J. , Kaushal Adi , Thomas Eleanor , McCormick David A. , Horwich Arthur L.
Published: November 2016

Significance

First recordings from awake walking symptomatic-stage amyotrophic lateral sclerosis (ALS) and control mice were made simultaneously from spinal cord motor pools and corresponding hindlimb flexor and extensor muscles. Spinal recordings revealed loss of high-frequency firing in ALS mice, and EMG showed an abnormal fractionated character with step-to-step variability and flexor/extensor coactivation, associated with step-to-step variability in kinematics and likely compensatory mechanisms that allow continued ability to walk in the face of motor neuron loss.
Learning and remembering real-world events after medial temporal lobe damage
Authors: Dede Adam J. O. , Frascino Jennifer C. , Wixted John T. , Squire Larry R.
Published: November 2016

Significance

We explored the role of the medial temporal lobe (MTL) in remembering recent events. Patients with MTL damage and healthy controls were taken on a walk during which 11 planned events occurred. Patients remembered fewer details about the events than controls. Nevertheless, the details made reference to particular places and events from the walk. In addition, patients were similarly impaired across different kinds of content (spatial and nonspatial). Last, the patients were particularly impaired at remembering the temporal order in which the events occurred. The findings illuminate the role of the MTL in memory for real-world events and in the spatial and nonspatial aspects of recollection.
The endosomal transcriptional regulator RNF11 integrates degradation and transport of EGFR
Authors: Scharaw Sandra , Iskar Murat , Ori Alessandro , Boncompain Gaelle , Laketa Vibor , Poser Ina , Lundberg Emma , Perez Franck , Beck Martin , Bork Peer , Pepperkok Rainer
Published: November 2016

Stimulation of cells with epidermal growth factor (EGF) induces internalization and partial degradation of the EGF receptor (EGFR) by the endo-lysosomal pathway. For continuous cell functioning, EGFR plasma membrane levels are maintained by transporting newly synthesized EGFRs to the cell surface. The regulation of this process is largely unknown. In this study, we find that EGF stimulation specifically increases the transport efficiency of newly synthesized EGFRs from the endoplasmic reticulum to the plasma membrane. This coincides with an up-regulation of the inner coat protein complex II (COPII) components SEC23B, SEC24B, and SEC24D, which we show to be specifically required for EGFR transport. Up-regulation of these COPII components requires the transcriptional regulator RNF11, which localizes to early endosomes and appears additionally in the cell nucleus upon continuous EGF stimulation. Collectively, our work identifies a new regulatory mechanism that integrates the degradation and transport of EGFR in order to maintain its physiological levels at the plasma membrane.
Recommendations for the use of oral treprostinil in clinical practice: a Delphi consensus project pulmonary circulation
Authors: Rahaghi Franck F. , Feldman Jeremy P. , Allen Roblee P. , Tapson Victor , Safdar Zeenat , Balasubramanian Vijay P. , Shapiro Shelley , Mathier Michael A. , Elwing Jean M. , Chakinala Murali M. , White R. James
Published: November 2016

Oral treprostinil was recently labeled for treatment of pulmonary arterial hypertension. Similar to the period immediately after parenteral treprostinil was approved, there is a significant knowledge gap for practicing physicians who might prescribe oral treprostinil. Despite its oral route of delivery, use of the drug is challenging because of the requirement for careful titration and management of drug‐related adverse effects. We aimed to create a consensus document combining available evidence with expert opinion to provide guidance for use of oral treprostinil. Following a methodology commonly used in business and social sciences (the ‘Delphi Process’), two investigators from the oral treprostinil (Freedom) studies created a series of statements based on available evidence and the package insert. The set of ‘best practice’ statements was circulated to nine other Freedom trial investigators. Their comments were incorporated into the document as new line items for further vote and comment. The subsequent document was put to vote line by line (scale of −5 to +5) and a final statement was drafted. Consensus recommendations include initial therapy with 0.125 mg for treatment naÿve patients, three times daily dosing, aggressive use of antidiarrheal medication, and a strong preference for use of the drug in combination with other approved PAH therapies. This process was particularly valuable in providing guidance for the management of adverse events (where essentially no data is available). The Delphi process was useful to codify investigator experience and subsequently develop investigator consensus about practical issues for physicians who may wish to prescribe oral treprostinil.
Final report on EUROMET key comparison EUROMET.M.D-K2 (EUROMET 627) "Comparison of density determinations of liquid samples"
Authors: Bettin Horst , Heinonen Martti , Gosset  , Zelenka n , Lorefice Salvatore , Hellerud Kristen , Durlik Hanna , Jordaan Werner , Field Ireen
Published: November 2016

The results of the key comparison EUROMET 627 (EUROMET.M.D-K2) are presented. This project covered the density measurements of three liquids: dodecane, water and an oil of high viscosity measured at 15 °C, 20 °C and 40 °C. Seven European metrology laboratories and the South African laboratory CSIR-NML (now: NMISA) measured the densities at atmospheric pressure by hydrostatic weighing of solid density standards between 04 October 2001 and 18 December 2001. The stability and homogeneity of the liquids were investigated by the pilot laboratory PTB.

The results generally show good agreement among the participants. Only for the simple Mohr-Westphal balances do the uncertainties seem to be underestimated by the laboratories. Furthermore, the measurement of high-viscosity oil was difficult for some laboratories.

Nevertheless, the five laboratories PTB/DE, BNM/FR (now: LNE/FR), OMH/HU (now: MKEH/HU), IMGC/IT (now: INRIM/IT) and GUM/PL agree with each other for stated uncertainties of 0.05 kg/m3 or less. This satisfies the current needs of customers who wish to calibrate or check liquid density measuring instruments such as oscillation-type density meters.

No reference values were calculated since the subsequent CCM key comparison CCM.D-K2 had a different scope and the EUROMET 627 comparison was soon superseded by the EURAMET 1019 (EURAMET.M.D-K2) comparison.

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Report on the APMP.M.F-S1 supplementary comparison for 2 MN force
Authors: Ueda K , Hayashi T , Maejima H , Kumme R , Röske D , Seidel M
Published: November 2016

This document describes the comparison scheme and reports the results of the APMP.M.F-S1 supplementary comparison for 2 MN Force, in which two force transducers of 2 MN capacity were used.

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
PhagesDB: the actinobacteriophage database
Authors: Russell Daniel A , Hatfull Graham F
Published: November 2016

The Actinobacteriophage Database (PhagesDB) is a comprehensive, interactive, database-backed website that collects and shares information related to the discovery, characterization and genomics of viruses that infect Actinobacterial hosts. To date, more than 8000 bacteriophages—including over 1600 with sequenced genomes—have been entered into the database. PhagesDB plays a crucial role in organizing the discoveries of phage biologists around the world—including students in the SEA-PHAGES program—and has been cited in over 50 peer-reviewed articles.

Availability and Implementation:  http://phagesdb.org/
Pulsation versus metallicism in Am stars as revealed by LAMOST and WASP
Authors: Smalley B. , Antoci V. , Holdsworth D. L. , Kurtz D. W. , Murphy S. J. , De Cat P. , Anderson D. R. , Catanzaro G. , Collier Cameron A. , Hellier C. , Maxted P. F. L. , Norton A. J. , Pollacco D. , Ripepi V. , West R. G. , Wheatley P. J.
Published: November 2016

We present the results of a study of a large sample of A and Am stars with spectral types from LAMOST and light curves from WASP. We find that, unlike normal A stars, δ Sct pulsations in Am stars are mostly confined to the effective temperature range 6900<Teff<7600 K. We find evidence that the incidence of pulsations in Am stars decreases with increasing metallicism (degree of chemical peculiarity). The maximum amplitude of the pulsations in Am stars does not appear to vary significantly with metallicism. The amplitude distributions of the principal pulsation frequencies for both A and Am stars appear very similar and agree with results obtained from Kepler photometry. We present evidence that suggests turbulent pressure is the main driving mechanism in pulsating Am stars, rather than the κ-mechanism, which is expected to be suppressed by gravitational settling in these stars.
Similar Risk Patterns After Cervical Screening in Two Large U.S. Populations
Authors: Gage Julia C. , Hunt William C. , Schiffman Mark , Katki Hormuzd A. , Cheung Li A. , Myers Orrin , Cuzick Jack , Wentzensen Nicolas , Kinney Walter , Castle Philip E. , Wheeler Cosette M. ,   for The New Mexico HPV Pap Registry Steering Committee
Published: November 2016

OBJECTIVE:

To compare the risks of histologic high-grade cervical intraepithelial neoplasia (CIN) or worse after different cervical cancer screening test results between two of the largest U.S. clinical practice research data sets.

METHODS:

The New Mexico Human Papillomavirus (HPV) Pap Registry is a statewide registry representing a diverse population experiencing varied clinical practice delivery. Kaiser Permanente Northern California is a large integrated health care delivery system practicing routine HPV cotesting since 2003. In this retrospective cohort study, a logistic-Weibull survival model was used to estimate and compare the cumulative 3- and 5-year risks of histologic CIN 3 or worse among women aged 21–64 years screened in 2007–2011 in the New Mexico HPV Pap Registry and 2003–2013 in Kaiser Permanente Northern California. Results were stratified by age and baseline screening result: negative cytology, atypical squamous cells of undetermined significance (ASC-US) (with or without HPV triage), low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion.

RESULTS:

There were 453,618 women in the New Mexico HPV Pap Registry and 1,307,528 women at Kaiser Permanente Northern California. The 5-year CIN 3 or worse risks were similar within screening results across populations: cytology negative (0.52% and 0.30%, respectively, P<.001), HPV-negative and ASC-US (0.72% and 0.49%, respectively, P=.5), ASC-US (3.4% and 3.4%, respectively, P=.8), HPV-positive and ASC-US (7.7% and 7.1%, respectively, P=.3), low-grade squamous intraepithelial lesion (6.5% and 5.4%, respectively, P=.009), and high-grade squamous intraepithelial lesion (53.1% and 50.4%, respectively, P=.2). Cervical intraepithelial neoplasia grade 2 or worse risks and 3-year risks had similar trends across populations. Age-stratified analyses showed more variability, especially among women aged younger than 30 years, but patterns of risk stratification were comparable.

CONCLUSION:

Current U.S. cervical screening and management recommendations are based on comparative risks of histologic high-grade CIN after screening test results. The similar results from these two large cohorts from different real-life clinical practice settings support risk-based management thresholds across U.S. clinical populations and practice settings.
Risk Factors and Outcomes for Conversion to Laparotomy of Laparoscopic Hysterectomy in Benign Gynecology
Authors: Lim Courtney S. , Mowers Erika L. , Mahnert Nichole , Skinner Bethany D. , Kamdar Neil , Morgan Daniel M. , As-Sanie Sawsan
Published: November 2016

OBJECTIVE:

To estimate the incidence and factors for conversion to laparotomy in women scheduled for laparoscopic hysterectomy for benign gynecologic indications and to examine the effect of conversion on patient outcomes.

METHODS:

A retrospective cohort study of a Michigan multicenter prospective database was abstracted from January 1, 2013, through July 2, 2014. Participants were collected from an all-payer quality and safety database maintained by the Michigan Surgical Quality Collaborative. Women with a preoperative indication of cancer or obstetric indications were excluded. A logistic regression model was used to calculate odds of conversion using patient preoperative and intraoperative attributes.

RESULTS:

During the study period, 6,992 women underwent an attempted laparoscopic hysterectomy with 3.93% (n=275) converted to laparotomy. After adjusting for socioeconomic differences, hysterectomy indication, and intraoperative factors, there were decreased odds of conversion to laparotomy with use of robotic-assisted laparoscopy compared with traditional laparoscopy (adjusted odds ratio [OR] 0.14, 95% confidence interval [CI] 0.07–0.25) with a predicted risk of conversion of 0.8% compared with 5.4% (P<.001). High-volume surgeons were less likely to convert to laparotomy compared with low- and medium-volume surgeons (adjusted OR 0.66, 95% CI 0.47–0.92) with a predicted risk of conversion of 1.4% compared with 2.25% (P=.015). Conversion was associated with moderate or severe adhesive disease and increasing specimen weight. Conversion was associated with increased rates of surgical site infection, blood transfusion, severe sepsis, and reoperation.

CONCLUSION:

This analysis demonstrates that conversion to laparotomy is associated with increased odds of postoperative morbidity, and robotic assistance and surgeon volume are strongly associated with decreased odds of conversion.
Intraoperative Cystoscopic Evaluation of Ureteral Patency
Authors: Espaillat-Rijo Luis , Siff Lauren , Alas Alexandriah N. , Chadi Sami A. , Zimberg Stephen , Vaish Sneha , Davila G. Willy , Barber Matthew , Hurtado Eric A.
Published: November 2016

OBJECTIVE:

To compare different modalities to aid in the evaluation of intraoperative ureteral patency on cystoscopy in the postindigo carmine era.

METHODS:

In a randomized controlled trial, participants undergoing pelvic surgery were randomized into one of four groups: saline distention (control), 10% dextrose distention, oral phenazopyridine, or intravenous sodium fluorescein. Our primary outcome was visibility of the ureteral jets. Secondary outcomes included surgeon satisfaction; adverse reactions including allergies, urinary tract infections, urinary retention, cystoscopy times, and ureteral obstruction; and delayed diagnosis. Participants were followed for 6 weeks. A sample size of 176 participants was planned to demonstrate a 30% difference in the visibility scale. All analyses were performed in an intention-to-treat fashion.

RESULTS:

From February 25, 2015, through August 2015, 176 participants were enrolled; 174 completed the trial, and two did not undergo intervention. Forty-four participants were included in the phenazopyridine, dextrose, saline, and sodium fluorescein groups. Sodium fluorescein and 10% dextrose resulted in significantly improved visibility and satisfaction when compared with the control group (P<.001 and P=.004, respectively). Dextrose provided the highest satisfaction and phenazopyridine provided lowest, but visibility was not statistically different between the two groups (P=.101). Three ureteral obstructions were identified intraoperatively and none in the postoperative period. Mean total cystoscopy time varied between 4.0 and 4.8 minutes and postoperative urinary retention rate was 50% across all groups. Overall urinary tract infection rate was 24.1%, which was similar between interventions. There were no related adverse events.

CONCLUSION:

Compared with the control, 10% dextrose and sodium fluorescein resulted in improved visibility and provided significantly more satisfaction in the evaluation for ureteral patency with no considerable increase in operative time or morbidity.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, https://clinicaltrials.gov, NCT02476448.
Raspberry Leaf and Hypoglycemia in Gestational Diabetes Mellitus
Authors: Cheang Kai I. , Nguyen Thanh T. , Karjane Nicole W. , Salley Kelsey E. S.
Published: November 2016

BACKGROUND:

Raspberry leaf is commonly consumed by pregnant women. Hypoglycemic effects have been documented with other species within the plant family. Whether raspberry leaf affects glycemic control in gestational diabetes mellitus (GDM) is unknown.

CASE:

A 38-year-old nulliparous woman with GDM developed hypoglycemia requiring lowered insulin dose after consuming raspberry leaf tea at 32 weeks of gestation. The temporal relationship was confirmed by the patient's self-withdrawal and reintroduction of the herb. Fetal surveillance and growth were reassuring. A cesarean delivery was performed at 39 weeks of gestation. The neonate did not experience hypoglycemia or other complications. Placental biopsy revealed normal findings.

CONCLUSION:

Consumption of raspberry leaf may lead to reduced insulin requirements in GDM. Women with GDM should be cautioned about its use and their glucose levels more closely monitored.
Relationship Between Excessive Gestational Weight Gain and Neonatal Adiposity in Women With Mild Gestational Diabetes Mellitus
Authors: Blackwell Sean C. , Landon Mark B. , Mele Lisa , Reddy Uma M. , Casey Brian M. , Wapner Ronald J. , Varner Michael W. , Rouse Dwight J. , Thorp John M. , Sciscione Anthony , Catalano Patrick , Saade George , Caritis Steve N. , Sorokin Yoram , Grobman William A. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: November 2016

OBJECTIVE:

To evaluate the relationships among excessive gestational weight gain, neonatal adiposity, and adverse obstetric outcomes in women with mild gestational diabetes mellitus.

METHODS:

This is a secondary analysis of a multicenter randomized clinical trial of women with mild gestational diabetes mellitus. Based on self-reported prepregnancy body weight, gestational weight gain was categorized as excessive if it was greater than 2009 Institute of Medicine guidelines. Maternal outcomes and neonatal anthropomorphic characteristics were compared between women with excessive weight gain and those without excessive weight gain. Multiple linear and logistic regression analyses were performed to adjust for confounding factors.

RESULTS:

We studied 841 women who participated in the main trial and had prepregnancy body mass index (BMI) and delivery information available (n=431 treatment group, n=410 no treatment). After adjustment for factors including treatment and prepregnancy BMI, excessive weight gain remained associated with large for gestational age (adjusted odds ratio [OR] 2.94, 95% confidence interval [CI] 1.81–4.93), birth weight greater than 4,000 g (adjusted OR 2.56, 95% CI 1.54–4.40), preeclampsia (adjusted OR 2.96, 95% CI 1.35–7.03), and cesarean delivery for labor arrest (adjusted OR 2.37, 95% CI 1.30–4.44). In addition, excessive weight gain was independently associated with increased total neonatal fat (P<.001) and birth weight (P<.001).

CONCLUSION:

In women with both treated and untreated mild gestational diabetes mellitus, excessive gestational weight gain was independently associated with both greater birth weight and adiposity.
Imaging for Polyps and Leiomyomas in Women With Abnormal Uterine Bleeding
Authors: Maheux-Lacroix Sarah , Li Fiona , Laberge Philippe Y. , Abbott Jason
Published: November 2016

OBJECTIVE:

To evaluate the accuracy of saline infusion sonohysterography in comparison with transvaginal ultrasonography for diagnosing polyps and submucosal leiomyomas in women with abnormal uterine bleeding.

DATA SOURCES:

We searched the databases MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov as well as citations and reference lists to the end of November 2015.

METHODS OF STUDY SELECTION:

Two authors screened 5,347 citations for eligibility. We included randomized controlled trials or prospective cohort studies published in English, assessing the accuracy of saline infusion sonohysterography and transvaginal ultrasonography for diagnosing polyps and submucosal leiomyomas in women with abnormal uterine bleeding. We considered studies using histopathologic specimens obtained at either hysteroscopy or hysterectomy as criterion standard.

TABULATION, INTEGRATION, AND RESULTS:

Twenty-five studies were eligible. Two authors extracted data and assessed the quality of included studies. Bivariate random-effects models were used to compare the different tests and evaluate sources of heterogeneity. Saline infusion sonohysterography was superior to transvaginal ultrasonography with pooled sensitivity and specificity of 0.92 and 0.89 compared with 0.64 and 0.90, respectively (P<.001). Transvaginal ultrasound sensitivity for diagnosing polyps was particularly low (0.51). Saline infusion sonohysterography was also compared with hysteroscopy in seven studies and had similar sensitivity but inferior specificity (0.93 and 0.83 compared with 0.95 and 0.90, respectively,P=.007). All three procedures were well-tolerated by women. Saline infusion sonohysterography was successfully completed in 95% of women. Technical variations such as the use of balloon catheters were not found to affect diagnostic accuracy.

CONCLUSION:

Transvaginal ultrasonography lacks sensitivity to be used alone to exclude the presence of polyps and leiomyomas in women with abnormal uterine bleeding. Although less specific than hysteroscopy, saline infusion sonohysterography offers a similar detection rate and permits concomitant visualization of the ovaries and myometrium. Cost, convenience, and tolerability of different imaging techniques require further evaluation.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO International prospective register of systematic reviews, http://www.crd.york.ac.uk/PROSPERO, CRD42016034005.
Surgical Treatment of Chronic Essex-Lopresti Lesion: Interosseous Membrane Reconstruction and Radial Head Prosthesis
Authors: Bigazzi Prospero , Marenghi Letizia , Biondi Marco , Zucchini Maura , Ceruso Massimo
Published: November 2016

The Essex-Lopresti lesion, or radioulnar longitudinal dissociation, results from an axial load to the forearm with lesion to the radial head, interosseous membrane and distal radioulnar joint. The lesion is rarely diagnosed early, therefore treatment is often subacute or chronic. In these cases, procedures such as radial head replacement, ulnar shortening and/or wafer procedures should be combined with reconstruction of the interosseous membrane central band to restore longitudinal stability of the forearm. In the technique described, we use a folded fascia lata allograft fixed with specific device throughout transulnar and transradial tunnels passed through dorsal soft tissue access. The graft tension is progressively addressed with the help of fixation device. It seems an easily surgical technique without donor site morbidity.
The Periacetabular Osteotomy Technique
Authors: Ziran Navid M. , Awad Taysir , Matta Joel M.
Published: November 2016

Adult development dysplasia of the hip is characterized predominantly by deficient anterior and lateral femoral head coverage. Numerous pelvic and femoral osteotomies have been developed to help restore proper joint biomechanics and delay the onset of osteoarthritis. Reinhold Ganz developed the Bernese periacetabular osteotomy in 1984 to address acetabular dysplasia. The Ganz osteotomy 3-dimensionally reorients the acetabulum so that hip joint forces are more evenly distributed. Since then, the procedure has evolved slightly in the surgical approach and technique, but the fundamental osteotomies remain the same. The learning curve for the technique remains steep with potentially high complication rates and long operative times. The senior author has been performing this procedure since 1987 with nearly 500 procedures performed. Initial operative times for the senior author averaged ∼3 hours and have decreased to ∼60 to 75 minutes. This manuscript will demonstrate the senior author’s surgical technique of the periacetabular osteotomy as it has evolved over nearly 30 years. The authors hope that this technique description can facilitate other surgeons’ progress on the learning curve for this technically difficult but beneficial technique.
Intra-articular Hip Injection: Tips & Pearls
Authors: Sampath Kumar Venkatesan , Chacko Vinay J. , Jain Mikhil V. , Agrawal Pranshu , Mohammed Aslam
Published: November 2016

The technique of administering an intra-articular hip injection with image guidance has been described in detail with important tips to avoid injury to labrum, neuro-vascular structures and other complications.
Fistula-Associated Anorectal Cancer in the Setting of Crohn’s Disease
Authors: Shwaartz Chaya , Munger Jordan A. , Deliz Juan R. , Bornstein Joseph E. , Gorfine Stephan R. , Chessin David B. , Popowich Daniel A. , Bauer Joel J.
Published: November 2016

BACKGROUND:

Cancer arising from perianal fistulas in patients with Crohn’s disease is rare. There are only a small series of articles that describe sporadic cases of perianal cancer in Crohn’s disease fistulas. Therefore, there are no clear guidelines on how to appropriately screen patients at risk and choose proper management.

OBJECTIVE:

The purpose of this study was to describe patients diagnosed with cancer in perianal fistulas in the setting of Crohn’s disease.

DESIGN:

The study involved an institutional review board–approved retrospective review of medical charts of patients with perianal Crohn’s disease. The data extracted from patient charts included demographic and clinical characteristics.

SETTINGS:

Patients seen at the Mount Sinai Medical Center were included.

PATIENTS:

We identified patients who were diagnosed with perianal cancer in biopsies of fistula tracts.

MAIN OUTCOME MEASURES:

We observed the number of patients with Crohn's disease who had fistulas, cancer in fistula tract, and time to diagnosis.

RESULTS:

The charts of 2382 patients with fistulizing perianal Crohn’s disease were reviewed. Cancer in a fistula tract was diagnosed in 19 (0.79%) of these patients, 9 with squamous-cell carcinoma and 10 with adenocarcinoma. The majority of the 19 patients (68%) had symptoms typical of perianal fistula. The mean time from diagnosis of Crohn’s disease to fistula diagnosis and from fistula diagnosis to cancer diagnosis was 19.4 and 6.0 years. In 5 patients (26%), cancer was not diagnosed in the first biopsy obtained from the fistula tract.

LIMITATIONS:

This is a retrospective chart review of a rare outcome; the results may not be generalizable.

CONCLUSIONS:

Routine biopsies of long-standing fistula tracts in patients with Crohn’s disease should be strongly considered and may yield an earlier diagnosis of cancer in the fistula tracts.
Predictive Neuroimaging Markers of Psychotherapy Response: A Systematic Review
Authors: Chakrabarty Trisha , Ogrodniczuk John , Hadjipavlou George
Published: November 2016

Introduction

Predictive neuroimaging markers of treatment response are increasingly sought in order to inform the treatment of major depressive and anxiety disorders. We review the existing literature regarding candidate predictive neuroimaging markers of psychotherapy response and assess their potential clinical utility.

Methods

We searched Embase, PsycINFO, and PubMed up to October 2014 for studies correlating pretreatment neuroimaging parameters with psychotherapy response in major depressive and anxiety disorders. Our search yielded 40 eligible studies.

Results

The anterior cingulate cortex, amygdala, and anterior insula emerged as potential markers in major depressive disorder and some anxiety disorders. Results across studies displayed a large degree of variability, however, and to date the findings have not been systematically validated in independent clinical cohorts and have not been shown capable of distinguishing between medication and psychotherapy responders. Also limited is the examination of how neuroimaging compares or might add to other prognostic clinical variables.

Conclusion

While the extant data suggest avenues of further investigation, we are still far from being able to use these markers clinically. Future studies need to focus on longitudinal testing of potential markers, determining their prescriptive value and examining how they might be integrated with clinical factors.
Educating Parents on Sports-Related Concussions
Authors: Macdonald Ian , Hauber Roxanne
Published: November 2016

Purpose: Approximately 30 million children and adolescents in the United States participate in various forms of organized sports, and incidents of traumatic brain injuries in emergency departments have increased to 62% from 2001 to 2009. Knowledge, information, and preventive interventions appear to have been well disseminated among athletic personnel at the professional, collegiate, and high school levels. Research regarding parents’ perceptions and knowledge of sports-related concussions (SRCs) however is lacking. This project aims to determine the impact of interventions designed to improve parental awareness of SRCs. Methods: The study used a demographic information sheet and a postintervention survey design. These surveys were to determine the impact of three distinct educational tools presented on the perceptions and knowledge of SRCs in a group of parents with children actively involved in sports. Results: Forty-seven participants completed the demographic information sheet, most of them African American and have at least one child competing in high school contact sports. Furthermore, 85.1% of the parents felt that SRCs are a critical issue, although only 46.8% of the parents have ever sought out information to learn more about SRC. Twenty-nine individuals participated in the posteducational survey after the intervention, and most parents perceived that all three educational tools were written and presented in a fashion that changed their perception, awareness, and knowledge base of SRCs. These parents however stated that none of the interventions captured their attention enough to want to go to a professional for further information. Conclusions: Findings from this study suggest that parents know what educational approaches work best for them. However, it also suggests that a one-time educational intervention is not sufficient to move many parents to be proactive. The scarcity of published studies speaks to the need for further research to determine the most effective approaches to engage all involved groups in an integrated approach to ensure that children can be safely involved in sports without jeopardizing their future.
Parent Perceptions of Family Social Supports in Families With Children With Epilepsy
Authors: Decker Kim A. , Miller Wendy R. , Buelow Janice M.
Published: November 2016

Purpose and Background: When a child is diagnosed with epilepsy, not only has the child’s life been disrupted but also the family’s sense of normalcy. Although there is considerable literature discussing family concerns and social support issues in families with chronically ill children, a major gap lies in the exploration of how the specifics of childhood epilepsy affect parents and family operations. The purpose of this study was to identify psychosocial care needs of parents of children with epilepsy. Methods: Utilizing the Family Systems Nursing theory as a framework, this correlation study examined the relationships among social and community support, family needs, family empowerment, and family quality of life in 29 primary caregivers of a child with epilepsy. Results: These families felt highly supported; they had low needs and high perceptions of empowerment. There was a negative association between social supports and the total family needs survey scale and the subscales of financial support, help regarding explaining to others, and professional support. There was no association between family empowerment or quality of life with parental perceptions of social support. Conclusion: In general, as parental perceptions of family needs increased, perceptions of familial social supports decreased. Further research is recommended to investigate varying socioeconomic status effects in families with children with pediatric epilepsy.
Biobehavioral Framework of Symptom and Health Outcomes of Uncertainty and Psychological Stress in Parkinson Disease
Authors: Austin Kim W. , Ameringer Suzanne W. , Starkweather Angela R. , Cloud Leslie J. , Sturgill Jamie L. , Elswick Ronald K.
Published: November 2016

Parkinson disease (PD) is a debilitating, progressive neurodegenerative disorder characterized by complex motor and nonmotor symptoms that fluctuate in onset, severity, level of disability, and responsiveness to treatment. The unpredictable nature of PD and the inability to halt or slow disease progression may result in uncertainty and psychological stress. Uncertainty and psychological stress have important implications for symptom and health outcomes in PD. Uncertainty and psychological stress have been shown to worsen symptoms, functional capacity, and quality of life in chronic illnesses; however, the causal mechanisms have yet to be elucidated. We propose a biobehavioral framework for examining uncertainty and psychological stress in PD. The framework considers factors that may contribute to uncertainty and neuroendocrine–immune mechanisms of uncertainty and psychological stress that may influence symptom and health outcomes in PD, for the ultimate purpose of improving symptom and disease progression, functional capacity, and quality of life.
Speculum Lubrication and Patient Comfort: A Meta-Analysis of Randomized Controlled Trials
Authors: Bakker Ronan , Peng Katherine , Chelmow David
Published: November 2016

Objective

The aim of the study was to examine the effect of water-based gel lubrication in decreasing discomfort during speculum examination.

Materials and Methods

Searches of standard databases were performed. Randomized controlled trials comparing speculums lubricated with water-based gel to no lubrication or water alone in women undergoing gynecologic examinations were included. Selected studies were required to report on the outcome of discomfort experienced during the examination. Six studies met the criteria. Two reviewers independently performed the search and excluded articles that did not meet the inclusion criteria. The primary outcome was change in the visual analog scale (VAS) measure of discomfort. Pooled mean differences and 95% confidence interval (CI) were calculated and heterogeneity was assessed.

Results

Five studies, totaling 2,383 subjects, each noted a significant decrease in the VAS score with use of lubrication. Pooling all studies, the VAS score with lubrication changed −0.87 (95% CI = −1.22 to −0.53, 6 studies, 2,453 subjects). Studies measured discomfort at different points in the examination and noted significant decreases with insertion (mean difference, −0.98; 95% CI = −1.13 to −0.83, 5 studies, 2,383 subjects), opening (mean difference, −1.52; 95% CI = −2.43 to −0.61, 3 studies, 1,864 subjects), and extraction (mean difference, −0.97; 95% CI = −1.29 to −0.65, 2 studies, 284 subjects). These significant decreases were consistent in subgroups of premenopausal, postmenopausal, gynecologic oncology, and radiation therapy patients.

Conclusions

Water-based gel lubrication decreased discomfort for women undergoing a plastic speculum examination in all populations studied.
Esophagorespiratory Fistulas
Authors: Lenz Charles J. , Bick Benjamin L. , Katzka David , Nichols Francis C. , Depew Zachary S. , Wong Kee Song Louis M. , Baron Todd H. , Buttar Navtej S. , Maldonado Fabien , Enders Felicity T. , Harmsen William S. , Dierkhising Ross A. , Topazian Mark D.
Published: November 2016

Goal:

The purpose of this study was to characterize outcomes of esophagorespiratory fistulas (ERF) by etiology and initial treatment strategy.

Background:

ERF is a morbid condition for which optimal treatment strategies and outcomes are still in evolution.

Study:

Medical records and images were reviewed for all patients diagnosed with ERF at Mayo Clinic in Rochester, MN, between September 1, 2001 and January 1, 2012. Fistulas were classified as malignant or benign. Treatment strategies were classified as surgical or nonsurgical (typically esophageal stent placement). Technical and clinical success, survival, and survival free of second intervention were assessed.

Results:

A total of 123 patients with acquired ERF were identified, of whom 65 (53%) were malignant and 58 (47%) benign. Initial treatment strategy was nonsurgical in 88 (72%) patients and surgical in 35 (28%); lower Charlson comorbidity scores were associated with increased likelihood of surgery. Technical and clinical success was seen in a majority of patients treated both surgically and nonsurgically. Patients with malignant ERF treated surgically survived longer than patients undergoing nonsurgical treatment (hazard ratio=5.6, P=0.005). In contrast, those with benign ERF had similar overall survival regardless of whether they received initial surgical or nonsurgical treatment; reintervention was more common in those who underwent nonsurgical treatment (hazard ratio=2.3, P=0.03).

Conclusions:

We conclude that survival in malignant ERF is better with surgical intervention in selected patients. Surgical and nonsurgical techniques achieve similar survival in benign ERF, but reintervention is more common in those treated endoscopically.
Permanent Indwelling Transmural Stents for Endoscopic Treatment of Patients With Disconnected Pancreatic Duct Syndrome
Authors: Téllez-Aviña Felix I. , Casasola-Sánchez Luis E. , Ramírez-Luna Miguel Á. , Saúl Ángela , Murcio-Pérez Enrique , Chan Carlos , Uscanga Luis , Duarte-Medrano Gilberto , Valdovinos-Andraca Francisco
Published: November 2016

Introduction:

Disconnected pancreatic duct syndrome (DPDS) is defined as the complete disruption of the main pancreatic duct, the result are peripancreatic fluid collections or pancreatic leaks. The aim of this study was to report the results of derivative endoscopic treatment of DPDS in a long-term follow-up period.

Patients and Methods:

We performed a retrospective analysis of prospectively collected data. Endoscopic treatment consisted of transmural drainage with 2 double pigtail plastic stents (7 F and 4 cm) deployed under endoscopic ultrasound guidance.

Results:

In total, 21 patients were included in our study. There were 15 (71%) men and the median age was 36 years (range, 23 to 86 y). The principal etiology of DPDS was acute pancreatitis. A total of 20 (95.2%) patients were diagnosed with DPDS by endoscopic pancreatography and only 1 (4.8%) patient by magnetic resonance cholangiopancreatography (MRCP). The median follow-up time was 28 months (range, 7 to 76 mo). Technique success was 100% and initial clinical success was 80.9% (17/21). Three (17.6%) of these patients required a new endoscopic procedure with success in all cases. During follow-up, 11 (52%) patients developed diabetes mellitus and 3 patients (14%) developed exocrine pancreatic insufficiency. There were 5 (15%) patients with complications.

Conclusion:

According to our data, endoscopic treatment with the placement of a permanent indwelling transmural stents is a useful and safe tool for the treatment of DPDS.
Practical Aspects of Discussing Marijuana in a New Era
Authors: LENOUE SEAN R. , WONGNGAMNIT NARIN , THURSTONE CHRISTIAN
Published: November 2016

The use of marijuana for the treatment of medical conditions is a highly controversial topic. Misconceptions by both patients and providers concerning the safety of and evidence-based indications for marijuana can complicate treatment planning and outcomes. Maintaining skills such as motivational interviewing, providing evidence-based informed consent, and increasing access to care remain top priorities for providing quality patient care. The goal of this article is to offer guidance to clinical providers who are adapting to the changing realities of medical marijuana and legalized recreational marijuana.
Chirality of the cytoskeleton in the origins of cellular asymmetry
Authors: Satir Peter
Published: November 2016

Self-assembly of two important components of the cytoskeleton of eukaryotic cells, actin microfilaments and microtubules (MTs) results in polar filaments of one chirality. As is true for bacterial flagella, in actin microfilaments, screw direction is important for assembly processes and motility. For MTs, polar orientation within the cell is paramount. The alignment of these elements in the cell cytoplasm gives rise to emergent properties, including the potential for cell differentiation and specialization. Complex MTs with a characteristic chirality are found in basal bodies and centrioles; this chirality is preserved in cilia. In motile cilia, it is reflected in the direction of the effective stroke. The positioning of the basal body or cilia on the cell surface depends on polarity proteins. In evolution, survival depends on global polarity information relayed to the cell in part by orientation of the MT and actin filament cytoskeletons and the chirality of the basal body to determine left and right coordinates within a defined anterior–posterior cell and tissue axis.

This article is part of the themed issue ‘Provocative questions in left–right asymmetry’.