bluuebunny/crossref_metadata_2025 huggingface dataset:
Two populations of circulating PD-1hiCD4 T cells with distinct B cell helping capacity are elevated in early rheumatoid arthritis
Authors: Fortea-Gordo Paula , Nuño Laura , Villalba Alejandro , Peiteado Diana , Monjo Irene , Sánchez-Mateos Paloma , Puig-Kröger Amaya , Balsa Alejandro , Miranda-Carús María-Eugenia
Published: April 2019

Objective

A novel population of B helper cells, phenotypically CD4+CXCR5−PD-1hi, has been described in the synovial tissues and peripheral blood of seropositive RA patients, and termed ‘peripheral helper T’ (Tph) cells. Contrary to CD4+CXCR5+PD-1hi follicular helper T (Tfh), Tph cells are not located in lymphoid organs but accumulate in inflamed tissues. Our objective was to study the frequency of circulating Tph (cTph) and circulating Tfh cell counterparts (cTfh) in patients with early RA (eRA).

Methods

Freshly isolated peripheral blood mononuclear cells from 56 DMARD-naïve eRA patients and 56 healthy controls were examined by flow cytometry. Autologous cocultures of naïve or memory B cells were established with isolated peripheral blood Tph or Tfh cells.

Results

Seropositive (RF+ and/or ACPA+, n = 38) but not seronegative eRA patients (n = 18) demonstrated increased frequencies and absolute numbers of cTph and cTfh cells. cTph but not cTfh cells expressed CCR2. Those eRA patients who experienced a significant clinical improvement at 12 months demonstrated a marked decrease of their cTph cell numbers whereas their cTfh cell numbers remained unchanged. Both isolated Tph and isolated Tfh cells were able to induce maturation of memory B cells, whereas only Tfh cells could differentiate naïve B cells.

Conclusion

Two populations of PD-1hiCD4 T cells with distinct phenotype and B cell helping capacity are increased in the peripheral blood of seropositive eRA patients. Whereas cTph cells are present only in patients with an active disease, cTfh cells seem to be constitutively elevated.
REDUCTION OF STAFF RADIATION DOSE IN PROSTATIC ARTERY EMBOLISATION
Authors: Andrade G , Garzón W J , Khoury H J , Savignon J , de Barros V S M , Fernandes J L , Abud D G
Published: April 2019

Prostatic artery embolisation (PAE) is used to treat patients with benign prostatic hyperplasia and with lower urinary obstructive tract symptoms. It is an interventional procedure which uses fluoroscopy equipment and can result in exposure to high doses of radiation in patients and staff. We aimed to demonstrate the reduction of radiation doses received by staff during PAE by implementing an optimised protocol called Radiation Exposure Curtailment for Embolisation (RECiFE). This protocol was implemented in cooperation with the medical team and technical team using Siemens Combined Applications to Reduce Exposure (CARE) protocol. The results showed approximately 83% reduction in the radiation doses received by the main physician during PAE. Thus, by adjusting the acquisition parameters of the angiographic equipment and implementing the RECiFE protocol, it is possible to optimise the PAE procedure and reduce the staff radiation dose.
Societal Costs of Schizophrenia in Denmark: A Nationwide Matched Controlled Study of Patients and Spouses Before and After Initial Diagnosis
Authors: Hastrup Lene Halling , Simonsen Erik , Ibsen Rikke , Kjellberg Jacob , Jennum Poul
Published: April 2019

Background

Information on welfare cost of patients with schizophrenia and spouses is limited.

Aim

The main aim of this study to investigate factual societal mean annual costs per individual during 5 years before and after the initial diagnosis of schizophrenia.

Method

A register-based cohort study of 12 227 patients with incident schizophrenia (International Classification of Diseases, Tenth Revision F20-F20.99) with spouses and 48 907 matched controls in Denmark during 2002–2016.

Results

The total annual costs of health care and lost productivity were Euro 43 561 higher for patients with schizophrenia and health care costs and costs of lost productivity were increased during 5 years before the initial diagnosis. The total annual direct health care and indirect costs of lost productivity were Euro 21 888 higher for spouses to patients with schizophrenia than spouses of individuals with no diagnosis of schizophrenia. Also before initial diagnosis, health care costs and lost productivity were increased among spouses of patients with schizophrenia.

Conclusion

Patients with schizophrenia differed from the general population with respect to all included costs. The study documented a significant burden on spouses. The excess health care costs of schizophrenia are further increased by psychiatric and somatic comorbidity, and the societal costs are 4–10 times higher than chronic neurological disorders such as epilepsy and multiple sclerosis. Early onset of schizophrenia implies that patients are affected before finishing school and before entrance to labor market. Cost savings could be achieved by investments in preventive interventions reaching young people’s needs; in initiatives to reduce hospital admissions caused by medication side effects, substance misuse, and lifestyle factors; and in occupational training.
Incumbents’ response to demand-side policies: The case of solar and wind power sectors
Authors: Choi Hyundo
Published: April 2019

This work examines incumbents’ responses to two demand-side policies by focusing on their investment in new sustainable technologies. It focuses on how economic incentive and regulatory policies shape the market environment and this affects incumbents’ investment in new technologies. By using mediation and difference-in-difference regression models, it examines incumbent utilities’ investment in solar and wind power plants. It reveals that incumbent utilities under the economic incentive policy more invest in the solar and wind power than those under the regulatory policy, as it places stronger competitive pressure on incumbent utilities to adapt to the new technology. Further, incumbents prefer alternative technologies complementary to their existing competences and expand their investment in a global market under policy-induced competitive pressures.
Law-Making by and for the People: A Case for Pre-legislative Processes in India
Authors: Jain Dipika
Published: April 2019

Recent legislative trends in India reflect the need for a mandatory pre-legislative process. Pre-legislative consultation affords the benefit of legitimacy to laws arrived at through citizen participation. Furthermore, it informs decision-makers of the lived experiences of those most likely impacted by the legislation. Laws that receive pre-legislative consultation are attuned to realities, which increases the likelihood of their effectiveness. This article explores how several of India’s recent laws that received pre-legislative consultation have been rendered more robust and effective than others. As exemplified by current protests by transgender, intersex and gender non-conforming people in India, the Government’s most recent Transgender Bill, which neglected pre-legislative deliberation process, fails the people it purports to protect. As explored in this article, the Bill fails to uphold constitutionally protected principles, as recognized in the recent Supreme Court case that upheld transgender persons’ fundamental rights. As such, the Transgender Bill reflects a need to engage with the intrinsic and instrumental value of pre-legislative consultation and deliberation in India. In locating transnational trends towards employing such a process, this article argues that India would greatly benefit from mandatory pre-legislative consultation and deliberation. By creating a process that allows for citizen participation in law-making, particularly when such laws impact marginalized communities, legislation would reflect societal needs and eschew a top-down, majoritarian approach.
Code of the Tweet: Urban Gang Violence in the Social Media Age
Authors: Stuart Forrest
Published: April 2019

Academics, criminal justice professionals, and news outlets have warned that gang-associated youth use social media to taunt rivals and trade insults in ways that cause offline retaliation. But there is surprisingly little empirical research investigating how gang-associated youth deploy social media in gang conflicts. Criminal justice professionals routinely overstate the violent effects of social media challenges, which further exacerbates criminalization, racial stereotyping, and social inequality. Drawing from two years of ethnographic fieldwork on Chicago’s South Side, this study asks how gang-associated black youth use social media to challenge rivals. Bridging traditional theories of urban violence with emerging media scholarship, I argue that social media disrupt the key impression management practices associated with the “code of the street.” Specifically, gang-associated youth exploit social media to publicly invalidate the authenticity of their rivals’ performances of toughness, strength, and street masculinity. Challengers do so through “cross referencing,” “calling bluffs,” and “catching lacking.” Each strategy differs in its likelihood to catalyze physical retaliation, which is a function of the amount and depth of counter-evidence necessary to refute a given challenge. These findings carry important implications for addressing urban violence, gangs, and inequality in the social media age.
Efficacy of mineral supplementation to growing cattle grazing winter-wheat pasture in northwestern Oklahoma1
Authors: Gunter S A , Combs G F
Published: April 2019

Two experiments were conducted to evaluate the efficacy of mineral supplementation to cattle grazing winter-wheat pasture. In experiment 1 (fall), 120 steers and heifers (body weight [BW] = 232 ± 11.4 kg) were assigned randomly to four blocks of replicated pastures during the second week of November in 2008 and 2009 and all herds (6 animals/pasture; 4.9 ha/pasture) were allowed to graze for 84 d. In experiment 2 (spring), 216 steers (BW = 248 ± 7.9 kg) were assigned randomly to five blocks of replicated pastures during the second week of February in 2009 and 2010 and all herds (12 or 6 animals/pasture; 4.9 ha/pasture) were allowed to graze for 84 d. Half the pastures in both experiments received a free-choice mineral mixture (Wheat Pasture Pro; Land O’Lakes Purina Feed, LLC; St. Paul, MN; Ca, 16% and P, 4%); mineral feeders were weighed weekly to determine mineral intake. All pastures were planted in early September of each year (67 kg of seed/ha) and fertilized with 50 kg of urea-N/ha. Standing herbage dry matter was determined midway between weigh dates by clipping wheat forage to the ground along 122 cm of drill rows at 10 locations/pasture. Data were analyzed by ANOVA, with treatment as the fixed effect and pasture, animal sex (experiment 1), and block as random effects. In experiment 1, cattle offered minerals had a 43% faster average daily gain (ADG; P = 0.02, 0.73 kg) than cattle not offered minerals (0.51 kg); hence, supplemented cattle weighed 6% more (P = 0.04; 286 kg) after 84 d than nonsupplemented cattle (271 kg). In experiment 2, cattle offered the mineral supplement had a faster ADG (20% increase; P = 0.04; 1.00 kg) than cattle not offered minerals (0.83 kg). Further, supplemented cattle weighed 4% more (P = 0.03; 326 kg) after 84 d than nonsupplemented cattle (312 kg). In both experiments, daily standing herbage dry matter averaged 1,381 kg/animal and never differed (P ≥ 0.47) between treatments. Mineral intakes averaged 135 (experiment 1) and 124 (experiment 2) g/d, resulting in a cost of supplement to kilogram of added BW gain of $0.53 and $0.64, respectively (assuming a mineral cost of $0.88/kg). Overall, supplementing an appropriate mineral mixture to cattle grazing winter-wheat pasture increased ADG in a cost-effective manner.
Molecular phylogeny reveals the gradual evolutionary transition to soft-bodiedness in click-beetles and identifies sub-Saharan Africa as a cradle of diversity for Drilini (Coleoptera: Elateridae)
Authors: Kundrata Robin , Bocak Ladislav
Published: April 2019

Drilini are soft-bodied predatory click-beetles (Elateridae: Agrypninae) with incompletely metamorphosed females. Due to divergent morphology, their classification has been contentious. We present the first densely sampled molecular phylogeny of Drilini based on nuclear and mitochondrial markers. Altogether, 44 species, representing all genera, were analysed using maximum likelihood and the Bayesian approach. Molecular analyses recovered five major clades that were also well supported by morphology. Afrotropical lineages mark deep splits. Most Palearctic species belong to a terminal clade. A few species of the predominantly Afrotropical Selasia are distributed from Arabia up to the Himalayas and Thailand. The origin of Drilini is dated to the Late Eocene (~35.5 Mya) and rapid radiation is identified from the Eocene/Oligocene to the Middle Miocene. We describe the gradual transformation of male morphological traits, e.g. the level of sclerotization, structure of mouthparts, loss of the thoracic interlocking mechanism, shortened elytra and expanded larviform abdomen. Five new genera, Austroselasia, Habeshaselasia, Illubaboria, Malacodrilus and Mashaselasia are proposed. Latoselasia, previously a subgenus of Wittmerselasia, is elevated to the genus rank. Five new species, Habeshaselasia nekemtensis, H. illubaborensis, Illubaboria bicolor, Malacodrilus hajeki and Mashaselasia aethiopica are described.
Evaluating the Effects of a Pressure Injury Prevention Algorithm
Authors: Yilmazer Tuba , Bulut Hulya
Published: April 2019

OBJECTIVE:

To evaluate the effect of a pressure injury prevention algorithm on pressure injury prevention.

DESIGN, SETTING, AND PARTICIPANTS:

This intervention study was conducted in the anesthesiology and reanimation ICU (ARICU) of a university hospital. The study included two sample groups (nurses and patients). All patients older than 18 years (prealgorithm, n = 80; postalgorithm, n = 74) in the ARICU who verbally consented were included in the study. All 15 nurses who worked in the ARICU during the postalgorithm period agreed to participate in the study.

INTERVENTIONS:

The study was performed in four phases. In the first phase, pressure injury incidence was evaluated in the ARICU (prealgorithm period; April 1 to September 30, 2016). At the same time, a pressure injury prevention algorithm was developed. In the second phase, ARICU nurses were provided education on how to prevent pressure injury and use the pressure injury prevention algorithm. In the third phase, the nurses provided care based on the pressure injury prevention algorithm (postalgorithm period; November 1, 2016, to April 30, 2017). In the fourth phase, the incidence of pressure injury in the pre- and postalgorithm periods was compared, and the effectiveness of the algorithm was evaluated.

MAIN RESULTS:

The pressure injury incidence was 46.10 per 1,000 patient-days in the prealgorithm period and 9.21 per 1,000 patient-days in the postalgorithm period. The decline was statistically significant (z = 9.590, P < .001).

CONCLUSIONS:

Nursing education and the evidence-based pressure injury prevention algorithm reduced pressure injury rates. Further study of this algorithm in other ICUs and among various care populations is recommended to fully establish its efficacy.
Visualizing Tissue Strain Under the Sacrum and Coccyx in Different Supine Postures: A Case Series
Authors: Sprigle Stephen , Sonenblum Sharon
Published: April 2019

OBJECTIVE:

To visually assess and report the influence of supine positioning and sacrum and coccyx anatomy on tissue deformation.

METHODS:

A convenience sample of three participants was scanned using MRI. All participants were scanned in a supine position with a rig oriented in a flat or horizontal position and with the torso portion of the rig elevated to 30° to simulate head-of-bed elevation. Representative images were identified to visualize and depict (1) the differences in tissue thickness and deformation in response to changes in supine positioning (0° and 30°), (2) the relative displacement of the skeleton relative to the skin during 30° incline, and (3) differences in sacrococcygeal morphology.

RESULTS:

The tissue thickness under the sacrum stayed the same or increased when torsos were elevated. Skeletons were displaced relative to the skin when the rig was elevated regardless of the pelvis location. Further, in the elevated position, coccyges flexed when pelvises were placed on the elevated segment but did not flex when pelvises were placed on the horizontal segment.

CONCLUSIONS:

This case series is useful in defining new areas of research that can (1) identify the deformation induced by normal and frictional forces resulting from different positions of the bed chassis, (2) assess the impact of positioning the pelvis on elevated versus horizontal segments of the bed chassis, and (3) define the association between sacral and coccyx morphology and pressure ulcer occurrence in hospitalized patients.
Body Composition and Acquired Functional Impairment in Survivors of Pediatric Critical Illness
Authors: Ong Chengsi , Lee Jan Hau , Senna Stephanie , Chia Aletheia Z. H. , Wong Judith J. M. , Fortier Marielle V. , Leow Melvin K. S. , Puthucheary Zudin A.
Published: April 2019

Objectives:

To identify whether body mass and composition is associated with acquired functional impairment in PICU survivors.

Design:

Retrospective dual-cohort study.

Setting:

Single multidisciplinary PICU.

Patients:

Two distinct PICU survivor cohorts: 432 unselected admissions from April 2015 to March 2016, and separately 92 patients with abdominal CT imaging at admission from January 2010 to December 2016.

Interventions:

None.

Measurements and Main Results:

Admission body mass index and Functional Status Scale scores at admission, PICU discharge, and hospital discharge were obtained for all patients. Acquired functional impairment was defined as increase greater than or equal to 3 in Functional Status Scale from baseline. Patients were classified as having: “temporary acquired impairment” (acquired impairment at PICU discharge recovering by hospital discharge), “persistent acquired impairment” (acquired impairment at PICU discharge persisting to hospital discharge), and “no acquired impairment.” CT scans were analyzed for skeletal muscle and fat area using National Institute of Health ImageJ software (Bethesda, MD). Multinomial logistic regression analyses were conducted to identify associations between body mass index, muscle and fat indices, and acquired functional impairment. High baseline body mass index was consistently predictive of persistent acquired impairment in both cohorts. In the second cohort, when body mass index was replaced with radiologic anthropometric measurements, greater skeletal muscle, and visceral adipose tissue indices were independently associated with persistent acquired impairment at hospital discharge (adjusted odds ratio, 1.29; 95% CI, 1.03–1.61;p= 0.024 and adjusted odds ratio, 1.13; 95% CI, 1.01–1.28;p= 0.042, respectively). However, this relationship was no longer significant in children with PICU stay greater than 2 days.

Conclusions:

In PICU survivors, baseline body mass and composition may play a role in the persistence of acquired functional impairment at hospital discharge. Characterization and quantification of skeletal muscle and fat deserves further study in larger cohorts of PICU children.
Enhancements in the Techa River Dosimetry System: TRDS-2016D Code for Reconstruction of Deterministic Estimates of Dose From Environmental Exposures
Authors: Degteva M.O. , Napier B.A. , Tolstykh E.I. , Shishkina E.A. , Shagina N.B. , Volchkova A.Yu. , Bougrov N.G. , Smith M.A. , Anspaugh L.R.
Published: April 2019

Waterborne releases to the Techa River from the Mayak plutonium facility in Russia during 1949–1956 resulted in significant doses to persons living downstream. The dosimetry system Techa River Dosimetry System-2016D has been developed, which provides individual doses of external and internal exposure for the members of the Techa River cohort and other persons who were exposed to releases of radioactive material to the Southern Urals. The results of computation of individual doses absorbed in red bone marrow and extraskeletal tissues for the Techa River cohort members (29,647 persons) are presented, which are based on residence histories on the contaminated Techa River and the East Urals Radioactive Trace, which was formed in 1957 as a result of the Kyshtym Accident. Available 90Sr body-burden measurements and available information on individual household locations have been used for refinement of individual dose estimates. Techa River Dosimetry System-2016D-based dose estimates will be used for verification of risk of low-dose-rate effects of ionizing radiation in the Techa River cohort.
Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally
Authors: Naslund John A. , Shidhaye Rahul , Patel Vikram
Published: April 2019

Workforce shortages pose major obstacles to delivering adequate mental health care and scaling up services to address the global treatment gap. Mounting evidence demonstrates the clinical effectiveness of having nonspecialist health workers, such as community health workers, lay health workers, midwives, or nurses, deliver brief psychosocial treatments for common mental disorders in primary care settings. With rapidly increasing access to, and use of, digital technology worldwide, new opportunities are available to leverage these emerging digital technologies to support nonspecialist health workers and increase mental health workforce capacity. This Perspectives article considers the potential that digital technology holds for supporting nonspecialist health workers in delivering evidence-based mental health care. Specifically, from our search of the academic literature, we identified seven promising examples from primary care settings in different low- and middle-income countries (India, Pakistan, Zimbabwe, Peru, China, and Nigeria) where digital platforms are being used to support delivery of mental health care from a variety of nonspecialist providers by offering training, providing digital tools for diagnosis, guiding treatment, facilitating supervision, and integrating services. We summarize these examples and discuss future opportunities to use digital technology for supporting the development of a trained, effective, and sustainable mental health workforce. We also consider the potential to leverage these technologies for integrating mental health care into existing health systems in low-resource settings.
INCREASED INCIDENCE OF CUTANEOUS KERATINOCYTIC AND MELANOCYTIC MALIGNANCIES IN PATIENTS WITH AGE-RELATED MACULAR DEGENERATION
Authors: Shah Saumya M. , Starr Matthew R. , Dalvin Lauren A. , Comfere Nneka I. , AbouChehade Jackson E. , Hodge David O. , Iezzi Raymond , Bakri Sophie J.
Published: April 2019

Purpose:

The relationship between age-related macular degeneration (AMD) and malignancy, especially cutaneous malignancies, is not well studied. We investigated a possible association between AMD and cutaneous malignancies.

Methods:

A retrospective, consecutive review of all patients who had received at least 1 intravitreal injection for wet AMD between January 1, 2004, and December 31, 2013, was conducted using the Rochester Epidemiology Project in Olmsted County, Minnesota. Age- and sex-matched control groups included 473 pre–anti–vascular endothelial growth factor era wet AMD patients, 504 concurrent time dry AMD patients, and 504 patients with no AMD. The rates of AMD and overall malignancy, cutaneous malignancies, and specific types of cutaneous malignancies were compared between groups of patients.

Results:

Patients with wet AMD incurred an increased rate of overall malignancies compared to patients with dry AMD {52.8% wet AMD (confidence interval [CI]: 48.3–57.2) vs. 43.7% dry AMD (CI: 39.3–48.1); P= 0.003} or those without AMD (52.8% wet AMD [CI: 48.3–57.2] vs. 35.3% no AMD [CI: 31.1–39.7]; P = <0.001). Patients with dry AMD also had higher rates of malignancy than those without AMD (43.7% dry AMD [CI: 39.3–48.1] vs. 35.3% no AMD [CI: 31.1–39.7]; P = 0.007). Rate of cutaneous malignancies was increased in patients with wet AMD compared to patients with dry AMD (24.4% wet AMD [CI: 20.7–28.4] vs. 14.6% dry AMD [CI: 11.5–17.9]; P = <0.001) and those with no AMD (24.4% wet AMD [CI: 20.7–28.4] vs. 9.7% no AMD [CI: 7.3–12.7]; P = <0.001).

Conclusion and Relevance:

To the best of our knowledge, this is the first report to establish an association between AMD and cutaneous malignancies, supporting a possible discussion of the association when a patient presents with one of the two conditions.
MORPHOLOGIC FEATURES OF THE RETINAL PIGMENT EPITHELIUM AND ASSOCIATED CHORIORETINAL CHARACTERISTICS IN EYES WITH EARLY AGE-RELATED MACULAR DEGENERATION AND SUBRETINAL DRUSENOID DEPOSITS
Authors: Jang Sungmin , Park Seo Yeon , Ahn So Min , Hwang Soon-Young , Kim Seong-Woo , Oh Jaeryung , Yun Cheolmin
Published: April 2019

Purpose:

To investigate the features of the retinal pigment epithelium (RPE) on optical coherence tomography in eyes with early age-related macular degeneration with subretinal drusenoid deposit.

Methods:

We classified the eyes into three types: nonundulating RPE, undulating RPE, and wedge-shaped RPE. We compared the retinal vessel densities, retinal thickness, and choroidal thickness of a 3-mm-diameter zone.

Results:

We classified 33, 27, and 20 as nonundulating RPE, undulating RPE, and wedge-shaped RPE eyes, respectively. The vascular densities of the superficial and deep capillary plexus showed differences; nonundulating RPE group (23.93 ± 2.26% and 23.54 ± 1.78%), undulating RPE group (22.29 ± 2.80% and 21.94 ± 2.42%), and wedge-shaped RPE group (21.93 ± 2.70% and 20.63 ± 2.42%, P = 0.010 and P < 0.001). The mean retinal thickness and choroidal thickness were also different, nonundulating RPE group (298.26 ± 13.81 µm and 180.08 ± 55.49 µm), undulating RPE group (285.29 ± 21.88 µm and 148.45 ± 55.08 µm), and wedge-shaped RPE group (274.86 ± 20.62 µm and 135.75 ± 39.77 µm) (P = 0.001 and P = 0.007).

Conclusion:

Altered features of the RPE on optical coherence tomography may indicate advancement in disease and be part of an overall degeneration process in these eyes.
PHOTODYNAMIC THERAPY FOR EXTRAFOVEOLAR CHOROIDAL OSTEOMA
Authors: Mazloumi Mehdi , Dalvin Lauren A. , Ancona-Lezama David , Mashayekhi Arman , Shields Carol L.
Published: April 2019

Purpose:

To evaluate the outcome of photodynamic therapy (PDT) in the management of extrafoveolar choroidal osteoma.

Methods:

The authors performed a retrospective chart review of all patients with choroidal osteoma that did not involve the foveola and were treated with standard-fluence PDT.

Results:

Nine eyes with extrafoveolar choroidal osteoma were studied. Mean logarithm of the minimum angle of resolution best-corrected visual acuity at initial examination was 0.07 (Snellen ∼20/25). The osteoma was treated with 1 (8/9) or 2 (1/9) PDT sessions using 50 J/cm2. After a mean follow-up of 49 months, the treated area of osteoma demonstrated complete (4/9) or partial (5/9) regression, with a mean of 73% regression in the PDT-treated areas. Tumor growth in the region of PDT was noted in 3 cases (3/9) (one tumor toward the foveola and two tumors at the margin away from the foveola), but in no case did the tumor reach the foveola. Therefore, PDT controlled tumor growth in 8 of 9 cases with only 1 of 9 cases showing growth through the PDT scar into foveola. Mean logarithm of the minimum angle of resolution visual acuity at last follow-up was 0.04 (Snellen ∼20/20) (P = 0.59).

Conclusion:

Photodynamic therapy is an effective modality for the management of extrafoveolar choroidal osteoma, minimizing tumor growth toward the foveola and preserving visual acuity.
COMPARISON OF INTRAVITREAL DEXAMETHASONE IMPLANT AND AFLIBERCEPT IN PATIENTS WITH TREATMENT-NAIVE DIABETIC MACULAR EDEMA WITH SEROUS RETINAL DETACHMENT
Authors: Ozsaygili Cemal , Duru Necati
Published: April 2019

Purpose:

To compare the efficacy and safety of intravitreal dexamethasone (DEX) implant versus aflibercept in patients with treatment-naive diabetic macular edema with inflammatory biomarkers.

Methods:

Ninety-eight eyes of 62 treatment-naive patients with diabetic macular edema with serous retinal detachment and hyperreflective foci were enrolled. Each patient was randomized to receive either aflibercept or DEX implant treatment. The treatment protocol included 3 monthly injections of 2 mg of aflibercept as a loading phase in the anti–vascular endothelial growth factor group and 0.7 mg of DEX implant in the DEX group and then pro re nata treatment. Primary outcome measures were mean changes in visual acuity and central retinal thickness at the end of the 12-month follow-up.

Results:

Forty-eight eyes of 29 patients were received DEX implant, and 50 eyes of 33 patients received the aflibercept injection. Mean central retinal thickness decreased from 615.2 µm at baseline to 297.7 µm at 12 months in the DEX group (P < 0.001) and from 576.5 µm to 367.4 µm in the aflibercept group (P < 0.001). Except for the first month, mean central retinal thickness reduction was significantly higher in the DEX group (P < 0.05, Mann–Whitney U Test). Visual acuity improved significantly at the end of the follow-ups (46.3–52.7 Early Treatment Diabetic Retinopathy Study letters in the DEX group and 47.5–56.8 Early Treatment Diabetic Retinopathy Study letters in the aflibercept group at 12 months, P < 0.001, paired-sample t-test). Adjusting by baseline values, the increase in mean visual acuity during the 12-month follow-ups favored the aflibercept group (P < 0.01), 25% of the DEX-treated eyes and 42% of the aflibercept treated eyes experienced 10 or more Early Treatment Diabetic Retinopathy Study letters visual gain (P: 0.058). The DEX group received significantly fewer (2.6 vs. 7.2) injections (P: 0.001).

Conclusion:

It was observed that the both of DEX implant and aflibercept were effective and safe in treatment-naive diabetic macular edema patients with inflammatory phenotype. Anatomical results were found to be better in the DEX group, and functional results were found to be better in the aflibercept group. In pseudophakic eyes, the functional superiority of aflibercept ceased to exist, and the low number of injections in the DEX implant group was seen as an advantage.
PHOTORECEPTOR DAMAGE IN DIABETIC CHOROIDOPATHY
Authors: Borrelli Enrico , Palmieri Michele , Viggiano Pasquale , Ferro Giada , Mastropasqua Rodolfo
Published: April 2019

Purpose:

To investigate the relationship between choriocapillaris (CC) hypoperfusion and photoreceptor alterations in eyes with nonproliferative diabetic retinopathy (NPDR).

Methods:

In this prospective, observational, case–control study, 30 eyes (30 patients) with NPDR and 30 healthy eyes from 30 controls were enrolled at the University G. d'Annunzio, Chieti-Pescara, Italy. This study cohort underwent an ophthalmologic examination, including optical coherence tomography and optical coherence tomography angiography. The main outcome measures were as follows: 1) “normalized” reflectivity of en face image segmented at the ellipsoid zone level, which was calculated to quantify the photoreceptor damage, and 2) CC perfusion density. Secondary outcome measures were as follows: 1) superficial retinal capillary plexus (SCP), intermediate retinal capillary plexus (ICP), and deep retinal capillary plexus (DCP) perfusion density (based on the area of vessels); 2) SCP, ICP, and DCP vessel length density (based on a map with vessels of 1-pixel width); and 3) SCP, ICP, and DCP vessel diameter.

Results:

Mean ± SD age was 58.9 ± 11.1 years (range 38–79 years) in the NPDR group and 61.7 ± 11.3 years (range 39–87 years) in the control group (P > 0.05 for all the comparisons). Compared with controls, NPDR eyes displayed a lower “normalized” reflectivity (0.96 ± 0.25 in controls and 0.73 ± 0.19 in the NPDR group, P < 0.0001). Moreover, the NPDR group was characterized by an impaired perfusion in both the retinal and choroidal vasculature. In multiple regression analysis, ellipsoid zone “normalized” reflectivity displayed a significant direct association with CC perfusion density in patients with NPDR (P = 0.025 and P = 0.476, in NPDR and controls, respectively).

Conclusion:

Eyes with NPDR are affected by macular hypoperfusion and photoreceptor damage, the latter investigated as ellipsoid zone “normalized” reflectivity. The diabetic choroidopathy seems to be strongly associated with photoreceptor damage.
EPIRETINAL MEMBRANE IN EYES WITH VITREOMACULAR TRACTION
Authors: Carpineto Paolo , Ciciarelli Vincenzo , Borrelli Enrico , Aharrh-Gnama Agbeanda , Mastropasqua Rodolfo
Published: April 2019

Purpose:

To describe the occurrence of epiretinal membrane (ERM) in eyes with vitreomacular traction and to correlate the presence of ERM with retinal structural alterations detected using spectral domain optical coherence tomography.

Methods:

In this retrospective observational cross-sectional study, we collected data from 502 eyes (307 patients) with diagnosis of vitreomacular traction. The presence of ERM and retinal lesions (cystoid cavities, neuroepithelial detachment, external limiting membrane, and ellipsoid zone discontinuity) was determined by standardized grading of macular spectral domain optical coherence tomography scans.

Results:

The occurrence of ERM in eyes with vitreomacular traction was 37.5%. The mean ± SD central foveal thickness was 411 ± 60 µm in eyes with ERM and 380 ± 148 µm in eyes without ERM (P < 0.05). The occurrence of cystoid cavities (38.3% vs. 23.2%, P < 0.05), neuroepithelial detachment (24.5% vs. 9.9%, P < 0.0001), external limiting membrane discontinuity (16.5% vs. 5.1%, P < 0.0001), and ellipsoid zone discontinuity (13.3% vs. 6.7%, P < 0.05) was higher in eyes with ERM. The mean ± SD best-corrected visual acuity was 0.45 ± 0.16 logarithm of the minimum angle of resolution (Snellen equivalent of approximately 20/50) in eyes with ERM and 0.37 ± 0.09 in eyes without ERM (Snellen equivalent of approximately 20/40, P < 0.0001). Symptoms of metamorphopsia were present in 55 of 188 eyes with ERM (29.3%) and 40 of 314 eyes without ERM (12.7%, P < 0.0001).

Conclusion:

This study reported the occurrence of ERM in eyes with vitreomacular traction and demonstrated that ERM is significantly associated with an increased occurrence of other structural changes of the neuroretina and a negative effect on quantity and quality of vision.
Health Care Provider Perspectives on Pre-exposure Prophylaxis: A Qualitative Study
Authors: Przybyla Sarahmona , LaValley Susan , St. Vil Noelle
Published: April 2019

Although pre-exposure prophylaxis (PrEP) requires a prescription from a health care provider, we lack unanimity in guidelines for the identification of the ideal provider type to prescribe PrEP. The purpose of our study was to understand clinician perspectives on provider categories to determine who is best suited to prescribe this medication to HIV-uninfected patients. We conducted 28 in-depth interviews between September 2017 and January 2018 with current prescribers of PrEP. Qualitative findings indicated that providers were split on recommended PrEP prescriber type. Five themes emerged that centered on the explicit identification of the issue of opportunity for providers to educate their patients on PrEP and offer this medication to at-risk populations. To effectively maximize presentation for care and subsequently amplify uptake of PrEP, growing the base of providers who offer PrEP to eligible patients can provide a meaningful public health impact on reducing HIV incidence.
A South African Couple-Based HIV Prevention Program: Preliminary Evidence of the Long-Term Effects
Authors: Belus Jennifer M. , Baucom Donald H. , Carney Tara , Carrino Emily A. , Wechsberg Wendee M.
Published: April 2019

The goal of our study was to provide qualitative data on the long-term effects of a couple-based HIV prevention program, the Couples Health Co-Op (CHC), in South Africa. Qualitative focus group discussions were conducted with nonrandomly selected Black South African men (n = 27) and women (n = 23) who had participated in the Couples Health Co-Op 4 to 6 years prior to our study. The study evaluated: (a) salient content and skills learned, (b) long-term changes and challenges, and (c) recommendations for intervention improvement. Findings revealed (a) communication/problem-solving, safe sexual behaviors, and negative effects of alcohol were most salient; (b) long-term changes occurred in communication and healthier sexual behavior; alcohol use remained challenging; and (c) participants recommended continuing the couple format and suggested targeting teenage couples. We offer preliminary evidence of the strengths and weaknesses of the Couples Health Co-Op and provide a basis for future studies to build on these results.
Neck Ultrasound for the Detection of Cervical Lymphadenopathy in Sarcoidosis
Authors: Ahmed Mohammed , Daneshvar Cyrus , Breen David
Published: April 2019

Background:

Sarcoidosis is diagnosed by demonstration of granulomatous inflammation and exclusion of other potential causes. Lung parenchyma and intrathoracic lymph nodes are currently the commonest sites from which tissue is obtained in clinical practice, but historically scalene lymph node biopsy was the procedure of choice for diagnosing sarcoidosis in many institutions.

Aim:

We aimed to assess the utility of neck ultrasound (NUS) and cervical lymph node needle sampling among patients with stage 1 and 2 sarcoidosis. In addition, we analyzed the potential predictors of cervical lymphadenopathy in this retrospective cohort study.

Methods:

Patients with evidence of intrathoracic lymphadenopathy and suspected sarcoidosis referred for an endobronchial ultrasound underwent NUS. Those with enlarged cervical lymph nodes underwent fine-needle aspiration and core needle biopsy when technically feasible.

Results:

A total of 38 patients were included of which 34 (89.5%) underwent endobronchial ultrasound. Sixteen patients had enlarged lymph nodes on ultrasound and 8 (50%) of these underwent needle sampling. Non-necrotizing granulomas were detected in 6 cases (16.8%, 95% confidence interval, 6.1%–31.3%). Cervical lymphadenopathy was significantly associated with the presence of upper paratracheal lymphadenopathy (P=0.018) and the size of mediastinal lymph nodes on computed tomography (P=0.011).

Conclusion:

NUS and needle sampling of cervical lymph nodes is a potential modality that can be used for the diagnosis of sarcoidosis in a selected group of patients.
The Impact of an Interventional Pulmonary Program on Nontherapeutic Lung Resections
Authors: Polcz Monica E. , Maiga Amelia W. , Brown Lawrence B. , Deppen Stephen A. , Montgomery Chandler , Rickman Otis , Grogan Eric L.
Published: April 2019

Background:

Pulmonary resection can concurrently diagnose and treat known or suspected lung cancer, but is not without risk. Benign resection rates range widely (9% to 40%). We evaluated the impact of an Interventional Pulmonology (IP) program and dedicated Pulmonary Nodule Clinic on surgical benign resection rates at a single institution.

Methods:

An IP program was initiated in August 2010 that offered advanced diagnostic techniques and a dedicated Pulmonary Nodule Clinic was opened in August 2013. We retrospectively reviewed all patients who underwent resection for known or suspected lung cancer between 2005 and 2015 at our tertiary referral hospital. Demographics, preoperative tissue diagnoses, surgical procedure, final pathology, and staging were collected. Quarterly benign resection rates were calculated and plotted on a statistical quality control chart (P-Chart) to determine the impact of the IP program and Pulmonary Nodule Clinic on benign resection rates over time.

Results:

Of 1112 resections, 209 (19%) were benign. Variation in quarterly benign resection rates decreased after introduction of the IP program in 2010, and a significant (P<0.05) sustained decrease in the quarterly benign resection rate occurred after introduction of the pulmonary nodule clinic in 2013 to a new baseline of 12% compared with 24% before 2010. After introduction of the IP program, mean quarterly preoperative tissue diagnostic rates increased from 45% to 58% (P<0.01).

Conclusion:

Integration of an IP program employing advanced diagnostic bronchoscopic techniques has improved preoperative diagnostic rates of suspicious pulmonary nodules and in combination with a pulmonary nodule clinic has resulted in fewer benign resections.
The immunomodulatory and antiallergic effects of human colonized probiotics
Authors: Mazarzaei Abdulbaset , Alnomani Yaqdhan , Shafiei Morvarid , Alghanimi Yasemin K. , Ali Mun’im R. , Al-gburi Nagham M. , Al-abodi Hiba R. , Kadhum Samah A.
Published: April 2019

The rate of allergy is increasing particularly among infants due to several factors reaching up to 30%. Several materials components have been implicated in the development and excessive activation of the immune system, acting as irritants and allergic agents. In several studies, in Mediterranean inhabitants with a specific diet, the prevalence of allergies in children was low, whereas dietary supplements in the Western and Mediterranean countries had a different role in the regulation of immune responses and in the reduction of allergic reactions. Probiotics have been associated with reduction of allergic reactions mostly by positive effect on T helper cells, regulatory T cells (Tregs), B cells and dendritic cells. Furthermore, probiotics existing in the human intestine can modulate the immune response and allergic reactions through downregulation of Th2-related responses (IgE, IL-4 and IL-5). They mostly exert anti-inflammatory and immunomodulatory properties by modulation of immune system components via hindering of various signaling pathways such as the NF-κB pathway, probably associated with changes in mitogen-activated protein kinases and pattern recognition receptors pathways. These microorganisms have also potential to inhibit the bacterial lipopolysaccharide attachment to the CD14 receptor, hence reducing the overall activation of NF-κB and proinflammatory cytokines production. Bifidobacterium and Lactobacillus species act through increase in proinflammatory (Th1) cytokines (INF-γ, IL-12, IL-13, TNF-α and also IL-4 and IL-10), dendritic cells, CD4+FoxP3+ T cells, GATA-3 and intestinal barrier maturation, whereas decrease the Th2-mediated cytokines, IgA, IgE, IgG1, IL-4, IL-5 and IL-6, IL-13, airway reactivity, pulmonary eosinophilia. Furthermore, Clostridium butyricum could act by improvement of anaphylaxis symptoms and increase of sIgA and CD4+ CD25+FoxP3Treg cells. In this review, we assessed the recent evidence that confirms the role of probiotics compounds as an important factor in the safety of homeostasis and the development of allergic reactions through a complex set of metabolites and the immune cells. The employment and application of probiotics combined with immunotherapy approaches can be possibly effective in reducing allergic reactions and related therapeutic costs.
Insanity
Authors: Weiss Kenneth J. , Friedman Susan Hatters , Shand John P.
Published: April 2019

The term “insanity” has been retired from medical nomenclature for about 100 years. Formerly interchangeable with the legal term, implying unsoundness of mind, it persists as a legal determination, mainly in criminal matters. However, the most prevalent uses of “insanity” are in colloquial speech and media. We track “insanity” in medical and legal parlance, reasons for its disappearance from psychiatry, and its persistence in popular culture. During the 19th century, specific types of legal insanity fell out of favor, especially “moral insanity,” referring to irresistible impulses. The term persisted, for example, in some civil cases and in criminal cases, both denoting lack of capacity. In America, early 20th century focus on disease classification and nomenclature shifted from catchall terms (such as insanity, dementia, mania, and idiocy) to medical labels (psychosis and neurosis). Psychiatrist William Alanson White led the movement to change nomenclature. In 1921, the American Journal of Insanity became the American Journal of Psychiatry. By the time White was the American Psychiatric Association president in 1925, the medical use of “insanity” had been replaced in textbooks by progressive terminology. However, variations on “insane,” suggesting loss of reason without diagnostic specificity, have become a staple among film tropes.
Skeletal surveys lack efficacy in obtunded polytrauma patients
Authors: Dmochowski Jakub M. , Wendell Cole , Bruggers Jennifer L. , Becher Stephen J.
Published: April 2019

Objectives:

To evaluate if a skeletal survey protocol initiated after 48 hours of intubation will decrease time to diagnosis and the treatment of occult fractures in the obtunded polytrauma patient.

Design:

Prospective cohort trial with a retrospective cohort comparison arm.

Setting:

A single level 1 trauma center.

Patients:

Forty-seven patients were identified prospectively for the skeletal survey protocol to screen for occult fractures. The results of the new protocol were compared to a retrospective comparison arm of 46 patients who would have met the same criteria.

Intervention:

A skeletal survey protocol using 2-view x-rays of the patients’ extremities to evaluate for any occult injuries after 48 hours of intubation in trauma patients with altered mental status and an unreliable tertiary examination.

Main Outcome Measure:

Time to diagnosis of delayed fractures and surgical intervention from date of admission.

Results:

The average time to fracture diagnosis and time to surgical intervention in days was not statistically significant between the retrospective and prospective groups [fracture diagnosis: 1.6 ± 5.1 (retrospective) versus 0.5 ± 0.9 (prospective) (P = .159); time to initial surgery: 2.7 ± 5.6 (retrospective) versus 1.1 ± 1.7 (prospective) (P = .064); time to final surgery: 5.3 ± 8.5 (retrospective) versus 2.4 ± 3.0 (prospective) (P = .029)]. In addition, only 24% (4/17) of patients with a delayed fracture diagnosis required surgical intervention making most nonoperative.

Conclusions:

Given the inability to have a clinically or statistically significant impact on time to fracture diagnosis or subsequent treatment, we cannot advocate for the routine use of a skeletal survey protocol in obtunded polytrauma patients.

Level of Evidence: Level III
Sudden Unexpected Death in a Child From an Anaplastic Ependymoma
Authors: Harrison William T. , Bouldin Thomas , Buckley Anne , Estrada Januario , McLendon Roger , Janssen Kimberly
Published: April 2019

Primary central nervous system tumors are an extremely rare cause of sudden, unexpected death in children as most patients develop symptoms because of increased intracranial pressure and seek medical attention. Rarely, a forensic pathologist may encounter a primary intracranial neoplasm in a pediatric decedent that was not suspected before death. Herein, we present a case of a supratentorial neuroepithelial tumor found at autopsy in a 3-year-old African American boy without any reported significant medical history. The tumor had significant mass effect and caused cerebral edema, which ultimately resulted in transtentorial herniation and death. The gross, histopathological, immunohistochemical, and ultrastructural findings were most consistent with an anaplastic ependymoma.