bluuebunny/crossref_metadata_2025 huggingface dataset:
Issues in Developing and Evaluating a Culturally Tailored Internet Cancer Support Group
Authors: Im Eun-Ok , Ji Xiaopeng , Zhang Jingwen , Kim Sangmi , Lee Yaelim , Chee Eunice , Chee Wonshik , Tsai Hsiu-Min , Nishigaki Masakazu , Yeo Seon Ae , Schapira Marilyn , Mao Jun James
Published: July 2016

The purpose of this article is to explore practical issues in developing and implementing a culturally tailored Internet Cancer Support Group for a group of ethnic minority patients with cancer—Asian Americans. Throughout the research process of the original study testing the Internet cancer support group, the research team made written records of practical issues and plausible rationales for the issues. Weekly group discussion among research team members was conducted, and the discussion records were evaluated and analyzed using a content analysis (with individual words as the unit of analysis). The codes from the analysis process were categorized into idea themes, through which the issues were extracted. The issues included those in (1) difficulties in using multiple languages, (2) collaboration with the information technology department and technical challenges, (3) difficulties in recruitment, (4) difficulties in retention, (5) optimal timing, and (6) characteristics of the users. Based on the findings, we suggest that researchers plan a workable translation process, check technical needs in advance, use multiple strategies to recruit and retain research participants, plan the right time for data collection, and consider characteristics of the users in the study design.
Social Competence in Childhood Brain Tumor Survivors: Feasibility and Preliminary Outcomes of a Peer-Mediated Intervention
Authors: Devine Katie A. , Bukowski William M. , Sahler Olle Jane Z. , Ohman-Strickland Pamela , Smith Tristram H. , Lown E. Anne , Patenaude Andrea Farkas , Korones David N. , Noll Robert B.
Published: July 2016

Objective:

Evaluate the acceptability, feasibility, and preliminary outcomes of a peer-mediated intervention to improve social competence of brain tumor survivors and classmates.

Method:

Twelve childhood brain tumor survivors and 217 classroom peers in intervention (n = 8) or comparison (n = 4) classrooms completed measures of social acceptance and reputation at 2 time points in the year. The intervention (5–8 sessions over 4–6 weeks) taught peer leaders skills for engaging classmates. Individual and classroom outcomes were analyzed with analysis of covariance.

Results:

Recruitment rates of families of brain tumor survivors (81%) and schools (100%) were adequate. Peer leaders reported satisfaction with the intervention. Preliminary outcome data trended toward some benefit in increasing the number of friend nominations for survivors of brain tumors but no changes in other peer-reported metrics. Preliminary results also suggested some positive effects on classroom levels of victimization and rejection.

Conclusion:

A peer-mediated intervention was acceptable to families of brain tumor survivors and feasible to implement in schools. Findings warrant a larger trial to evaluate improvements for children with brain tumors and their peers.
Reported History of Developmental Regression and Restricted, Repetitive Behaviors in Children with Autism Spectrum Disorders
Authors: Bradley Catherine C. , Boan Andrea D. , Cohen Amy P. , Charles Jane M. , Carpenter Laura A.
Published: July 2016

Objective:

Previous research on developmental regression in youth with autism spectrum disorders (ASD) has often been limited by the definition, assessment, and methodology used to evaluate and describe regression. This study sought to overcome these limitations by examining the prevalence, timing, and correlates of documented cases of developmental regression in a large, epidemiological sample of youth with ASD.

Method:

Utilizing a population-based surveillance methodology, this study includes 862 youth with ASD identified through abstraction and clinician record review.

Results:

Approximately 21% of the sample had developmental regression documented in their medical or educational records with the mean age of regression being 24.2 ± 14.3 months. Youth with ASD and a history of regression were more likely to have comorbid intellectual disability, a prior community diagnosis of ASD, and be eligible for educational services as a student with autism. Youth with a documented history of regression also had higher rates of restricted, repetitive behaviors, such as stereotyped speech, nonfunctional routines/rituals, and sensory interests.

Conclusion:

Results suggest that youth with a history of regression are not only more likely to have comorbid intellectual disability but are also are more likely to have been previously diagnosed with ASD in the community, suggesting that development regression may play an important role in identifying children who are at the risk for ASD and need evaluation. Higher rates of restricted, repetitive behaviors in youth with a documented history of regression may also provide important insights into the relationship between ASD and developmental regression.
Acute Agitation and Self-Injury in a 5-Year Old with Autism
Authors: Schweitzer Jason , James Christine , Jenkins Willough , Reiff Michael I. , Stein Martin T.
Published: July 2016

CASE: A 5-year-old nonverbal child with autism spectrum disorder (ASD) was admitted to inpatient pediatrics with new onset agitation and self-injurious behavior. His parents described him as a pleasant child without previous episodes of self-injury. Four days before admission, the parents noted new irritability followed by 2 days of self-injury to the face without clear precipitant. His hitting intensified with closed fist to face, and he required parental physical restraint to prevent further injury. Car rides and ibuprofen provided only temporary relief. He consumed minimal liquid and ate no solid food for 2 days. The parents denied any changes to the environment or routine and denied recent travel, sick contacts, fevers, cough, otalgia, vomiting, diarrhea, and constipation. The patient had been diagnosed with ASD at age 18 months old but had no other significant medical history.

On examination, the child was alert but distressed and restless, wearing padded mitts as his parents attempted to calm him by pushing him in a stroller. He had multiple areas of severe bruising and facial swelling in the right periorbital area, cheek, and jaw. The rest of the physical examination was unremarkable. Laboratory results included a leukocytosis with left shift, a normal metabolic panel, and an elevated creatine kinase. Other investigations included a normal lumber puncture, chest radiograph, head and face computerized tomography without contrast, and brain magnetic resonance imaging. A dentist consultant examined him and noted an erupting molar but no decay or abscesses. A psychiatric evaluation was requested as there was no clear medical source for the patient's distress.
The urinary microbiota: a paradigm shift for bladder disorders?
Authors: Brubaker Linda , Wolfe Alan
Published: July 2016

Purpose of review

A resident microbial community [the female urinary microbiota (FUM)] exists within the female bladder of many adult women. Information about the FUM is likely to modify the diagnosis, prevention and treatment of adult women with urinary disorders. This review highlights key findings from recent literature relevant to adult, nonpregnant women.

Recent findings

Similar to other human microbial communities, the FUM varies in its characteristics, including organism diversity and predominant organism identity. Recent literature reveals previously undetected organisms and community characteristics that appear associated with certain urinary symptoms, including urinary tract infection and urgency urinary incontinence. The role of individual organisms may range from beneficial to pathogenic and may vary on the basis of an individual's FUM characteristics. The simple dichotomy of ‘infected’ or ‘sterile’ no longer sufficiently captures the microbiological complexity of the female bladder.

Deeper understanding of the FUM should yield better methods to restore the microbiota to a healthy state, providing symptom relief. Opportunities to modify the FUM without antibiotic use are exciting possibilities for future research; stand-alone antibiotic use may be reevaluated to improve treatment precision. Long-standing nomenclature for conditions such as asymptomatic bacteriuria and urinary tract infection will likely require modification.
Surgical Delay of the Nipple–Areolar Complex in High-risk Nipple-sparing Mastectomy Reconstruction
Authors: Martinovic Maryann E. , Pellicane James V. , Blanchet Nadia P.
Published: July 2016

As nipple-sparing mastectomy gains increasing popularity, minimizing the risk of nipple necrosis continues to be of critical importance to patients and surgeons. Patients with large or ptotic breasts, scars from previous cosmetic and/or oncologic breast surgery, or previous irradiation have often been denied nipple-sparing mastectomy (NSM) because of increased risk of nipple necrosis. A variety of interventions have been suggested to minimize the ischemic insult to the nipple–areolar complex (NAC). This article presents our experience in 26 high-risk patients with surgical delay of the NAC.
Chimeric Superficial Circumflex Iliac Perforator Flap Including External Oblique Fascia: A Refinement of Conventional Harvesting
Authors: Fernandez Garrido Manuel , Qiu Shan Shan , Vega Garcia Carmen , Pons Playa Gemma , Masiá Ayala Jaume
Published: July 2016

The superficial circumflex iliac perforator (SCIP) flap is one of the most suitable flaps to cover distal extremity defects due to its lack of bulkiness and donor site concealment. However, it is less popular than other perforator flaps due to its anatomical variations, short pedicle length, and small caliber vessels. We describe a novel design for the SCIP flap, consisting of a chimeric flap with a piece of the external oblique muscle fascia. The purpose of this design is to cover and protect the vascular anastomosis in distal lower limb defects where recipient vessels are superficial and skin coverage is poor. In addition, lengthening the pedicle with this design makes the flap more versatile. The addition of a cuff of fascia in harvesting of the SCIP flap lengthens the pedicle, allowing easier insetting of the skin paddle and providing complete protection and coverage of the vessels. This procedure allows greater versatility in inset of the skin paddle and is particularly suitable in cases where recipient vessels are superficial or when skin coverage is poor.
A Case of Extensive Sacral Decubitus Ulcer Complicated by an Epidural Abscess
Authors: Murata Mai , Yoshikawa Katsuhiro , Hiratsuka Munehisa , Suzuki Shigehiko
Published: July 2016

We herein report a 62-year-old man with an extensive sacral decubitus ulcer complicated by an epidural abscess. An epidural abscess is a rare disease, but it should be considered in the differential diagnosis of a deep infection with decubitus. Moreover, the diagnosis may be late in such instances and should be carefully considered when a patient has paralysis.
Detectability of Visual Field Defects in Glaucoma With High-resolution Perimetry
Authors: Numata Takuya , Matsumoto Chota , Okuyama Sachiko , Tanabe Fumi , Hashimoto Shigeki , Nomoto Hiroki , Shimomura Yoshikazu
Published: July 2016

Purpose:

To extrapolate the optimal test point resolution for assessment of glaucomatous visual field (VF) defects including subtle functional defects, we performed high-resolution perimetry with the 0.5 degrees test point resolution.

Subjects and Methods:

Subjects were 11 eyes of 11 normal volunteers and 16 eyes of 16 glaucomatous patients. Octopus 900 custom test was used to measure 61 points with the test point resolution of 0.5 degrees on the temporal meridian of 45 degrees within the eccentricity of 30 degrees. In the glaucoma cases, VF profiles were extracted in 17 patterns of the test point resolutions that ranged from 0.5 to 8.5 degrees and the mean defect (MD), square root of loss variance (sLV), and maximum sensitivity loss (Max loss) were calculated. The influence of the test point resolution on MD, sLV, and Max loss was examined. In addition, the test range from the fixation point to the eccentricity of 30 degrees was divided into 3 zones. Similarly, each zone was investigated if the test point resolution exerted influence on the MD, sLV, and Max loss.

Results:

Our glaucoma cases did not show any significant differences in MD and sLV regardless of the resolution. Max loss showed significant difference at resolution ≥1.0 degree. MD and sLV did not show significant differences by the change of resolution in each zone. Max loss showed significant differences at resolution ≥1.5 degrees within the central 10 degrees.

Conclusions:

To detect subtle VF defects within the eccentricity of 10 degrees, high-resolution perimetry with the test point resolution of <1.5 degrees is necessary.
Risk Factors for False Fecal Immunochemical Test Results in Colorectal Cancer Screening
Authors: Kim Nam Hee , Park Jung Ho , Park Dong Il , Sohn Chong Il , Choi Kyuyong , Jung Yoon Suk
Published: July 2016

Goals:

We investigated the factors associated with false fecal immunochemical test (FIT) results for advanced colorectal neoplasm (ACRN).

Background:

Data on whether certain subgroups of patients have an increased risk of inaccurate FIT results are extremely limited.

Study:

This was a retrospective study conducted in a university hospital in Korea from June 2013 to May 2015. Out of 34,547 participants who had an FIT completed, we analyzed a total of 3990 subjects aged 50 years and above who underwent colonoscopy.

Results:

The rates of false-negative and false-positive results were 58.0% and 15.7%, respectively. Elevated fasting blood glucose [adjusted odds ratio (AOR), 0.59; 95% confidence interval (CI), 0.36-0.97], the presence of high-grade dysplasia (AOR, 0.49; 95% CI, 0.25-0.95), 3 or more adenomas (AOR, 0.56; 95% CI, 0.35-0.89), cancer (AOR, 0.20; 95% CI, 0.11-0.38), and distal ACRN (AOR, 0.61; 95% CI, 0.39-0.96) were associated with a lower risk of false-negative FIT results. The presence of proximal ACRN (AOR, 1.59; 95% CI, 1.01-2.51) and adenoma ≥10 mm (AOR, 4.38; 95% CI, 2.17-8.87) were associated with a higher risk of false-negative results. Older age (70 y and above; AOR, 1.67; 95% CI, 1.29-2.17), diverticulum (AOR, 1.94; 95% CI, 1.45-2.58), and hemorrhoid (AOR, 1.63; 95% CI, 1.32-2.01) were associated with false-positive results.

Conclusions:

Subjects with a higher risk of false-negative results should be prioritized for earlier colonoscopy and subjects with inaccurate results should be more cautiously considered for screening by using modalities other than FIT. Our findings will contribute to individualization of screening programs.
Influence of preoperative sodium concentration on outcome of patients with hepatitis B virus cirrhosis after liver transplantation
Authors: Wang Peijie , Huang Gang , Tam Ngalei , Wu Chenglin , Fu Shunjun , Hughes Bridget P. , Wu Linwei , He Xiaoshun
Published: July 2016

Objectives

Whether preoperative serum sodium concentration could influence post-transplant patients' prognosis remains controversial. The aim of this study was to evaluate the influence of patients’ pretransplant sodium concentration on the prognosis after liver transplantation in a cohort of patients with hepatitis B virus-related cirrhosis.

Patients and methods

Data derived from the Chinese Liver Transplantation Registry system from 1 January 2000 to 31 December 2011 were extracted. The serum sodium concentrations and model for end-stage liver disease scores were recorded at listing before liver transplantation, and the relationship between the above parameters and patients’ outcome was analyzed.

Results

A total of 2733 patients were included in this study. Compared with patients in the normal group (serum sodium between 135 and 150 mmol/l), patients in the severe hyponatremia group (<125 mmol/l) (P=0.022) and hypernatremia group (>150 mmol/l) (P=0.008) had a poorer prognosis. No significant differences were found among the moderate hyponatremia group (125–130 mmol/l) (P=0.113) and the mild hyponatremia group (130–135 mmol/l) (P=0.461). The 5-year cumulative survivals for the hyponatremia (≤135 mmol/l), normal (135–150 mmol/l), and hypernatremia (≥150 mmol/l) pretransplant group are 79.52, 82.23, and 69.30%, respectively.

Conclusion

Our analysis showed that for patients with hepatitis B virus-related cirrhosis in mainland China, patients with abnormal serum sodium concentrations have poorer prognosis; both preoperative hyponatremia and hypernatremia were identified as negative risk factors for patients’ outcome.
Amyloidosis of the gastrointestinal tract and the liver: clinical context, diagnosis and management
Authors: Syed Umer , Ching Companioni Rafael A. , Alkhawam Hassan , Walfish Aron
Published: July 2016

Amyloidosis is a group of disorders that can manifest in virtually any organ system in the body and is thought to be secondary to misfolding of extracellular proteins with subsequent deposition in tissues. The precursor protein that is produced in excess defines the specific amyloid type. This requires histopathological confirmation using Congo red dye with its characteristic demonstration of green birefringence under cross-polarized light. Gastrointestinal (GI) manifestations are common and the degree of organ involvement dictates the symptoms that a patient will experience. The small intestine usually has the most amyloid deposition within the GI tract. Patients generally have nonspecific findings such as abdominal pain, nausea, diarrhea, and dysphagia that can often delay the proper diagnosis. Liver involvement is seen in a majority of patients, although symptoms typically are not appreciated unless there is significant hepatic amyloid deposition. Pancreatic involvement is usually from local amyloid deposition that can lead to type 2 diabetes mellitus. In addition, patients may undergo either endoscopic or radiological evaluation; however, these findings are usually nonspecific. Management of GI amyloidosis primarily aims to treat the underlying amyloid type with supportive measures to alleviate specific GI symptoms. Liver transplant is found to have positive outcomes, especially in patients with specific variants of hereditary amyloidosis.
The Impact of Using Mid-level Providers in Face-to-Face Primary Care on Health Care Utilization
Authors: Liu Hangsheng , Robbins Michael , Mehrotra Ateev , Auerbach David , Robinson Brandi E. , Cromwell Lee F. , Roblin Douglas W.
Published: July 2016

Background:

There has been concern that greater use of nurse practitioners (NP) and physician assistants (PA) in face-to-face primary care may increase utilization and spending.

Objective:

To evaluate a natural experiment within Kaiser Permanente in Georgia in the use of NP/PA in primary care.

Study Design:

From 2006 through early 2008 (the preperiod), each NP or PA was paired with a physician to manage a patient panel. In early 2008, NPs and PAs were removed from all face-to-face primary care. Using the 2006–2010 data, we applied a difference-in-differences analytic approach at the clinic level due to patient triage between a NP/PA and a physician. Clinics were classified into 3 different groups based on the percentage of visits by NP/PA during the preperiod: high (over 20% in-person primary care visits attended by NP/PAs), medium (5%–20%), and low (<5%) NP/PA model clinics.

Measures:

Referrals to specialist physicians; emergency department visits and inpatient admissions; and advanced diagnostic imaging services.

Results:

Compared with the low NP/PA model, the high NP/PA model and the medium NP/PA model were associated with 4.9% and 5.1% fewer specialist referrals, respectively (P<0.05 for both estimates); the high NP/PA model and the medium NP/PA model also showed fewer hospitalizations and emergency department visits and fewer advanced diagnostic imaging services, but none of these was statistically significant.

Conclusions:

We find no evidence to support concerns that under a physician's supervision, NPs and PAs increase utilization and spending.
The role of the tissue factor pathway in haemostasis and beyond
Authors: McVey John H.
Published: July 2016

Purpose of review

The role of tissue factor (TF) in the initiation of the blood coagulation network leading to generation of a fibrin clot has been well defined over the past 50 years. Although much is known about this sequence of events and its regulation, many important questions remain unresolved. More recently, a complex role for TF in cellular processes independent of fibrin generation has emerged. This review summarizes some of the advances in this field.

Recent findings

TF is the cellular receptor and cofactor for factor VII/VIIa; however, controversy still surrounds expression of TF within the vasculature, the role of circulating microvesicle pools of TF and mechanisms of ‘encryption’ of TF activity. However, there have been significant advances in the role of TF-initiated cell signalling. Lastly, an alternatively spliced TF transcript has been identified and some insights into its role in cancer cell metastasis/proliferation have been elucidated.

Understanding of TF structure function has increased substantially; however, multiple controversies still surround some aspects of its regulation. TF has emerged as a pivotal player in orchestrating not only fibrin generation but wound repair. Derangement of these repair processes contributes significantly to the pathophysiology of a number of disease processes.
Controversies in the treatment of immune thrombocytopenia
Authors: Cuker Adam , Cines Douglas B. , Neunert Cindy E.
Published: July 2016

Purpose of review

We address three current controversies in management of immune thrombocytopenia (ITP): Should asymptomatic children with newly diagnosed ITP and severe thrombocytopenia be treated? Does intensification of up-front therapy in adults with newly diagnosed ITP impact long-term outcomes? Is splenectomy still the second-line treatment of choice in adults with chronic ITP?

Recent findings

Severe bleeding is rare in children with ITP. There is little evidence that the platelet count predicts or that treatment prevents severe bleeding in this population. Intensified treatment with high-dose dexamethasone and rituximab in adults with newly diagnosed ITP is associated with improved platelet responses at 6 and 12 months but greater toxicity compared with standard therapy. Rituximab and thrombopoietin receptor agonists have emerged as suitable alternatives to splenectomy for second-line management of adults with chronic ITP.

We generally observe children with newly diagnosed ITP and mild or no bleeding symptoms, irrespective of platelet count. We do not routinely use intensified up-front therapy in adults with newly diagnosed ITP. We discuss the advantages and disadvantages of splenectomy, rituximab, and thrombopoietin receptor agonists with our patients and make a joint decision that takes into consideration age, comorbidities, lifestyle, values, preferences, and financial considerations.
Management of heparin-induced thrombocytopenia
Authors: Warkentin Theodore E. , Greinacher Andreas
Published: July 2016

Purpose of review

The purpose of this review is to summarize recent findings on heparin-induced thrombocytopenia (HIT), a prothrombotic disorder caused by platelet-activating IgG targeting platelet factor 4 (PF4)/polyanion complexes.

Recent findings

HIT can explain unusual clinical events, including adrenal hemorrhages, arterial/intracardiac thrombosis, skin necrosis, anaphylactoid reactions, and disseminated intravascular coagulation. Sometimes, HIT begins/worsens after stopping heparin (‘delayed-onset’ HIT). Various HIT-mimicking disorders are recognized (e.g., acute disseminated intravascular coagulation/‘shock liver’ with limb ischemia). HIT has features of both B-cell and T-cell immune responses; uptake of PF4/heparin complexes into macrophages (‘macropinocytosis’) facilitates the anti-PF4/heparin immune response. Antibody-induced activation of monocytes and platelets via their FcγIIA receptors triggers an intense procoagulant response. Sometimes, HIT antibodies recognize PF4 bound to (platelet-associated) chondroitin sulfate, explaining how HIT might occur without concurrent or recent heparin (delayed-onset HIT, ‘spontaneous HIT syndrome’). The molecular structure of HIT antigen(s) has been characterized, providing a rationale for future drug design to avoid HIT and improve its treatment. The poor correlation between partial thromboplastin time and plasma argatroban levels (risking subtherapeutic anticoagulation) and need for intravenous administration of argatroban have led to increasing ‘off-label’ treatment with fondaparinux or one of the direct oral anticoagulants.

Understanding the molecular mechanisms and unusual clinical features of HIT will improve its management.
ABO-incompatible heart transplantation
Authors: Urschel Simon , West Lori J.
Published: July 2016

Purpose of review

ABO-incompatible (ABOi) heart transplantation (HTx) in young children has evolved from an experimental approach to a standard allocation option in many countries. Clinical and immunological research in ABOi transplantation has revealed insight into the immature immune system and its role in superior graft acceptance in childhood and antigen-specific tolerance.

Recent findings

Multicenter experience has confirmed equal actuarial survival, freedom from rejection, and graft vasculopathy comparing ABOi with ABO-compatible HTx. Observations of reduced antibody production and B-cell immunity toward the donor blood group have been confirmed in long-term follow-up. Mechanisms contributing to tolerance in this setting involve the interplay between B-cells and the complement system and the development of B-cell memory. Better characterization of the ABH polysaccharide antigens has improved diagnostic methods and clinical assessment of blood group antibodies. Boundaries regarding age, immune maturity, and therapeutic interventions to extend the applicability of ABOi HTx have been explored and resulted in data that may be useful for HTx patients beyond infancy and ABOi transplantation of other organs. Tolerance of ABH antigens possibly extends to HLA response.

The review provides insight into the clinical evolution of ABOi HTx and associated immunologic discoveries. Current experiences and boundaries are discussed together with recent and potential future developments for utilization in other patient and age groups.
Coronary artery anomalies in children: what is the risk?
Authors: Brothers Julie A.
Published: July 2016

Purpose of review

To better understand the risk of sudden death from coronary anomalies.

Recent findings

Most coronary anomalies are benign, but there are certain coronary anomalies that increase the risk of sudden cardiac death (SCD) in the young, notably anomalous aortic origin of a coronary artery from the wrong sinus. Previously, the risk of SCD attributed to certain coronary anomalies was felt to be quite high, as the risk assessment was based on autopsy series. Recent studies have shown that the risk attributed to anomalous coronary arteries is much lower than once believed. Risk appears to be highest with anomalous left coronary artery from the right sinus of Valsalva with interarterial course, notably when the young patient is participating in vigorous physical exertion, such as with competitive sports.

Treatment strategies may include exercise restriction or surgical repair. Management decisions should be based on a complete understanding of the risk for SCD because of anomalous coronary arteries. Future directions should focus on better methods to risk stratify these pediatric patients.
Outcomes of Children With and Without Hepatic Encephalopathy From the Pediatric Acute Liver Failure Study Group
Authors: Ng Vicky L. , Li Ruosha , Loomes Kathleen M. , Leonis Mike A. , Rudnick David A. , Belle Steven H. , Squires Robert H. ,   Pediatric Acute Liver Failure Study Group (PALFSG)
Published: July 2016

Objectives:

Hepatic encephalopathy (HE) is challenging to identify in children with acute liver failure and was not a requirement for enrollment into the Pediatric Acute Liver Failure Study Group (PALFSG). The outcomes of PALFSG participants presenting with and without HE are presented.

Methods:

PALFSG participants were classified based on daily assessment of HE during the first 7 days following study enrollment: group 1—never developed HE; group 2—no HE at enrollment with subsequent HE development; and group 3—HE at study enrollment. Clinical and biochemical parameters and outcomes of death, spontaneous recovery, or liver transplantation were compared between groups.

Results:

Data from 769 PALFSG (54% boys; median age 4.2 years; range 0–17.9 years) participants were analyzed, with 277 in group 1 (36%), 83 in group 2 (11%), and 409 in group 3 (53%). Mortality occurred in 11% of all participants and was highest among group 3 participants who demonstrated persistent grade III–IV HE (55%) or showed progression of HE (26%). Eleven (4%) group 1 participants died within 21 days of enrollment. Spontaneous recovery was highest in group 1 (79%) and lowest in group 2 (25%; P < 0.001).

Conclusions:

Mortality 21 days after enrollment was highest in participants enrolled with severe HE (grades III or IV) or demonstrating HE progression. Four percent of participants without recorded clinical HE in the 7 days after enrollment, however, died within 21 days. Improved assessment of neurological injury and pediatric acute liver failure prognostication schema are needed.
Early Microbe Contact and Obesity Risk
Authors: Isolauri Erika , Salminen Seppo , Rautava Samuli
Published: July 2016

The industrialized societies worldwide are in the middle of epidemics of diet‐related chronic diseases, obesity being the common denominator. Lately, these conditions have been linked with a distinct microbiota composition in affected individuals different from that of healthy individuals. In particular, dysbiosis during critical stages of development induces lasting alterations in the immune and metabolic phenotype. The compositional development of the gut microbiota, again, is highly sensitive to environmental influences such as maternal health and nutrition, the mode of delivery, early feeding and antibiotic use. Shifts in the microbiota by high‐energy diet increase energy extraction and storage, provoke a low‐grade inflammatory response and impair gut barrier function, and, consequently, result in obesity and metabolic disease. A lower abundance of butyrate‐producing bacteria and lower overall richness of bacteria has been associated with increased metabolic disease risk in humans. Recent reports suggest that Akkermansia type bacteria or butyrate producing microbes may have anti‐inflammatory potential and enhance intestinal barrier function, which may both alleviate obesity and related metabolic complications. Thus we are not directly what we eat or our mother eats, but what our microbiota eat and how the collective composition of the microbiome is modified by the diet. On this basis, altering the intestinal microecosystem may be taken as a key target to attain prophylactic or therapeutic effects in metabolic and inflammatory conditions. Tools for such modulation include specific probiotic bacteria and potentially also non‐digestible carbohydrate components able to modify microbiota composition and activity.
Serum Lipid Profile, Prevalence of Dyslipidaemia, and Associated Risk Factors Among Northern Mexican Adolescents
Authors: Bibiloni Maria del Mar , Salas Rogelio , De la Garza Yolanda E. , Villarreal Jesus Z. , Sureda Antoni , Tur Josep A.
Published: July 2016

Background:

The increase in overweight and obese children and adolescents may be linked to increased rates of dyslipidaemia. The aim was to assess the serum lipid profile, the prevalence of dyslipidaemia, and associated risk factors among the North Mexican adolescent population.

Methods:

Two hundred and ninety‐three subjects (47.8% girls) ages 11 to 16 years took part in the Nuevo León State Survey of Nutrition and Health 2011–2012. According to the 2011 Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, dyslipidaemia was defined as a presence of ≥1 of the following levels (mg/dL): Total cholesterol ≥200, low‐density lipoprotein cholesterol ≥130, non–high‐density lipoprotein cholesterol <40, and triglyceride ≥130.

Results:

The overall frequency of dyslipidaemia was 48.8% with no differences between sexes. Adolescents with high body mass index were more likely to have at least 1 abnormal lipid level (overweight: odds ratio [OR]: 2.07; 95% confidence interval [CI]: 1.14–3.77, P < 0.05; obesity: OR: 2.21, 95% CI: 1.11–4.41, P < 0.05) than those with normal weight. Abdominally subjects with obesity were also more likely to have at least 1 abnormal lipid level (OR: 2.30; 95% CI: 1.35–3.91, P < 0.01) than their leaner counterparts.

Conclusions:

Half of Mexican adolescents living in the State of Nuevo León have at least 1 abnormal lipid concentration. Low HDL‐chol level was the most common dyslipidaemia. Body mass index and abdominal obesity were associated with the prevalence of at least 1 abnormal lipid level.
Intraventricular Hemorrhage and Platelet Indices in Extremely Premature Neonates
Authors: Mitsiakos Georgios , Papathanasiou Aimilia-E. , Kyriakidis Ioannis , Karagianni Paraskevi , Tsepis Konstantinos , Tzimou Irene , Lazaridou Eleni , Chatziioannidis Ilias
Published: July 2016

Intraventricular hemorrhage (IVH) is a multifactorial disorder, the most important risk factors of which are prematurity and low birth weight. Disturbances in cerebral blood flow, inherent fragility of the germinal matrix vasculature, and platelet/coagulation disturbances are the 3 major pathogenic mechanisms. In this context, we investigated the role of platelet indices and several maternal and neonatal characteristics in the development of IVH through a retrospective cohort analysis of 130 extremely premature neonates, 24% of whom presented with severe IVH. There was a significant difference in platelet counts between the IVH and the control group on the first day of life (P=0.046). Presence of IVH was linked with lower birth weight (P=0.006) and lower gestational age (P=0.001). Platelet count on the first day of life was positively correlated with survival (P=0.001) and, along with platelet mass, was indicative of the worst IVH grade recorded for each neonate (P=0.002 and 0.007, respectively). Prolonged prothrombin time was also correlated with IVH (P<0.001), but factor analysis supported no prominent role. Maternal medications seem to play a minor role as well. In conclusion, IVH in extremely premature infants cannot be solely explained by platelet parameters, and further studies are required to determine the relationships between IVH, platelet indices, and outcomes.
Transcranial Doppler Screening in a Regional Care Network for Sickle Cell Disease in the United Kingdom
Authors: Telfer Paul , Dwan Kerry , Simmons Andrea , Evanson Jane , Gadong Nimze , Newell Kim , Tangayi Sekayi , Leigh Andrea , Tsouana Eva , Hemmaway Claire , Kaya Banu
Published: July 2016

The risk of stroke in children screened with transcranial Doppler ultrasound in the United Kingdom is not known. We evaluated a clinician-led program using a risk assessment modified from the STOP protocol. High-risk classification included abnormal velocities in the anterior cerebral artery, and single abnormal scan if initial velocity >220 cm/s (high abnormal) or if preceded by at least 2 conditional scans. In total, 1653 scans were performed in 542 children, followed for 2235 patient-years. Fifty-eight (10.7%) high-risk subjects were identified, including 18 (31%) with high abnormal, and 15 (26%) with previous conditional scans. In 2 (3%), abnormal velocity was restricted to the anterior cerebral artery. The estimated proportion of children at high risk, scanned before 6 years of age was >20%. There were 4 cases of acute ischemic stroke (AIS) and 2 of acute hemorrhagic stroke. The incidence of all stroke, AIS, and acute hemorrhagic stroke were 0.27, 0.18, and 0.09 per 100 patient-years, respectively. The proportion of children at high risk is higher than most previous estimates, partly as a result of our modified risk assessment. About 2 children per 1000 screened with transcranial Doppler ultrasound progress to AIS.
Importance of an education programme for patients with chronic widespread pain
Authors: Horvat Barbara , Jamnik Helena
Published: July 2016

The structured education programme for patients with chronic widespread pain is the first stage of the interdisciplinary group-based rehabilitation programme for those patients at the University Rehabilitation Institute in Ljubljana, Slovenia. The aim of our pilot study was to investigate the impact of the education programme on the patients’ attribution of pain as dangerous. Ninety-three participants with chronic widespread pain volunteered for the study. They were first screened to verify whether they were suitable for inclusion in the rehabilitation programme. They filled in the Pain Catastrophizing Scale and the Tampa Scale of Kinesiophobia as part of the screening and after the education programme. The results showed a statistically significantly reduced fear of movement and catastrophizing. Hence, the education programme appears to be achieving its goals.
Effects of dry needling (DNHS technique) on the contractile properties of spastic muscles in a patient with stroke: a case report
Authors: Calvo Sandra , Quintero Isabel , Herrero Pablo
Published: July 2016

Dry needling for hypertonia and spasticity (DNHS) is a technique used for decreasing hypertonia and spasticity and for the improvement of function in patients with damage to the central nervous system. There is limited evidence supporting the effectiveness of this technique on the basis of objective assessments. The aim of the present case report was to quantify the effects of dry needling (DNHS technique) on the contractile properties of spastic muscles in an individual with stroke. The DNHS technique was applied to a 50-year-old male 2.5 years after stroke who had a complaint of spasticity. The treated muscles were biceps brachii, triceps brachii, rectus femoris, semitendinosus, biceps femoris, medial gastrocnemius, and lateral gastrocnemius. Tensiomyography was used to assess maximal displacement (D
m) of treated muscles. We performed a preintervention and postintervention measurement and a follow-up measurement 3 weeks after intervention. After the application of the DNHS technique, a decrease in the level of local muscle stiffness was observed for all muscles after intervention and at the 3-week follow-up, quantified by an increase in D
m. The usefulness of tensiomyography for detecting changes in patients with spasticity correlated with clinical measures in this field requires further research to establish the reliability of the different parameters provided by the equipment.
Catheter Securement Systems for Peripherally Inserted and Nontunneled Central Vascular Access Devices
Authors: Krenik Karen M. , Smith Graham E. , Bernatchez Stéphanie F.
Published: July 2016

Sutureless catheter securement systems are intended to eliminate risks associated with sutures. The clinical acceptability of a novel system was investigated compared with the current method of securement for peripherally inserted central catheters (19 facilities using StatLock or sutures) or nontunneled central vascular access devices (3 facilities using StatLock or sutures or HubGuard + Sorbaview Shield). More than 94% of respondents rated the novel system as same, better, or much better than their current product. More than 82% of respondents were willing to replace their current system with the new one.
The Dark Side of Addiction
Authors: Koob George F.
Published: July 2016

W. Horsley Gantt and Joseph V. Brady laid a rich foundation for understanding the concept of emotion, derived from 2 prominent traditions of physiology and psychology: classic conditioning and operant conditioning, respectively. This framework guided my fierce interest in motivation in general and the interaction between reward and stress, which began at John Hopkins with my thesis work under the guidance of Drs. Zoltan Annau, Solomon Synder, and Joseph Brady, among many others. Using the study of the neurobiology of addiction as a framework, I argue that drug addiction not only involves positive reinforcement associated with the rewarding effects of drugs of abuse but also involves another major source of reinforcement, specifically negative reinforcement driven by negative emotional states (termed the “dark side” of addiction). Excessive activation of the brain reward systems leads to antireward or a decrease in the function of normal reward-related neurocircuitry and persistent recruitment of the brain stress systems, both of which may be neurobiologically linked. Understanding the neuroplasticity of the neurocircuitry that comprises the negative reinforcement associated with addiction is a key to understanding negative emotional states in general and their pathophysiology.
Social Support and Relationship Satisfaction as Moderators of the Stress-Mood-Alcohol Link Association in US Navy Members
Authors: Kelley Michelle L. , Milletich Robert J. , Hollis Brittany F. , Veprinsky Anna , Robbins Allison T. , Snell Alicia K.
Published: July 2016

The present study examined associations between stress and problematic alcohol use among US Navy members anticipating deployment, whether depressive symptoms mediated the stress-alcohol link, and whether social support and relationship satisfaction moderated associations between stress, depressive symptoms, and problematic alcohol use. Participants were 108 US Navy members assigned to an Arleigh Burke–class destroyer anticipating an 8-month deployment after Operational Enduring Freedom/Operation Iraqi Freedom. Stress was indirectly related to problematic alcohol use such that higher levels of stress were associated with higher levels of depressive symptoms, which were further associated with higher levels of alcohol use. The indirect effect of stress to problematic alcohol use via depressive symptoms was tested at different levels of social support and relationship satisfaction. At higher levels of social support and relationship satisfaction, the association between stress and problematic alcohol use via depressive symptoms decreased. Results help identify targets for alcohol prevention efforts among current military members.
Myopia—What is Old and What is New?
Authors: Schaeffel Frank
Published: July 2016

The recent “boom of myopia,” described predominantly for East Asia, is assumed to result from increasingly demanding education programs that include extensive near work (and perhaps also extensive use of computers) and little exposure to bright light as found outdoors. Already in 1892, Hermann Cohn stated that the prevalence of myopia is related to the educational level which is related to the economic status of a country. It is not much appreciated that the rates of myopia were already high among school children in central Europe in the middle of the 19th century, as described by Hermann Cohn. From extensive research in recent times, three major approaches have emerged to interfere with myopia progression in children: (1) promoting exposure to bright light and enforce outdoor activity, (2) adapting/improving optical corrections and visual behavior to generate inhibitory signals for eye growth in the retina, and (3) applying atropine eye drops at low doses. However, Hermann Cohn had already proposed that low luminances during school work promote myopia development and requested that lighting in the classrooms needs to be at least “10 meter candles” (equivalent to an illuminance of 10 lux). Different from today, he explained the link between low light and myopia by shorter reading distances that he observed at low luminances of the reading surface (<<1 cd/m2). He suggested that short reading distances should be avoided in children and described several devices to control them. He further suggested that reading duration should be limited and urged myopes to choose professions that do not involve extensive near work. He also studied the effects of atropine against myopia but concluded that the side effects make it less useful than simply “3–4 weeks without reading.” In summary, a number of his findings were re-discovered today, but they are now much better supported by data, and their interpretations have changed, at least in some aspects.
The Case for Lens Treatments in the Control of Myopia Progression
Authors: Troilo David
Published: July 2016

Myopia is on the rise in the United States and around the world, and with its progression comes increasing risk of a wide variety of associated vision-threatening conditions. Fortunately, several evidence-based treatments for myopia control are currently available and show promise. Basic research on the visual control of eye growth and the development of refractive state is being successfully translated to clinical studies on lens and drug treatments, and patients are already benefiting. Evidence-based practice is transforming the clinical care for myopia from correction to treatment. In this commentary on the role of lens treatments for myopia control from the 15th International Myopia Conference, the author considers bifocals, progressive addition lenses, multifocal contact lenses, and orthokeratology to make the case that lens treatments, particularly using multifocal contact lenses, are effective for myopia control and should be considered as a first-line treatment. A number of areas for further research and treatment optimization are also identified.
What Do Animal Studies Tell Us about the Mechanism of Myopia—Protection by Light?
Authors: Norton Thomas T.
Published: July 2016

Human studies have provided strong evidence that exposure to time outdoors is protective against the onset of myopia. A causal factor may be that the light levels outdoors (30,000–130,000 lux) are much higher than light levels indoors (typically less than 500 lux). Studies using animal models have found that normal animals exposed to low illuminance levels (50 lux) can develop myopia. The myopia and axial elongation, produced in animals by monocular form deprivation, is reduced by light levels in the 15,000 to 25,000 range. Myopia induced with a negative-power lens seems less affected, perhaps because the lens provides a powerful target for the emmetropization mechanism. Animal studies suggest that raising the light levels may have their effect by increasing retinal dopamine activity, probably via the D2 receptor pathway, altering gene expression in the retina and reducing the signals that produce axial elongation.
An Autopsy Checklist
Authors: Shkrum Michael James , Kent Jessica
Published: July 2016

Any autopsy has safety and risk management issues, which can arise in the preautopsy, autopsy, and postautopsy phases. The London Health Sciences Department of Pathology and Laboratory Medicine Autopsy Checklist was developed to address these issues. The current study assessed 1 measure of autopsy safety: the effectiveness of the checklist in documenting pathologists’ communication of the actual or potential risk of blood-borne infections to support staff. Autopsy checklists for cases done in 2012 and 2013 were reviewed. The frequency of communication, as recorded in checklists, by pathologists to staff of previously diagnosed blood-borne infections (hepatitis B/C and human immunodeficiency virus) or the risk of infection based on lifestyle (eg, intravenous drug abuse) was tabulated. These data were compared with medical histories of the deceased and circumstances of their deaths described in the final autopsy reports. Information about blood-borne infections was recorded less frequently in the checklists compared with the final reports. Of 4 known human immunodeficiency virus cases, there was no checklist documentation in 3. All 11 hand injuries were documented. None of these cases had known infectious risks. The Autopsy Checklist is a standardized means of documenting safety and risk issues arising during the autopsy process, but its effectiveness relies on accurate completion.