bluuebunny/crossref_metadata_2025 huggingface dataset:
Loss of Cajal bodies in motor neurons from patients with novel mutations in VRK1
Authors: El-Bazzal Lara , Rihan Khalil , Bernard-Marissal Nathalie , Castro Christel , Chouery-Khoury Eliane , Desvignes Jean-Pierre , Atkinson Alexandre , Bertaux Karine , Koussa Salam , Lévy Nicolas , Bartoli Marc , Mégarbané André , Jabbour Rosette , Delague Valérie
Published: March 2019

Distal hereditary motor neuropathies (dHMNs) are a heterogeneous group of diseases, resembling Charcot–Marie–Tooth syndromes, but characterized by an exclusive involvement of the motor part of the peripheral nervous system.

Here, we describe two new compound heterozygous mutations in VRK1, the vaccinia-related kinase 1 gene, in two siblings from a Lebanese family, affected with dHMN associated with upper motor neurons (MNs) signs. The mutations lead to severely reduced levels of VRK1 by impairing its stability, and to a shift of nuclear VRK1 to cytoplasm. Depletion of VRK1 from the nucleus alters the dynamics of coilin, a phosphorylation target of VRK1, by reducing its stability through increased proteasomal degradation. In human-induced pluripotent stem cell-derived MNs from patients, we demonstrate that this drop in VRK1 levels leads to Cajal bodies (CBs) disassembly and to defects in neurite outgrowth and branching. Mutations in VRK1 have been previously reported in several neurological diseases affecting lower or both upper and lower MNs. Here, we describe a new phenotype linked to VRK1 mutations, presenting as a classical slowly progressive motor neuropathy, beginning in the second decade of life, with associated upper MN signs. We provide, for the first time, evidence for a role of VRK1 in regulating CB assembly in MNs. The observed MN defects are consistent with a length dependent axonopathy affecting lower and upper MNs, and we propose that diseases due to mutations in VRK1 should be grouped under a unique entity named `VRK1-related motor neuron disease’.
Intestinal CD103+CD4+ and CD103+CD8+ T-Cell Subsets in the Gut of Inflammatory Bowel Disease Patients at Diagnosis and During Follow-up
Authors: Roosenboom Britt , Wahab Peter J , Smids Carolijn , Groenen Marcel J M , van Koolwijk Elly , van Lochem Ellen G , Horjus Talabur Horje Carmen S
Published: March 2019

Background

The integrin CD103 is proposed to be a potential therapeutical target in inflammatory bowel disease (IBD), as it can form a heterodimeric integrin with β7 (Etrolizumab, anti-β7 integrin) on epithelial T cells. Therefore, we aimed to study the frequencies of different intestinal CD103+T-cell subsets, both CD4+ and CD8+, in newly diagnosed, untreated IBD patients at baseline and during follow-up, compared with healthy controls.

Methods

Intestinal biopsies from inflamed segments during colonoscopy and peripheral blood samples were prospectively taken from IBD patients at diagnosis and during follow-up. Blood and single cell suspensions from biopsies were analyzed for CD103+ T-cell subpopulations by flow cytometry and expressed as median percentages of the total T-cell population.

Results

In total, 75 Crohn’s disease (CD) patients, 49 ulcerative colitis (UC) patients, and 16 healthy controls were included. At presentation, IBD patients displayed lower percentages of CD103+T-cell subsets in inflamed biopsies: 3% (1 to 5) CD103+CD4+ in IBD vs 5% (5 to 7) in healthy controls (P = 0.007) and 9% (4 to 15) CD103+CD8+ compared with 42% (23 to 57) in healthy controls (P = 0.001). The majority of intestinal T cells was composed of CD103-CD4+ T cells (65% [52 to 74]) in IBD compared with 30% (21 to 50) in healthy controls (P = 0.001). In patients with endoscopic remission during follow-up (n = 27), frequencies of CD103+ and CD103-T-cell subsets were comparable with healthy controls.

Conclusion

At diagnosis, active inflammation in IBD was associated with decreased percentages of both CD103+CD4+ and CD103+CD8+T-cell subsets in colon and ileum biopsies. In active disease during follow-up, these T-cell populations remained low but increased in remission to values comparable with healthy controls. A shift toward more CD103-T cells was observed during active inflammation.
Spectral Gaps of Random Graphs and Applications
Authors: Hoffman Christopher , Kahle Matthew , Paquette Elliot
Published: March 2019

We study the spectral gap of the Erdős–Rényi random graph through the connectivity threshold. In particular, we show that for any fixed $\delta> 0$ if $$\begin{equation*} p \geq \frac{(1/2 + \delta) \log n}{n}, \end{equation*}$$then the normalized graph Laplacian of an Erdős–Rényi graph has all of its nonzero eigenvalues tightly concentrated around $1$. This is a strong expander property. We estimate both the decay rate of the spectral gap to $1$ and the failure probability, up to a constant factor. We also show that the $1/2$ in the above is optimal, and that if $p = \frac{c \log n}{n}$ for $c < 1/2,$ then there are eigenvalues of the Laplacian restricted to the giant component that are separated from $1.$ We then describe several applications of our spectral gap results to stochastic topology and geometric group theory. These all depend on Garland’s method [24], a kind of spectral geometry for simplicial complexes. The following can all be considered to be higher-dimensional expander properties. First, we exhibit a sharp threshold for the fundamental group of the Bernoulli random $2$-complex to have Kazhdan’s property (T). We also obtain slightly more information and can describe the large-scale structure of the group just before the (T) threshold. In this regime, the random fundamental group is with high probability the free product of a (T) group with a free group, where the free group has one generator for every isolated edge. The (T) group plays a role analogous to that of a “giant component” in percolation theory. Next we give a new, short, self-contained proof of the Linial–Meshulam–Wallach theorem [35, 39], identifying the cohomology-vanishing threshold of Bernoulli random $d$-complexes. Since we use spectral techniques, it only holds for $\mathbb{Q}$ or $\mathbb{R}$ coefficients rather than finite field coefficients, as in [35] and [39]. However, it is sharp from a probabilistic point of view, providing for example, hitting time type results and limiting Poisson distributions inside the critical window. It is also a new method of proof, circumventing the combinatorial complications of cocycle counting. Similarly, results in an earlier preprint version of this article were already applied in [33] to obtain sharp cohomology-vanishing thresholds in every dimension for the random flag complex model.
Improvement on Natural Enemies of Bemisia tabaci (Hemiptera: Aleyrodidae) Using Extracts of Agrimonia pilosa
Authors: Guo Huifang , Qu Yufeng
Published: March 2019

Compared with the numerous natural enemies against insect pests that have been identified, the commercialization of natural biological control resources remains very limited. To increase the use of natural enemies for biological control, determining how to improve the low efficacy, slow speed, and high cost of natural enemies is very important. Mediterranean species of The whitefly, Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodoidea), increasingly threatens many crops in China, and control primarily depends on chemical insecticides. Here, the effect of ethanol extracts from two plants, Agrimonia pilosa (Ledeb) (Rosales: Rosaceae) and Melia azedarach (Linn) (Meliaceae: Melia), on predominant natural enemies of B. tabaci was investigated using a leaf dipping or spraying method. The results showed that the ethanol extract of A. pilosa significantly improved the infectivity of the fungus Isaria javanica (Friedrichs & Bally) (Ascomycota: Hypocreales), and the mortality of whiteflies caused by the combination of fungus (105 spores/mL) with the extract of A. pilosa (2 mg/mL dried powder of A. pilosa containing 0.0942 mg/mL total polyphenols) was 81.6%, which was significantly higher than that caused by the fungus only. However, the ethanol extract of M. azedarach had no effect on fungus infectivity. Additionally, insecticide tolerance of the predator Pardosa pseudoannulata was also significantly improved by the extract of A. pilosa. The longevity of the parasitoid Encarsia formosa was not affected by the extracts. These findings indicate that the extract of A. pilosa played a dual role that included improving pathogenic fungi infectivity and insecticidal tolerance of a predator and thus could be a synergist in the biological control of B. tabaci.
ExoMol line lists – XXXII. The rovibronic spectrum of MgO
Authors: Li Heng Ying , Tennyson Jonathan , Yurchenko Sergei N
Published: March 2019

Line lists for magnesium oxide are computed and extensive comparisons are made with existing experimental spectra. The LiTY line lists cover all rovibration transitions within the five lowest lying electronic states ($X\, {}^1\Sigma ^+$, $a\, {}^3\Pi$, $A\, {}^1\Pi$, $B\, {}^1\Sigma ^+$ and $b\, {}^3\Sigma ^{+}$) and five isotopologues: 24Mg16O, 25Mg16O, 26Mg16O, 24Mg17O and 24Mg18O. The calculations use potential energy cures, spin-orbit and electronic angular momentum coupling curves determined by fitting to empirical energy levels; these levels are reproduced to within 0.01 cm−1 in most cases. Computed nuclear-motion wavefunctions are combined with ab initio dipole moment curves to give transition intensities and excited state radiative lifetimes, which are compared with laboratory measurements. The 24Mg16O line list comprises 186 842 (J ≤ 320) rovibronic states and 72 833 173 transitions with angular momenta, J, up to 300 and covering wavenumbers up to 33 000 cm−1 (λ > 0.3 μm). The line lists are suitable for temperatures up to about 5000 K. They are relevant to astrophysical studies of exoplanet atmospheres, cool stars and brown dwarfs, and are made available in electronic form in the CDS and ExoMol databases.
Ninety-Day Bundled Payment Reimbursement for Patients Undergoing Anterior and Posterior Procedures for Degenerative Cervical Radiculopathy
Authors: Alhourani Ahmad , Sharma Mayur , Ugiliweneza Beatrice , Wang Dengzhi , Nuño Miriam , Drazin Doniel , Boakye Maxwell
Published: March 2019

BACKGROUND

Anterior cervical discectomy with fusion (ACDF) or posterior cervical foraminotomy (PCF) are the mainstay surgical treatment options for patients with degenerative cervical radiculopathy (DCR).

OBJECTIVE

To compare 90-d bundled payments between ACDF and PCF for DCR in a cohort study.

METHODS

Data were extracted from MarketScan database (2000-2016) using ICD-9, ICD-10, and CPT-4 codes. The bundle payments were calculated as the payments accumulated from the index hospitalization admission to 90 d postsurgery. We also analyzed the index hospitalization (physician, hospital, and total) and the postdischarge payments (hospital readmission, outpatient services, medications, and total). Surgical groups were matched based on baseline characteristics (age, sex, insurance type, and Elixhauser score).

RESULTS

A total of 100 041 patients met the inclusion criteria. 94.9% of patients (n = 95 031). Patients underwent ACDF with 5.1% (n = 5 010) treated via PCF. Overall, median 90-d costs were significantly higher for ACDF than for PCF ($31567 vs $18412; P < .0001). The median total index hospitalization ($27841 vs $15043), physician ($4572 vs $1920), and hospital payments ($14540 vs $7404) were higher for ACDF compared to PCF for both single- and multiple-level cohorts (P < .0001). There was no difference in overall 90-d postdischarge payments. Factors associated with higher 90-d payments for both cohorts included age and comorbidity scores.

CONCLUSION

ACDF is associated with greater bundle payments in patients diagnosed with DCR. No difference was noted for the total postdischarge payments. PCF may be a cost-effective surgical option in appropriately selected patients with unilateral, paracentral, and foraminal soft herniated discs.
Association of Surgical Overlap during Wound Closure with Patient Outcomes among Neurological Surgery Patients at a Large Academic Medical Center
Authors: Glauser Gregory , Agarwal Prateek , Ramayya Ashwin G , Chen H Isaac , Lee John Y K , Schuster James M , Osiemo Benjamin , Goodrich Stephen , Smith Lachlan J , McClintock Scott D , Malhotra Neil R
Published: March 2019

BACKGROUND

Several studies have explored the effect of overlapping surgery on patient outcomes, but impact of surgical overlap during wound closure has not been studied.

OBJECTIVE

To examine the association of overlap during wound closure and suture time overlap (STO) with patient outcomes in a heterogeneous neurosurgical population.

METHODS

Over 4 yr (7/2013-7/2017), 1 7689 neurosurgical procedures were retrospectively reviewed at a single, multihospital academic medical center. STO was defined as all surgeries for which an overlapping surgery occurred, exclusively, during wound closure of the index case being studied. We excluded nonelective cases and overlapping surgeries that involved overlap during surgical portions of the case other than wound closure. Tests of independence and Wilcoxon tests were used for statistical analysis.

RESULTS

Patients with STO had a shortened length of hospital stay (100.6 vs 135.1 h; P < .0001), reduced deaths in follow-up (1.59% vs 5.45%; P = .0004), and lower 30- to 90-d readmission rates (3.64% vs 7.47%; P = .0026). Patients with STO had no increase in revision surgery. Patients with STO had longer wound closure times (26.5 vs 23.9 min; P < .0001) but shorter total surgical times (nonclosure surgical time 101.8 vs 133.3 min; P < .0001; and total surgical time 128.3 vs 157.1 min; P < .0001).

CONCLUSION

Surgical overlap during wound closure (STO) is associated with improved or at least noninferior patient outcomes, as it pertains to readmissions and wound revisions.
Climate and litter C/N ratio constrain soil organic carbon accumulation
Authors: Zhou Guoyi , Xu Shan , Ciais Philippe , Manzoni Stefano , Fang Jingyun , Yu Guirui , Tang Xuli , Zhou Ping , Wang Wantong , Yan Junhua , Wang Gengxu , Ma Keping , Li Shenggong , Du Sheng , Han Shijie , Ma Youxin , Zhang Deqiang , Liu Juxiu , Liu Shizhong , Chu Guowei , Zhang Qianmei , Li Yuelin , Huang Wenjuan , Ren Hai , Lu Xiankai , Chen Xiuzhi
Published: March 2019

Soil organic carbon (SOC) plays critical roles in stabilizing atmospheric CO2 concentration, but the mechanistic controls on the amount and distribution of SOC on global scales are not well understood. In turn, this has hampered the ability to model global C budgets and to find measures to mitigate climate change. Here, based on the data from a large field survey campaign with 2600 plots across China's forest ecosystems and a global collection of published data from forested land, we find that a low litter carbon-to-nitrogen ratio (C/N) and high wetness index (P/PET, precipitation-to-potential-evapotranspiration ratio) are the two factors that promote SOC accumulation, with only minor contributions of litter quantity and soil texture. The field survey data demonstrated that high plant diversity decreased litter C/N and thus indirectly promoted SOC accumulation by increasing the litter quality. We conclude that any changes in plant-community composition, plant-species richness and environmental factors that can reduce the litter C/N ratio, or climatic changes that increase wetness index, may promote SOC accumulation. The study provides a guideline for modeling the carbon cycle of various ecosystem scales and formulates the principle for land-based actions for mitigating the rising atmospheric CO2 concentration.
Lexemes
Authors: Andreou Marios
Published: March 2019

A lexeme is a theoretical construct that stands for the unitary meaning and shared syntactic properties of a group of word forms. A lexeme is stripped of any inflectional endings. Thus play, plays, played, and playing are all inflected forms of the lexeme play. In a similar vein, cat and cats are inflected forms of the same lexeme, i.e., cat. Although inflection creates forms of the same lexeme, derivation creates new lexemes. Thus, player is not a form of the lexeme play but is considered a different lexeme; it has its own meaning and lexical category; it is a noun. With respect to their morphology, lexemes can be either simple or complex. For example, door is simple and lemon-tree is complex. With respect to their semantics, lexemes can be monosemous or polysemous. For instance, names for days such as Saturday have only one meaning and are monosemous, whereas a lexeme such as university is polysemous; it has more than one meaning. Polysemy is often contrasted with homonymy, under which the same form is associated with two or more unrelated meanings. Polysemous senses are attributed to the same lexeme; homonyms are considered as different lexemes. Although it is usually possible to identify a phonological form that is basic to all the forms of a lexeme, this is not always the case. For example, the form kiss is shared by all forms of the lexeme kiss (e.g., kiss, kisses, kissed, kissing). There is no common phonological form, however, between all forms of the lexeme go (e.g., go, went). Lexemes and their citation form should be kept distinct since the way a lexeme is cited is merely a convention and does not bear on any crucial phonological property of that lexeme. In certain traditions, as for example in Greek, the first-person singular is used as a citation form for verbs, whereas in other traditions, as for example in French, the infinitive is used. For nouns, the nominative singular is used. The terms lexeme, lexical unit, lexical item, word, and lemma are often used interchangeably in the relevant literature and in different linguistic fields. The author gratefully acknowledges the financial support of the Deutsche Forschungsgemeinschaft (DFG Collaborative Research Centre 991: “The structure of representations in language, cognition, and science,” Project C08, “The semantics of derivational morphology: A frame-based approach”).
Yiddish
Authors: Beider Alexander
Published: March 2019

According to its main system-level characteristics, Yiddish belongs to the High German branch of West Germanic languages. During its development, it underwent an important influence of Hebrew. In modern times, we can distinguish three main varieties of Yiddish: (1) Western Yiddish in western German-speaking territories; (2) Yiddish spoken until the twentieth century in Central Europe (Czech and East German lands), and (3) Eastern Yiddish in eastern Europe. From the point of view of Germanistics, it is appropriate to consider that the inception of Yiddish varieties corresponds to the Early New High German period (1350–1650). It was during that period that the Jewish vernacular idiom started to have system-level differences in comparison to the dialects spoken by German Christians, namely, in phonology and grammar. Before that period, differences surely existed in such domains, surface level for any language, as orthography and lexicon. The German dialects from southern Germany represent the linguistic basis for Western Yiddish. The medieval Bohemian dialect of German represents the linguistic basis for Yiddish spoken in Central Europe and eastern Europe. Due to permanent contacts with the Slavic Christian population, Eastern Yiddish underwent numerous changes in all of its systems due to the strong influence of Polish, Ukrainian, and Belarusian. It eventually branched into three subdialects: Lithuanian Yiddish, Polish Yiddish, and Ukrainian Yiddish. In modern times, in numerous countries the decline of the use of Yiddish as a living language was related to the assimilation of local Jews to the culture of the Gentile majority. At the end of the eighteenth century and during the nineteenth century it was the case in various German-speaking provinces of Central Europe and western Europe where local Jews abandoned Yiddish in favor to German. Similar shifts to the dominant non-Jewish languages took place during the twentieth century in various western European countries. In the USSR, during the 1920s and the 1930s the shift to Russian was already well advanced. For those who survived the Holocaust, the assimilation accelerated during the following decades. In Poland, Lithuania, Hungary, and Romania, Yiddish-speaking communities were decimated by the Holocaust. In North America, most immigrant families shifted to English within a generation or two. Yet, because of a permanent influx of masses of native speakers between the 1880s and the 1920s, Yiddish was actively used until the mid-twentieth century even in certain secular Jewish groups. However, during the second half of the twentieth century its decline was accelerated outside of certain Haredi groups.
Growth Models and Female Labor in Post-Socialist Eastern Europe
Authors: Avlijaš Sonja
Published: March 2019

Eastern European women had the highest labor force participation in the world during socialism. With the onset of capitalism, significant shares of women permanently exited the labor market in some countries, while they stayed economically active in others. This article shows that the countries’ different capitalist growth models—defined as strategic national approaches to growth stimulation and job creation—can explain this divergence. Nonlinear interactions between national growth models and structuring of female labor are theoretically abstracted in this article, following which they are tested empirically using a statistical dataset that covers twelve Eastern European countries during the period 1997–2015.
A Dual Role of Amino Acids from Sesbania rostrata Seed Exudates in the Chemotaxis Response of Azorhizobium caulinodans ORS571
Authors: Liu Xiaolin , Xie Zhihong , Wang Yixuan , Sun Yu , Dang Xiaoxiao , Sun Haishuan
Published: March 2019

Azorhizobium caulinodans ORS571 can induce nodule formation on the roots and the stems of its host legume, Sesbania rostrata. Plant exudates are essential in the dialogue between microbes and their host plant and, in particular, amino acids can play an important role in the chemotactic response of bacteria. Histidine, arginine, and aspartate, which are the three most abundant amino acids present in S. rostrata seed exudates, behave as chemoattractants toward A. caulinodans. A position-specific-iterated BLAST analysis of the methyl-accepting chemotaxis proteins (MCPs) (chemoreceptors) in the genome of A. caulinodans was performed. Among the 43 MCP homologs, two MCPs harboring a dCache domain were selected as possible cognate amino acid MCPs. After analysis of relative gene expression levels and construction of a gene-deleted mutant strain, one of them, AZC_0821 designed as TlpH, was confirmed to be responsible for the chemotactic response to the three amino acids. In addition, it was found that these three amino acids can also influence chemotaxis of A. caulinodans independently of the chemosensory receptors, by being involved in the increase of the expression level of several che and fla genes involved in the chemotaxis pathway and flagella synthesis. Thus, the contribution of amino acids present in seed exudates is directly related to the role as chemoattractants and indirectly related to the role in the regulation of expression of key genes involved in chemotaxis and motility. This “dual role” is likely to influence the formation of biofilms by A. caulinodans and the host root colonization properties of this bacterium.
Measuring Patient Safety Competence Among Nursing Students in the Classroom and Clinical Settings
Authors: Suliman Mohammad
Published: March 2019

BACKGROUND

Little is known of the extent to which patient safety (PS) education is addressed in nursing curricula in the classroom and clinical settings in Jordan.

METHOD

An Arabic version of the Health Professional Education in Patient Safety Survey was administered to a convenience sample of 297 nursing students from two governmental universities in Jordan.

RESULTS

Nursing students were moderately satisfied about their knowledge and competencies regarding most PS dimensions; they also had more confidence about the knowledge and competencies they learned in the classroom than during the clinical training. Students in their advanced year had lower confidence about their PS knowledge and competencies than students in the earlier years.

CONCLUSION

The study suggests the need to close the gap between theory and practice in the nursing curriculum. The adoption of a comprehensive framework that integrates PS knowledge and competencies is recommended.
Predicting Physician Assistant Program Matriculation Among Diverse Applicants: The Influences of Underrepresented Minority Status, Age, and Gender
Authors: Yuen Cynthia X. , Honda Trenton J.
Published: March 2019

Purpose

Health professions schools can foster a diverse medical workforce by ensuring equal educational access for students of varied backgrounds. This study examined how physician assistant (PA) applicants’ demographic characteristics and prior academic history affected likelihood of PA program matriculation.

Method

The authors used national application data from the 2015–2016 PA application cycle to investigate associations between applicants’ underrepresented minority (URM) status, age, and gender, and likelihood of matriculating into a PA program. Effects were examined alone and after adjusting for other demographics and potential confounders (number of applications submitted, patient care hours, academic achievement). The authors tested whether odds of matriculation differed among demographic subgroups with and without current Graduate Record Examinations (GRE) scores.

Results

In univariate models, likelihood of matriculation was lower among URM, older, and male applicants. In fully adjusted models, the URM effect became nonsignificant and the gender effect reversed, while older applicants remained less likely to matriculate. URM and age, but not gender, effects differed by GRE status; only URMs and older applicants without current GRE scores were less likely to matriculate than non-URMs and younger applicants.

Conclusions

Findings that URMs, older individuals, and men had lower matriculation odds changed when controlling for academic achievement and GRE status, indicating the importance of these components in the admissions process. URM and age findings were contingent on GRE status such that odds of matriculation decreased among URM and older applicants without GRE scores, suggesting that standardized test requirements may be a barrier to PA workforce diversity.
Hamstring lengthening in females with cerebral palsy have greater effect than in males
Authors: White Hank , Wallace Juanita , Walker Janet , Augsburger Sam , Talwalkar Vishwas R. , Muchow Ryan D. , Iwinski Henry
Published: March 2019

Children with spastic diplegia cerebral palsy often demonstrate crouched gait patterns, and typically undergo hamstring lengthenings. The objective of this retrospective study was to determine if the surgical response to medial and lateral hamstring lengthenings is different between males and females. Preoperative and postoperative kinematic data of 109 (71 males and 38 females) patients with cerebral palsy were evaluated. Females demonstrated larger decreases in popliteal angle, larger decreases in mid-stance knee flexion, and higher incidences of knee hyperextension postoperatively. Results indicate that females have larger responses to hamstring lengthenings than males.
Frequency of Screening for Weaning From Mechanical Ventilation: Two Contemporaneous Proof-of-Principle Randomized Controlled Trials*
Authors: Burns Karen E. A. , Wong Jessica T. Y. , Dodek Peter , Cook Deborah J. , Lamontagne Francois , Cohen Ashley , Mehta Sangeeta , Kho Michelle E. , Hebert Paul C. , Aslanian Pierre , Friedrich Jan O. , Brochard Laurent , Rizvi Leena , Hand Lori , Meade Maureen O. , Amaral Andre C. , Seely Andrew J.
Published: March 2019

Objectives:

It is unknown whether more frequent screening of invasively ventilated patients, identifies patients earlier for a spontaneous breathing trial, and shortens the duration of ventilation. We assessed the feasibility of conducting a large trial to evaluate screening frequency in critically ill adults in the North American context.

Design:

We conducted two contemporaneous, multicenter, pilot, randomized controlled trials (the LibeRation from MEchanicaL VEntilAtion and ScrEening Frequency [RELEASE] and Screening Elderly PatieNts For InclusiOn in a Weaning [SENIOR] trials) to address concerns regarding the potential for higher enrollment, fewer adverse events, and better outcomes in younger patients.

Setting:

Ten and 11 ICUs in Canada, respectively.

Patients:

Parallel trials of younger (RELEASE < 65 yr) and older (SENIOR ≥ 65 yr) critically ill adults invasively ventilated for at least 24 hours.

Interventions:

Each trial compared once daily screening to “at least twice daily” screening led by respiratory therapists.

Measurements and Main Results:

In both trials, we evaluated recruitment (aim: 1–2 patients/month/ICU) and consent rates, reasons for trial exclusion, protocol adherence (target: ≥ 80%), crossovers (aim: ≤ 10%), and the effect of the alternative screening frequencies on adverse events and clinical outcomes. We included 155 patients (53 patients [23 once daily, 30 at least twice daily] in RELEASE and 102 patients [54 once daily, 48 at least twice daily] in SENIOR). Between trials, we found similar recruitment rates (1.32 and 1.26 patients/month/ICU) and reasons for trial exclusion, high consent and protocol adherence rates (> 92%), infrequent crossovers, and few adverse events. Although underpowered, at least twice daily screening was associated with a nonsignificantly faster time to successful extubation and more successful extubations but significantly increased use of noninvasive ventilation in both trials combined.

Conclusions:

Similar recruitment and consent rates, few adverse events, and comparable outcomes in younger and older patients support conduct of a single large trial in North American ICUs assessing the net clinical benefits associated with more frequent screening.
Palisaded Neutrophilic Granulomatous Dermatitis Leading to Diagnosis of Hodgkin Lymphoma: Report of Rare Case and Literature Review of Paraneoplastic Granulomatous Dermatitides
Authors: Pei Susan , Hinshaw Molly A.
Published: March 2019

Palisaded neutrophilic granulomatous dermatitis (PNGD) presents as skin-colored to erythematous papules symmetrically distributed on extensor extremities. Histologically, interstitial and/or palisaded granulomatous infiltrates are present with neutrophils and leukocytoclasis. Together with interstitial granulomatous dermatitis (IGD), PNGD is considered a reactive granulomatous dermatitis to a systemic trigger including connective tissue disease, infection, medication reaction, and less commonly malignancy. We present the second case of PNGD leading to diagnosis of Hodgkin lymphoma. A 47-year-old woman presented with a new asymptomatic eruption of erythematous, nonscaly papules and thin plaques with variable annular configuration, symmetrically distributed on extremities. Biopsies revealed mid-dermal focal degeneration of collagen and leukocytoclasis in association with a palisaded mixed inflammatory infiltrate of neutrophils, lymphocytes, and histiocytes, some forming small granulomas. She had associated fevers, night sweats, weight loss, arthralgias and malaise. Imaging revealed retroperitoneal adenopathy. Excisional lymph node biopsy led to diagnosis of Hodgkin lymphoma. Paraneoplastic PNGD is rare with only 9 reported cases. In all cases, PNGD presented concurrently or before presentation of clinical signs/symptoms of underlying neoplasm. We reviewed a total of 37 cases of paraneoplastic PNGD/IGD, summarizing clinical presentation, histology, associated neoplasm, and response of the skin lesions to treatment. The most commonly associated neoplasia is hematologic, with myelodysplastic syndrome (9 of the 37 cases or 24%) being the most frequent. Seven cases of solid tumor malignancies (prostate, esophageal, hypopharyngeal, breast, endometrial, and lung cancers) have been reported. Recognition of paraneoplastic PNGD/IGD may allow dermatopathologists, pathologists, and dermatologists to direct further workup that reveals underlying malignancy.
The Legacy for Children™ Randomized Control Trial: Effects on Cognition Through Third Grade for Young Children Experiencing Poverty
Authors: Perou Ruth , Robinson Lara R. , Danielson Melissa L. , Claussen Angelika H. , Visser Susanna N. , Scott Keith G. , Beckwith Leila , Katz Lynne , Smith D. Camille
Published: March 2019

Objective:

In an effort to promote the health and developmental outcomes of children born into poverty, the Centers for Disease Control and Prevention (CDC) conceptualized and designed the Legacy for Children™ (Legacy) public health prevention model. This article examines the impact of Legacy on children's cognitive and language development (intelligence quotient [IQ], achievement, language skills, and early reading skills) using both standardized assessments and parent-reported indictors through third grade.

Methods:

Data were collected from 2001 to 2014 from 541 mother-child dyads who were recruited into the 2 concurrent randomized controlled trials of Legacy in Miami and Los Angels. Cognitive and/or language outcomes of children were assessed annually from age 2 to 5 years as well as during a follow-up visit in the third grade.

Results:

Children experiencing Legacy at the Los Angeles site had significantly higher IQ and achievement scores at 2 and 6 years postintervention, equivalent to approximately one-third of an SD (4 IQ points). IQ results persisted over time, and the difference between intervention and comparison groups on achievement scores widened. There were no significant differences in cognitive outcomes in the Miami sample. There were no significant differences in language outcomes for either site.

Conclusion:

Legacy shows evidence of effectiveness as an intervention to prevent cognitive delays among children living in poverty. The mixed findings across sites may not only reflect the impact of heterogeneous risk profiles noted by other intervention research programs but also warrant additional study.
Depressive Symptoms and Care Demands Among Primary Caregivers of Young Children with Evidence of Congenital Zika Virus Infection in Brazil
Authors: Kotzky Kim , Allen Jacob E. , Robinson Lara R. , Satterfield-Nash Ashley , Bertolli Jeanne , Smith Camille , Ornelas Pereira Isabela , Faria e Silva Santelli Ana Carolina , Peacock Georgina
Published: March 2019

Objective:

Evidence suggests that caring for a child with special health care needs can affect many domains of family life, including caregiver mental health. However, few studies have examined these outcomes among families impacted by the Zika virus (ZIKV). This study examines depressive symptom severity and care demands among primary caregivers of children, aged 15 to 26 months, with evidence of congenital Zika virus infection (ZVI).

Methods:

A sample of primary caregivers of children with evidence of congenital ZVI in northeastern Brazil (n = 150) reported on depressive symptoms, care demands, and their children's development. Children were categorized into groups according to their developmental delay status. Bivariate analyses were run to test for differences between groups. A path analysis model was used to examine the indirect effects of developmental delay on depressive symptoms through economic challenges and time spent providing health care at home and whether these associations varied by child care support.

Results:

Compared to primary caregivers of children without developmental delay, primary caregivers of children with developmental delay had higher depression scores (p = 0.002), reported more economic (p < 0.001) and child care (p < 0.001) challenges, and spent more time providing health care at home (p < 0.001). Among primary caregivers who did not have child care support, developmental delay had a significant indirect effect on depressive symptoms through economic challenges but not through time spent providing health care at home.

Conclusion:

For families impacted by the ZIKV outbreak in Brazil, economic and child care challenges may be associated with primary caregiver mental health.
Augmented Subscleral Trabeculectomy With Beta Radiation and Mitomycin C in Egyptian Glaucoma Patients
Authors: El Mazar Hesham M. , Mandour Sameh S. , Mostafa Mohamed I. , Elmorsy Osama A.
Published: March 2019

Purpose:

Subscleral trabeculectomy is the most common surgical treatment for glaucoma. However, wound healing and scar formation may result in bleb fibrosis, leading to bleb failure. The healing response of the wound is reported to be the single most important risk factor in determining the final intraocular pressure (IOP) after glaucoma filtration surgery. Thus, we aimed to evaluate the effect of preoperative beta irradiation and intraoperative mitomycin C (MMC) treatment as combined adjuncts to subscleral trabeculectomy in the management of glaucoma in Egyptian patients.

Patients and Methods:

This prospective, interventional, comparative masked clinical study was performed between October 2016 and January 2018. This study included 50 subjects, 25 of whom underwent trabeculectomy augmented by MMC intraoperatively and beta radiation preoperatively at the bleb area (patient group #1). The remaining 25 subjects underwent trabeculectomy with MMC alone (control group #2). Beta radiation was administered 5 to 7 days before the surgery as a single dose (1000 cGy) using a strontium-90 probe. MMC (0.2 mg/mL) was administered for 2 minutes.

Results:

There was a statistically significant difference in postoperative IOP between the groups from the second week. Intraoperative hyphema occurred in 6 cases in the control group #2, whereas no intraoperative hyphema was observed in patient group #1; this difference was statistically significant.

Conclusions:

Subscleral trabeculectomy augmented by beta radiation and MMC gives greater control over IOP. Therefore, we recommend using beta radiation before trabeculectomy in patients who may have a high risk of developing conjunctival fibrosis.
Implementation of an Activity-Monitoring System in Hospital-Based COPD Patients: A Retrospective Cohort Study
Authors: Wilson Christopher M. , Burns Grace , Bove Jonathon , Ferranti Vincenzo , McCown Benjamin , Wiechec Seidell Janet , Colombo Reyna
Published: March 2019

Introduction:

Patients with chronic obstructive pulmonary disorder are at risk of complications after hospitalization, including readmissions. The purpose of this study was to assess the effects of an activity-monitoring device on the outcomes of patient with chronic obstructive pulmonary disorder during and after a hospital admission.

Methods:

During a hospitalization, 52 patients (experimental group) diagnosed with chronic obstructive pulmonary disorder were provided with an activity monitor (Tractivity; (Kineteks Corporation, Vancouver, British Colombia, http://tractivity-online.squarespace.com/)) and 99 usual care patients were chosen as controls. Following hospital discharge, retrospective chart analysis examined patient demographics including falls, length of stay, discharge disposition, and hospital readmissions.

Results:

No difference in number of falls, length of stay, discharge disposition, and hospital readmissions could be found between groups (P > .05). Within the experimental group, those who were discharged home (n = 45) displayed a greater daily activity, number of steps, and ambulation distance as compared with patients who were discharged to another facility (n = 7, P < .05).

Discussion:

Readmissions are multifactorial and activity during a hospitalization may not be the primary cause of readmissions. Activity monitoring can help quantify ambulation and may be useful as a means to predict discharge disposition.

Conclusion:

No clear effect of using an activity monitor could be found on length of stay, readmission rates, and discharge disposition between the 2 groups. However, less activity and shorter ambulation distance were associated with discharge to another facility instead of home.
A retrospective analysis of the prevalence of dental diseases in patients with digestive system cancers
Authors: Sakai Hironori , Yamada Shin-Ichi , Gibo Takahiko , Yoshimura Nobuhiko , Nishimaki Fumihiro , Kondo Eiji , Kamata Takahiro , Kurita Hiroshi
Published: March 2019

The relationship between dental diseases and the prevalence of digestive system cancers remains unclear. The aim of the present study was to examine the prevalence of dental diseases in patients treated for digestive system cancers.

The medical and dental records of patients treated for digestive system cancers were retrospectively reviewed, and the results obtained (decayed/filled/missing teeth [DMFT] indices and community periodontal index [CPI] codes) were compared with data from the national survey of dental diseases in order to investigate the relationship between oral health and digestive system cancers.

DMFT, D, and F indices were significantly lower, while the M index was slightly higher in digestive system cancer patients than in the national survey. The proportions of individuals with more than 20 residual teeth and denture wearers were significantly lower in cancer patients than in the national survey. The prevalence of periodontitis (CPI codes 3 and 4) and severe periodontitis (CPI code 4) were significantly higher in cancer patients than in the national survey.

The present results showed that digestive system cancers were closely associated with multi-tooth loss and/or a low denture-wearing rate. The prevalence of severe periodontitis was also found to be higher in cancer patients. These results suggest that periodontitis and associated multi-tooth loss play a potential role in digestive system cancers.
Cardiac health in patients with hepatitis B virus-related cirrhosis
Authors: Yuan Wei , Lu Hong-Zhou , Mei Xue , Zhang Yu-Yi , Zhang Zheng-Guo , Zou Ying , Wang Jie-Fei , Qian Zhi-Ping , Guo Hong-Ying
Published: March 2019

Not only alcoholic cirrhosis related to cardiac dysfunction, cirrhosis caused by nonalcoholic etiology including hepatitis B virus (HBV) infection also related to impaired cardiac health. The aims of present study were to perform a noninvasive evaluation of cardiac function and to evaluate exercise performance in HBV related cirrhotic patients without typical symptoms of cardiac disease.

Seventy-nine HBV related cirrhotic patients and 103 matched subjects without a previous history of cardiac involvement were recruited. Clinical examination and cardiac health evaluation were performed. The incidence, risk factors of cardiac dysfunction and exercise tolerance were investigated.

A correlation between QTc interval and model for end-stage liver disease score (R = 0.239, P = .018) was detected, however, the connection between QTc prolongation and the severity of liver disease was uncertain. Patients with HBV related cirrhosis had a tendency toward left ventricular wall thickening (P = .007). Forty-one patients (51.90%) were in accordance with the definition of cirrhotic cardiomyopathy, and a significant increase in the incidence of cardiac diastolic dysfunction (CDD) could be found with increasing Child-Pugh grade (P = .004). HBV related cirrhotic patients with CDD had a higher level of pro-brain natriuretic peptide (P = .025), international normalized ratio (P = .010) Child-Pugh score (P = .020), and a higher proportion of ascites (P < .001). The higher Child-Pugh score (odds ratio = 1.662, P = .010) was an independent diagnostic predictor of CDD. The cardiac depression and exercise tolerance also got worse with increasing Child-Pugh score (P < .001).

Impaired cardiac health was common in HBV related cirrhotic patients. Cardiogenic factors must be carefully considered in the integral therapy of cirrhosis. Hepatology physicians should lay emphasis on exercise training in daily life.
Unsuccessful removal of a totally implantable venous access port caused by thrombosis in the left brachiocephalic vein
Authors: Zhang Xi , Geng Cuizhi
Published: March 2019

Rationale:

Thrombosis is a common complication associated with implantable venous access ports (IVAPs) and often results in loss of catheter function but is rarely associated with difficulty in IVAP removal.

Patient concerns:

A 53-year-old woman presented to the hospital due to difficulty in IVAP removal. The patient had been diagnosed with breast cancer and received modified radical mastectomy. After that, she underwent IVAP implantation. Four and half years later, the IVAP catheter had become stuck while the catheter remained unobstructed. The patient had no special chief complaints.

Diagnosis:

Postoperative breast cancer; difficulty in removal of IVAP (caused by thrombus in the left brachiocephalic vein).

Interventions:

We injected urokinase 5 ml 1000U/L into the catheter once a day for three days but failed to remove the IVAP. Vasography showed a thrombus in the left brachiocephalic vein. Removal of the thrombus would have been very dangerous, so we decided to leave both thrombus and catheter in the body and used heparin and warfarin as anticoagulants.

Outcomes:

The general situation of the patient, followed-up for 20 months, was good and there was no psychological impact or other special chief complaints.

Lessons:

It is best to remove the IVAP in a timely manner once all treatments are finished.
Treatment for upper esophageal sphincter dysfunction in a patient with poststroke dysphagia
Authors: Wei Pengxu , Xu Yafei , Zhang Zuting , Zhang Simin , Lv Zeping
Published: March 2019

Rationale:

Botulinum toxin injection is a widely used procedure for the treatment of the dysfunction of the upper esophageal sphincter (UES). Although the injection can be guided by ultrasound, electromyography, or computed tomography, such techniques cannot determine the exact extent of narrowed UES and ensure that the narrowed extent is fully covered by the treatment. This report describes a dual guiding technique with ultrasound and the balloon catheter in a patient with poststroke dysphagia to improve these weaknesses.

Patient concerns:

The patient was admitted to a rehabilitation hospital 2 weeks postcerebral infarction.

Diagnoses:

Clinical presentation of the patient included severe hemiplegia and dysphagia. The fiberoptic endoscopic evaluation of swallowing (FEES) revealed penetration/aspiration when swallowing 1 ml water and 1 ml yogurt and pooling in the postcricoid region.

Interventions:

Balloon catheter dilatation procedures and Botulinum toxin injection were performed. We used a dual guiding technique with ultrasound and the balloon catheter to determine the whole segment of UES dysfunction by locating the lowest level of the impaired UES opening and to reduce difficulty in differentiating UES from adjacent tissues during Botulinum toxin injection.

Outcomes:

No persistent progress was observed on the symptoms and volume of the balloon during dilatation. The patient showed quick responses after Botulinum toxin injection. The postinjection balloon catheter dilatation showed an increased maximum volume (preinjection, 5.5 ml vs. postinjection, 14 ml), and the patient was able to eat yogurt, congee, or semi-solid food 100–150 ml 4 weeks after the injection.

Lessons:

The dual guiding method holds several advantages, suggesting that it may be considered as a promising choice in dealing with UES dysfunction.