bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid assessment of the dose–response relationship of methamphetamine using the progressive-dosing procedure
Authors: Watanabe Shigeru
Published: May 2018

This paper describes a new method to rapidly obtain dose–response curves for a drug with rewarding properties using the conditioned place preference protocol. In the usual single-dosing procedure, different animals receive single, varying doses. Thus, a large number of animals are required to generate a curve. A new procedure, known as progressive dosing, alternates increasing drug doses with saline. In this way, the same animal can receive multiple tests. The dose–response curves of the rewarding effect of methamphetamine in mice were obtained using both single-dosing and progressive-dosing procedures. Although the progressive-dosing curves were not identical to the single-dosing curves, they showed a similar pattern. The progressive-dosing procedure was replicated with a new set of mice to confirm the reliability of the method and a dose–response curve similar to the previous one was obtained. This new method can reduce the number of animals required and shorten the duration of the experiment.
Pharmacokinetics Evaluation of Mycophenolic Acid and Its Glucuronide Metabolite in Chinese Renal Transplant Recipients Receiving Enteric-Coated Mycophenolate Sodium and Tacrolimus
Authors: Xu Lu-yang , Jiao Zheng , Liu Fei-yan , Qiu Xiao-yan , Ji Li , Zhang Ming
Published: May 2018

Background:

The aim of this study was to characterize the pharmacokinetics of mycophenolic acid (MPA) and MPA glucuronide (MPAG) in Chinese renal transplant patients taking enteric-coated mycophenolate sodium (EC-MPS). Limited sampling strategies (LSSs) were developed to estimate the area under the concentration curve from 0 to 12 hours (AUC0–12h) of total and free MPA. Another objective was to investigate the correlation between high-performance liquid chromatography (HPLC) and enzyme-multiplied immunoassay technology (EMIT) for total MPA determination.

Methods:

Serial blood samples were collected over 12 hours from 15 patients who were administered multiple doses of EC-MPS. LSS was developed by multiple stepwise regression analysis. Measurement by HPLC and EMIT was compared using Passing–Bablok regression and Bland–Altman analysis.

Results:

Normalized to 720 mg twice daily, the AUC0–12h of total MPA and MPAG was 43.0 ± 17.4 and 653 ± 329 mg·h/L, respectively, whereas the free MPA AUC0–12h was 1.368 ± 0.988 mg·h/L. The free fraction of MPA was 3.01% ± 3.15%. The combination of C2h–C4h–C6h and C2h–C4h–C6h–C8h was found to be superior to estimate total and free MPA simultaneously. The EMIT showed an acceptable correlation with HPLC, with an AUC0–12h overestimation of 11.32% ± 15.77%.

Conclusions:

The pharmacokinetic profile of total and free MPA and its main metabolite MPAG was examined in Chinese adult renal transplant patients receiving EC-MPS. The use of LSS to estimate individual free and total MPA exposure could be useful in optimizing patient care.
Vasomotor and Related Menopause Symptoms
Authors: STUENKEL CYNTHIA A.
Published: May 2018

Vasomotor symptoms are the most common manifestation of the menopause transition and postmenopausal phases of reproductive life. They interfere not only in quality of life, but also contribute to sleep and mood disturbances that potentially compromise home and work effectiveness. Treatment options include hormone therapy (HT), nonhormonal prescription drugs, mind body and behavior therapies, and over-the-counter preparations. Evidence confirms that HT is the most effective option. The initial reticence to prescribe HT immediately following publication of the Women’s Health Initiative has been replaced by clear guidelines for confidently identifying women for whom this therapy will be safe.
COMBINING EN FACE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY WITH STRUCTURAL OPTICAL COHERENCE TOMOGRAPHY AND BLOOD FLOW ANALYSIS FOR DETECTING CHOROIDAL NEOVASCULAR COMPLEXES IN PIGMENT EPITHELIAL DETACHMENTS
Authors: Kang Hyunseung , Byeon Suk Ho , Kim Sung Soo , Koh Hyoung Jun , Lee Sung Chul , Kim Min
Published: June 2018

Purpose:

This work aimed to describe the morphology of pigment epithelial detachment (PED) using optical coherence tomography angiography and to investigate its potential to detect choroidal neovascularization in various types of PEDs.

Methods:

In this retrospective study, 53 patients diagnosed with PED after undergoing both optical coherence tomography angiography (AngioPlex, CIRRUS HD-OCT) and spectral domain optical coherence tomography (Spectralis SD-OCT) were included.

Results:

Among the 53 eyes, flat vascularized PED (vPED) affected 21 eyes (40%), peaked vPED affected 10 eyes (19%), serous PED affected 12 eyes (23%), drusenoid PED affected 6 eyes (11%), and 4 eyes (7%) had multiple PED subtypes. The main underlying etiologies were pachychoroid spectrum disorder (30.2%), wet age-related macular degeneration (28.3%), central serous chorioretinopathy (18.9%), dry age-related macular degeneration (11.3%), and polypoidal choroidal vasculopathy (11.3%). Optical coherence tomography angiography identified neovascularization in 29 (94%) of the vPED eyes, 2 (17%) of the serous PED eyes, and all 4 (100%) mixed PED eyes.

Conclusion:

Optical coherence tomography angiography successfully identified neovascularization in both vPEDs and PEDs previously considered to be nonneovascular. However, structural OCT and blood flow analysis should be combined to interpret PED-associated neovascularization accurately in the clinic.
SPONTANEOUS CLOSURE OF SIMULTANEOUS IDIOPATHIC MACULAR HOLES DOCUMENTED BY SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY
Authors: Gonzalez-Cortes Jesus H. , Toledo-Negrete Juan J. , Bages-Rousselon Yunuen , de Alba-Castilla Manuel A. , Mohamed-Hamsho Jesus
Published: May 2018

Purpose:

To report a case of spontaneous closure of simultaneous full-thickness macular hole.

Methods:

Case report and literature review.

Results:

A 67-year-old woman with small-diameter simultaneous macular holes was observed for a period of 5 months, and progression was documented with spectral-domain optical coherence tomography. Closure of right full-thickness macular hole was evidenced by 1 month and left full-thickness macular hole by 5 months.

Conclusion:

This case demonstrates possible spontaneous resolution of a condition that is usually treated surgically. A period of observation with serial imaging studies may be advised in cases of small macular holes.
Topography-Based Removal of Corneal Epithelium for Keratoconus: A Novel and Customized Technique
Authors: Shetty Rohit , Vunnava KrishnaPoojita , Khamar Pooja , Choudhary Urvija , Sinha Roy Abhijit
Published: May 2018

Purpose:

To report 3 cases of management of keratoconus with a novel topography-based removal of corneal epithelium in keratoconic eyes combined with corneal crosslinking.

Methods:

Case report and technique description.

Results:

Three eyes were imaged with the Sirius topographer (Schwind Eye-Tech-Solutions, Germany). Single-step transphototherapeutic keratectomy was performed. After removal of epithelium with laser, 4-mm diameter ablation was performed centered at the location of the maximum anterior tangential curvature point. An ellipsoid ablation pattern was used for all eyes. The stromal ablation depth did not exceed 25 μm. Next, epithelium over the remaining central 8-mm cornea was manually scraped. Accelerated crosslinking (9 mW/cm2 for 10 min) of the central 8-mm cornea was performed. After 3 months, spherical equivalent, maximal anterior curvature, and root mean square of higher-order aberrations decreased by 1.75 D, 2.0 D, and 0.15 μm, respectively, in the first eye. The spherical equivalent, maximal anterior curvature, and root mean square decreased by 2.75 D, ∼4.0 D, and 0.36 μm, respectively, in the second eye. In the third eye, the decrease was 0.75 D, 8.3 D, and 1.0 μm, respectively. After 3 months, improvement in visual acuity was significant in 2 of the 3 eyes. In 1 eye, there was a slight reduction in corrected distance visual acuity mostly because of ongoing remodeling of the cornea and delayed vision stabilization.

Conclusions:

A novel technique named topography-based removal of corneal epithelium in keratoconic eyes was described. This combined technique ablated less stroma and achieved outcomes comparable to those of existing techniques.
Serum Bile Acids in Patients With Primary Open-angle Glaucoma
Authors: Jacob Mridula M. , Pai H. Vijaya , Gnanaharan John , Kamath Shobha
Published: May 2018

Purpose:

To measure the serum bile acids (SBA) in patients with primary open-angle glaucoma (POAG) and to compare with nonglaucomatous controls.

Patients and Methods:

A hospital-based case control study of 90 patients above the age of 40 years was conducted. Patients with POAG formed the study group and individuals without glaucoma in the same age group formed the control group. SBA estimation was done using ELISA kit enzymatic assay technique and the median value was compared between the 2 groups.

Results:

The median of SBA level was found to be more in POAG patients when compared with the control group. The difference was statistically significant (P<0.001). Median SBA level was not affected by the age or sex of the participants in the study.

Conclusions:

“Bile acids” may have a role in the oxidative stress and apoptosis involved in the pathophysiology of POAG.
Early Intervention Outcomes for Toddlers With Autism Spectrum Disorder and Their Families
Authors: Noyes-Grosser Donna M. , Elbaum Batya , Wu Yan , Siegenthaler Kirsten M. , Cavalari Rachel S. , Gillis Jennifer M. , Romanczyk Raymond G.
Published: May 2018

Autism spectrum disorder (ASD) can be diagnosed as early as 18 months of age. State Early Intervention (EI) programs under Part C of the Individuals with Disabilities Education Act (IDEA) are serving increasing numbers of children with ASD; however, little is known about outcomes of these services. This study evaluated the impact of EI for toddlers with ASD (n = 193) and other disabilities (n = 129) and their families, using measures that included federal Part C outcome indicators. Children with ASD showed reduced maladaptive behaviors and improved social and communication skills on the PDD Behavior Inventory; some also made progress on the Part C child outcome indicators. Families of children with ASD reported that EI helped them achieve many outcomes identified as important to families participating in EI. Results provide a rich description of outcomes experienced by children with ASD and their families in one of the largest EI programs in the United States. Implications for results-driven accountability and future research are discussed.
Integration of a Patient-Centered Medical Home Into Ambulatory Health Care Services Centers in Abu Dhabi
Authors: Baynouna Al Ketbi Latifa Mohammad , Al Kwuiti Mariam Mohammad , Abdulbaqi Hanan , Al Kwuiti Mouza Hamad , Al Alawi Shamma , Al Zarouni Amal , Al Awadhi Fathyia , Al Bloushi Durra , Al Harbi Amal , Saadon Bakr , Al Jabri Omar
Published: May 2018

This study describes the transformation of Abu Dhabi Ambulatory Healthcare Services into patient-centered medical homes (PCMH) in 3 pilot sites by applying the National Commission for Quality Assurance (NCQA) PCMH standards. The intervention was system redesign, population management, team building, and optimizing electronic medical records toward patient-centered care. The pilot centers outperformed non–pilot centers in clinical key performance indicators. Based on the NCQA 2011 PCMH criteria, the pilot achieved 84% compared with 42% at the start of the project. In conclusion this study shed light on a firm path to operationalizing PCMH to enhance the quality and access to care.
Do Depressive Symptoms Moderate the Effects of Exercise Self-efficacy on Physical Activity Among Patients With Coronary Heart Disease?
Authors: Siow Elaine , Leung Doris Yin Ping , Wong Eliza Mi Ling , Lam Wai Han , Lo Shuk Man
Published: May 2018

Background:

Exercise self-efficacy is an important predictor of physical activity. Patients with coronary heart disease are at risk of developing depressive symptoms that could further weaken their self-efficacy and interfere with their ability to engage in physical activity.

Objective:

The aim of this study was to examine the relationship between depressive symptoms, exercise self-efficacy, and physical activity among patients with coronary heart disease and how the efficacy-activity relationship is affected by the patient's level of depression.

Methods:

A survey was conducted on 149 participants at the time of discharge from the emergency and in-patient medical wards at 2 regional hospitals.

Results:

The sample was mostly male, married, living with families, and of lower socioeconomic status. The mean exercise self-efficacy was 4.26 ± 2.73, and the median physical activity was 12 (interquartile range, 6–21). Approximately 26% of participants had high depressive symptoms. Those with more depressive symptoms reported lower self-efficacy scores and lower physical activity. In multivariate regressions, self-efficacy was an independent predictor of physical activity (b = 1.48, P < .001). After including depressive symptoms as the interaction term, exercise self-efficacy had a significantly stronger and positive relationship with physical activity (b = 0.14, P = .043).

Conclusion:

Exercise self-efficacy had a positive association with physical activity, and this relationship was stronger among coronary heart disease patients with depressive symptoms. This finding suggests that self-efficacy might be important in encouraging individuals with depressive symptoms to participate in physical activity. More efforts should target the development of effective strategies to improve exercise self-efficacy as a way of promoting physical activity among depressed coronary heart disease patients.
Trends and Patterns of Antidepressant Use in French Children and Adolescents From 2009 to 2016
Authors: Revet Alexis , Montastruc François , Raynaud Jean-Philippe , Baricault Bérangère , Montastruc Jean-Louis , Lapeyre-Mestre Maryse
Published: May 2018

Purpose/Background

Over the last decade, the use of antidepressants (ATDs) in children and adolescents has markedly increased in several occidental countries, but recent data in French children are missing. This study aimed to assess trends of ATD use in French children (6–11 years) and adolescents (12–17 years) and to characterize changes in ATD prescribing patterns from 2009 to 2016.

Methods

Using data from the French Health Insurance Database, annual prevalence and incidence of ATD use and changes in ATD prescribing patterns were analyzed.

Results

Overall ATD prevalence of use rose slightly from 0.51% in 2009 to 0.53% in 2016 (+3.9%), with a decrease in children (0.18%–0.11%; −38.9%) and an increase in adolescents (0.86%–0.98%; +14.0%) and an overall female preponderance (56.7% in 2009; 58.7% in 2016). Serotonin reuptake inhibitor prevalence of use increased from 0.24% to 0.34%, whereas tricyclic ATD use decreased (from 0.20% to 0.16%). Similar trends were obtained with overall incidence of use, from 0.39% in 2009 to 0.36% in 2016 (−7.7%). Sertraline was the most frequently prescribed in adolescents (2009: 22.2% of all ATD prescriptions; 2016: 32.9%), whereas amitriptyline was the most prescribed in children (2009: 42.7% and 2016: 41.2%). Off-label use decreased in adolescents (from 48.4% to 34.8%) but increased in children (from 10.0% to 26.5%).

Implications/Conclusions

Antidepressant level of use in French children and adolescents was stable in recent years and lower than that observed in other European countries and the United States.
Sustained Impairment of Lurasidone Clearance After Discontinuation of Posaconazole
Authors: Greenblatt David J. , Harmatz Jerold S. , Ryan Michael J. , Chow Christina R.
Published: May 2018

Purpose/Background

The antipsychotic agent lurasidone (Latuda®) is metabolized by Cytochrome P450-3A (CYP3A) enzymes. Coadministration with strong CYP3A inhibitors (such as ketoconazole, posaconazole, and ritonavir) is contraindicated due to the risk of sedation and movement disorders from high levels of lurasidone. This study evaluated the time-course of recovery from the posaconazole drug interaction, and the effect of obesity on the recovery process.

Methods/Procedures

Healthy normal-weight volunteers (n = 11, mean body mass index, BMI, = 23.1 kg/m2) and otherwise healthy obese subjects (n = 13, mean BMI = 49.3 kg/m2) received single doses of lurasidone in the baseline control condition, again during coadministration of posaconazole, and at 4 additional time points during the 2 weeks after posaconazole discontinuation.

Findings/Results

With posaconazole coadministration, lurasidone area under the concentration curve (AUC) increased by an arithmetic mean factor of 6.2 in normals, and by 4.9 in obese subjects. Post-treatment washout of posaconazole was slow in normals (mean half-life 31 hours), and further prolonged in obese subjects (53 hours). Recovery of lurasidone AUC toward baseline was correspondingly slow, and was incomplete. AUC remained significantly elevated above baseline both in normals (factor of 2.1) and obese subjects (factor of 3.4) even at 2 weeks after stopping posaconazole.

Implications/Conclusions

Product labeling does not address the necessary delay after discontinuation of a strong CYP3A inhibitor before lurasidone can be safely administered. We recommend requiring normal-weight and obese patients to limit the dosage of lurasidone, or undergo a washout period, for two and three weeks, respectively, after discontinuation of posaconazole.
Analgesic Management of Pain in Elite Athletes: A Systematic Review
Authors: Harle Christopher A. , Danielson Elizabeth C. , Derman Wayne , Stuart Mark , Dvorak Jiri , Smith Lisa , Hainline Brian
Published: May 2018

Objective:

To identify the prevalence, frequency of use, and effects of analgesic pain management strategies used in elite athletes.

Design:

Systematic literature review.

Data Sources:

Six databases: Ovid/Medline, SPORTDiscus, CINAHL, Embase, Cochrane Library, and Scopus.

Eligibility Criteria for Selecting Studies:

Empirical studies involving elite athletes and focused on the use or effects of medications used for pain or painful injury. Studies involving recreational sportspeople or those that undertake general exercise were excluded.

Main Results:

Of 70 articles found, the majority examined the frequency with which elite athletes use pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anesthetics, and opioids. A smaller set of studies assessed the effect of medications on outcomes such as pain, function, and adverse effects. Oral NSAIDs are reported to be the most common medication, being used in some international sporting events by over 50% of athletes. Studies examining the effects of pain medications on elite athletes typically involved small samples and lacked control groups against which treated athletes were compared.

Conclusions:

Existing empirical research does not provide a sufficient body of evidence to guide athletes and healthcare professionals in making analgesic medication treatment decisions. Based on the relatively robust evidence regarding the widespread use of NSAIDs, clinicians and policymakers should carefully assess their current recommendations for NSAID use and adhere to a more unified consensus-based strategy for multidisciplinary pain management in elite athletes. In the future, we hope to see more rigorous, prospective studies of various pain management strategies in elite athletes, thus enabling a shift from consensus-based recommendations to evidence-based recommendations.
The Relationship Between Prescription Copayments and Contraceptive Adherence in a New-user Cohort
Authors: Marshall Cassondra , Schmittdiel Julie , Chandra Malini , Calhoun Amanda , Raine-Bennett Tina
Published: May 2018

Background:

Contraceptive nonadherence is an important contributor to unintended pregnancy in the United States. While the elimination of patient cost sharing has been cited as means to improve contraceptive access, little is known about the relationship between cost sharing and ongoing adherence and continuation of chosen methods. The purpose of this study was to examine the relationship between copayment amount and adherence to pharmacy-dispensed contraception in young women.

Methods:

We conducted a retrospective cohort study of 39,142 women ages 19–29 with a new prescription for the contraceptive pill, patch, or ring at Kaiser Permanente Northern California during 2011–2014. We examined 12-month nonadherence as measured by timely prescription refills and used multivariable Cox proportional hazards models to assess the association between copayment amount and the risk of nonadherence.

Results:

Ninety-four percent of women used the pill, and 6% used the patch or ring. Forty percent of patients had no copayment and 25% had a copayment of ≥$30. Nearly 75% of women were nonadherent during the study period. In 2013 and 2014, women with a copayment had a 9% increased risk of nonadherence (adjusted hazard ratio, 1.09; 95% confidence interval, 1.04, 1.14) compared with women with no copayment.

Conclusions:

Prescription copayments may serve as a barrier to adherence of pharmacy-dispensed contraception. Given recent changes to Affordable Care Act contraceptive coverage requirement, these findings can be used to support state-level and health system-level policies for no-cost contraception, and to determine the potential public health impact of this policy change.
Academic Stress May Contribute to the Onset of Pediatric Inflammatory Bowel Diseases
Authors: Krishna Mahesh Z. , Barton Keisha R. , Perez Carla M. , Walsh Seema M. , Assa Amit , Kellermayer Richard
Published: May 2018

It is currently unclear whether seasonality affects the onset of inflammatory bowel diseases (IBDs: Crohn disease and ulcerative colitis) in children. Here, we examined the records of pediatric patients with IBD diagnosed between 2009 and 2015 in a discovery cohort of 169 cases and a validation cohort of 122 subjects, where the month of symptoms onset could be determined. No seasonal patterns could be identified in respect to conception, birth, and disease onset. An annual rhythm of symptomatic onset, however, correlating with academic semesters was identified. IBD symptoms in the discovery cohort presented significantly more (P = 0.0218) during 5 months including the initiation (August, September, January) and the termination of academic semesters (December, May) compared to any other 5 months of the year. This observation was validated in the independent cohort (P < 0.0001). Our findings imply that academic stress may contribute to disease onset in pediatric IBD, which may improve timely diagnosis.
Management of Paediatric Ulcerative Colitis, Part 2
Authors: Turner Dan , Ruemmele Frank M. , Orlanski‐Meyer Esther , Griffiths Anne M. , de Carpi Javier Martin , Bronsky Jiri , Veres Gabor , Aloi Marina , Strisciuglio Caterina , Braegger Christian P. , Assa Amit , Romano Claudio , Hussey Séamus , Stanton Michael , Pakarinen Mikko , de Ridder Lissy , Katsanos Konstantinos H. , Croft Nick , Navas‐López Víctor Manuel , Wilson David C. , Lawrence Sally , Russell Richard K.
Published: May 2018

Background and aim:

Acute severe colitis (ASC) is one of the few emergencies in pediatric gastroenterology. Tight monitoring and timely medical and surgical interventions may improve outcomes and minimize morbidity and mortality. We aimed to standardize daily treatment of ASC in children through detailed recommendations and practice points which are based on a systematic review of the literature and consensus of experts.

Methods:

These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Fifteen predefined questions were addressed by working subgroups. An iterative consensus process, including 2 face‐to‐face meetings, was followed by voting of the national representatives of ECCO and all members of the Paediatric Inflammatory Bowel Disease (IBD) Porto group of ESPGHAN (43 voting experts).

Results:

A total of 24 recommendations and 43 practice points were endorsed with a consensus rate of at least 91% regarding diagnosis, monitoring, and management of ASC in children. A summary flowchart is presented based on daily scoring of the Paediatric Ulcerative Colitis Activity Index. Several topics have been altered since the previous 2011 guidelines and from those published in adults.

Discussion:

These guidelines standardize the management of ASC in children in an attempt to optimize outcomes of this intensive clinical scenario.
Total Bile Acid Concentration in Duodenal Fluid Is a Useful Preoperative Screening Marker to Rule Out Biliary Atresia
Authors: Fukuoka Tomoya , Bessho Kazuhiko , Tachibana Makiko , Satomura Yoshinori , Konishi Akiko , Yasuda Kie , Kimura Takeshi , Hasegawa Yasuhiro , Ueno Takehisa , Miyoshi Yoko , Ozono Keiichi
Published: May 2018

Objectives:

Duodenal tube test (DTT) is used as a preoperative screening to rule out biliary atresia (BA). In previous reports, DTT was assessed by the color of the duodenal fluid, but there were no quantitative criteria. The aim of this study was to examine the efficacy of DTT based on the total bile acid (TBA) concentration in duodenal fluid.

Methods:

This is a single‐center retrospective study of infants with cholestasis who underwent DTT from 2008 to 2016 at the Osaka University Hospital. The cut‐off values of maximum TBA in duodenal fluid (dTBA), dTBA/serum TBA ratio (sTBA), and dTBA/serum gamma‐glutamyl transpeptidase (sGGT) ratio were assessed for the accuracy in excluding BA.

Results:

A total of 37 infants were included in this study; 16 infants with BA and 21 infants with other causes of intrahepatic cholestasis. dTBA demonstrated sensitivity of 100% and specificity of 90.5% with the cut‐off value of 16.8 μmol/L. Specificity was further improved to 95.2% with dTBA/sTBA ratio (cut‐off value: 0.088) and 100% with dTBA/sGGT ratio (cut‐off value: 0.076 μmol/U). DTT could be performed 0.8 ± 1.4 days after admission. Hypoglycemia was developed in 1 infant.

Conclusions:

DTT evaluated by dTBA, dTBA/sTBA ratio, and dTBA/sGGT ratio had high accuracy to rule out BA and could avoid unnecessary surgery in some infants.
Interrater and Intrarater Reliability of the Congenital Muscular Torticollis Severity Classification System
Authors: Oledzka Magdalena M. , Kaplan Sandra L. , Sweeney Jane K. , Coulter Colleen , Evans-Rogers Debbie L.
Published: May 2018

Purpose:

To establish inter- and intrarater reliability for determining severity grades of the congenital muscular torticollis severity classification system (CMT-SCS).

Methods:

A prospective reliability study with 145 physical therapists recorded severity ratings on 24 randomly-ordered patient cases including age of infant, cervical range of motion, and presence or absence of sternocleidomastoid mass. To compute intrarater reliability, cases were randomly reordered and graded by 82 of the original raters.

Results:

For the CMT-SCS, overall reliability was good with an interrater reliability intraclass correlation coefficient (ICC) (2,1) of 0.83 (95% confidence interval [CI], 0.74-0.91) and an intrarater reliability ICC (3,1) of 0.81 (95% CI, 0.66-0.91).

Conclusions:

The CMT-SCS has good reliability for infants up to 12 months of age. Physical therapists can use the scale for initial assessment of infants suspected to have CMT. The CMT-SCS should be standard documentation for infants with CMT.
Does Partner Selection Mediate the Relationship Between School Attendance and HIV/Herpes Simplex Virus-2 Among Adolescent Girls and Young Women in South Africa: An Analysis of HIV Prevention Trials Network 068 Data
Authors: Stoner Marie C. D. , Edwards Jessie K. , Miller William C. , Aiello Allison E. , Halpern Carolyn T. , Julien Aimée , Rucinski Katherine B. , Selin Amanda , Twine Rhian , Hughes James P. , Wang Jing , Agyei Yaw , Gómez-Olivé Francesc Xavier , Wagner Ryan G. , Laeyendecker Oliver , Macphail Catherine , Kahn Kathleen , Pettifor Audrey
Published: May 2018

Objective:

School attendance prevents HIV and herpes simplex virus-2 (HSV-2) in adolescent girls and young women, but the mechanisms to explain this relationship remain unclear. Our study assesses the extent to which characteristics of sex partners, partner age, and number mediate the relationship between attendance and risk of infection in adolescent girls and young women in South Africa.

Design:

We use longitudinal data from the HIV Prevention Trials Network 068 randomized controlled trial in rural South Africa, where girls were enrolled in early adolescence and followed in the main trial for more than 3 years. We examined older partners and the number of partners as possible mediators.

Methods:

We used the parametric g-formula to estimate 4-year risk differences for the effect of school attendance on the cumulative incidence of HIV/HSV-2 overall and the controlled direct effect (CDE) for mediation. We examined mediation separately and jointly for the mediators of interest.

Results:

We found that young women with high attendance in school had a lower cumulative incidence of HIV compared with those with low attendance (risk difference = −1.6%). Partner age difference (CDE = −1.2%) and the number of partners (CDE = −0.4%) mediated a large portion of this effect. In fact, when we accounted for the mediators jointly, the effect of schooling on HIV was almost removed, showing full mediation (CDE = −0.3%). The same patterns were observed for the relationship between school attendance and cumulative incidence of HSV-2 infection.

Conclusion:

Increasing school attendance reduces the risk of acquiring HIV and HSV-2. Our results indicate the importance of school attendance in reducing partner number and partner age difference in this relationship.
Spectral Computed Tomography Angiography With a Gadolinium-based Contrast Agent
Authors: Nadjiri Jonathan , Pfeiffer Daniela , Straeter Alexandra S. , Noël Peter B. , Fingerle Alexander , Eckstein Hans-Henning , Laugwitz Karl-Ludwig , Rummeny Ernst J. , Braren Rickmer , Rasper Michael
Published: May 2018

Purpose:

Computed tomography angiography (CTA) requires IV application of iodine-based contrast agents. There are several medical conditions in which application is not advisable or even feasible, especially for elective examinations. Novel techniques such as monoenergetic reconstructions from dual-energy computed tomographic (CT) data have been shown to increase radiation attenuation of gadolinium (Gd)-based contrast agents in a phantom model. Therefore, the purpose of the present investigation was to evaluate the technical feasibility and image quality of clinical spectral CTA with a Gd-based contrast agent.

Materials and Methods:

Eleven consecutive patients with common indications for thoracic CTA and contraindications for iodine-based contrast agents were examined using clinical routine doses (0.2 mmol/kg) of Gd-based contrast agent with spectral CT. Monoenergetic reconstructions of the spectral data set were computed.

Results:

We performed 11 Gd-enhanced CTAs: 9 aortic angiographies, 1 coronary angiography, and 1 angiography of the pulmonary arteries. Image quality of the monoenergetic reconstructions with 40 keV (monoE40) was considered diagnostic by 2 experienced radiologists in each patient; the conventional CT reconstructions did not reach diagnostic image quality. MonoE40 reconstruction resulted in a substantial, ∼2-fold increase of intravascular Gd attenuation compared with the conventional images (P<0.0001). No relevant change of attenuation was observed for the myocardium or the skeletal muscle.

Conclusions:

With spectral CT and reconstruction of monoenergetic images with extrapolated 40 keV, Gd-based contrast agent thoracic angiography with clinical doses of Gd is technically feasible. Gd-based CTA seems a valuable alternative in patients with contraindications for iodine-based contrast media.
The Role of Platelet Concentrates in Facial Fat Grafting
Authors: Xiong Shaoheng , Qiu Lihong , Zhao Jianhui , Zheng Hui , Cui Dong , Su Yinjun , Yi Chenggang
Published: May 2018

Autologous fat grafting is increasingly being used as a method for the repair of facial soft tissue defects and facial rejuvenation, given its low risk of adverse effects and high efficacy. However, the unpredictability of graft retention is a limitation of this procedure. In addition, there is no standard procedure to date for autologous fat grafting. Different methods have been developed to increase the retention of grafted fat. For instance, platelet concentrates have been used to directly deliver bioactive factors to grafted fat. Platelet concentrates also provide incidental therapeutic benefits by enhancing the persistence of fat grafted in the face via the release of growth factors and cytokines. In this review, we describe current strategies for improving the survival of facial fat grafts, mainly focusing on the application of growth factors/cytokines and platelet concentrates to fat grafting.
Adult Laryngeal Ossified Hemangioma: Difficulties in Differential Diagnosis
Authors: Aluffi Valletti Paolo , Toso Andrea , Gorris Christel , Dell’Era Valeria , Golinelli Gloria , Pia Francesco
Published: May 2018

Adult laryngeal hemangiomas are uncommon and often poorly symptomatic. The authors describe a laryngeal hemangioma with acute airway obstruction and radiologic findings suggesting a chondrosarcoma-like neoplasm, while pathologic features were consistent with an ossified hemangioma. The presence of fields of bone metaplasia into a classical cavernous hemangioma is an unusual phenomenon which, to our knowledge, was never previously described in the larynx. Difficulties concerning the differential diagnosis and modality of treatment are also discussed.
Mesenchymal Chondrosarcoma of the Orbit Attached to the Optic Nerve
Authors: Bagheri Abbas , Abbaszadeh Mohammad , Torbati Peyman , Rezaei Kanavi Mozhgan
Published: May 2018

Mesenchymal chondrosarcoma (MCS) is a rare tumor in the orbit. Although optic nerve displacement is a common finding in intraorbital MCS, optic nerve tissue involvement in tumor has rarely been reported in huge tumors associated with intracranial extension. Herein the authors report a patient with MCS involving optic nerve tissue without intracranial extension. A 59-year-old woman with a 2-month history of progressive proptosis and normal vision presented to us. Computed tomography revealed a clearly outlined heterogeneous mass with calcified foci in its center, which was attached to the optic nerve, magnetic resonance imaging showed the mass to be isointense to gray matter on T1- and T2-weighted images. She underwent lateral orbitotomy and partial tumor excision. Histopathologic study confirmed MCS. She refused exenteration till 1 year but the tumor recurred and her vision decreased to no light perception. Then exenteration was performed with obtaining free margin and she is now free of tumor after 6 months without radiotherapy or chemotherapy. Mesenchymal chondrosarcoma must be differentiated from more common calcified tumors attached to optic nerve like meningioma.
Three-Dimensional Printed Model and Transantral Endoscopy to Orbital Fracture Repair
Authors: Moura Lucas Borin , Carvalho Pedro Henrique de Azambuja , Gabrielli Marisa Aparecida Cabrini , Pereira-Filho Valfrido Antonio
Published: May 2018

Orbital fractures are high prevalent and result in several complications such as diplopia, muscular entrapment, visual impairment, and enophthalmos. The goal of orbital reconstruction is to restore orbital anatomy, volume, and globe symmetry. This case report aims to describe the use of transantral endoscopy and 3D printed model for treatment of an orbital floor fracture. A 54-year-old woman presented orbital floor fracture with diplopia and extraocular muscle entrapment. The surgical treatment was performed using a standard titanium mesh bended over 3D printed model, and transantral endoscopy to verify fracture extension and implant adaptation. The postoperative evaluation demonstrates correction of diplopia and ocular motility restriction. Computed tomography scan showed reestablishment of the orbital anatomy. The association of transantral endoscopy and 3D printed models is a feasible technique to improve orbital reconstruction.
Faciocervical Reconstruction Using a Large Expanded Forehead Island Flap Grafted Using a Microsurgical Technique for Burned Cicatricial Contracture Correction
Authors: Han Bing , Fan Jincai , Liu Liqiang , Tian Jia , Gan Cheng , Yang Zengjie , Jiao Hu , Zhang Tiran , Liu Zheng , Zhang Hua
Published: May 2018

Extrinsic cicatricial contracture is still one of the most common and frustrating complications in the faciocervical area after severe burns. Because of these contractured scars, patients not only suffer from aesthetic issues but also local dysfunction, especially when it comes to the faciocervical region. Esthetical and functional reconstruction of these regions remains a great challenge for reconstructive surgeons. This report presents a 28-year-old man with postburn mentocervical adhesion treated successfully with a large expanded forehead island flap. Cosmetic and functional results have been achieved in this patient during long-term follow-ups.
Intestinal Fatty Acid Binding Protein is Associated With Mortality in Patients With Acute Heart Failure or Cardiogenic Shock
Authors: Kastl Stefan P. , Krychtiuk Konstantin A. , Lenz Max , Distelmaier Klaus , Goliasch Georg , Huber Kurt , Wojta Johann , Heinz Gottfried , Speidl Walter S.
Published: May 2018

Background:

Acute heart failure and cardiogenic shock are associated with an impaired intestinal perfusion, which may lead to a release of cytoplasmatic proteins by hypoxic epithelial injury. Intestinal fatty acid binding protein (iFABP), highly specific for the small bowel enterocyte, may pose a useful novel and very sensitive biomarker for predicting outcome of these patients.

The aim of this study was to investigate whether circulating levels of iFABP are associated with mortality in patients with acute heart failure or cardiogenic shock requiring intensive care unit (ICU) admission.

Methods:

We included 90 consecutive patients with cardiogenic shock (74.4%) or severe acute heart failure (25.6%) admitted to a cardiac ICU. Blood samples were taken at day 0 and day 3. Median age was 64.7 (49.4–74.3), 76.7% of patients were male and median NT-proBNP levels were 4,986 (1,525–23,842) pg/mL. 30-day survival was 64.4%.

Results:

Patients with serum levels of iFABP at day 0 in the highest quartile (iFABP ≥ 588.4 pg/mL) had a 2.5-fold risk (P = 0.02) of dying independent of demographics, NT-proBNP levels, and vasopressor use. Extensively elevated admission levels of iFABP above the 90th percentile (iFABP ≥ 10208.4 pg/mL) were associated with an excessive mortality rate of 88.9%. In contrast, iFABP levels at day 3 were not associated with outcome.

Conclusion:

Circulating levels of iFABP at admission predict mortality. This suggests that early inadequate perfusion of the small intestine may be associated with a dramatically decreased survival in patients with cardiogenic shock or severe acute heart failure.
A different form of injury prevention: Successful screening and referral for human immunodeficiency virus and hepatitis C virus in a trauma population
Authors: Privette Alicia R. , White Benjamin , Ferguson Pamela L. , Norcross E. Douglas , Richey Lauren E.
Published: May 2018

BACKGROUND

In the United States, millions of patients are living with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) (0.44% and 1.5%) and many are currently undiagnosed. Because highly effective treatments are now available, early identification of these patients is extremely important to achieve improved clinical outcomes. Prior data and trauma-associated risk factors suggest a higher prevalence of both diseases in the trauma population. We hypothesized that a screening program could be successfully initiated among trauma activation patients and that a referral and linkage-to-care program could be developed.

METHODS

Hepatitis C virus and HIV screening tests were added to standard trauma activation laboratory orders at an academic Level I Trauma Center. Confirmatory viral load was sent when indicated. Patients with positive results were educated about their disease and referred to disease-specific follow-up. Data were collected prospectively from January 1, 2016, until June 30, 2017. Total and new diagnosis, referral rates, and linkage-to-care rates were analyzed.

RESULTS

One thousand eight hundred ninety-eight patients arrived as trauma activations. One thousand two hundred seventeen (64.1%) patients were screened (Level A, 75.6%; Level B, 60.2%). Seven percent of the screened patients were initially positive, and 5.5% were confirmed positive. Rates of both HIV (1.1%) and HCV (4.4%) were almost triple the national average. Overall, 3.3% screened positive for a new diagnosis. For HCV, the rate of new diagnosis was twice the national average (3%). Over 85% of all cases were referred for follow-up, and the combined linkage-to-care rate was 43.3%.

CONCLUSION

The majority of patients were screened and referred for follow-up, indicating successful implementation of our trauma screening program. Routine screening of trauma patients should be considered to increase diagnosis rate, increase linkage-to-care rates, and decrease disease transmission. These screening efforts would help bridge the health care gap that exists in the trauma population due to lower insurance rates and limited access to primary care.

LEVEL OF EVIDENCE

Therapeutic/Care management, level III.
Prevalence and treatment of depression and posttraumatic stress disorder among trauma patients with non-neurological injuries
Authors: Bell Teresa M. , Vetor Ashley N. , Zarzaur Ben L.
Published: May 2018

BACKGROUND

Psychological impairment among injury survivors is well documented. Little is known about the prevalence of treatment of psychological impairment, however. We aimed to determine the proportion of injury survivors treated for depression and posttraumatic stress disorder (PTSD) in the year after injury as well as to determine potential barriers to treatment.

METHODS

Adults (18 and older) admitted to a Level I trauma center with an injury severity score greater than 10 but without traumatic brain injury or spinal cord injury were eligible for study inclusion. The Center for Epidemiological Studies—Depression and PTSD CheckList—Civilian Versions surveys were administered during the initial hospitalization and repeated at 1, 2, 4, and 12 months after injury. Patients were asked if they received treatment specifically for depression or PTSD at each follow-up. Factors associated with treatment were determined using multivariable logistic regression analysis.

RESULTS

Five hundred injury survivors were enrolled in this prospective observational study. Of those, 68.4% of patients screened positive for depression at some point in the year after their injury (53.3%, 1 month; 49.9%, 2 months; 49.0%, 4 months; and 50.2%, 12 months). Only 22.2% of depressed patients reported receiving treatment for depression; 44.4% of patients screened positive for PTSD (26.6%, 1 month; 27.8%, 2 months; 29.8%, 4 months; and 30.0%, 12 months), but only 9.8% received treatment for PTSD. After adjusting for other factors, compared to commercial insurance status, self-pay insurance status was negatively associated with treatment for PTSD or depression (odds ratio, 0.44; 95% confidence interval, 0.21–0.95).

CONCLUSION

Depression and PTSD are common in non-neurotrauma patients in the year following injury. Greater collaboration between those caring for injury survivors and behavioral health experts may help improve psychological outcomes after injury.

LEVEL OF EVIDENCE

Therapeutic/Care management, level IV.
High-dose Factor XIII administration induces effective hemostasis for trauma-associated coagulopathy (TAC) both in vitro and in rat hemorrhagic shock in vivo models
Authors: Nagashima Futoshi , Inoue Satoshi , Koami Hiroyuki , Miike Toru , Sakamoto Yuichiro , Kai Keita
Published: May 2018

BACKGROUND

Trauma-associated coagulopathy (TAC) is an early and primary complication in severe trauma patients. Factor XIII (FXIII) is reported to stabilize a clot in the late phase of the coagulation cascade. The goal of this study was to investigate whether the administration of FXIII improves the condition of TAC both in vitro and in vivo.

METHODS

We evaluated the effects of different doses, including a very high dose of FXIII (3.6–32.4 IU/mL) on tissue-plasminogen activator–induced hyperfibrinolysis and the combined condition of dilutional coagulopathy and tissue-plasminogen activator–induced hyperfibrinolysis in vitro. The coagulation status was analyzed by rotational thromboelastometry (ROTEM) and Sonoclot. Then, we evaluated the effect of high-dose FXIII (300 IU/kg) for severe coagulopathy in vivo using a rat liver trauma model in which coagulopathy similar to TAC was observed. Survival time and the amount of intra-abdominal bleeding of rats were measured, and a coagulation test was also performed. Histologic evaluations of rats’ lung and kidney after FXIII administration were completed.

RESULTS

High-dose FXIII significantly improved clot strength as well as increased resistance to hyperfibrinolysis in vitro which was confirmed by ROTEM. Platelet function on Sonoclot was significantly increased by FXIII in a dose-dependent manner. Factor XIII significantly decreased the total amount of bleeding and prolonged the survival time compared to control (control vs FXIII: 108.9 ± 11.4 vs 32.6 ± 5.5 mL/kg; p < 0.001; 26.0 ± 8.8 vs 120 minutes, p < 0.001) in a rat model. Rotational thromboelastometry parameters and platelet function on Sonoclot were significantly improved in the FXIII (+) group compared to control. No adverse effects of FXIII were detected histologically.

CONCLUSION

Factor XIII not only generated stable clot resistance to hyperfibrinolysis but also enhanced platelet function by facilitating clot retraction. High-dose FXIII administration therapy has significant clinical impact for severe trauma accompanied with TAC.

STUDY TYPE

Human in vitro and rat in vivo experimental study.