bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of morphological characteristics on late outcomes in patients born with hypoplastic left heart syndrome†
Authors: Newland David P , Poh Chin L , Zannino Diana , Elias Patrick , Brizard Christian P , Finucane Kirsten , Winlaw David S , d’Udekem Yves
Published: February 2019

OBJECTIVES

Patients with hypoplastic left heart syndrome are at high risk of late adverse events after Fontan completion, but it is unclear whether their morphological characteristics influence these outcomes.

METHODS

Retrospective review of the data from the Australian and New Zealand Fontan Registry identified 185 patients with hypoplastic left heart syndrome who survived to hospital discharge after Fontan completion. Their outcomes were reviewed to identify predictors of adverse events with a particular focus on the impact of morphological characteristics. All available echocardiographic parameters were collected, and the hypoplasia of the left ventricle was subjectively considered to be mild, moderate or severe.

RESULTS

The mean follow-up after the Fontan procedure was 6.4 ± 4.7 years. The median age at Fontan procedure was 4.41 years, 95% (176/185) of patients underwent an extracardiac conduit Fontan procedure and 71% (132/185) of those were fenestrated. At 15 years after Fontan, freedom from death and cardiac transplantation was 90% [95% confidence interval (CI) 85–97], freedom from Fontan failure was 78% (95% CI 70–87) and freedom from adverse events was 32% (95% CI 22–46). Morphological parameters did not influence transplant-free survival or Fontan failure. Independent risk factors predicting higher incidence of adverse events included aortic atresia (P = 0.003).

CONCLUSIONS

The long-term survival of Fontan survivors with hypoplastic left heart syndrome is excellent and appears comparable to that of the general Fontan population. However, intrinsic morphological characteristics may continue to burden patients with late morbidity.
Are futures prices good price forecasts? Underestimation of price reversion in the soybean complex
Authors: Huang Joshua , Serra Teresa , Garcia Philip
Published: February 2019

Using quantile regression, we evaluate the forecasting performance of futures prices in the soybean complex. The procedure provides a more complete picture of the distribution of forecasts than mainstream methods that only focus on central tendency measures. Forecast performance differs by location in the futures price distribution. Futures forecast perform well in the centre of the distribution. However, futures prices tend to over-forecast when futures prices are high and under-forecast when futures prices are low, suggesting that futures prices tend to under-estimate price reversion towards the centre of the distribution. Forecast errors are larger when futures prices are high. The findings are related to theories in the literature used to explain pricing bias, and their implications for market participants are discussed.
A Mixed-Mode and Incentive Experiment Using Administrative Data
Authors: Bucks Brian , Couper Mick P , Fulford Scott L
Published: February 2019

This research note compares sequential and concurrent web-mail mixed-mode approaches and incentives for a survey on US consumers’ use of financial products, especially when their finances are tight. The sample (n = 2,000) was drawn from credit bureau data. We examine the effects on response rates, survey costs, and possible nonresponse bias in an experiment varying two factors in a 2x2 design: (1) using concurrent or sequential web and then mail survey modes, and (2) different incentive amounts given to initial survey nonrespondents ($5 versus $10). The sequential (web-first) design had a significantly lower response rate (3.9 percent) at week five—before the paper questionnaire was mailed—than the concurrent group (11.0 percent). This difference was nearly fully eliminated by the end of the field period. The higher incentive brought in slightly more respondents in the concurrent arm and slightly fewer respondents in the sequential arm, but neither difference is statistically significant. Compared with the sample frame, respondents in both groups were generally older and had many of the characteristics that come from being older: higher credit scores, more open credit cards, lower credit card utilization, greater likelihood of having a mortgage, and lower likelihood of being delinquent on credit card payments. Given the lower initial response rate and the need for more follow-up mailing, the sequential mixed-mode approach resulted in a higher cost per complete survey.
Demystifying Biclonal Gammopathy: A Pathologist’s Perspective
Authors: Sharma Sudha , Gupta Parikshaa , Aggarwal Ritu , Malhotra Pankaj , Minz Ranjana Walker , Bansal Frainey
Published: February 2019

Background

The production of 2 monoclonal proteins characterizes biclonal gammopathic manifestations (BGMs). The available medical literature from India is chiefly restricted to case reports.

Objective

To study the incidence of BGMs in a tertiary care center in Chandigarh, India, during a 4-year period. We evaluated these cases further for their laboratory characteristics.

Methods

We scrutinized the contents of a database containing information from the studied 4-year period. Cases reported as BGMs on serum protein electrophoresis (SPEP) and confirmed by serum immunofixation electrophoresis (SIFE) were included.

Results

A total of 15 cases, from a cohort of 914 cases of monoclonal gammopathic manifestations (MGMs), were available. On SPEP, 2 M bands were observed in 12 cases. On SIFE, 4 cases were reported as being of true BGMs. The most common heavy-chain combination observed was immunoglobulin (Ig)A-IgG. Follow-up was available in 2 patients.

Conclusion

Identification of BGMs increases diagnostic precision, despite that the treatment is similar to that for monoclonal gammopathic manifestations (MGMs). BGMs can be transitory and may be observed at presentation or during the disease course.
Serum Free Light Chain Assay in Monoclonal Gammopathic Manifestations
Authors: Lee Won S , Singh Gurmukh
Published: February 2019

Background

Serum free light chain assay is used in the diagnosis and monitoring of monoclonal gammopathic manifestations. For the kappa (κ)/lambda (λ) ratio, there is a 36% false-positive rate in patients without monoclonal gammopathic manifestations and a 30% false-negative rate in patients with monoclonal gammopathic manifestations. This study was undertaken to address the higher false-negative rate in λ chain–associated monoclonal lesions.

Methods

Results of serum protein electrophoresis, serum immunofixation electrophoresis, and serum free light chain assays were reviewed retrospectively. The results for serum free light chains in cases of intact immunoglobulin monoclonal gammopathic manifestations only were analyzed.

Results

Concentrations of involved serum free light chains were significantly higher in κ chain–associated lesions than in λ chain–associated lesions. The concentration of uninvolved light chains was significantly higher in λ chain–associated lesions.

Conclusions

κ light chains are present in significantly greater abundance than are λ chains in their respective monoclonal lesions. Moreover, κ and λ light-chain levels are not comparable for similar quantitative levels of monoclonal immunoglobulins. The findings warrant a reconsideration of the role of serum free light chain concentrations and involved to uninvolved serum free light chain ratio in designation of myeloma-defining conditions and other diagnostic criteria based on serum free light chain assay.
How Transparency Affects Survey Responses
Authors: Connors Elizabeth C , Krupnikov Yanna , Ryan John Barry
Published: February 2019

Following a shift toward greater transparency, many academic journals across a variety of disciplines now require authors to post their data. At the same time, many university Institutional Review Boards (IRBs) have followed recent US federal guidelines and now require researchers to be more transparent with survey participants regarding what will happen to the collected data. In this paper, we take the first steps toward considering the interaction between these two survey research developments. Using a nationally representative panel, we show that informing survey participants that their de-identified data will be publicly shared by a researcher can affect how these participants answer certain questions. In some cases, public posting notifications can increase data quality (e.g., knowledge measures), but in other cases informing participants of the data’s future use can exacerbate social desirability issues (e.g., turnout). Our results suggest conditional costs and benefits to the intersection between two critical ethical norms underlying survey research: data-sharing and informed consent.
Development and validation of a patient-reported gout attack intensity score for use in gout clinical studies
Authors: Janssen Carly A , Oude Voshaar Martijn A H , ten Klooster Peter M , Vonkeman Harald E , van de Laar Mart A F J
Published: February 2019

Objective

Inflammation-related symptoms such as pain, swelling and tenderness of the affected joint are frequently assessed using 5-point diary rating scales in gout clinical trials. Combining these into a single gout attack symptom intensity score may be a useful summary measure for these data, which is potentially more responsive to change compared with the individual components. The objective of this study was to develop a patient-reported gout flare intensity score, the Gout Attack Intensity Score (GAIS), for use in clinical studies, that includes components for gout-related pain, swelling and tenderness.

Methods

Data from a randomized controlled trial comparing anakinra to standard of care for the treatment of acute gout attacks were used for this study. A 7-day flare diary was completed by patients, including questions relating to intensity of pain, swelling and tenderness (5-point rating scales). Scalability of these items was assessed using Mokken Scale Analysis, and reliability using greatest lower bound reliability coefficients. Known-groups validity was evaluated, as well as the responsiveness to change and the presence of floor and ceiling effects.

Results

Scalability of the single items was supported, and GAIS scores were reliable (greatest lower bound >0.80). GAIS scores demonstrated responsiveness to change with high effect sizes (>0.8), and discriminated better between responders and non-responders compared with its single-item components. No floor and ceiling effects were found.

Conclusion

The GAIS seems to be a reliable and responsive instrument for assessing patient-reported gout attack intensity that may be used in gout clinical studies.
Cash Transfers and Management Advice for Agriculture: Evidence from Senegal
Authors: Ambler Kate , de Brauw Alan , Godlonton Susan
Published: February 2019

This study analyzes impacts of large, one-time cash transfers and farm management plans among farmers in Senegal. Farmers were randomized into groups receiving advisory visits; the visits and an individualized farm management plan; or the visits, the plan, and a cash transfer. After one year, crop production and livestock ownership were higher in the transfer group relative to the group that only received visits. Livestock gains persisted after two years. The evidence suggests the results were driven by increased investment, and, indeed, there is no robust evidence that the management plans alone affected agricultural outcomes.
Orientation Learning Needs of Adjunct Clinical Faculty in the United States
Authors: Sousa Monica P. , Resha Cheryl A.
Published: February 2019

AIM

The aim of the study was to examine the orientation learning needs of adjunct clinical faculty as they transition from expert clinicians to novice educators.

BACKGROUND

Schools of nursing are increasingly using adjunct clinical faculty because of the nurse faculty shortage. Retention is a concern.

METHOD

This descriptive quantitative study used the Needs Assessment Survey for Topic Inclusion in a Guide to Orientation. Adjunct clinical faculty rated the level of importance of orientation topics and if they received needed information.

RESULTS

The majority of topics were found to be rated very important or important. Several items deemed very important or important were either not discussed or not sufficiently discussed in orientation.

CONCLUSION

The information obtained demonstrates the vast amount of information that adjunct clinical faculty want and need in an orientation.
Lessons From the Heart: A Kinesthetic Activity for Practical Nursing Students
Authors: Hudson Sue
Published: February 2019

Current trends in health care delivery require nursing programs to change how education is presented to nursing students. Active learning strategies, such as discovery learning through kinesthetic activities, have been associated with increases in student engagement and satisfaction. A kinesthetic learning strategy was developed and implemented at a licensed practical nursing program to increase student engagement and provide knowledge of cardiovascular function and various etiologies associated with the heart. The goals of the activity were to provide deeper understanding and improve critical thinking and clinical application for the student.
Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery
Authors: Turan Alparslan , Chang Christine , Cohen Barak , Saasouh Wael , Essber Hani , Yang Dongsheng , Ma Chao , Hovsepyan Karen , Khanna Ashish K. , Vitale Joseph , Shah Ami , Ruetzler Kurt , Maheshwari Kamal , Sessler Daniel I.
Published: February 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Intraoperative and postoperative hypotension are associated with myocardial and kidney injury and 30-day mortality. Intraoperative blood pressure is measured frequently, but blood pressure on surgical wards is usually measured only every 4 to 6 h, leaving long intervals during which hypotension and hypertension may be undetected. This study evaluated the incidence and severity of postoperative hypotension and hypertension in adults recovering from abdominal surgery and the extent to which serious perturbations were missed by routine vital-sign assessments.

Methods

Blood pressure was recorded at 1-min intervals during the initial 48 h in adults recovering from abdominal surgery using a continuous noninvasive monitor. Caregivers were blinded to these measurements and depended on routine vital-sign assessments. Hypotension and hypertension were characterized as time under and above various mean arterial pressure thresholds.

Results

Of 502 available patients, 312 patients with high-quality records were analyzed, with a median measurement time of 48 [interquartile range: 41, 48] postoperative hours. Nearly a quarter experienced an episode of mean arterial pressure of less than 70 mm Hg lasting at least 30 min (24%; 95% CI, 20%, 29%), and 18% had an episode of mean arterial pressure of less than 65 mm Hg lasting at least 15 min. Nearly half the patients who had mean arterial pressure of less than 65 mm Hg for at least 15 min (47%; 95% CI, 34%, 61%) were undetected by routine vital-sign assessments. Episodes of mean arterial pressure greater than 110 mm Hg lasting at least 30 min were observed in 42% (95% CI, 37%, 48%) of patients; 7% had mean arterial pressure greater than 130 mm Hg for at least 30 min, 96% of which were missed by routine assessments. Episodes of mean arterial pressure less than 65 mm Hg and mean arterial pressure greater than 110 mm Hg captured by routine vital-sign assessments but not by continuous monitoring occurred in 34 and 8 patients, respectively.

Conclusions

Postoperative hypotension and hypertension were common, prolonged, profound, and largely undetected by routine vital-sign assessments in a cohort of adults recovering from abdominal surgery. Frequent or continuous blood pressure monitoring may detect hemodynamic perturbations more effectively and potentially facilitate treatment.
Anterior and Posterior Approaches for Cervical Myelopathy
Authors: Hitchon Patrick W. , Woodroffe Royce W. , Noeller Jennifer A. , Helland Logan , Hramakova Nataliya , Nourski Kirill V.
Published: February 2019

Study Design.

A retrospective cohort study.

Objective.

The aim of this study was to identify advantages and disadvantages of the anterior and posterior approaches in the treatment of cervical stenosis and myelopathy.

Summary of Background Data.

Both anterior and posterior surgical approaches for cervical stenosis and myelopathy have been shown to result in improvement in health-related outcomes. Despite the evidence, controversy remains regarding the best approach to achieve decompression and correct deformity.

Methods.

We retrospectively reviewed patients with cervical stenosis and myelopathy who had undergone anterior cervical fusion and instrumentation (n = 38) or posterior cervical laminectomy and instrumentation (n = 51) with at least 6 months of follow-up. Plain radiographs, magnetic resonance imaging, and computed tomography scans, as well as health-related outcomes, including Visual Analog Scale for neck pain, Japanese Orthopedic Association score for myelopathy, Neck Disability Index, and Short Form-36 Health Survey, were collated before surgery and at follow-up (median 12.0 and 12.1 months for anterior and posterior group, respectively).

Results.

Both anterior and posterior approaches were associated with significant improvements in all studied quality of life parameters with the exception of general health in the anterior group and energy and fatigue in the posterior group. In the anterior group, follow-up assessment revealed a significant increase in C2–7 lordosis. Both approaches were accompanied by significant increases in C2–7 sagittal balance [sagittal vertical axis (SVA)]. There were two complications in the anterior group and nine complications in the posterior group; the incidence of complications between the two groups was not significantly different.

Conclusion.

When the benefits of one approach over the other are not self-evident, the anterior approach is recommended, as it was associated with a shorter hospital stay and more successful restoration of cervical lordosis than posterior surgery.

Level of Evidence: 3
Morphometric Characteristics of Sacral-2 Alar Iliac Screw Fixation in Pediatric Population
Authors: Shen Zhi-Hao , Wang Kai , Chen Dong , Zheng Xuan-Qi , Huang Jin-Feng , Wu Ai-Min
Published: February 2019

Study Design.

A computed tomographic assessment.

Objective.

To establish morphometric data of sacral-2 alar iliac (S2AI) screw fixation in pediatric population.

Summary of Background Data.

Studies on morphometric parameters of S2AI screw fixation are mostly based on adult population. The pediatric scoliosis also needs the S2AI screw fixation, however, without the previous morphometric information of among pediatric population.

Methods.

Computed tomography (CT) scans of 120 pediatric patients without spinal deformities are obtained and imported to Mimics software for 3D reconstruction. Then, a cylinder (radius of 3.25 mm) is drawn to imitate the screw trajectory of S2AI screw and adjusted to a maximum upward and downward angle to obtain the feasible region. Nine parameters of the S2AI screw are measured. Differences between age groups are compared and significant statistical correlations are carefully studied to determine the potentially important clinical relationships.

Results.

The mean values and standard deviations (SD) for nine parameters at the maximum upward and downward angles were determined. With age increased, the S2AI screw trajectory becomes more caudal in the coronal (44.03 ± 4.43°–53.15 ± 4.68°) and sagittal planes (50.33 ± 5.89°–57.69 ± 4.21°) and more lateral in the transverse plane (49.40 ± 5.90°–54.44 ± 2.99°), and all of the distance parameters include max-length, sacral distance, iliac width, S2 midline, iliac wing, and skin distance increased. Age has a more significant effect on other parameters than transverse angle and skin distance (P < 0.05).

Conclusion.

The S2AI screw fixation could be used on pediatric population too, but the pediatric population had smaller size of pelvis than adults, surgeons should choose the smaller diameters and the shorter length of screws for pediatric population depends on their age.

Level of Evidence: N/ A
Dual Modality Radiation With External Beam Radiation Therapy and Transarterial Radioembolization for Hepatocellular Carcinoma With Gross Vascular Invasion
Authors: McGee Heather M. , King Michael J. , Özbek Umut , Olson Ashley , Kim Edward , Fischman Aaron M. , Schwartz Myron , Rosenzweig Kenneth E. , Buckstein Michael
Published: February 2019

Objectives:

Patients with hepatocellular carcinoma (HCC) and gross vascular invasion (GVI) have poor outcomes with systemic therapy such as sorafenib. Both external beam radiation therapy (EBRT) and transarterial radioembolization (TARE) have been utilized for this patient population. We sought to compare outcomes using dual modality radiation (EBRT+TARE) versus EBRT alone in patients with HCC and GVI.

Materials and Methods:

Between 2011 and 2017, 45 patients with HCC and GVI were treated with EBRT±TARE at our institution. Progression-free survival (PFS) and overall survival (OS) were assessed and compared using Kaplan-Meier method and log-rank test. Univariable and multivariable Cox proportional hazards regression was used to assess the impact of the variables stage, etiology of cirrhosis, Child-Pugh (CP) score, and Karnofsky Performance Score (KPS) on PFS and OS.

Results:

Patient characteristics were well-balanced except for KPS (80 vs. 90) and CP score. Median OS for patients receiving EBRT+TARE was 263 days (95% confidence interval [CI]: 167, -) versus 193 days (95% CI: 51, 262) for EBRT alone (P=0.049). However, this did not hold up on MVA. When EBRT and TARE were delivered within 2 months as planned (n=12), median PFS was 218 days (95% CI: 44, -) for dual modality radiation versus 63 days (95% CI: 38, 137) for EBRT alone (P=0.048). When EBRT and TARE were delivered within 6 months, the difference in PFS was no longer seen (P=NS), because some patients received TARE as a salvage therapy.

Conclusions:

Dual modality radiation with EBRT and TARE may be associated with improved OS in patients with HCC and GVI. Dual modality radiation may be associated with improved PFS in patients with HCC and GVI compared with EBRT alone when EBRT and TARE are delivered within 2 months of each other as part of a planned dual modality treatment strategy. However, since this is a retrospective study with inherent selection bias, these findings need further validation in a prospective clinical trial for patients with HCC and GVI.
Early-life stress influences acute and sensitized responses of adult mice to cocaine by interacting with GABAA α2 receptor expression
Authors: Dixon Claire I. , Walker Sophie E. , Swinny Jerome , Belelli Delia , Lambert Jeremy J. , King Sarah L. , Stephens David N.
Published: February 2019

Early-life stress (ELS) is known to exert long-term effects on brain function, with resulting deleterious consequences for several aspects of mental health, including the development of addiction to drugs of abuse. One potential mechanism in humans is suggested by findings that ELS interacts with polymorphisms of the GABRA2 gene, encoding α2 subunits of GABAA receptors, to increase the risk for both post-traumatic stress disorder and vulnerability to cocaine addiction. We used a mouse model, in which the amount of material for nest building was reduced during early postnatal life, to study interactions between ELS and expression of α2-containing GABAA receptors in influencing cocaine-related behaviour. Breeding of parents heterozygous for a deletion of α2 resulted in litters containing homozygous knockout (α2−/−), heterozygous knockout (α2+/−) and wild-type (α2+/+) offspring. Following the ELS procedure, the mice were allowed to develop to adulthood before being tested for the acute effect of cocaine on locomotor stimulation, behavioural sensitization to repeated cocaine and to cocaine-conditioned activity. Exposure to ELS resulted in increased acute locomotor stimulant effects of cocaine across all genotypes, with the most marked effects in α2−/− mice (which also showed increased activity following vehicle). Repeated cocaine administration to nonstressed mice resulted in sensitization in α2+/+ and α2+/− mice, but, in keeping with previous findings, not in α2−/− mice. Previous exposure to ELS reduced sensitization in α2+/+ mice, albeit not significantly, and abolished sensitization in α2+/− mice. Conditioned activity was elevated following ELS in all animals, independently of genotype. Thus, while the enhanced acute effects of cocaine following ELS being most marked in α2−/− mice suggests a function of α2-containing GABAA receptors in protecting against stress, the interaction between ELS and genotype in influencing sensitization may be more in keeping with ELS reducing expression of α2-containing GABAA receptors. The ability of ELS to increase cocaine-conditioned locomotor activity appears to be independent of α2-containing GABAA receptors.
The muscarinic agonist pilocarpine modifies cocaine-reinforced and food-reinforced responding in rats: comparison with the cholinesterase inhibitor tacrine
Authors: Grasing Kenneth W. , Xu Haiyang , Idowu Jessica Y.
Published: February 2019

Activation of muscarinic receptors in the brain antagonizes the actions of cocaine, blocking both its discriminative stimulus and reinforcing properties. Pilocarpine is a nonselective muscarinic agonist that is used clinically, but has not been well characterized for its actions during cocaine-reinforced behavior. This study evaluated its effects on cocaine-reinforced and food-reinforced behaviors in rats, using the cholinesterase inhibitor tacrine as a comparator. Intraperitoneal pilocarpine or tacrine at doses of 1.0 mg/kg or more attenuated self-administration of low-dose cocaine (0.1 mg/kg injection) but also increased oral movements. Pilocarpine was less potent than tacrine in decreasing responding supported by low or intermediate amounts of liquid food. Combined treatment with pilocarpine and tacrine was more effective than either compound alone in attenuating self-administration of intermediate-dose cocaine. At a low (0.66 mg/kg) dose which did not modify reinforced responding, pilocarpine increased nonspecific behavior (sniffing, rearing, and activity) in cocaine-reinforced but not in food-reinforced animals; with greater doses increasing cholinergic or gastrointestinal signs. These effects were most consistently correlated with changes in reinforcement in rats responding for cocaine relative to food-reinforced animals. Overall, pilocarpine exhibited modest selectivity for attenuating self-administration of low-dose cocaine without affecting a nondrug reinforcer.
Longitudinal Evaluation of the Progression of Keratoconus Using a Novel Progression Display
Authors: Kosekahya Pinar , Caglayan Mehtap , Koc Mustafa , Kiziltoprak Hasan , Tekin Kemal , Atilgan Cemile Ucgul
Published: February 2019

Objectives:

To evaluate the longitudinal tomographic changes and to compare the discriminatory potential of a novel progression display between progressive and nonprogressive keratoconic eyes.

Methods:

Retrospective evaluation was made of 81 eyes of 81 patients with keratoconus who had undergone Scheimpflug measurements at least twice with an interval of 12 months or longer between each measurement. The progressive group was defined as 36 eyes, which showed progression according to the definition of the global consensus on keratoconus and ectatic diseases when 2 of the 3 criteria were met, and the other 45 eyes were considered the nonprogressive group. The main outcome measures from progression display were “A” for anterior radius of curvature, “B” for posterior radius of curvature, “C” for thinnest pachymetry, “D” for distance visual acuity; Kmax; Q-value front and back; index of surface variance (ISV), vertical asymmetry, height asymmetry, and height decentration; overall deviation of normality (final D); average pachymetric progression index; and maximum Ambrósio relational thickness.

Results:

The rate of change per year of A, B, C, thinnest pachymetry, Kmax, final D, and ISV was significantly different between groups (P≤0.01 for all values). It was determined that yearly change rates greater than 0.12 for A, 0.14 for B, 10.04 μm for thinnest pachymetry, 0.68 D for Kmax, 0.15 for final D, and 2.11 for ISV might indicate progression in keratoconus management.

Conclusions:

Belin progression display parameters may be useful in discriminating progressive from nonprogressive keratoconic eyes.
Does Herpes 6 Infection Have a Role in Bell’s Palsy Among Children and Adolescents?
Authors: Genizi Jacob , Golan-Shany Orit , Tarazov Tanya , Pechter Sarel , Assaf Nurit , Segal Idan , Srugo Isaac , Bamberger Ellen
Published: February 2019

Background:

Bell’s palsy is a peripheral paralysis of the seventh cranial nerve, whose etiology is unknown. Using polymerase chain reaction technology, it is possible to sample accessible body fluids and identify possible viral factors. The purpose of this research is to investigate its connection to the herpes virus family by testing for the presence of the virus in the saliva and tear fluid of Bell’s palsy patients.

Methods:

Saliva and tears were collected from 42 children and adolescents suffering from idiopathic facial nerve paralysis. Polymerase chain reaction was used to test for the presence of the viruses Epstein-Barr virus, cytomegalovirus, herpes simplex virus 1 and 2, varicella zoster virus and human herpes virus 6 (HHV-6). Samples were also taken from a control group without paralysis. A second specimen was taken from patients who tested positive for HHV-6 several months after their recovery.

Results:

Of the 42 patients in the study group, 71% (30 patients) tested positive for HHV-6, compared with only 37% of the control group (P = 0.001). The prevalence of the other 5 viruses tested was low—herpes simplex virus 1: 9.5%, Epstein-Barr virus: 9.5%, cytomegalovirus: 4.8%, varicella zoster virus: 2.3% and herpes simplex virus 2: 0%. Twenty-four of the 30 patients who were HHV-6-positive during their illness were reexamined following recovery. Only 13 patients (54.2%) excreted the virus after recovery from the paralysis.

Conclusions:

Herpes 6 virus appears to play some role in the etiology of facial nerve paralysis. The virus was detected in the saliva of children during acute illness and decreased with resolution. Our research opens new insights linking HHV-6 to the etiology of Bell’s palsy in children.
HIV-1 Drug Resistance and Virologic Outcomes Among Tanzanian Youth Living With HIV
Authors: Dow Dorothy E. , Shayo Aisa M. , Cunningham Coleen K. , Mmbaga Blandina T.
Published: February 2019

Adolescents living with HIV tend to have poor adherence that often breeds HIV resistance mutations and virologic failure (VF). This study evaluated risk behavior, virologic outcomes and HIV resistance mutations in Tanzanian youth living with HIV. Participants were primarily perinatally infected and of mean age 16.7 years; among them 41.5% had VF. Those receiving first-line therapy demonstrated over 90% resistance to their current therapy.
The Effects of Community Health Center Care on Medical Expenditures for Children and Adults
Authors: Bruen Brian K. , Ku Leighton
Published: February 2019

This study examines whether community health center (CHC) patients have lower medical expenditures. Using 2011-2012 Medical Expenditure Panel Survey data, propensity score methods are used to compare annual expenditures for adults and children receiving at least half their ambulatory care at CHCs versus those who did not. For children, CHC use was associated with 35.3% lower total medical expenditures ($627), 40.0% lower ambulatory expenditures ($279), and 49.1% lower prescription drug expenditures ($157) (all Ps < .05). For adults, the reduction in hospital expenditures for CHC users ($529) was statistically significant at a P < .10 threshold. Estimated differences in total expenditures and other expenditure categories were not statistically significant for adults.
Entecavir and other nucleos(t)ide analogs prophylaxis in hepatitis B virus-related liver transplantation: long-term efficacy and safety
Authors: Darweesh Samar K. , Gad Amal A. , Akroof Kafya , ElLatif Zainab A.
Published: February 2019

Background and aim

Although hepatitis B virus (HBV) recurrence after liver transplantation (LTx) has been reduced since the application of the combination of hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogs (NUCs), the optimum regimen to prevent HBV recurrence with LTx favorable outcome is still not clear.

Aim

The aim was to evaluate the efficacy and safety of NUCs prophylaxis (±HBIG) against HBV recurrence after LTx.

Patients and methods

This was a retrospective cohort-longitudinal study on 44 HBV-related post-LTx patients on anti-HBV prophylactic therapy. They included the entecavir (ETV)-based (n=34, 30 males) and the other NUC-based (n=10, 7 males) groups±HBIG.

Results

The median age was 63.5 (60–70) years in ETV and 62.5 (55–65) years in other NUCs groups. The mean follow-up duration was 6.09±1.83 years in ETV-based group and 6.3±1.89 years in other NUCs-based group. The mean ETV duration was 3.47±3.04 years. In ETV+HBIG patients, none of them developed HBV recurrence throughout the ±8 years. In the 14 patients on ETV+other NUC+HBIG, four developed HBsAg positive and then transformed to HbsAb positive at the end of ±8 years without hepatitis or detectable HBV-DNA. Liver graft function showed nonsignificant difference for ETV-based patients, in comparison with other NUC groups (P=0.09). With subdivision, the graft function was maintained significantly better in ETV+HBIG or other NUCs+HBIG (P=0.04) groups. None of our patients reported NUCs-related complications or adverse effects.

Conclusion

ETV and other NUCs were effective and safe as a long-term prophylaxis of HBV recurrence after LTx, leading to a good graft function. HBsAg temporally reappeared in a minority of patients, where all showed HBsAb seroconversion without detectable HBV-DNA or clinical hepatitis.
The effect of repetitive transcranial magnetic stimulation combined with traditional dysphagia therapy on poststroke dysphagia: a pilot double-blinded randomized-controlled trial
Authors: Tarameshlu Maryam , Ansari Noureddin N. , Ghelichi Leila , Jalaei Shohreh
Published: February 2019

Dysphagia following stroke is common and can lead to severe complications such as aspiration pneumonia, but there is inconclusive evidence on how poststroke dysphagia should be treated. This study aimed to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with the traditional dysphagia therapy on the swallowing function in patients with poststroke dysphagia. In this pilot double-blind randomized clinical trial, 18 patients with poststroke dysphagia were allocated randomly to three groups: (i) traditional dysphagia therapy, (ii) rTMS, and (iii) combined intervention. Patients received traditional dysphagia therapy for 18 treatment sessions three times per week. The inhibitory rTMS was applied to the intact cerebral hemisphere at 1 Hz with a train of 1200 for 5 consecutive days. The patients in the combined intervention group received traditional dysphagia therapy and rTMS simultaneously. The Mann Assessment of Swallowing Ability (MASA) and Functional Oral Intake Scale were performed before treatment, after the end of the fifth session, after the end of the 10th session, after the end of the 15th session, and after the end of the 18th session. All groups had improved on MASA and Functional Oral Intake Scale scores over time (P<0.01). The improvements achieved in all outcomes were significantly greater in the combined intervention group than those of the traditional dysphagia therapy and rTMS groups. The large effect sizes were found for the MASA score in all groups: traditional dysphagia therapy group (d = 3.57), rTMS group (d = 2.67), and combined intervention group (d = 3.87). This pilot randomized-controlled trial showed that the combination of rTMS and traditional dysphagia therapy significantly improved swallowing function in patients with poststroke dysphagia.
Cultural Identity Confusion and Psychopathology
Authors: Groen Simon P.N. , Richters Annemiek J.M. , Laban Cornelis J. , van Busschbach Jooske T. , Devillé Walter L.J.M.
Published: February 2019

Although there is ample empirical evidence that traumatic events, postmigration stress, and acculturation problems have a great impact on the mental health of refugees, so far no studies have included cultural identity after migration in the equation. This mixed-methods study conducted among Afghan and Iraqi refugee and asylum-seeker psychiatric patients aims to fill this gap. Associations between postmigration stress, symptoms of anxiety and depression disorders, and symptoms of posttraumatic stress disorder were significant. When differentiated for the two groups, associations with postmigration stress were no longer significant for Afghan patients, who were predominantly younger and more often single, lower educated, and without resident status compared with Iraqi patients. Qualitative results indicate that, in addition to psychopathology and postmigration stress, acculturation problems contribute to confusion of cultural identity. The findings suggest that reduction of postmigration stress and acculturation problems may clarify cultural identity and as such may contribute to posttraumatic recovery.
Compressed Sensing and Parallel Imaging for Double Hepatic Arterial Phase Acquisition in Gadoxetate-Enhanced Dynamic Liver Magnetic Resonance Imaging
Authors: Yoon Ja Kyung , Kim Myeong-Jin , Lee Sunyoung
Published: February 2019

Objectives

The aim of this study was to investigate the utility of a combined compressed sensing and parallel imaging (C-SENSE) technique for single breath-hold, double arterial phase (AP) examinations in gadoxetate-enhanced magnetic resonance imaging (MRI) of the liver.

Materials and Methods

We retrospectively reviewed single breath-hold, double AP images obtained by using a C-SENSE technique for gadoxetate-enhanced dynamic liver MRI in a total of 127 patients (89 men and 38 women; mean age, 62.6 ± 7.5 [range, 29–87] years). For qualitative analysis, 3 readers independently scored the timing of the AP images, degree of artifacts, and overall image quality on both the first and second AP images (AP1 and AP2, respectively). The combined scores of AP1 and AP2 (AP1 + AP2) were determined by using the better scores from the 2 sets. Focal lesion detectability was assessed for 124 lesions with arterial enhancement on AP1 and AP2, and on simultaneous review of both AP1 and AP2. Then, in 62 patients whose previous gadoxetate-enhanced single AP images were available, AP timing and overall image quality were compared between single and double AP images. Wilcoxon signed rank test was performed for each comparison. Fleiss kappa value was calculated for analysis of interreader agreement.

Results

Optimal AP timing was achieved in 86% of AP1, 65% of AP2, and 90% of AP1 + AP2 images; results were significantly better for AP1 and AP1 + AP2 images than for AP2 images (P < 0.001 for both comparisons). Respiratory motion artifacts were negligible in 73% of the AP1 + AP2 images, which was significantly better than the corresponding values for the AP1 (61%, P < 0.001) or AP2 (50%, P < 0.001) images. Overall image quality was significantly better for AP1 + AP2 (excellent in 54%) than for AP1 (49%, P < 0.001) or AP2 (39%, P < 0.001) images. Lesion detectability was comparable between AP1 and AP2 images and was significantly better on AP1 + AP2. Comparison of single and double AP imaging techniques showed better AP timing (P = 0.004) and fewer respiratory motion artifacts (P < 0.001) for AP1 + AP2 than for the single AP images.

Conclusions

The C-SENSE technique may facilitate single breath-hold, double AP imaging with optimal timing and reduced respiratory motion artifacts in gadoxetate-enhanced dynamic MRI of the liver.
Shear Wave Elastography Evaluation of Testes in Patients With Varicocele
Authors: Erdogan Hasan , Durmaz Mehmet Sedat , Arslan Serdar , Gokgoz Durmaz Funda , Cebeci Hakan , Ergun Osman , Sogukpinar Karaagac Seda
Published: February 2019

We aimed to determine histological damage in patients with varicocele by comparing the elasticity of their affected testes with that of their normal contralateral testes as well as normal testes of control subjects without varicocele using shear wave elastography (SWE). In total, 48 patients with varicocele (96 testes) and 52 control subjects (104 testes) were included in this study. Shear wave elastography values were measured in the longitudinal plane using an oval region of interest that covered as much of the testicular contours as possible. Fifty testes with varicocele were classified as group A, 46 normal contralateral testes of the same patients as group B, and 104 normal testes of control subjects as group C. The normal group C testes were randomly chosen from patients who had applied for ultrasonography for any reason and agreed to participate in the study. The testicular volume and SWE values were compared between these 3 groups. The average age of the patients was 28.45 years, and no significant difference in age was found between the 3 groups (P = 0.665). A significant difference in the testicular volume was found between groups A and C (P = 0.014). The SWE values were significantly higher in group A than in groups B and C (P < 0.001). No significant correlation was observed between the testicular volume and SWE values in any of the groups. Our results showed that SWE can be used as an effective technique to assess testicular stiffness in patients with varicocele to predict interstitial fibrosis and the severity of histological damage.
Sonographic Appearances of Portal Vein Abnormalities
Authors: Kulkarni Naveen M. , Griffin Michael O. , O'Connor Stacy D. , Sudakoff Gary
Published: February 2019

Portal venous system evaluation is required in many clinical circumstances, as substantial morbidity and mortality can be associated with a spectrum of portal vein abnormalities. Portal venous system pathologies can be congenital or acquired, and the knowledge of their imaging appearances will allow for a confident diagnosis and appropriate treatment options. In addition, a firm understanding of anatomical variants is important for planning surgical procedures and percutaneous interventions of the liver. This article will review various imaging appearances of portal venous systems abnormalities.
High Central Venous-to-Arterial CO2 Difference is Associated With Poor Outcomes in Patients After Cardiac Surgery: A Propensity Score Analysis
Authors: Chen Tao , Pan Tuo , Luo Xuan , Wang Dongjin
Published: February 2019

Purpose:

In contrast to arterial lactate, previous studies have proposed central venous-to-arterial CO2 difference (P (v-a)CO2) as a more useful guide for categorizing patients at risk of developing septic shock. It is worthwhile studying P (v-a)CO2 in determining whether it could serve as a useful predictor for poor postoperative outcomes in patients undergoing cardiac surgery. We investigated the ability of P(v-a)CO2 to predict poor outcomes of patients with postoperative cardiogenic shock.

Methods:

In total, 1,672 patients were enrolled in this study from January 1, 2014 to June 1, 2017. Of these patients, 143 exhibited complicated and poor outcomes. To address any bias, we derived a propensity score predicting the functions of P(v-a)CO2 on poor outcomes and matched 114 cases to 114 controls with a similar risk profile. In this cohort study, poor outcomes were defined as the occurrence of any adverse complications, including sudden death, cardiac arrest, extracorporeal membrane oxygenation, oliguria, and the administration of a large amount of vasoactive-inotropic drugs.

Results:

In propensity-matched patients, significant differences in P(v-a)CO2 (6.11 ± 2.94 mm Hg vs. 11.21 ± 5.22 mm Hg, P < 0.001) were noted between the control group and poor outcome group. The area under the receiver operating characteristic curve of P(v-a)CO2 (AUC: 0.837, 95% CI: 0.782–0.892) for the detection of poor outcomes was significantly better compared to that of the central venous oxygen saturation and arterial lactate. Additionally, there was a negative correlation between cardiac index and P(v-a)CO2 (R= −0.68, P < 0.001).

Conclusion:

We have shown a correlation between P(v-a)CO2 to cardiac output which may be used as an alternative metric to predict the poor outcomes of patients with postoperative cardiogenic shock.
Treatment of Poststroke Pathologic Laughing With Duloxetine: A Case Series
Authors: Shin Sang Hoon , Kim Yong Wook , Kim Na Young
Published: February 2019

Objectives

Pathologic laughing is characterized by episodes of uncontrollable laughter caused by underlying neurologic disturbances, such as stroke. Several types of medication, including selective serotonin reuptake inhibitors, have demonstrated only limited success at treating the condition. Duloxetine, a dual serotonin-norepinephrine reuptake inhibitor, is reportedly effective in treating the symptoms of mood disorders. We herein introduce a prospective consecutive sample of stroke patients with pathologic laughing treated with duloxetine.

Methods

We enrolled patients without a history of psychological illness who exhibited poststroke pathologic laughter. Duloxetine administration was commenced at an initial dose of 30 mg once daily. The dose was increased to 60 mg once daily within 2 weeks for all patients except 2. The effect of the treatment was assessed by means of the Pathological Laughter and Crying Scale.

Results

A total of 7 patients were included in the study. Improvements were observed within an average of 10 days after duloxetine administration. Pathological Laughter and Crying Scale score decreased after duloxetine administration in all patients, and 4 patients demonstrated a decrease in score of more than 50%. All patients reported subjective improvement of symptoms, and no adverse effects were observed.

Conclusions

This case series demonstrates that duloxetine could attenuate pathologic laughing exhibited by stroke patients; however, further randomized controlled studies are necessary to validate our findings.
Network reconstruction from infection cascades
Authors: Braunstein Alfredo , Ingrosso Alessandro , Muntoni Anna Paola
Published: February 2019

Accessing the network through which a propagation dynamics diffuses is essential for understanding and controlling it. In a few cases, such information is available through direct experiments or thanks to the very nature of propagation data. In a majority of cases however, available information about the network is indirect and comes from partial observations of the dynamics, rendering the network reconstruction a fundamental inverse problem. Here we show that it is possible to reconstruct the whole structure of an interaction network and to simultaneously infer the complete time course of activation spreading, relying just on single epoch (i.e. snapshot) or time-scattered observations of a small number of activity cascades. The method that we present is built on a belief propagation approximation, that has shown impressive accuracy in a wide variety of relevant cases, and is able to infer interactions in the presence of incomplete time-series data by providing a detailed modelling of the posterior distribution of trajectories conditioned to the observations. Furthermore, we show by experiments that the information content of full cascades is relatively smaller than that of sparse observations or single snapshots.