bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence for Phosphate Starvation of Rhizobia without Terminal Differentiation in Legume Nodules
Authors: Hu Yue , Jiao Jian , Liu Li Xue , Sun Yan Wei , Chen Wen Feng , Sui Xin Hua , Chen Wen Xin , Tian Chang Fu
Published: April 2018

Phosphate homeostasis is tightly modulated in all organisms, including bacteria, which harbor both high- and low-affinity transporters acting under conditions of fluctuating phosphate levels. It was thought that nitrogen-fixing rhizobia, named bacteroids, inhabiting root nodules of legumes are not phosphate limited. Here, we show that the high-affinity phosphate transporter PstSCAB, rather than the low-affinity phosphate transporter Pit, is essential for effective nitrogen fixation of Sinorhizobium fredii in soybean nodules. Symbiotic and growth defects of the pst mutant can be effectively restored by knocking out PhoB, the transcriptional repressor of pit. The pst homologs of representative rhizobia were actively transcribed in bacteroids without terminal differentiation in nodules of diverse legumes (soybean, pigeonpea, cowpea, common bean, and Sophora flavescens) but exhibited a basal expression level in terminally differentiated bacteroids (alfalfa, pea, and peanut). Rhizobium leguminosarum bv. viciae Rlv3841 undergoes characteristic nonterminal and terminal differentiations in nodules of S. flavescens and pea, respectively. The pst mutant of Rlv3841 showed impaired adaptation to the nodule environment of S. flavescens but was indistinguishable from the wild-type strain in pea nodules. Taken together, root nodule rhizobia can be either phosphate limited or nonlimited regarding the rhizobial differentiation fate, which is a host-dependent feature.
Imaging Mass Spectrometry of Endogenous Polypeptides and Secondary Metabolites from Galls Induced by Root-Knot Nematodes in Tomato Roots
Authors: Barbosa Eder Alves , Bonfim Mauro Ferreira , Bloch Carlos , Engler Gilbert , Rocha Thales , de Almeida Engler Janice
Published: April 2018

Nematodes are devastating pests that infect most cultivated plant species and cause considerable agricultural losses worldwide. The understanding of metabolic adjustments induced during plant–nematode interaction is crucial to generate resistant plants or to select more efficient molecules to fight against this pest. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) has been used herein for in situ detection and mapping endogenous polypeptides and secondary metabolites from nematode-induced gall tissue. One of the major critical features of this technique is sample preparation; mainly, the generation of intact sections of plant cells with their rigid cell walls and vacuolated cytoplasm. Our experimental settings allowed us to obtain sections without contamination of exogenous ions or diffusion of molecules and to map the differential presence of low and high molecular weight ions in uninfected roots compared with nematode-induced galls. We predict the presence of lipids in both uninfected roots and galls, which was validated by MALDI time-of-flight tandem mass spectrometry and high-resolution mass spectrometry analysis of lipid extracts. Based on the isotopic ion distribution profile, both esters and glycerophospholipids were predicted compounds and may be playing an important role in gall development. Our results indicate that the MALDI-MSI technology is a promising tool to identify secondary metabolites as well as peptides and proteins in complex plant tissues like galls to decipher molecular processes responsible for infection and maintenance of these feeding sites during nematode parasitism.
The Coiled-Coil and Leucine-Rich Repeat Domain of the Potyvirus Resistance Protein Pvr4 Has a Distinct Role in Signaling and Pathogen Recognition
Authors: Kim Saet-Byul , Lee Hye-Young , Choi Eun-Hye , Park Eunsook , Kim Ji-Hyun , Moon Ki-Beom , Kim Hyun-Soon , Choi Doil
Published: April 2018

The pepper Pvr4 protein encoding coiled-coil (CC) nucleotide-binding (NB) leucine-rich repeat (LRR) (NLR) confer hypersensitive response (HR) to potyviruses, including Pepper mottle virus (PepMoV), by recognizing the viral avirulence protein NIb. To figure out the Pvr4-mediated HR mechanism, we analyzed signaling component genes and structure-function relationships of Pvr4, using chimeras and deletion mutants in Nicotiana benthamiana. Molecular chaperone components including HSP90, SGT1, and RAR1 were required, while plant hormones and mitogen-activated protein kinase signaling components had little effect on Pvr4-NIb-mediated HR cell death. Domain swap analyses indicated that the LRR domain of Pvr4 determines recognition of PepMoV-NIb. Our deletion analysis further revealed that the CC domain or CC-NBARC domain alone can trigger autoactive cell death in N. benthamiana. However, the fragments having only an LRR domain could suppress CC-NBARC domain-induced cell death in trans. Further, C-terminal truncation analysis of Pvr4 revealed that a minimum three of five LRR exons showing high similarity was essential for Pvr4 function. The LRR domain may maintain Pvr4 in an inactive state in the absence of NIb. These results provide further insight into the structure and function of NLR protein signaling in plants.
Phytobiomes Contribute to Climate Processes that Regulate Temperature, Wind, Cloud Cover, and Precipitation
Authors: Morris Cindy E.
Published: April 2018

In the management of plant health, climate and weather can be perceived as variables of the abiotic environment to which plants, and their associated biota, are passively subjected. However, research on Earth systems is now revealing how weather and climate can be markedly influenced by land use and by the types and extent of vegetation in particular. Plant-associated biota can alter the properties of vegetation that underlie the mechanisms by which it influences weather and climate. Therefore, it is important to consider the extent to which phytobiomes could impact climate and weather and the potential consequences for plant health and production and for processes that possibly exacerbate or modulate climate change. This commentary will illustrate how the exchange of mass and energy between the atmosphere and land cover modulates temperature, winds, cloud formation and precipitation at local, regional and even greater scales and the role of plants and their associated biota in these effects. Via these exchanges, phytobiomes contribute to the climatic and weather variations to which they are in turn subjected. This argues for an expanded perspective of phytobiomes that considers their role in Earth system processes and that integrates knowledge of land-atmosphere feedbacks into the management practices of crops and other vegetation. This knowledge will contribute to a vision of how management of the biophysical setting of crop cultivation could leverage environmental conditions locally and regionally.

[Formula: see text] Copyright © 2018 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
‘Candidatus Liberibacter solanacearum’ Is Tightly Associated with Carrot Yellows Symptoms in Israel and Transmitted by the Prevalent Psyllid Vector Bactericera trigonica
Authors: Mawassi M. , Dror O. , Bar-Joseph M. , Piasezky A. , Sjölund J. M. , Levitzky N. , Shoshana N. , Meslenin L. , Haviv S. , Porat C. , Katsir L. , Kontsedalov S. , Ghanim M. , Zelinger-Reichert E. , Arnsdorf Y. M. , Gera A. , Bahar O.
Published: April 2018

Carrot yellows disease has been associated for many years with the Gram-positive, insect-vectored bacteria, ‘Candidatus Phytoplasma’ and Spiroplasma citri. However, reports in the last decade also link carrot yellows symptoms with a different, Gram-negative, insect-vectored bacterium, ‘Ca. Liberibacter solanacearum’. Our study shows that to date ‘Ca. L. solanacearum’ is tightly associated with carrot yellows symptoms across Israel. The genetic variant found in Israel is most similar to haplotype D, found around the Mediterranean Basin. We further show that the psyllid vector of ‘Ca. L. solanacearum’, Bactericera trigonica, is highly abundant in Israel and is an efficient vector for this pathogen. A survey conducted comparing conventional and organic carrot fields showed a marked reduction in psyllid numbers and disease incidence in the field practicing chemical control. Fluorescent in situ hybridization and scanning electron microscopy analyses further support the association of ‘Ca. L. solanacearum’ with disease symptoms and show that the pathogen is located in phloem sieve elements. Seed transmission experiments revealed that while approximately 30% of the tested carrot seed lots are positive for ‘Ca. L. solanacearum’, disease transmission was not observed. Possible scenarios that may have led to the change in association of the disease etiological agent with carrot yellows are discussed.

[Formula: see text] Copyright © 2018 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
CE: A Review of Current Practice in Transfusion Therapy
Authors: Carman Margaret , Uhlenbrock Jennifer Schieferle , McClintock Sara Marie
Published: April 2018

In the United States, roughly 4.5 million patients per year receive transfusions of various blood products. Despite the lifesaving benefits of transfusion therapy, it is an independent risk factor for infection, morbidity, and death in critically ill patients. It's important for nurses to understand the potential complications patients face when blood products are administered and to recognize that patients who have received blood products in the past remain at risk for delayed reactions, including immune compromise and infection. Here, the authors review the blood products that are commonly transfused; discuss potential complications of transfusion, as well as their associated signs and symptoms; and outline current recommendations for transfusion therapy that are widely supported in the medical and nursing literature.
Academic Medical Centers as Innovation Ecosystems: Evolution of Industry Partnership Models Beyond the Bayh–Dole Act
Authors: Silva Patrick J. , Ramos Kenneth S.
Published: April 2018

Innovation ecosystems tied to academic medical centers (AMCs) are inextricably linked to policy, practices, and infrastructure resulting from the Bayh–Dole Act in 1980. Bayh–Dole smoothed the way to patenting and licensing new drugs and, to some degree, medical devices and diagnostic reagents. Property rights under Bayh–Dole provided significant incentive for industry investments in clinical trials, clinical validation, and industrial scale-up of products that advanced health care. Bayh–Dole amplified private investment in biotechnology drug development and, from the authors’ perspective, did not significantly interfere with the ability of AMCs to produce excellent peer-reviewed science. In today’s policy environment, it is increasingly difficult to patent and license products based on the laws of nature—as the scope of patentability has been narrowed by case law and development of a suitable clinical and business case for the technology is increasingly a gating consideration for licensees. Consequently, fewer academic patents are commercially valuable. The role of technology transfer organizations in engaging industry partners has thus become increasingly complex. The partnering toolbox and organizational mandate for commercialization must evolve toward novel collaborative models that exploit opportunities for future patent creation (early drug discovery), data exchange (precision medicine using big data), cohort assembly (clinical trials), and decision rule validation (clinical trials). These inputs contribute to intellectual property rights, and their clinical exploitation manifests the commercialization of translational science. New collaboration models between AMCs and industry must be established to leverage the assets within AMCs that industry partners deem valuable.
Does Medical Cannabis Use Increase or Decrease the Use of Opioid Analgesics and Other Prescription Drugs?
Authors: Bachhuber Marcus A. , Arnsten Julia H. , Cunningham Chinazo O. , Sohler Nancy
Published: April 2018

In observational and retrospective studies, people who use cannabis are more likely than people who do not use cannabis to also use other drugs. People who take medical cannabis are also more likely to report medical and non-medical use of opioid analgesics, stimulants, and tranquilizers. Given that people who take medical cannabis and those who do not are likely to have different underlying morbidity, it is possible that medical cannabis use reduces prescription drug use yet prescription drug use remains relatively high. Studies comparing people who take medical cannabis with people who do not take it cannot draw conclusions about the effect of medical cannabis on drug use. To fully understand the effect of medical cannabis on the use of other drugs, prospective longitudinal studies randomizing individuals to cannabis versus other treatments are urgently needed.
Two-Point Method for Measuring the Temporal Modulation Transfer Function
Authors: Morimoto Takashi , Irino Toshio , Harada Kouta , Nakaichi Takeshi , Okamoto Yasuhide , Kanno Ayako , Kanzaki Sho , Ogawa Kaoru
Published: April 2018

Objective:

The temporal modulation transfer function (TMTF) has been proposed to estimate the temporal resolution abilities of listeners with normal hearing and listeners with hearing loss. The TMTF data of patients would be useful for clinical diagnosis and for adjusting the hearing instruments at clinical and fitting sites. However, practical application is precluded by the long measurement time of the conventional method, which requires several measurement points. This article presents a new method to measure the TMTF that requires only two measurement points.

Design:

Experiments were performed to estimate the TMTF of normal listeners and listeners with hearing loss to demonstrate that the two-point method can estimate the TMTF parameter and the conventional method. Sixteen normal hearing and 21 subjects with hearing loss participated, and the difference between the estimated TMTF parameters and measurement time were compared.

Results:

The TMTF parameters (the peak sensitivity L
ps and cutoff frequency f
cutoff) estimated by the conventional and two-point methods showed significantly high correlations: the correlation coefficient for L
ps was 0.91 (t(45) = 14.3; p < 10−10) and that for f
cutoff was 0.89 (t(45) = 13.2; p < 10−10). There were no fixed and proportional biases. Therefore, the estimated values were in good agreement. Moreover, there was no systematic bias depending on the subject’s profile. The measurement time of the two-point method was approximately 10 min, which is approximately one-third that of the conventional method.

Conclusion:

The two-point method enables the introduction of TMTF measurement in clinical diagnosis.
Surgical Treatment of Venous Malformations of the Knee: Treatment Outcomes for 35 Patients
Authors: Laurian Claude , Masonni Claudine , Wassef Michel , Houdart Emmanuel , Toni Francesca , Marteau Veronique , Paraskevas Nikos , Lenck Stephanie , Bisdorff Annouk
Published: April 2018

Background:

The place of open surgery in venous malformations (VMs) of knee joint is still discussed. The aim of this study was to evaluate the benefits of surgery in terms of pain, function, and quality of life.

Design:

This was a retrospective observational study.

Methods:

Thirty-five consecutive young patients undergoing surgery for VMs of the knee between 2011 and 2014 were included. Data collection was performed using a prospective database by reviewing patient records. Pain, mobility of the joint, residual VMs as seen by magnetic resonance imaging, and quality of life were the main outcome endpoints for this study.

Results:

Thirty-five patients (22 females and 13 males, with a median age of 15 y, range of 5 to 20 y) were included. Twenty-seven VMs were localized in and around the knee joint, of which 8 were extensive. Indication for surgery was intermittent or permanent pain.

Details of the surgical excisions of the VM are as follows: suprapatellar area in 57%, suprapatellar and infrapatellar area in 29%, infrapatellar area in 2%, limited in the femoropatellar area in 12%. Partial resection of a vastus muscle or patellar retinaculum was necessary for 19 patients.

The median duration of the surgery was 4 hours (range: 2 to 7 h). The median hospital stay was 5 days; full-time physiotherapy was systematic for 2 to 3 weeks.

After 6 months, 74% had no longer pain, the mobility of the joint was normal for 60%. Of the 33 patients who had a magnetic resonance imaging at 6 months, 86% (28 patients) had no residual intra-articular VMs, and 14% had focal residual VMs.

At the last follow-up, 77% (27 patients) had no longer pain, 23% experienced intermittent pain with unusual activities, and 91% (32 patients) had normal mobility of the joint. Quality of life was increased significantly due to the pronounced impact on pain.

Conclusion:

Extensive surgical excision of knee VMs is a safe procedure with good outcomes in terms of pain, function, and quality of life.

Level of Evidence:

Level II—retrospective observational monocentric study.
Juvenile Osteochondritis Dissecans of the Trochlea: A Cohort Study of 34 Trochlear Lesions Associated With Sporting Activities That Load the Patellofemoral Joint
Authors: Price Meghan J. , Tuca Maria , Nguyen Joseph , Silberman Jason , Luderowski Eva , Uppstrom Tyler J. , Green Daniel W.
Published: April 2018

Background:

Juvenile osteochondritis dissecans (JOCD) lesions are rarely located in the trochlea and few studies have focused on the causes and outcomes of JOCD lesions in this part of the knee. The purpose of this study is to (1) evaluate the clinical characteristics and outcomes of patients who undergo surgery for JOCD in this unusual location as well as (2) assess the association between trochlear JOCD and participation in sporting activities that load the patellofemoral joint.

Methods:

We conducted a retrospective cohort study of 34 trochlear JOCD lesions in 30 patients. Cases that involved traumatic cartilage shear or patella instability were excluded. Preoperative and postoperative magnetic resonance images and x-rays were evaluated and demographic data, sports played, comorbidities, surgical procedures, and clinical data were extracted from medical records. A case-control cohort of 102 femoral condyle lesions was used to assess the correlation between sports played and lesion location.

Results:

The cohort comprised 34 consecutive trochlear JOCD lesions in 30 patients (26 males, 4 females). Average age at surgery was 13.8 years (9.3 to 18.0 y). In total, 27 (90%) patients were active, and of these active patients, soccer and basketball were the most common sports played. In the case-control comparison, the correlation between playing either basketball or soccer and the presence of a trochlear JOCD lesion was statistically significant (P=0.017). In total, 21 knees (62%) received operative treatment. Sixteen of the surgical patients underwent repair and fixation with bioabsorbable nails. The average length of clinical and radiographic follow-up was 21.1 months. All patients who underwent fixation showed radiographic and/or clinical indications of healing at most recent follow-up. Thirteen of the patients who underwent fixation were active, and all of these patients reported successful return to sports. Thirteen knees underwent nonoperative treatment, and the majority of these patients had limited follow-up.

Conclusions:

We report a significant association between pediatric athletes who play basketball and soccer and the development of trochlear JOCD, suggesting that repetitive loading of the patellofemoral joint may play a role in the development of JOCD lesions. Patients with trochlear JOCD lesions were likely to undergo surgery, and repair and fixation of the lesions produced good outcomes at short-term follow-up.

Level of Evidence:

Level III—case-control study.
C2 Translaminar Screw Fixation in Children
Authors: Yang Brian W. , Glotzbecker Michael P. , Troy Michael , Proctor Mark R. , Hresko Michael T. , Hedequist Daniel J.
Published: April 2018

Background:

Axis (C2) screw fixation has been shown to be effective in treating disorders that necessitate cervical stabilization. Although translaminar C2 screws have demonstrated clinical efficacy in adults, this technique has not yet been thoroughly investigated in children. This study describes the indications, technique, and results of translaminar C2 screw fixation in a case series of pediatric cervical spine disorders.

Methods:

We searched the orthopaedic database at our institution for patients who had undergone a cervical spinal fusion that encompassed C2 between 2007 and 2017. Operative records were reviewed to determine if C2 screw fixation was performed and, if so, the type of C2 screw fixation. Clinical data with regard to patient age at surgery, diagnosis, procedure details, intraoperative complications, and postoperative complications were recorded. Preoperative and postoperative computer tomographic scans were reviewed to determine laminar measurements and containment, respectively.

Results:

In total, 39 C2 translaminar screws were placed in 23 patients that met our inclusion criteria. The mean age was 12.6 years (range, 5.2 to 17.8 y) with a mean of 2 levels fused (range, 1 to 6). Diagnoses included 7 patients with instability related to skeletal dysplasia, 6 os odontoideum, 4 congenital deformities, 3 basilar invaginations, 2 cervical spine tumors, and 1 fracture. Indications for C2 translaminar screws included 14 cases with distorted anatomy favoring C2 translaminar screws, 6 cases without explicit reasoning for translaminar screw usage in the patient records, and 3 cases with intraoperative vertebral artery injury (1 sacrificed secondary to tumor load and 2 others injured during exposure because of anomalous anatomy). The vertebral artery injuries were not due to placement of any instrumentation. There were no screw-related intraoperative or postoperative complications and no neurological injuries. All patients demonstrated clinical union or healing on follow-up with no episodes of nonunion.

Conclusions:

Translaminar C2 screw fixation can be reliably used in the pediatric population. Our series contained no screw-related complications, no neurological injuries, and all patients demonstrated clinical union or healing.

Level of Evidence:

Level IV—Case series.
Health-related Quality of Life and Body Image Disturbance of Adolescents With Severe Untreated Idiopathic Early-onset Scoliosis in a Developing Country
Authors: Soliman Hany Abdel Gawwad
Published: April 2018

Study Design.

A cross-sectional study.

Objective.

This study aimed to investigate the health-related quality of life (HRQOL) and body image disturbance of adolescents with untreated severe idiopathic early-onset scoliosis (IEOS) in a developing country.

Summary of Background Data.

IEOS has the potential to progress rapidly and may lead to significant disability if left untreated. Moreover, it can lead to significant body image changes that may lead to social and psychological stresses on developing adolescents. In developing countries, untreated severe IEOS among adolescents is common.

Methods.

The Scoliosis Research Society 22 revision (SRS-22r) Arabic version questionnaire and Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) were used to investigate the HRQOL and body image disturbance of these patients.

Results.

A total of 137 patients with untreated severe IEOS (mean age, 15.5 years; range, 12–21 years) were included: group 1 (76 patients) with major curve angles of 90° to 120°, group 2 (61 patients) with major curve angles above 120°, and group 3 comprising 50 healthy controls were used for comparison. No significant differences were found regarding age, sex, and body mass index among the groups. Group 1 had significantly lower scores than group 3 in all SRS-22r domains (P < 0.001). Group 2 had significantly lower scores than group 1 in all SRS-22r domains, except for satisfaction (P < 0.005); the satisfaction domain had 100% worst answers in groups 1 and 2. Group 2 had worse scores than group 1 in all BIDQ-S questions (P < 0.001). No significant differences were found between males and females in all SRS-22r domains and BIDQ-S questions (P > 0.05). Further, 13% to 100% and 25% to 71% of the patients provided the worst answers to the SRS-22r and BIDQ-S questions, respectively.

Conclusion.

The HRQOL and body image of the adolescents with untreated severe IEOS in a developing country were severely impaired.

Level of Evidence: 3
Second primary cancers and survival in patients with gastric cancer: association with prediagnosis lifestyles
Authors: Morais Samantha , Castro Clara , Antunes Luís , Peleteiro Bárbara , Bento Maria J. , Lunet Nuno
Published: April 2018

To quantify the association between prediagnosis lifestyles with the risk of second primary cancers (SPCs) and survival of patients with gastric first primary cancer (FPC). We recruited 574 gastric patients from two major public hospitals in North Portugal (2001–2006). Smoking, alcohol and dietary habits in the year before FPC diagnosis were evaluated. Patients were followed up to 31 December 2011 for an SPC and to 31 May 2017 for vital status. Cox proportional hazards regression was used to estimate adjusted hazard ratios for incidence of an SPC or death. During follow-up, SPCs were diagnosed in five women and 23 men, and 409 patients died, corresponding to an estimated 10-year cumulative incidence of 5.2% for SPC and an estimated 15-year cumulative mortality of 72.1%. A significantly higher hazard ratio (95% confidence interval) for SPCs was observed in patients reporting a higher consumption of red and processed meat versus the lowest third (4.49: 1.31–15.37), and for mortality in those with heavy alcohol intake versus never drinkers (1.73: 1.00–2.99) and excess weight versus normal weight (1.31: 1.04–1.65); no other significant associations were observed according to prediagnosis lifestyle. Prediagnosis lifestyles may affect the occurrence of an SPC and survival among gastric FPC survivors in the long term.
Determinants of Parent Satisfaction with Emergency or Urgent Care When the Patient Has Autism
Authors: Kirsch Sarah F. , Meryash David L. , González-Arévalo Bárbara
Published: April 2018

Objective:

The purpose of this study was to identify factors that predict parent satisfaction (PS) with their child with autism spectrum disorder (ASD)’s visit to a hospital emergency department (ED) or urgent care (UC) center.

Methods:

Parents recruited through a national database whose child (3–21 years; N = 378) with ASD had been treated in an ED/UC center within the previous 3 years completed an anonymous on-line questionnaire. They answered questions about whether they were satisfied overall with the visit and the care provided, their demographics, patient characteristics, their expectations and preparation for the visit, and the ED/UC center experience itself, including their observations of staff interpersonal and communication skills (ICSs) and behaviors, and whether the patient was disruptive (D). Multiple correspondence analysis (MCA) was used to demonstrate the relative effects of individual variables on PS.

Results:

Among the 10 most important determinants of PS with the visit were the 9 assessed staff ICS behaviors. These were followed by shorter than expected waiting time and the patient not being disruptive (ND) during the visit. PS was not associated with any of the 3 measures of patient disability severity (ASD subtype, communicative competence, or restrictiveness of educational placement), whether the patient is hyperreactive to sensory stimuli, reason for the visit, or parent's education.

Conclusion:

PS with an ED/UC center visit when the patient has autism depends mostly on the quality of staff interactions with the patient and family. It is important for ED/UC center administrators to ensure that staff understand how to interact and communicate effectively with patients with ASD and their families.
The Rectal Cancer Female Sexuality Score: Development and Validation of a Scoring System for Female Sexual Function After Rectal Cancer Surgery
Authors: Thyø Anne , Emmertsen Katrine J. , Laurberg Søren
Published: April 2018

BACKGROUND:

Sexual dysfunction and impaired quality of life is a potential side effect to rectal cancer treatment.

OBJECTIVE:

The objective of this study was to develop and validate a simple scoring system intended to evaluate sexual function in women treated for rectal cancer.

DESIGN:

This is a population-based cross-sectional study.

SETTINGS:

Female patients diagnosed with rectal cancer between 2001 and 2014 were identified by using the Danish Colorectal Cancer Group’s database. Participants filled in the validated Sexual Function Vaginal Changes questionnaire. Women declared to be sexually active at follow-up were randomly assigned to 2 groups: one for development and one for validation. Logistic regression analyses identified items for the score, and multivariate analysis established a weighted-score value allocated to each item, adding up to the total score. The validity of the score was tested in the validation group.

PATIENTS:

Female patients with rectal cancer above the age of 18 who underwent abdominoperineal resection, Hartmann procedure, or total/partial mesorectal excision were selected.

MAIN OUTCOME MEASURES:

The primary outcome measured was the quality of life that was negatively affected because of sexual problems.

RESULTS:

A total of 466 sexually active women responded. The score includes 7 items with a range of 0 to 29 points. Score ≥9 indicates sexual dysfunction. The score has a sensitivity/specificity of 76%/75% detecting patients bothered by sexual dysfunction with a negative impact on quality of life.

LIMITATIONS:

This study was limited by the large amount of nonresponders.

CONCLUSIONS:

Living up to our demands for a short and easy-to-use validated tool, we have developed the Rectal Cancer Female Sexuality score. It captures, with high sensitivity, the essential problems of female sexuality seen from the perspective of a surviving rectal cancer patient. See Video Abstract at http://links.lww.com/DCR/A576.
Effects of 1,540-nm Fractional Nonablative Erbium and 2,940-nm Fractional Ablative Erbium on p53 Epidermal Expression After 3 months: A Split-Face Interventional Study
Authors: Borges Juliano , Araújo Luciana , de Oliveira Rodrigo P.B. , Manela-Azulay Monica
Published: April 2018

BACKGROUND

Expression of p53 by keratinocytes may be important in the pathogenesis of skin cancer induced by ultraviolet light.

OBJECTIVE

We used side-by-side nonablative and ablative erbium fractional laser resurfacing to assess the effects on expression of p53 by facial keratinocytes.

METHODS

Ten female patients (age range, 50–63 years) with Fitzpatrick skin Types I–IV and clinical signs of photoaging underwent erbium fractional laser resurfacing (nonablative, 1,540-nm; ablative, 2,940-nm) on opposite sides of the face. Skin biopsies were obtained before treatment and 3 months after treatment for comparison with control biopsies of face and inner arm, quantifying p53 in immunostained tissue sections.

RESULTS

Only ablative (2,940-nm) treatments produced a statistically significant reduction in p53 scoring after 3 months. The histologic appearance of skin after ablative resurfacing more closely resembled inner arm skin (rather than facial skin) of control subjects.

CONCLUSION

Epidermal repopulation with p53-negative keratinocytes through ablative erbium fractional laser resurfacing may diminish the risk of eventual malignancy in photoaged skin.
Neoumbilicoplasty with a Superiorly Based Abdominal Skin Flap
Authors: Tessler Oren , Bourn Lynn , Khoobehi Kamran , Walters Jules , Jansen David
Published: April 2018

We propose a neoumbilicoplasty technique that can be applied when the umbilical stalk becomes disrupted during an abdominoplasty. This case used surgical concepts that involved progressive thinning of the flap in a 3-cm radius around the neoumbilicus, with increased thinning toward the neoumbilical position. This was followed with suture tacking of the thinned abdominal flap to create a concavity around the neoumbilicus. A longer “U” shaped incision was created and also sutured down to abdominal wall to recreate an umbilical “floor” with the adjacent skin sutured to the superior-based flap to construct the walls of the neoumbilicus. An aesthetically pleasing umbilicus resulted with high patient satisfaction and a lack of postoperative complications. There were no additional scars extending beyond the umbilical region.
Fetal-onset Congenital Dyserythropoietic Anemia Type 1 due to a Novel Mutation With Severe Iron Overload and Severe Cholestatic Liver Disease
Authors: Chin Hui-Lin , Lee Le Ye , Koh Pei Lin
Published: April 2018

We report a rare case of severe congenital dyserythropoietic anemia type 1 with fetal onset. Our patient presented with fetal hydrops from 19 weeks of gestation, requiring multiple intrauterine transfusions. At birth, she had severe hemolytic anemia with severe jaundice, and was subsequently transfusion dependent. She eventually developed severe iron overload and fulminant liver failure before her demise at 5 months of age. Genetic testing revealed a novel mutation in CDAN1.
Addition of Vincristine and Irinotecan to Standard Therapy in a Patient With Refractory High-risk Hepatoblastoma Achieving Long-term Relapse-free Survival
Authors: Powers Jacquelyn M. , Pacheco Martha M. , Wickiser Jonathan E.
Published: April 2018

Children with metastatic hepatoblastoma have a poor prognosis, even with dose intensification of cisplatin and doxorubicin. Vincristine and irinotecan have demonstrated activity in high risk disease. This report describes a 3-year-old girl with metastatic hepatoblastoma with unresectable disease after 5 cycles of cisplatin, 5-fluorouracil, vincristine, and doxorubicin who had a complete response of her metastatic disease to vincristine and irinotecan (intravenous and oral forms), allowing surgical resection of her liver disease. She remains in remission 48 months since therapy completion.
Multiple Epstein-Barr Virus–associated Smooth Muscle Sarcomas of the Gut in a Child Treated for Acute Lymphoblastic Leukemia
Authors: Boulanger Cécile , de Ville de Goyet Maëlle , de Magnée Catherine , Dupont Sophie , Galant Christine , Van Damme An , Brichard Bénédicte
Published: April 2018

A 7-year-old boy with a history of low-risk acute lymphoblastic leukemia developed multiple intussusceptions shortly after the end of maintenance therapy. Explorative laparotomy showed >10 polyps in the small intestine. Histologic examination revealed intestinal smooth muscle sarcomas associated with Epstein-Barr virus. The patient recovered well after partial cuneiform resection of the largest polyps and treatment with sirolimus. This case report indicates that these tumors may arise even after moderate transient immunosuppression and that association with acute lymphoblastic leukemia is possible although rarely described. We discuss the potential benefit of the mTor/Akt signal inhibitors as treatment for these tumors.
Proceedings of the 2017 International Forum on Gonococcal Infections and Resistance in Shenzhen, China
Authors: Chen Xiang-Sheng
Published: April 2018

The 2017 International Forum on Gonococcal Infections and Resistance (2017 IFGIR) was held at Shenzhen, China from September 17, 2017, to September 19, 2017. The key objectives of the conference were to review and analyze the epidemiological profiles of gonococcal infections and antimicrobial resistance (AMR) at global, regional, and national levels; to share and discuss findings from ongoing and completed research studies; and to identify research needs to respond to the spread of gonococcal infections and AMR. The following contents were presented at the conference: global estimates of infections with Neisseria gonorrhoeae; global, regional and country status of gonococcal AMR; molecular techniques for predicting gonococcal AMR and the use of these technologies to enhance gonococcal AMR surveillance and clinical management; and updates on therapeutic approaches to gonococcal AMR.
Primary Vaginal Gastric-type Adenocarcinoma and Vaginal Adenosis Exhibiting Gastric Differentiation
Authors: Wong Richard Wing-Cheuk , Moore Michelle , Talia Karen L. , Ganesan Raji , McCluggage W. Glenn
Published: April 2018

So-called gastric-type adenocarcinoma and related premalignant lesions have been characterized in the cervix, but similar lesions are not widely recognized in the vagina. We report a series of 11 vaginal glandular lesions exhibiting gastric differentiation, comprising 5 cases of adenocarcinoma and 6 of adenosis. All cases occurred in adults (aged 33 to 69) with no known history of diethylstilboestrol exposure. The vaginal adenocarcinomas exhibited morphologic features identical to gastric-type adenocarcinoma of the cervix, but 1 case additionally demonstrated basaloid and sarcomatoid components, which have not been previously reported in cervical gastric-type adenocarcinoma. Immunohistochemically, the adenocarcinomas were positive for MUC6 (4/5), PAX8 (3/5), CK7 (5/5), CK20 (1/5), CDX2 (5/5), CA19.9 (5/5), CEA (4/5), CA125 (5/5), and hepatocyte nuclear factor 1β (5/5). p16, estrogen receptor, and Napsin A were negative in all cases tested, whereas p53 exhibited mutation-type staining in 3/5 cases. In all 5 adenocarcinomas, a component of adenosis with benign or atypical nuclear features was identified; the adenosis displayed gastric morphology in 4 cases and tuboendometrial morphology in 1. The 6 cases of pure vaginal adenosis (without associated adenocarcinoma) all contained gastric-type mucinous glands together with tuboendometrial glands in 2 cases. There was focal intestinal differentiation with goblet cells in all 6 cases and neuroendocrine cells with eosinophilic granules in 3. Cytologic atypia was observed in 4/6 cases of pure vaginal adenosis. Immunohistochemically, the gastric-type adenosis (10 cases) was positive for MUC6 (10/10), estrogen receptor (5/10), PAX8 (8/10), CK7 (9/9), CK20 (2/9), CDX2 (5/9), CA19.9 (8/9), CEA (6/9), CA125 (6/9), hepatocyte nuclear factor 1β (10/10), and Napsin A (1/10). p53 exhibited wild-type immunoreactivity in all 10 cases, whereas p16 was negative in all cases tested. Scattered individual chromogranin-positive cells were present in all 5 cases of pure adenosis tested. Follow-up was available in 4 of the adenocarcinoma cases, with 3 patients dead of disease within 1 to 3 years and 1 patient alive with disease at 1 year. The morphologic and immunohistochemical findings in our study suggest a close relationship between vaginal gastric-type adenocarcinoma and adenosis exhibiting gastric differentiation. This probably represents a distinct pathway of vaginal gastric-type carcinogenesis analogous to that occurring in the cervix. We propose that gastric-type adenocarcinoma be recognized as a distinct histologic subtype of vaginal adenocarcinoma while vaginal adenosis of gastric-type represents a novel subtype of adenosis that requires further study to clarify its biological potential.
Do-Not-Resuscitate Orders in the Neonatal ICU: Experiences and Beliefs Among Staff*
Authors: Arzuaga Bonnie H. , Wraight C. Lydia , Cummings Christy L. , Mao Wenyang , Miedema David , Brodsky Dara D.
Published: April 2018

Objectives:

Studies in adult patients have shown that do-not-resuscitate orders are often associated with decreased medical intervention. In neonatology, this phenomenon has not been investigated, and how do-not-resuscitate orders potentially affect clinical care is unknown.

Design:

Retrospective medical record data review and staff survey responses about neonatal ICU do-not-resuscitate orders.

Setting:

Four academic neonatal ICUs.

Subjects:

Clinical staff members working in each neonatal ICU.

Interventions:

Survey response collection and analysis.

Measurements and Main Results:

Participating neonatal ICUs had 14–48 beds and 120–870 admissions/yr. Frequency range of do-not-resuscitate orders was 3–11 per year. Two-hundred fifty-seven surveys were completed (46% response). Fifty-nine percent of respondents were nurses; 20% were physicians. Over the 5-year period, 44% and 17% had discussed a do-not-resuscitate order one to five times and greater than or equal to 6 times, respectively. Fifty-seven percent and 22% had cared for one to five and greater than or equal to 6 patients with do-not-resuscitate orders, respectively. Neonatologists, trainees, and nurse practitioners were more likely to report receiving training in discussing do-not-resuscitate orders or caring for such patients compared with registered nurses and respiratory therapists (p < 0.001). Forty-one percent of respondents reported caring for an infant in whom interventions had been withheld after a do-not-resuscitate order had been placed without discussing the specific withholding with the family. Twenty-seven percent had taken care of an infant in whom interventions had been withdrawn under the same circumstances. Participants with previous experiences withholding or withdrawing interventions were more likely to agree that these actions are appropriate (p < 0.001).

Conclusions:

Most neonatal ICU staff report experience with do-not-resuscitate orders; however, many, particularly nurses and respiratory therapists, report no training in this area. Variable beliefs with respect to withholding and withdrawing care for patients with do-not-resuscitate orders exist among staff. Because neonatal ICU patients with do-not-resuscitate orders may ultimately survive, withholding or withdrawing interventions may have long-lasting effects, which may or may not coincide with familial intentions.
Alkaline Phosphatase Activity and Endotoxemia After Infant Cardiothoracic Surgery
Authors: Davidson Jesse A. , Urban Tracy T. , Tong Suhong , Maddux Aline , Hill Gerald , Frank Benjamin S. , Watson John D. , Jaggers James , Simões Eric A. F. , Wischmeyer Paul
Published: April 2018

Objective:

Infant cardiopulmonary bypass (CPB) increases intestinal permeability leading to endotoxemia. Alkaline phosphatase (AP) reduces endotoxin toxicity in vitro but its effects on endotoxemia in human disease are poorly understood. We assessed the association between serum AP activity and endotoxemia in infants undergoing CPB and determined the effect of ex vivo addition of AP on endotoxemia.

Methods:

Prospective cohort study of 62 infants ≤120 days of age undergoing CPB. AP activity and Endotoxin Activity Assay (EAA) were measured pre-operatively, during rewarming, and 24 h after cardiac intensive care unit admission. In 22 subjects, EAA was measured in pre-operative and rewarming whole blood samples with/without addition of 1,600 U/L of human liver AP.

Results:

AP activity decreased during CPB (mean decrease 94.8U/L; P < 0.0001). Median EAA was 0.41 pre-operation, rose to 0.52 (P < 0.05) during rewarming, and remained stably elevated at 24 h. Subjects with low pre-operative AP activity had significantly higher pre-operative (0.47 vs. 0.36; P < 0.05) and rewarming (0.59 vs. 0.43; P < 0.01) EAA with a trend toward higher EAA at 24 h (0.52 vs. 0.45; P = 0.12). Subjects with low rewarming AP activity showed similar differences that did not reach statistical significance. Ex vivo addition of human liver AP decreased pre-operative EAA by 29% (P < 0.001) and rewarming EAA by 51% (P < 0.0001).

Conclusion:

Endotoxemia is common in infants undergoing CPB. Native AP activity and endotoxemia are inversely related and ex vivo addition of exogenous AP reduces whole blood EAA. Future research should evaluate AP as a therapy to reduce the harmful effects of endotoxemia following infant CPB.
Tailored Fundoplication With Endoluminal Functional Lumen Imaging Probe Allows for Successful Minimally Invasive Hiatal Hernia Repair
Authors: Kim Min P. , Meisenbach Leonora M. , Chan Edward Y.
Published: April 2018

Endoluminal functional lumen imaging probe (EndoFLIP) can provide real time information about characteristics of the gastroesophageal junction. We performed retrospective analysis of prospectively collected data on use of EndoFLIP during minimally invasive hiatal hernia repair to tailor the size of the crural closure and size of the fundoplication. We then determined whether it provides good reflux control without significant dysphagia. Forty patients underwent minimally invasive hiatal hernia repair with fundoplication. After fundoplication, the average minimal diameter (D
min) decreased to 5.97±0.6 from 8.92±1.93 mm, and distensibility index decreased to 1.26±0.38 from 2.88±1.55 mm2/mm Hg (P<0.0001). After 1 month, none of the patients had reflux or significant dysphagia. EndoFLIP can be used to tailor fundoplication with good functional outcome. Further studies are needed to understand the long-term consequences of tailored fundoplication.
Combination of Electronic Choledochoscopy and Holmium Laser Lithotripsy for Complicated Biliary Calculus Treatment: A New Exploration
Authors: Ni Zhong-Kai , Jin Hai-Min , Li Xiao-Wen , Li Ye , Huang Hai
Published: April 2018

The safety and efficacy of the combination of electronic choledochoscopy and holmium laser lithotripsy for complicated bile duct stones were assessed. In total, 20 patients participated in this study, which was conducted between 2012 and 2017. None of the patients were candidates for endoscopic retrograde cholangiopancreatography with stone extraction. Outcome measures included complete stone clearance and complications postprocedure. Mean stone size was 17±5.2 mm (8 to 30 mm) and mean number of stones was 1.7±1.3 (1 to 5). The mean number of laser sessions was 1.3±0.7 (1 to 4). A mean of 1.0 to 1.5 J/20 to 25 Hz was applied during laser lithotripsy sessions with a mean operative time of 67.8±24.8 minutes. The clearance rate of stone was 18/20 (90%). No mortality existed in this study; however, 1 patient developed acute pancreatitis. The combination of holmium laser lithotripsy and electronic choledochoscopy for complicated biliary calculi is safe, reliable, and minimally invasive and has low residual stone rate.