bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Use of the Latissimus Dorsi Musculocutaneous Flap and the Anterolateral Thigh Flap to Reconstruct an Extensive Shoulder Defect in an NF-1 Patient
Authors: Miyamoto Shimpei , Fujiki Masahide , Sakisaka Masanobu , Kawai Akira
Published: April 2016

Soft tissue coverage after the resection of a large malignant peripheral neural sheath tumor (MPNST) is a challenge. We report the successful reconstruction of an extensive shoulder defect after MPNST resection in a patient with a type 1 neurofibromatosis with a novel combination of flaps. A 70-year-old man with type 1 neurofibromatosis presented with a recurrent MPNST on his right shoulder. He underwent a wide excision of the tumor, which resulted in a huge soft tissue defect around the shoulder joint. The resultant defect was reconstructed with a pedicled latissimus dorsi musculocutaneous flap and a free anterolateral thigh flap. The flaps survived, and the wounds healed uneventfully. His affected arm was useful. The combination of a pedicled latissimus dorsi musculocutaneous flap and a free anterolateral thigh flap is a versatile option for the reconstruction of an extensive shoulder defect.
BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION: A CASE REPORT
Authors: Alasil Tarek , Coady Patrick A. , Koudsi Sirine , Mathur Mahan , Materin Miguel A.
Published: April 2016

Purpose:

To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) in the setting of metastatic ovarian cancer.

Methods:

In this observational case report, a 59-year-old woman presented with bilateral worsening vision and photophobia. She had been diagnosed with metastatic ovarian cancer 5 years prior for which she received Tamoxifen. Ophthalmic examination was completed followed by fluorescein angiography and optical coherence tomography (Spectralis OCT; Heidelberg Engineering).

Results:

The visual acuity was 20/150 in both eyes. Exam demonstrated an iris pigmented lesion in the right eye, bilateral nuclear sclerotic cataracts, multiple orange lesions in the fundus, elevated pigmented uveal melanocytic tumors with diffuse choroidal thickening and multifocal early hyperfluorescence of these lesions (giraffe-like pattern) on fluorescein angiography, and exudative retinal detachment on OCT. The patient was diagnosed with BDUMP in the setting of metastatic ovarian carcinoma. Further metastatic workup demonstrated enlarged lymphadenopathy in the right axilla and inguinal regions. The patient declined chemotherapy and was initiated on plasmapheresis.

Conclusions:

BDUMP is a peculiar paraneoplastic syndrome in the setting of metastatic ovarian cancer, where antigens from the retinal pigment epithelium, iris and choroidal melanocytes cross-react with ovarian tumor cell antibodies that are circulating in the serum. Plasmapheresis can decrease the concentrations of the antibodies, maintain reasonable functional vision and improve the quality of life.
PERSISTENT PLACOID MACULOPATHY IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Puche Nathalie , Hera Ruxandra , Terrada Celine , Souied Eric H.
Published: April 2016

Purpose:

To describe the case of a patient presenting with persistent placoid maculopathy imaged with optical coherence tomography angiography.

Methods:

Case report of a 72-year-old man who presented with blurred vision in his right eye. fundus photography, fluorescein angiography, infracyanine green angiography, fundus autofluorescence imaging, spectral domain optical coherence tomography, optical coherence tomography angiography, and split spectrum amplitude decorrelation angiography were performed. The diagnosis was made based on ophthalmological manifestations and multimodal imaging.

Results:

The spectral domain optical coherence tomography image of the right eye revealed disruption of the ellipsoid layers, and an underlying sliver of hyporeflectance. In the left eye, there were no obvious changes on spectral domain optical coherence tomography. In both eyes, infracyanine green angiography showed hypocyanescence of the lesions, persisting throughout late phases. In optical coherence tomography angiography, imaging of the choroidal capillary layers revealed hyposignal lesions, topographically corresponding exactly to hypocyanescent lesions on infracyanine green angiography.

Conclusion:

In this patient, a distinct hyposignal on optical coherence tomography angiography, combined with hypocyanescence on infracyanine green angiography, was interpreted as indicating focal hypoperfusion of the choriocapillaris.
FLATTENING OF A TREATMENT-RESISTANT RETINAL PIGMENT EPITHELIAL DETACHMENT AFTER A SINGLE INTRAVITREAL INJECTION OF ZIV-AFLIBERCEPT
Authors: Yogi Rohit , Stewart Michael , Chhablani Jay
Published: April 2016

Purpose:

To report flattening of a treatment-resistant retinal pigment epithelial detachment (PED) due to neovascular age-related macular degeneration after a single intravitreal injection of ziv-aflibercept (Zaltrap).

Methods:

A 67-year-old woman with a neovascular age-related macular degeneration–related PED was treated with intravitreal injections of bevacizumab and ranibizumab, and in combination with verteporfin photodynamic therapy, before receiving a single intravitreal injection of ziv-aflibercept (1.25 mg/0.05 mL).

Results:

The patient presented with a visual acuity of 20/30 in the right eye, a PED height of 581 μm, and a central macular thickness of 381 μm. She received eight intravitreal injections of bevacizumab and ranibizumab, one in combination with photodynamic therapy. The height of the PED and the central macular thickness varied over time, but 3 years later, they measured 382 μm and 418 μm, respectively. A single intravitreal injection of ziv-aflibercept resulted in a dramatic reduction in PED height to 140 μm, which was maintained 2 months later. The visual acuity remained stable, and there were no clinical signs of toxicity.

Conclusion:

Intravitreal ziv-aflibercept safely and effectively improved a treatment-resistant PED. Intravitreal ziv-aflibercept could become a treatment option for neovascular age-related macular degeneration in countries where aflibercept (Eylea) is not available or its cost is prohibitive, but further studies are necessary to establish efficacy and safety.
Aspergillus Mycetoma Causing Epiphora and Ipsilateral Facial Pain
Authors: Kauh Courtney Y. , Gentry Lindell R. , Hartig Gregory K. , Lucarelli Mark J.
Published: April 2016

Tearing is a frequently encountered chief complaint in an ophthalmologist’s office. Certain associated atypical symptoms may warrant further workup. The authors present a case of a patient presenting with painful tearing which elicited further evaluation with CT imaging. This revealed a maxillary sinus fungus ball as the cause for the patient’s tearing.
Orbital Plasmacytoma Mimicking an Orbital Abscess
Authors: Russell David J. , Seiff Stuart R.
Published: April 2016

An 83-year-old male with a 15-month history of multiple myeloma presented with acute onset of swelling, redness, and pain around his right eye. CT scan was consistent with an orbital abscess. The patient was taken to the operating room for drainage of the orbital abscess. Abnormal tissue was encountered intraoperatively so biopsies were taken. His cultures grew only one colony of coagulase-negative Staphylococcus aureus. The histopathology from the biopsies showed a CD-138 positive plasma cell neoplasia consistent with a plasmacytoma. Plasmacytomas have been reported to present as orbital cellulitis and as abscesses in other locations in the body, but to our knowledge, this is the first case of a plasmacytoma presenting as an orbital abscess.
Restraint training for awake functional brain scanning of rodents can cause long-lasting changes in pain and stress responses
Authors: Low Lucie A. , Bauer Lucy C. , Pitcher Mark H. , Bushnell M. Catherine
Published: April 2016

With the increased interest in longitudinal brain imaging of awake rodents, it is important to understand both the short-term and long-term effects of restraint on sensory and emotional processing in the brain. To understand the effects of repeated restraint on pain behaviors and stress responses, we modeled a restraint protocol similar to those used to habituate rodents for magnetic resonance imaging scanning, and studied sensory sensitivity and stress hormone responses over 5 days. To uncover lasting effects of training, we also looked at responses to the formalin pain test 2 weeks later. We found that while restraint causes acute increases in the stress hormone corticosterone, it can also cause lasting reductions in nociceptive behavior in the formalin test, coupled with heightened corticosterone levels and increased activation of the “nociceptive” central nucleus of the amygdala, as seen by Fos protein expression. These results suggest that short-term repeated restraint, similar to that used to habituate rats for awake functional brain scanning, could potentially cause long-lasting changes in physiological and brain responses to pain stimuli that are stress-related, and therefore could potentially confound the functional activation patterns seen in awake rodents in response to pain stimuli.
Thymic Carcinoma With Endobronchial Metastasis
Authors: Nagamata Makoto , Okuma Yusuke , Hosomi Yukio , Hishima Tsunekazu
Published: April 2016

Thymic carcinoma is a rare cancer, accounting for only 1% to 4% of thymic epithelial tumors. Endobronchial metastasis is a rare presentation of these tumors. A 64-year-old man presented with a cough. Lung cancer was suspected because a chest radiograph showed a 7-cm mass in the left pulmonary hilum. Computed tomography showed a mass in the anterior mediastinum and an infiltrate in the upper lobe of the left lung. Bronchoscopy demonstrated bilateral polypoid tumors in the left B3 bronchus and the right B1 bronchus. Endobronchial biopsies of both lesions resulted in a diagnosis of squamous cell carcinoma that was positive for c-KIT by immunohistochemical staining. The patient was eventually found to have thymic squamous cell carcinoma with bilateral endobronchial metastases (stage IVb according to the Masaoka-Koga staging system) by diagnostic video-assisted thoracoscopic surgery. He was subsequently treated with platinum-doublet chemotherapy and achieved a partial response for 18.8 months.
Development and Assessment of a Low-Cost 3D-printed Airway Model for Bronchoscopy Simulation Training
Authors: Byrne Timothy , Yong Sarah A. , Steinfort Daniel P.
Published: April 2016

We report upon the techniques used to create a plastic 3-dimensional-printed bronchoscopy trainer from an actual patient computed tomography scan. The formatting methods to create the printable file, using free open access software, are outlined. The resulting high anatomic fidelity part-task trainer is described, as well as experienced bronchoscopists' perception of its realism and utility as a training tool. A discussion of the current state of knowledge about the role of simulation in bronchoscopy training, as well as the potential contribution of this device, is presented.
A Simple Dietary Questionnaire Correlates With Formal Dietitian Evaluation and Frequently Identifies Specific Clinical Interventions in an Outpatient Gastroenterology Clinic
Authors: Dubin Sterling M. , Vadivelu Jaya , Copur-Dahi Nedret , Miranda Leslie , Palermo Dana , Pandey Braj , Groessl Erik J. , Ho Samuel B.
Published: April 2016

Background:

The spectrum of gastroenterology-related diseases related to obesity is growing. Few clinical tools exist to aid in clinician-guided dietary counseling.

Goals:

(1) Develop and validate a 1-page diet history form that would provide information on dietary factors that can contribute to gastrointestinal (GI) illness and to assess adherence to the Mediterranean diet; and (2) evaluate the form in a general GI clinic to determine its potential utility as a clinical tool.

Study:

A 1-page diet history form was developed and underwent qualitative and quantitative validation in comparison to a formal diet evaluation by a registered dietitian. The form was then evaluated in consecutive patients attending a general GI clinic, and analyzed for overall diet content, compliance with a Mediterranean diet, and presence of high-risk (red flag) dietary behaviors.

Results:

The form was evaluated in 134 patients. In a validation cohort (n=30) the qualitative dietary components measured were highly concordant with a formal dietary interview. Total daily calorie intake correlated with formal dietary review (R=0.61), but tended to underestimate total calories due to less precision in portion size. The prospective cohort (n=104) patients had a mean body mass index of 29.8. Overall, 52.9% were obese, 50% had metabolic syndrome, and 51% had a primary GI illness directly impacted by dietary factors (gastroesophageal reflux, irritable bowel, fatty liver). Overall, 85.6% of patients documented red flag behaviors. Patients with obesity trended for more red flags than overweight or normal body mass index groups.

Conclusion:

A 1-page diet questionnaire correlated well with formal dietary assessment and identified clinically relevant dietary interventions in a high percentage of GI patients.
Palliative Locoregional Treatment for Unresectable Nonmetastatic Klatskin Tumor
Authors: Liu Yanfeng , Sun Jingxian , Ma Dening , Jin Bin , Shao Zhenyu , Wang Jianbo , Zhang Zongli
Published: April 2016

Purpose:

This study aimed to identify the effect of percutaneous transhepatic biliary drainage (PTBD) combined with 3-dimensional conformal radiotherapy (3D-CRT) in comparison with PTBD therapy only on the treatment of unresectable Klatskin tumors (KTs).

Materials and Methods:

Thirty-seven patients with unresectable KTs were included in the study. Twenty-six patients received PTBD and 3D-CRT successively, whereas the other 11 patients received PTBD only. Changes in the clinical symptoms after the PTBD treatment, the radiotherapy effect, and the survival time were recorded and analyzed.

Results:

The clinical symptoms of the 2 groups gradually decreased after the PTBD treatment. The radiotherapy effect showed an overall effective rate (complete response+partial response) of 17 (65.38%), and the serum carbohydrate antigen-19-9 levels before and after 3D-CRT were significantly different (P<0.001). The mean survival time of the PTBD group was 11.27 months; the 1- and 2-year cumulative survival rates were 36.4% and 9.1%, respectively. The mean survival time of the combined therapy group was 22.77 months; the 1-, 2-, and 3-year cumulative survival rates were 53.8%, 38.5%, and 11.5%, respectively. The log-rank test showed that the patients who received combined therapy had longer survival time than the patients who only received PTBD (P=0.001).

Conclusions:

Patients with unresectable KTs who underwent PTBD could relieve biliary obstruction effectively. Although this study is not a randomized trial, 3D-CRT combined with PTBD seems to be a promising and an effective method as a palliative treatment for unresectable KTs.
Gastric Activity and Gut Peptides in Patients With Functional Dyspepsia
Authors: Russo Francesco , Chimienti Guglielmina , Clemente Caterina , Riezzo Giuseppe , D’Attoma Benedetta , Martulli Manuela
Published: April 2016

Goals:

The goals of the study were to investigate in both postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) the gastric electrical activity and the gastric emptying (GE) time together with the circulating concentrations of motilin, somatostatin, corticotrophin-releasing factor, and neurotensin, and to establish whether the genetic variability in the neurotensin system genes differs between these 2 categories of functional dyspepsia (FD).

Background:

The current FD classification is based on symptoms and it has been proven not to be completely satisfying because of a high degree of symptom overlap between subgroups.

Study:

Gastric electrical activity was evaluated by cutaneous electrogastrography: the GE time by 13C-octanoic acid breast test. Circulating concentrations of gut peptides were measured by a radioimmunoassay. NTS 479 A/G and NTSR1 rs6090453 SNPs were evaluated by PCR and endonuclease digestion.

Results:

Fifty-four FD patients (50 female/4 male) were studied. Using a symptom questionnaire, 42 patients were classified as PDS and 12 as EPS, although an overlap between the symptom profiles of the 2 subgroups was recorded. The electrogastrographic parameters (the postprandial instability coefficient of dominant frequency, the dominant power, and the power ratio) were significantly different between the subgroups, whereas the GE time did not differ significantly. In addition, EPS was characterized by a different gut peptide profile compared with PDS. Finally, neurotensin polymorphism was shown to be associated with neurotensin levels. This evidence deserves further studies in consideration of an analgesic role of neurotensin.

Conclusions:

Analysis of gut peptide profiles could represent an interesting tool to enhance FD diagnosis and overcome limitations due to a distinction based solely on symptoms.
Adolescent tracheal intubation in an adult urban emergency department: a retrospective, observational study
Authors: Hale James J. , Lynch Stephen , Ray David C. , Reid Lindsay A.
Published: April 2016

Objectives

Tracheal intubation is the cornerstone of advanced emergency airway management in children and adults and there is good-quality data characterizing intubation in both groups. There are, however, few published studies on emergency tracheal intubation in adolescents. We carried out an observational study to characterize tracheal intubation in adolescents.

Methods

We analysed data from a previously collected Emergency Department Intubation Registry. We included all attempts at tracheal intubation performed in our adult emergency department between 1999 and 2011. We recorded the indication for intubation, the staff involved, the technique and drugs used, and the rates of successful intubation and adverse events. We classified patients into three age groups: 13–16 years (adolescent), 17–24 years (young adult) and at least 25 years (older adult).

Results

Trauma was the most common indication for intubation in adolescents, and rapid sequence induction was used in 88% of cases. Ninety-nine percent of tracheal intubations in adolescent patients were successful on the first or the second attempt, no adolescent underwent more than three attempts and none required a surgical airway. The initial intubation attempt in adolescents was more likely to be performed by an anaesthetist (P<0.005). The first attempt success rate was higher (P<0.01) and adverse event rate was lower (P<0.05) in adolescents than in adults. Hypotension was the only adverse event recorded in adolescents; this occurred in three patients (4.5%).

Conclusion

Our findings suggest that the airway in adolescent patients can be managed successfully and safely in an adult emergency department where there is close collaboration between anaesthetists and emergency physicians.
Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults
Authors: Hoffman Geoffrey J. , Hays Ron D. , Shapiro Martin F. , Wallace Steven P. , Ettner Susan L.
Published: April 2016

Objectives:

Compare expenditures of fall-related injuries (FRIs) using several methods to identify FRIs in administrative claims data.

Research Design:

Using 2007–2009 Medicare claims and 2008 Health and Retirement Survey data, FRIs were identified using external-cause-of-injury (e-codes 880/881/882/884/885/888) only, e-codes plus a broad set of primary diagnosis codes, and a newer approach using e-codes and diagnostic and procedural codes. Linear regression models adjusted for sociodemographic, health, and geographic characteristics were used to estimate per-FRI, service component, patient cost share, expenditures by type of initial FRI treatment (inpatient, emergency department only, outpatient), and total annual FRI-related Medicare expenditures.

Subjects:

The analysis included 5497 community-dwelling adults ≥65 (228 FRI, 5269 non-FRI individuals) with continuous Medicare coverage and alive during the 24-month study.

Results:

The 3 FRI identification methods produced differing distributions of index FRI type and varying estimated expenditures: $12,171 [95% confidence interval (CI), $4662–$19,680], $5648 (95% CI, $3819–$7476), and $9388 (95% CI, $5969–$12,808). In all models, most spending occurred in hospital, outpatient, and skilled nursing facility (SNF) settings, but greater proportions of SNF and outpatient spending were observed with commonly used FRI identification methods. Patient cost-sharing was estimated at $691–$1900 across the 3 methods. Inpatient-treated index FRIs were more expensive than emergency department and outpatient-treated FRIs across all methods, but were substantially higher when identifying FRI using only e-codes. Estimated total FRI-related Medicare expenditures were highly variable across methods.

Conclusions:

FRIs are costly, with implications for Medicare and its beneficiaries. However, expenditure estimates vary considerably based on the method used to identify FRIs.
Effects of melatonin on cardiovascular diseases: progress in the past year
Authors: Sun Hang , Gusdon Aaron M. , Qu Shen
Published: April 2016

Purpose of review

Melatonin is a neuroendocrine hormone synthesized primarily by the pineal gland. Numerous studies have suggested that melatonin plays an important role in various cardiovascular diseases. In this article, recent progress regarding melatonin's effects on cardiovascular diseases is reviewed.

Recent findings

In the past year, studies have focused on the mechanism of protection of melatonin on cardiovascular diseases, including myocardial ischemia-reperfusion injury, myocardial hypoxia-reoxygenation injury, pulmonary hypertension, hypertension, atherosclerosis, valvular heart diseases, and other cardiovascular diseases.

Studies have demonstrated that melatonin has significant effects on ischemia-reperfusion injury, myocardial chronic intermittent hypoxia injury, pulmonary hypertension, hypertension, valvular heart diseases, vascular diseases, and lipid metabolism. As an inexpensive and well tolerated drug, melatonin may be a new therapeutic option for cardiovascular disease.
Accuracy of a Genetic Test for the Diagnosis of Hypolactasia in Chilean Children
Authors: Alliende Francisco , Vial Cecilia , Espinoza Karen , Schnettle Daniela , Romero Victoria , Miquel Isabel , Arancibia Maria E. , Rios Gloria , Rodriguez Lorena , Quesada Soledad , Lucero Yalda , Repetto Gabriela M.
Published: April 2016

Background:

Lactase nonpersistence (LNP) in humans is a genetically determined trait. This age‐dependent decrease of lactase expression is most frequently caused by single nucleotide polymorphisms in the regulatory region of the lactase (LCT) gene. The homozygous LCT‐13,910C/C genotype (rs 4988235) predominates in Caucasian adults with LNP, and is useful for its diagnosis in this population. The accuracy of this genetic test (GT) has not been completely established in children or in a Latin‐American population.

Objectives:

The aim of the study was to determine diagnostic accuracy of GT for LNP in Chilean children using the lactose breath test (BT) as a reference, and to compare diagnostic yield in preschool‐ (<6 years) and in school‐age (≥6 years) children.

Methods:

Children referred for BT for diagnosis of lactose malabsorption to the Gastroenterology Laboratory at Clínica Alemana, Santiago, from October 2011 to March 2012 were invited to participate. After informed consent, symptom questionnaires, both historic and post lactose ingestion were completed. H2 and CH4 in expired air and −13,910 C>T single nucleotide polymorphism by polymerase chain reaction, restriction enzyme analysis, and/or Sanger sequencing were determined. GT accuracy was calculated compared to BT as reference method. Diagnostic yield of GT in preschool‐ and school‐age children was compared.

Results:

Lactose malabsorption was detected by BT in 42 of 60 children (70%). Genotype −13,910C/C was identified in 41 of 60 patients (68%). GT showed 80% sensitivity, 63% specificity, and 74% accuracy for LNP in the preschool population. In school‐age children values were higher, 85%, 80%, and 84%, respectively.

Conclusions:

GT results were significantly concordant with BT results for hypolactasia detection in Chilean children, particularly in those of age 6 years and older.
Pneumatosis Coli in Complex Neurodisability
Authors: West Rebecca , Dass Dipanker , Mordekar Santosh , Campbell David , Lindley Richard
Published: April 2016

This case series describes our experience in managing 4 children with complex neurodisability, feed intolerance, and pneumatosis coli. In all of the 4 patients, symptoms and feed tolerance were substantially improved by the formation of a laparoscopically assisted defunctioning ileostomy. We describe our present management strategy and believe this is a promising treatment for those patients who can reduce long‐term dependence on parenteral nutrition, although we acknowledge that there is a long‐term risk of disuse colitits in the defunctioned bowel.
Hepatitis E in Children
Authors: Fischler Björn , Baumann Ulrich , Dezsofi Antal , Hadzic Nedim , Hierro Loreto , Jahnel Jörg , McLin Valérie , Nobili Valerio , Smets Francoise , Verkade Henkjan , Debray Dominique
Published: April 2016

Background:

Hepatitis E virus (HEV) is endemic in large parts of the developing world. Waterborne transmission of genotypes 1 or 2 commonly causes acute hepatitis, which is usually self‐limited in healthy individuals. In addition, acute HEV infections also occur outside endemic areas, mostly related to foodborne transmission of HEV genotype 3. A growing number of publications in the last decade have reported chronic infection progressing to cirrhosis in immunosuppressed patients. It has also been suggested that HEV transmission may occur via contaminated blood products. This publication aims to provide recommendations for diagnosis, prevention, and treatment of HEV infection, particularly in children after solid organ transplantation.

Methods:

A systematic PubMed literature search on HEV infection from 1990 to January 2016 was performed focusing on pediatric studies. The existing body of evidence was reviewed and recommendations were agreed upon following discussion and unanimous agreement by all members of the ESPGHAN Hepatology Committee during a consensus meeting in January 2016. In the absence of randomized controlled studies these recommendations were considered to be expert opinions.

Key Recommendations:

Immunocompetent children with increased transaminases and/or extrahepatic manifestations should be considered for testing for evidence of HEV infection. Immunocompromised children with increased aminotransferases should be repeatedly tested for HEV and may require therapeutic intervention.
The Relationship Between Inflammatory Biomarkers and Symptom Distress in Lung Cancer Patients Undergoing Chemotherapy
Authors: Chou Hsiu-Ling , Chao Tsu-Yi , Chen Tsan-Chi , Chu Chi-Ming , Hsieh Chen-Hsi , Yao Chung-Tay , Janckila Anthony J.
Published: April 2016

Background:

Symptom distress often occurs in lung cancer patients undergoing chemotherapy. However, a biomarker has not been identified to reflect the severity of their symptom distress.

Objective:

The aim of this study was to investigate the relationship between symptom distress and serum inflammatory biomarkers in lung cancer patients undergoing chemotherapy.

Methods:

A longitudinal, repeated-measures design was used to assess subjective symptoms (fatigue, sleep disturbance, pain, depression, and confusion), serum biomarkers (tartrate-resistant acid phosphatase 5a [TRACP5a], interleukin 6 [IL-6], IL-8, and C-reactive protein), and white blood cells in 62 lung cancer patients recruited from a single medical center at 3 time points: T1 was the baseline, T2 was the eighth day after the first chemotherapy cycle, and T3 was prior to the second cycle. Symptom distress was measured individually by 5 questionnaires (General Fatigue Scale, Pittsburgh Sleep Quality Index, Brief Pain Inventory, Profile of Mood States–Depressive, and Confusion).

Results:

The trend of TRACP5a was positively correlated to the trend of the patients’ symptom distress. However, the trends of IL-6 and IL-8 did not correlate.

Conclusions:

Serum TRACP5a was associated with symptom distress in lung cancer patients. Therefore, TRACP5a might be a potential biomarker to assess symptom distress of lung cancer patients undergoing chemotherapy.

Implications for Practice:

Oncology nurses may be able to apply TRACP5a expression to predict or monitor multiple distress symptoms in lung cancer patients undergoing chemotherapy. Furthermore, nurses can use these study findings to better understand the patients who need more attention to improve their quality of life.
Implementation of a Ventilator-Associated Pneumonia Prevention Bundle in a Single PICU*
Authors: De Cristofano Analía , Peuchot Verónica , Canepari Andrea , Franco Victoria , Perez Augusto , Eulmesekian Pablo
Published: April 2016

Objective:

Ventilator-associated pneumonia is considered the second most frequent infection in pediatric intensive care, and there is agreement on its association with higher morbidity and increased healthcare costs. The goal of this study was to apply a bundle for ventilator-associated pneumonia prevention as a process for quality improvement in the PICU of Hospital Italiano de Buenos Aires, Argentina, aiming to decrease baseline ventilator-associated pneumonia rate by 25% every 6 months over a period of 2 years.

Design:

Quasi-experimental uninterrupted time series.

Setting:

PICU of Hospital Italiano de Buenos Aires, Argentina.

Patients:

All mechanical ventilated patients admitted to the unit.

Intervention:

It consisted of the implementation of an evidence-based ventilator-associated pneumonia prevention bundle adapted to our unit and using the plan-do-study-act cycle as a strategy for quality improvement. The bundle consisted of four main components: head of the bed raised more than 30°, oral hygiene with chlorhexidine, a clean and dry ventilator circuit, and daily interruption of sedation.

Measurements and Main Results:

Ventilator-associated pneumonia prevention team meetings started in March 2012, and the ventilator-associated pneumonia bundle was implemented in November 2012 after it had been developed and made operational. Baseline ventilator-associated pneumonia rate for the 2 years before intervention was 6.3 episodes every 1,000 mechanical ventilation days. ventilator-associated pneumonia rate evolution by semester and during the 2 years was, respectively, 5.7, 3.2, 1.8, and 0.0 episodes every 1,000 mechanical ventilation days. Monthly ventilator-associated pneumonia rate time series summarized in a 51-point control chart showed the presence of special cause variability after intervention was implemented.

Conclusions:

The implementation over 2 years of a ventilator-associated pneumonia prevention bundle specifically adapted to our unit using quality improvement tools was associated with a reduction in ventilator-associated pneumonia rate of 25% every 6 months and a nil rate in the last semester.
Perforator Mapping and Optimizing Design of the Lateral Arm Flap: Anatomy Revisited and Clinical Experience
Authors: Chang Edward I. , Ibrahim Amir , Papazian Nazareth , Jurgus Abdo , Nguyen Alexander T. , Suami Hiroo , Yu Peirong
Published: April 2016

Background:

The lateral arm flap remains an underused flap, especially as a free flap. In this article, the authors describe the perforator anatomy to optimize flap design and harvest.

Methods:

Perforator locations were mapped in 12 cadavers (24 arms), and a retrospective review was conducted of 51 patients undergoing lateral arm flap surgery.

Results:

One to three reliable perforators supply the lateral arm flap. Based on cadaveric dissections, from the deltoid insertion, the A, B, and C perforators were located at 7.2 ± 1.0 cm, 9.9 ± 1.2 cm, and 11.8 ± 0.8 cm, which was 0.44, 0.61, and 0.72 of the distance from the deltoid insertion, respectively. The average pedicle length was 7.0 ± 1.1 cm. The cadavers were entirely symmetric in the number and location of the perforators between the right and left arms. All 51 patients (24 male and 27 female patients) had at least one perforator with an average pedicle length of 7.0 ± 1.3 cm, an average arterial diameter of 1.7 ± 0.3 mm, and a vein diameter of 2.5 ± 0.5 mm. All but one flap was performed as a free flap for head and neck reconstruction, with one pedicled flap for shoulder reconstruction. The average flap size was 72.2 ± 37.1 cm2 (range, 21 to 165 cm2). The nondominant arm was used for all free flaps. There were no total or partial flap losses. Twenty-eight patients reported donor-site numbness, with one infection, one hematoma, and one wound dehiscence.

Conclusion:

The lateral arm flap can be harvested reliably based on well-defined perforators and anatomical landmarks with minimal donor-site morbidity and should be included among the techniques used by reconstructive microsurgeons.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Diagnosis and Disclosure of HIV Status: Implications for Women's Risk of Physical Partner Violence in the Postpartum Period
Authors: Maman Suzanne , Groves Allison K. , McNaughton Reyes H. Luz , Moodley Dhayendre
Published: April 2016

Introduction:

This study prospectively examined whether HIV leads to elevated risk for intimate partner violence (IPV) for women and how this risk varies depending on HIV status disclosure to a partner.

Methods:

We ran a series of logistic regression models using data from 1092 pregnant and postpartum women enrolled in an RCT in Durban, South Africa. Model 1 assessed whether baseline HIV status predicted 14-week postpartum physical IPV, controlling for baseline physical IPV, disclosure to partner, and demographic and study covariates. Model 2 added the interaction between HIV status and disclosure.

Results:

HIV was not associated with 14-week physical IPV in the main effects model [adjusted odds ratio: 1.34, 95% confidence interval (CI): 0.88 to 2.05]. However, there was a statistically significant positive interaction between HIV and disclosure (adjusted odds ratio: 0.22, 95% CI: 0.05 to 0.96). Among women who disclosed their HIV status, HIV was not significantly associated with 14-week IPV (adjusted odds ratio: 1.12, 95% CI: 0.71 to 1.89). However, among women who had not disclosed, the odds of reporting IPV at 14 weeks was 5.15 times higher for HIV-positive women as compared with HIV-negative women (95% CI: 1.25 to 21.00).

Discussion:

Although we established that HIV does not increase incidence of IPV for all HIV-positive women, we found an elevated risk of IPV among the HIV-positive women who chose not to disclose their status to their partner. Nondisclosure is likely a marker for other problematic aspects of the relationship, and counselors should either find alternative safe options for disclosure or support women's decisions not to disclose.
Impact of Peer Support on Behavior Change Among Newly Diagnosed Australian Gay Men
Authors: Prestage Garrett , Brown Graham , Allan Brent , Ellard Jeanne , Down Ian
Published: April 2016

Introduction:

Treatment as prevention relies on early uptake of HIV treatment, but onward transmission during primary HIV infection may be affected by changes in sexual risk behavior after diagnosis. What factors are associated with these changes in sexual risk behavior among gay and bisexual men?

Methods:

We surveyed gay and bisexual men recently diagnosed with HIV about changes to their sexual behavior since their diagnosis. In 2008–2010, 263 men described their sexual behavior during the 4 weeks before, and during the 4 weeks after, their HIV diagnosis. In 2010–2015, 301 men reported how they had changed their sexual behavior since their HIV diagnosis.

Results:

During 2008–2010, 26.6% engaged in condomless anal intercourse with non–HIV-positive casual partners during the 4 weeks before diagnosis, and 9.7% did so during the 4 weeks after diagnosis (P < 0.001). Only peer support from other people with HIV was associated with this change in behavior (OR = 1.42; 95% confidence interval = 1.07 to 1.88; P = 0.014). Peer support was also associated with partner reduction after diagnosis (P = 0.010). During 2010–2015, 31.9% reported that they had increasingly disclosed their HIV status to sex partners since their diagnosis, and 74.1% reported having reduced the number of men with whom they had sex. Peer support was associated with both these changes in behavior (P = 0.003 and P = 0.015, respectively).

Conclusions:

The risk of onward transmission is likely to be less affected by immediate versus early treatment than it is by earlier diagnosis and peer support for those newly diagnosed with HIV. Enhanced peer support may further reduce the likelihood of onward transmission after diagnosis.
High-Dose Naltrexone Treatment and Gender in Alcohol Dependence
Authors: Yoon Gihyun , Kim Suck Won , Petrakis Ismene Leonida , Westermeyer Joseph
Published: April 2016

Objectives

Little is known about whether safety and effectiveness of high-dose naltrexone (150 mg/d) are different in alcohol-dependent women and men. This study investigated sex differences in safety and treatment outcomes in alcohol-dependent women and men on high-dose naltrexone (150 mg/d).

Methods

In this exploratory study, safety and effectiveness of high-dose naltrexone (150 mg/d) were examined in men and women with alcohol dependence (n = 24; 11 men and 13 women) treated in an 8-week outpatient setting.

Results

Women and men had similar dropout rates, adverse effects, tolerability, and hepatic function during high-dose naltrexone treatment (150 mg/d). Drinking outcomes were significantly improved in both women and men, but no sex differences were found.

Conclusions

High-dose naltrexone seems to be well tolerated, safe, and effective in both men and women with alcohol dependence in this small study. Given the small sample size of the current study, our results cannot be considered definitive, and larger trials with longer durations are needed to confirm these findings.
Quantum walks, deformed relativity and Hopf algebra symmetries
Authors: Bisio Alessandro , D'Ariano Giacomo Mauro , Perinotti Paolo
Published: April 2016

We show how the Weyl quantum walk derived from principles in D'Ariano & Perinotti (D'Ariano & Perinotti 2014
Phys. Rev. A
90, 062106. (
doi:10.1103/PhysRevA.90.062106
)), enjoying a nonlinear Lorentz symmetry of dynamics, allows one to introduce Hopf algebras for position and momentum of the emerging particle. We focus on two special models of Hopf algebras–the usual Poincaré and the
κ
-Poincaré algebras.
Contact statistics highlight distinct organizing principles of proteins and RNA
Authors: Liu Lei , Hyeon Changbong
Published: April 2016

Although both RNA and proteins have densely packed native structures, chain organizations of these two biopolymers are fundamentally different. Motivated by the recent discoveries in chromatin folding that interphase chromosomes have territorial organization with signatures pointing to metastability, we analyzed the biomolecular structures deposited in the Protein Data Bank and found that the intrachain contact probabilities,P(s) as a function of the arc lengths, decay in power-law ~s‒γover the intermediate range ofs, 10 ≲s≲ 110. We found that the contact probability scaling exponent isγ≈ 1.11 for large RNA (N> 110),γ≈ 1.41 for small sized RNA (N< 110), andγ≈ 1.65 for proteins. Given that Gaussian statistics is expected for a fully equilibrated chain in polymer melts, the deviation ofγvalue fromγ= 1.5 for the subchains of large RNA in the native state suggests that the chain configuration of RNA is not fully equilibrated. It is visually clear that folded structures of large sized RNA (N≳ 110) adopt crumpled structures, partitioned into modular multi-domains assembled by proximal sequences along the chain, whereas the polypeptide chain of folded proteins looks better mixed with the rest of the structure. Our finding ofγ≈ 1 for large RNA might be an ineluctable consequence of the hierarchical ordering of the secondary to tertiary elements in the folding process.
Development of prokaryotic cell-free systems for synthetic biology
Authors: Chiao Abel C. , Murray Richard M. , Sun Zachary Z
Published: April 2016

Prokaryotic cell-free systems are currently heavily used for the production of protein that can be otherwise challenging to produce in cells. However, historically cell-free systems were used to explore natural phenomena before the advent of genetic modification and transformation technology. Recently, synthetic biology has seen a resurgence of this historical use of cell-free systems as a prototyping tool of synthetic and natural genetic circuits. For these cell-free systems to be effective prototyping tools, an understanding of cell-free system mechanics must be established that is not purely protein-expression driven. Here we discuss the development ofE. coli-based cell-free systems, with an emphasis on documenting published extract and energy preparation methods into a uniform format. We also discuss additional considerations when applying cell-free systems to synthetic biology.
Levels and patterns of genetic diversity differ between two closely related endemicArabidopsisspecies
Authors: Jacquemin Julie , Hohmann Nora , Buti Matteo , Selvaggi Alberto , Müller Thomas , Koch Marcus A. , Schmid Karl J.
Published: April 2016

Theory predicts that a small effective population size leads to slower accumulation of mutations, increased levels of genetic drift and reduction in the efficiency of natural selection. Therefore endemic species should harbor low levels of genetic diversity and exhibit a reduced ability of adaptation to environmental changes.Arabidopsis pedemontanaandArabidopsis cebennensis, two endemic species from Italy and France respectively, provide an excellent model to study the adaptive potential of species with small distribution ranges. To evaluate the genome-wide levels and patterns of genetic variation, effective population size and demographic history of both species, we genotyped 53A. pedemontanaand 28A. cebennensisindividuals across the entire species ranges with Genotyping-by-Sequencing. SNPs data confirmed a low genetic diversity forA. pedemontanaalthough its effective population size is relatively high. Only a weak population structure was observed over the small distribution range ofA. pedemontana, resulting from an isolation-by-distance pattern of gene flow. In contrary,A. cebennensisindividuals clustered in three populations according to their geographic distribution. Despite this and a larger distribution, the overall genetic diversity was even lower forA. cebennensisthan forA. pedemontana.A demographic analysis demonstrated that both endemics have undergone a strong population size decline in the past, without recovery. The more drastic decline observed inA. cebennensispartially explains the very small effective population size observed in the present population. In light of these results, we discuss the adaptive potential of these endemic species in the context of rapid climate change.
Adaptation-induced blindness is orientation-tuned and monocular
Authors: Apthorp Deborah , Griffiths Scott , Alais David , Cass John
Published: April 2016

We examined the recently discovered phenomenon of Adaptation-Induced Blindness (AIB), in which highly visible gratings with gradual onset profiles become invisible after exposure to a rapidly flickering grating, even at very high contrasts. Using very similar stimuli to those in the original AIB experiment, we replicated the original effect across multiple contrast levels, with observers at chance in detecting the gradual onset stimuli at all contrasts. Then, using full-contrast target stimuli with either abrupt or gradual onsets, we tested both the orientation tuning and interocular transfer of AIB. If, as the original authors suggested, AIB were a high-level (perhaps parietally mediated) effect resulting from the ‘gating’ of awareness, we would not expect the effects of AIB to be tuned to the adapting orientation, and the effect should transfer interocularly. Instead, we find that AIB (which was present only for the gradual onset target stimuli) is both tightly orientation-tuned and shows absolutely no interocular transfer, suggesting a very early cortical locus.
On the importance of skewed offspring distributions and background selection in viral population genetics
Authors: Irwin Kristen K. , Laurent Stefan , Matuszewski Sebastian , Vuilleumier Séverine , Ormond Louise , Shim Hyunjin , Bank Claudia , Jensen Jeffrey D.
Published: April 2016

Many features of virus populations make them excellent candidates for population genetic study, including a very high rate of mutation, high levels of nucleotide diversity, exceptionally large census population sizes, and frequent positive selection. However, these attributes also mean that special care must be taken in population genetic inference. For example, highly skewed offspring distributions, frequent and severe population bottleneck events associated with infection and compartmentalization, and strong purifying selection all affect the distribution of genetic variation but are often not taken in to account. Here, we draw particular attention to multiple-merger coalescent events and background selection, discuss potential mis-inference associated with these processes, and highlight potential avenues for better incorporating them in to future population genetic analyses.
Involvement of phosphorylated Apis mellifera CREB in gating a honeybee's behavioral response to an external stimulus
Authors: Gehring Katrin B. , Heufelder Karin , Feige Janina , Bauer Paul , Dyck Yan , Ehrhardt Lea , Kühnemund Johannes , Bergmann Anja , Göbel Josefine , Isecke Marlene , Eisenhardt Dorothea
Published: April 2016

The transcription factor cAMP-response element-binding protein (CREB) is involved in neuronal plasticity. Phosphorylation activates CREB and an increased level of phosphorylated CREB is regarded as an indicator of CREB-dependent transcriptional activation. In honeybees (Apis mellifera) we recently demonstrated a particular high abundance of the phosphorylated honeybee CREB homolog (pAmCREB) in the central brain and in a subpopulation of mushroom body neurons. We hypothesize that these high pAmCREB levels are related to learning and memory formation. Here, we tested this hypothesis by analyzing brain pAmCREB levels in classically conditioned bees and bees experiencing unpaired presentations of conditioned stimulus (CS) and unconditioned stimulus (US). We demonstrate that both behavioral protocols display differences in memory formation but do not alter the level of pAmCREB in bee brains directly after training. Nevertheless, we report that bees responding to the CS during unpaired stimulus presentations exhibit higher levels of pAmCREB than nonresponding bees. In addition, Trichostatin A, a histone deacetylase inhibitor that is thought to enhance histone acetylation by CREB-binding protein, increases the bees’ CS responsiveness. We conclude that pAmCREB is involved in gating a bee's behavioral response driven by an external stimulus.