bluuebunny/crossref_metadata_2025 huggingface dataset:
Current and Emerging Medical Treatments for Uterine Fibroids
Authors: Chwalisz Kristof , Taylor Hugh
Published: November 2017

Uterine fibroids (leiomyomata) are common uterine neoplasms that are often associated with detrimental symptoms, such as heavy menstrual bleeding, dysmenorrhea, and pressure-related symptoms, which often lead to surgical intervention, including hysterectomy. Although our understanding of the pathophysiology of uterine fibroids, particularly their dependency on progesterone and the role of growth factors, has increased during the past two decades, the medical options currently approved by the United States Food and Drug Administration are limited and are only used for short-term symptom management. A long-term, safe, and effective treatment is not yet available in the United States. However, emerging medical treatments that are currently under clinical development, including progesterone receptor modulators and oral gonadotropin-releasing hormone antagonists, offer hope of new long-term medical therapies for symptomatic uterine fibroids as an alternative to surgery. Herein, we discuss the current and emerging medical therapies for fibroids based on evidence from randomized clinical trials.
Minimally Invasive Approaches to the Surgical Management of Fibroids
Authors: Wu Harold , Wang Karen
Published: November 2017

Uterine fibroids, as the most common benign neoplasm of the female reproductive tract, can significantly impact a woman's quality of life through abnormal uterine bleeding, infertility, and bulk symptoms. When medical therapy for symptomatic fibroids fails, surgery is the recommended treatment. While a hysterectomy through laparotomy was historically the first-line surgical approach for fibroids, multiple minimally invasive and uterine-sparing techniques are now available. An evidence-based literature review of the following minimally invasive approaches is detailed in this article: hysteroscopic myomectomy, laparoscopic and robotically assisted myomectomy, laparoscopic and robotically assisted hysterectomy, and ultrasound-guided radiofrequency ablation. For each approach, this review discusses the indications, patient selection, adjunct preoperative treatment modalities, instrumentation, techniques, and pertinent intraoperative considerations such as fluid management, interventions to reduce blood loss, antiadhesion barriers, and tissue extraction. Perioperative benefits, long-term outcomes including recurrence and fertility, and comparisons of outcomes among the various approaches are outlined as well. With continued technological advancements and surgical innovations, minimally invasive techniques will become the mainstay of surgical management for symptomatic fibroids to provide high-quality patient-centered care.
Uterine Fibroids: Burden and Unmet Medical Need
Authors: Al-Hendy Ayman , Myers Evan , Stewart Elizabeth
Published: November 2017

Uterine fibroids affect a wide cross-section of the population, with prevalence, symptom severity, and overall disease burden generally higher among black women, likely due to both genetic and environmental factors. Potential symptoms of uterine fibroids include painful and excessive uterine bleeding, interference with everyday life and self-image, and impaired fertility. Because of the high estimated prevalence and costs associated with treatments, the direct and indirect costs of uterine fibroids are substantial for both the health care system and the individual patient. Special patient populations—such as black women, women seeking to retain fertility, and women with asymptomatic fibroids—have particular treatment needs that require a variety of diagnostic methods and treatment options. Despite the widespread occurrence of uterine fibroids and newer treatment options, little high-quality data are available to formulate evidence-based guidelines that address these unmet patient needs. Specific areas in need of attention include improving diagnostic techniques, increasing patient access to early treatment, and identifying best practices for this diverse patient population.
Low-Intensity Pulsed Ultrasound and Halo Immobilization Is an Effective Treatment for Nonunion Following Traumatic Spondylolisthesis of the Axis
Authors: Oda Kohtaroh , Ohba Tetsuro , Ebata Shigeto , Haro Hirotaka
Published: November 2017

This case report describes a unique case involving traumatic spondylolisthesis of the axis that resulted in nonunion, angulation, and displacement after conservative treatment with a cervical collar, but which was successfully achieved union with halo immobilization and low-intensity pulsed ultrasound (LIPUS). Halo immobilization of a traumatic spondylolisthesis in a 20-year-old patient, that previously failed to improve after wearing a cervical collar for 3 months, was immediately followed by treatment with a LIPUS device (SAFHS 4000J; Teijin Pharma, Tokyo, Japan) 20 minutes once daily to the right and left fracture sites which were located using fluoroscopic guidance. Radiographs and computed tomography showed conclusive evidence of bone union after 10 weeks of treatment with halo immobilization. No adverse events were observed. To the best of our knowledge, this is the first report describing that the combination of halo immobilization and LIPUS therapy might be a safe, effective, and feasible method by which to treat cervical spine fractures.
Verdauung und Entzündung – schützen Nährstoffe vor Darmentzündungen?
Authors: Schmiedel Volker
Published: November 2017

Chronisch entzündliche Darmerkrankungen sind in den letzten Jahrzehnten enorm angestiegen. Dies wird auch auf eine veränderte Lebensweise, Ernährung und Nährstoffversorgung zugeführt. In diesem Artikel wird der Nutzen von Vitamin D, sekundären Pflanzeninhaltsstoffen, Selen, Zink und ω-3-Fettsäuren anhand zahlreicher Studien unter Beweis gestellt und praktische Tipps zu Diagnostik und Therapie gegeben.
Colitis ulcerosa
Authors: Schmiedel Volker
Published: November 2017

Eine junge Colitis-ulcerosa-Patientin konnte durch naturheilkundliche Behandlung geheilt werden. Therapiebestandteile waren u. a. Ernährungs- und orthomolekulare Therapie sowie Schwarztee-einläufe.
Prävention durch Mikronährstoffe
Authors: Friedrichsen Hans-Peter
Published: November 2017

Nährstoffe sind für den Körper und seine Funktionen essenziell. Dementsprechend ist eine ausreichende Versorgung für die Gesundheit bedeutsam. Allerdings haben sich die Ernährung und damit auch die Zufuhr der Mikronährstoffe im Laufe der Zeit verändert und der Stoffwechsel sich entsprechend den Gegebenheiten angepasst.
Radiological Diagnoses in the Context of Emigration: Infectious diseases
Authors: Stojkovic Marija , Müller Jan , Junghanss Thomas , Weber Tim
Published: November 2017

Background Globalization and emigration impact on the spectrum of diseases challenging health care systems. Medical practitioners have to particularly prepare for infectious diseases.

Methods The database of a health care center specialized on tropical medicine was screened for patients with history of migration and one of the following diagnoses: Cystic echinococcosis, tuberculosis, schistosomiasis, visceral leishmaniosis, and neurocysticercosis. Representative casuistics were prepared from select case histories. Radiological pertinent knowledge was compiled based on literature search.

Results A small selection of frequently imported infectious diseases covers a considerable fraction of health care problems associated with migration. For cystic echinococcosis, schistosomiasis, and neurocysticercosis imaging is the most relevant diagnostic procedure defining also disease stages. Tuberculosis and visceral leishmaniosis are important differentials for malignant diseases.

Conclusion Imaging plays a meaningful role in diagnosis, treatment stratification, and follow-up of imported infectious diseases. Radiological skills concerning these diseases are important for providing health care for patients in context of migration.

Key Points 

Citation Format
Host governments, national minorities, and minorities’ kin states: assessing the triadic nexus
Authors: Fedotov Egor
Published: November 2017

Ethnic politics necessarily entails conflict-ridden scenarios in which trust is broken and identities compromised, and as such, is an area in need of urgent scholarship. The notion that minority elites in ethnic politics in general take cues from their kin-states as well as host governments, in strategizing how to do politics, is the key idea behind ‘the triadic thesis’. The ethnographic study presented in this article shows, however, on the example of the minority elites’ speech-based or rhetorical acts regarding claim-making about these elites’ demands that the behaviors by the minority elites unfold autonomously from the above. The latter behaviors are either a politics of consensus or a politics of disengagement. Re-assessing the triadic nexus involving the relationships between host governments, national minorities and the latter’s kin-states therefore allows us to make more room for an agency-based perspective.
Electrically injected GaAsBi/GaAs single quantum well laser diodes
Authors: Liu Juanjuan , Pan Wenwu , Wu Xiaoyan , Cao Chunfang , Li Yaoyao , Chen Xiren , Zhang Yanchao , Wang Lijuan , Yan Jinyi , Zhang Dongliang , Song Yuxin , Shao Jun , Wang Shumin
Published: November 2017

We present electrically injected GaAs/GaAsBi single quantum well laser diodes (LDs) emitting at a record long wavelength of 1141 nm at room temperature grown by molecular beam epitaxy. The LDs have excellent device performances with internal quantum efficiency of 86%, internal loss of 10 cm-1 and transparency current density of 196 A/cm2. The LDs can operate under continuous-wave mode up to 273 K. The characteristic temperature are extracted to be 125 K in the temperature range of 77∼150 K, and reduced to 90 K in the range of 150∼273 K. The temperature coefficient of 0.3 nm/K is extracted in the temperature range of 77∼273 K.
A lattice model for the impact of volume fraction fluctuations upon percolation by cylinders
Authors: Chatterjee Avik P. , Grimaldi Claudio
Published: November 2017

A lattice model for continuum percolation by cylindrical rods is generalized to account for inhomogeneities in the volume fraction that are indicative of particle clustering or aggregation. The percolation threshold is evaluated from a formalism that uses two different categories of occupied sites (denoting particles) with different occupation probabilities that represent large and small local volume fractions. Our modeling framework enables independent variations in (i) the strength of the correlation that adjacent particles experience high (or low) effective volume fractions, (ii) the disparity between the macroscopically averaged volume fraction and (say) the volume fraction characterizing the regions with high effective particle concentrations, and (iii) the overall proportion of particles that are located in regions with either high or low volume fraction. Calculations performed for monodisperse cylinders show that enhancement in each of the above factors leads to reduction in the macroscopically averaged volume fraction at the percolation threshold.
Confocal spectroscopic imaging measurements of depth dependent hydration dynamics in human skin in-vivo
Authors: Behm P. , Hashemi M. , Hoppe S. , Wessel S. , Hagens R. , Jaspers S. , Wenck H. , Rübhausen M.
Published: November 2017

We present confocal spectroscopic imaging measurements applied to in-vivo studies to determine the depth dependent hydration profiles of human skin. The observed spectroscopic signal covers the spectral range from 810 nm to 2100 nm allowing to probe relevant absorption signals that can be associated with e.g. lipid and water-absorption bands. We employ a spectrally sensitive autofocus mechanism that allows an ultrafast focusing of the measurement spot on the skin and subsequently probes the evolution of the absorption bands as a function of depth. We determine the change of the water concentration in m%. The water concentration follows a sigmoidal behavior with an increase of the water content of about 70% within 5 μm in a depth of about 14 μm. We have applied our technique to study the hydration dynamics of skin before and after treatment with different concentrations of glycerol indicating that an increase of the glycerol concentration leads to an enhanced water concentration in the stratum corneum. Moreover, in contrast to traditional corneometry we have found that the application of Aluminium Chlorohydrate has no impact to the hydration of skin.
Surface plasmon-enhanced two-photon excited whispering-gallery modes ultraviolet laser from Zno microwire
Authors: Wang Yunpeng , Zhu Gangbei , Mei Jingjing , Tian Cancan , Liu Hongzhen , Wang Fei , Zhao Dongxu
Published: November 2017

The two-photon excited UV laser with narrow line width and high Q value was obtained. The total internal reflection from the four side surfaces of the quadrilateral-ZnO microwire offered the whispering gallery mode (WGM) resonant cavity. The UV emission, resonant mechanism, and laser mode characteristics were discussed in detail for this special type of micro-cavity. In addition, in order to enhance the power of the two-photon excited UV laser, the surface plasmon enhancement by the Au nanoparticles was also performed and explained well by the theory of the localized surface plasmon.
Antimicrobial resistance a threat to public health
Authors: Merlino John
Published: November 2017

Antimicrobial resistance is a complex issue and is a threat to public health globally. While emerging and re-emerging diseases have captured news headlines with outbreaks such SARS, bird flu, Ebola and Zika virus around the world, leading health experts tells us that there is a more serious threat to public health – antimicrobial resistance (AMR)1.
Profilin 1 plays feedback role in actin-mediated polar body extrusion in mouse oocytes
Authors: Liu Jun , Wang Qiao-Chu , Duan Xing , Cui Xiang-Shun , Kim Nam-Hyung , Zhang Yu , Sun Shao-Chen
Published: November 2017

Mammalian oocytes undergo several crucial processes during meiosis maturation, including spindle formation and migration and polar body extrusion, which rely on the regulation of actin. As a small actin-binding protein, profilin 1 plays a central role in the regulation of actin assembly. However, the functions of profilin 1 in mammalian oocytes are uncertain. To investigate the function of profilin 1 in oocytes, immunofluorescent staining was first used to examine profilin 1 localisation. The results showed that profilin 1 was localised around the meiotic spindles and was colocalised with cytoplasmic actin. Knockdown (KD) of profilin 1 with specific morpholino microinjection resulted in failure of polar body extrusion. This failure resulted from an increase of actin polymerisation both at membranes and in the cytoplasm. Furthermore, western blot analysis revealed that the expression of Rho-associated kinase (ROCK) and phosphorylation levels of myosin light chain (MLC) were significantly altered after KD of profilin 1. Thus, the results indicate that a feedback mechanism between profilin, actin and ROCK–MLC2 regulates actin assembly during mouse oocyte maturation.
The question of politeness in political interviews
Authors: Macaulay Marcia
Published: November 2017

This paper examines the question of politeness in political interviews, looking particularly at the use of loaded questions. Comparison is made between the two principal paradigms of politeness, Locher and Watts (2005) and Brown and Levinson (1987). The paper focuses on the interviewing style of Steven Sackur (HARDtalk, BBC) who employs loaded questions in his political interviews in keeping with the analysis of Walton (1991) who argues that loaded questions can function as a ‘reasonable’ means to constrain the response of an interviewee and in turn further discourse. Sackur employs loaded questions selectively to convey and reinforce a presupposition to which an interviewee is not committed. In so doing, he is able to constrain the contribution of his interviewee. Loaded questions are a linguistic means of (im)politeness used strategically by Sackur to further the discourse of his interviews.
Stereochemical assignment of the unique electron acceptor 5′-hydroxyphylloquinone, a polar analog of vitamin K1 in photosystem I
Authors: Kosugi Makiko , Lee Changwoo , Misaki Tomonori , Kashino Yasuhiro , Fujita Morifumi , Sugimura Takashi
Published: November 2017

A unique electron-accepting analog of vitamin K1 found in photosystem I in several species of oxygenic photosynthetic microorganisms was confirmed to be 5′-hydroxyphylloquinone (1) through stereo-uncontrolled synthesis. Furthermore, the stereochemistry of 1 obtained from Synechococcus sp. PCC 7942 was assigned to be 5′S using proline-catalyzed stereocontrolled reactions.
Muscular fitness, Southern European Atlantic Diet and inflammation in adolescents. Azorean Physical Activity and Health Study II
Authors: Agostinis‐Sobrinho César , Brand Caroline , Moreira Carla , Lopes Luís , Oliveira‐santos José , Silva Pedro , Reis Gaya Anelise , Gaya Adroaldo , Mota Jorge , Santos Rute , Abreu Sandra
Published: November 2017

High muscular fitness (MF) and high adherence to the Southern European Atlantic Diet (the SEADiet) have been associated with several positive metabolic outcomes. The purpose of the present study was two‐fold: (i) to explore the independent associations between MF and C‐reactive protein (CRP) levels; and (ii) to investigate the combined impact of MF and SEADiet on the CRP levels in a sample of adolescents. A cross‐sectional school‐based study was conducted on 463 adolescents (272 girls) aged 15–18 years, from the Portuguese Azorean Archipelago. Anthropometric indicators (stature, body mass, waist circumference (WC)) were measured by standardized protocols and pubertal stages were assessed by Tanner criteria. Blood samples were taken after an overnight fast. MF was assessed by the curl‐up and push‐up tests (from the Fitnessgram test battery). Adherence to the SEADiet was assessed with a semi‐quantitative food frequency questionnaire. Linear regression models showed that MF was inversely associated with hs‐CRP (unstandardized B = −0.127; p < .009), after adjustments for age, sex, and pubertal stage, adherence of SEADiet, total energy intake and low‐energy reporter and WC. Analysis of covariance (ANCOVA) showed a significant difference between the low adherence of SEADiet with low MF group and those with a high adherence of SEADiet and high MF (p < .05) (F(5, 453) = 2.238, p = .040). Our results showed that MF is inversely associated with hs‐CRP. In addition, the adolescents with Low adherence of SEADiet/Low MF group had high levels of hs‐CRP compared those who with high adherence of SEADiet/high MF group.
Activity measurements of the radionuclides 18F and 64Cu for the NIST, USA in the ongoing comparisons BIPM.RI(II)-K4.F-18 and BIPM.RI(II)-K4.Cu-64
Authors: Michotte C , Nonis M , Bergeron D , Cessna J , Fitzgerald R , Pibida L , Zimmerman B , Fenwick A , Ferreira K , Keightley J , Silva I Da
Published: November 2017

In 2016, comparisons of activity measurements of 18F and 64Cu using the Transfer Instrument of the International Reference System (SIRTI) took place at the National Institute of Standards and Technology (NIST, USA). This is the first SIRTI comparison for 64Cu. Ampoules containing about 27 kBq of 18F and 100 kBq of 64Cu solutions were measured in the SIRTI for about 5 and 1.5 half-lives, respectively. The NIST standardized the activity in the ampoules by ionization chamber measurements traceable to 4π(LS)β−γ anticoincidence measurements. The comparisons, identifiers BIPM.RI(II)-K4.F-18 and BIPM.RI(II)-K4.Cu-64, are linked to the corresponding BIPM.RI(II)-K1.F-18 and BIPM.RI(II)-K1.Cu-64 comparisons and degrees of equivalence with the respective key comparison reference values have been evaluated. The NIST replaces its earlier degree of equivalence for 18F obtained in the frame of the CCRI(II)-K3.F-18 comparison in 2001.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Draft genome of the Marco Polo Sheep (Ovis ammon polii)
Authors: Yang Yongzhi , Wang Yutao , Zhao Yue , Zhang Xiuying , Li Ran , Chen Lei , Zhang Guojie , Jiang Yu , Qiu Qiang , Wang Wen , Wei Hong-Jiang , Wang Kun
Published: November 2017

Background

The Marco Polo Sheep (Ovis ammon polii), a subspecies of argali (Ovis ammon) that is distributed mainly in the Pamir Mountains, provides a mammalian model to study high altitude adaptation mechanisms. Due to over-hunting and subsistence poaching, as well as competition with livestock and habitat loss, O. ammon has been categorized as an endangered species on several lists. It can have fertile offspring with sheep. Hence, a high-quality reference genome of the Marco Polo Sheep will be very helpful in conservation genetics and even in exploiting useful genes in sheep breeding.

Findings

A total of 1022.43 Gb of raw reads resulting from whole-genome sequencing of a Marco Polo Sheep were generated using an Illumina HiSeq2000 platform. The final genome assembly (2.71 Gb) has an N50 contig size of 30.7 Kb and a scaffold N50 of 5.49 Mb. The repeat sequences identified account for 46.72% of the genome, and 20 336 protein-coding genes were predicted from the masked genome. Phylogenetic analysis indicated a close relationship between Marco Polo Sheep and the domesticated sheep, and the time of their divergence was approximately 2.36 million years ago. We identified 271 expanded gene families and 168 putative positively selected genes in the Marco Polo Sheep lineage.

Conclusions

We provide the first genome sequence and gene annotation for the Marco Polo Sheep. The availability of these resources will be of value in the future conservation of this endangered large mammal, for research into high altitude adaptation mechanisms, for reconstructing the evolutionary history of the Caprinae, and for the future conservation of the Marco Polo Sheep.
Early-Season Pests of Soybean in the United States and Factors That Affect Their Risk of Infestation
Authors: Hesler Louis S , Allen K Clint , Luttrell Randall G , Sappington Thomas W , Papiernik Sharon K
Published: November 2017

Soybean faces potential economic damage from a wide variety of early-season invertebrate pests. The objective of this article was to determine the extent and intensity of nine early-season soybean insect pests targeted for control by insecticidal seed treatments in the United States and to identify various management options for them: bean leaf beetle (Cerotoma trifurcate Förster, Coleoptera: Chrysomelidae); grape colaspis, Colaspis brunnea (F.) (Coleoptera: Chrysomelidae); leafhoppers (Hemiptera: Ciccadellidae); seedcorn maggot, Delia platura (Meigen) (Diptera: Anthomyiidae); soybean aphid (Aphis glycines Matsumura, Hemiptera: Aphididae); threecornered alfalfa hopper, Spsistilus festinus (Say) (Hemiptera: Membracidae); thrips (Thysanoptera: Thripidae); white grubs (Coleoptera: Scarabaeidae); and wireworms (Coleoptera: Elateridae). Seedcorn maggot, white grubs, and wireworms have been limited to a relatively small proportion of soybean fields with readily defined factors regarding their risk. However, questions about the pest status of the other six pests were identified. Bean leaf beetle, which vectors Bean pod mottle virus to soybean, has been present across major soybean-production regions, but frequency and proportion of soybean fields that economically impacted is not adequately documented. The impact of threecornered alfalfa hopper and thrips on soybean productivity varied within regions, but specific reasons for the variation were unclear. Early-season management of grape colaspis and leafhoppers has been infrequent, but factors that promoted economic injury and the need for management in specific fields were undetermined. Although early-season management of soybean aphid has not proven feasible for individual fields, questions remain regarding its management in fields near overwintering stands and the possibility for areawide suppression.
Highly reddened Type Ia supernova SN 2004ab: another case of anomalous extinction
Authors: Chakradhari N K , Sahu D K , Anupama G C , Prabhu T P
Published: November 2017

We present optical photometric and spectroscopic data for supernova SN 2004ab, a highly reddened normal Type Ia supernova. The total reddening is estimated as E(B − V) = 1.70 ± 0.05 mag. The intrinsic decline-rate parameter Δm15(B)true is 1.27 ± 0.05, and the B-band absolute magnitude at maximum $M_{B}^{{\rm max}}$ is −19.31 ± 0.25 mag. The host galaxy NGC 5054 is found to exhibit anomalous extinction with a very low value of RV = 1.41 ± 0.06 in the direction of SN 2004ab. The peak bolometric luminosity is derived as $\log L_{\rm bol}^{\rm max}$ = 43.10 ± 0.07 erg s−1. The photospheric velocity measured from the absorption minimum of the Si ii λ6355 line shows a velocity gradient of $\dot{v}$ = 90 km s−1 d−1, indicating that SN 2004ab is a member of the high velocity gradient (HVG) subgroup. The ratio of the strengths of the Si ii λ5972 and λ6355 absorption lines, $\cal R$(Si ii), is estimated as 0.37, while their pseudo-equivalent widths suggest that SN 2004ab belongs to the broad line (BL) type subgroup.
Dose-Dependent Effect of Cotinine-Verified Tobacco Smoking on Serum Immunoglobulin E Levels in Korean Adult Males
Authors: Dong Jae-June , Shen Jay J , Lee Yong-Jae
Published: November 2017

Background

Smoking is one of the risk factors to exacerbate allergic diseases, and it may affect serum immunoglobulin E (IgE) levels. However, few studies have relied on an objective biomarker to examine the effect of tobacco smoking on serum IgE levels.

Method

A nationwide cross-sectional study was conducted to examine the relationship between urinary cotinine (Ucot) concentrations and IgE levels in 973 males using data from the 2010 Korean National Health and Nutrition Examination Survey (KNHANES). Ucot was classified into four groups based on concentration (ng/mL) as follows: nonsmoker group (Ucot <50 ng/mL) and three tertile groups in smokers (T1 [Ucot: 50.00–921.28 ng/mL]; T2 [Ucot: 921.29–1869.36 ng/mL]; and T3 [Ucot ≥1869.37 ng/mL]). The dose-response relationships between Ucot concentrations and total serum IgE level were estimated using analysis of covariance (ANCOVA) and multiple linear regression analysis after adjusting for confounding variables.

Results

We found a significant and positive dose-related effect of cigarette smoking as measured by Ucot concentrations on the total serum IgE level. The multivariate adjusted means of total serum IgE levels (SE) were 321.0 (36.3), 404.4 (102.7), 499.2 (79.2), and 534.7 (82.7) IU/mL, after adjusting for age, body mass index, alcohol ingestion, physical exercise, job, and household income. The regression coefficient β for total serum IgE was β = 68.6 with increasing level of Ucot group after adjusting for the same covariables (p = .009).

Conclusion

These findings suggest that the amount of smoking may have a dose-dependent effect on total serum IgE levels.

Implication

Smoking is one of the risk factors to exacerbate allergic diseases, and it may affect serum immunoglobulin E (IgE) levels, which is closely related to type 1 mediated allergic diseases. However, few studies have relied on an objective biomarker to examine the effect of tobacco smoking on serum IgE levels. We found that tobacco exposure, as measured by Ucot concentrations, increased the serum IgE levels in a dose-response manner in a representative sample of Korean adult males.
A Nosocomial Outbreak of Human Monkeypox in the Central African Republic
Authors: Nakoune Emmanuel , Lampaert Emmanuel , Ndjapou Séverin Gervais , Janssens Carole , Zuniga Isabel , Van Herp Michel , Fongbia Jean Paul , Koyazegbe Thomas Daquin , Selekon Benjamin , Komoyo Giscard Francis , Garba-Ouangole Sandra Miriella , Manengu Casimir , Manuguerra Jean-Claude , Kazanji Mirdad , Gessain Antoine , Berthet Nicolas
Published: November 2017

An outbreak of familial monkeypox occurred in the Central African Republic in 2015/2016 by 3 transmission modes: familial, health care–related, and transport-related. Ten people (3 children and 7 adults) were infected. Most presented with cutaneous lesions and fever, and 2 children died. The viral strain responsible was a Zaire genotype strain.
Pitfalls Associated With the Use of Molecular Diagnostic Panels in the Diagnosis of Cryptococcal Meningitis
Authors: O’Halloran Jane A , Franklin Alexander , Lainhart William , Burnham Carey-Ann , Powderly William , Dubberke Erik
Published: November 2017

We report the case of a kidney transplantation patient on chronic immunosuppressive therapy presenting with subacute meningitis. The final diagnosis of cryptococcal meningitis was delayed due to 2 false-negative cryptococcal results on a molecular diagnostic panel. Caution with such platforms in suspected cryptococcal meningitis is needed.
Transitioning to a High-Value Health Care Model: Academic Accountability
Authors: Johnson Pamela T. , Alvin Matthew D. , Ziegelstein Roy C.
Published: November 2017

Health care spending in the United States has increased to unprecedented levels, and these costs have broken medical providers’ promise to do no harm. Medical debt is the leading contributor to U.S. personal bankruptcy, more than 50% of household foreclosures are secondary to medical debt and illness, and patients are choosing to avoid necessary care because of its cost. Evidence that the health care delivery model is contributing to patient hardship is a call to action for the profession to transition to a high-value model, one that delivers the highest health care quality and safety at the lowest personal and financial cost to patients. As such, value improvement work is being done at academic medical centers across the country. To promote measurable improvements in practice on a national scale, academic institutions need to align efforts and create a new model for collaboration, one that transcends cross-institutional competition, specialty divisions, and geographical constraints. Academic institutions are particularly accountable because of the importance of research and education in driving this transition. Investigations that elucidate effective implementation methodologies and evaluate safety outcomes data can facilitate transformation. Engaging trainees in quality improvement initiatives will instill high-value care into their practice. This article charges academic institutions to go beyond dissemination of best practice guidelines and demonstrate accountability for high-value quality improvement implementation. By effectively transitioning to a high-value health care system, medical providers will convincingly demonstrate that patients are their most important priority.
Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Adults With Tinnitus in the United Kingdom: A Randomized Controlled Trial
Authors: Beukes Eldré W. , Baguley David M. , Allen Peter M. , Manchaiah Vinaya , Andersson Gerhard
Published: November 2017

Objectives:

Specialist tinnitus services are in high demand as a result of the negative effect tinnitus may have on quality of life. Additional clinically and cost-effective tinnitus management routes are needed. One potential route is providing Cognitive Behavioural Therapy for tinnitus via the Internet (iCBT). This study aimed to determine the efficacy of guided iCBT, using audiological support, on tinnitus distress and tinnitus-related comorbidities, in the United Kingdom. A further aim was to establish the stability of intervention effects 2-months postintervention. The hypothesis was that iCBT for tinnitus would be more effective at reducing tinnitus distress than weekly monitoring.

Design:

A randomized, delayed intervention efficacy trial, with a 2-month follow-up was implemented to evaluate the efficacy of iCBT in the United Kingdom. Participants were randomly assigned to the experimental (n = 73) or weekly monitoring control group (n = 73) after being stratified for tinnitus severity and age. After the experimental group completed the 8-week long iCBT intervention, the control group undertook the same intervention. Intervention effects were, therefore, evaluated in two independent groups at two time points. The primary outcome was a change in tinnitus distress between the groups as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life. These were completed at baseline, postintervention, and at a 2-month postintervention follow-up.

Results:

After undertaking the iCBT intervention, the experimental group had a greater reduction in tinnitus distress when compared with the control group. This reduction was statistically significant (Cohen’s d = 0.7) and was clinically significant for 51% of the experimental group and 5% of the control group. This reduction was evident 4 weeks after commencing the iCBT intervention. Furthermore, the experimental group had a greater reduction in insomnia, depression, hyperacusis, cognitive failures, and a greater improvement in quality of life, as evidenced by the significant differences in these assessment measures postintervention. Results were maintained 2 months postintervention.

Conclusions:

Guided (using audiological support) iCBT for tinnitus resulted in statistically significant reductions in tinnitus distress and comorbidities (insomnia, depression, hyperacusis, cognitive failures) and a significant increase in quality of life. These effects remained stable at 2-months postintervention. Further trials to determine the longer term efficacy of iCBT to investigate predictors of outcome and to compare iCBT with standard clinical care in the United Kingdom are required.

Registered at clinicaltrials.gov: NCT02370810 on 5/03/2015.
Left Ventricular Assist Device Infections: A Systematic Review
Authors: O’Horo John C. , Abu Saleh Omar M. , Stulak John M. , Wilhelm Mark P. , Baddour Larry M. , Rizwan Sohail M.
Published: November 2017

Left ventricular assist devices (LVADs) are becoming a more frequent life-support intervention. Gaining an understanding of risk factors for infection and management strategies is important for treating these patients. We conducted a systematic review and meta-analysis of studies describing infections in continuous-flow LVADs. We evaluated incidence, risk factors, associated microorganisms, and outcomes by type of device and patient characteristics. Our search identified 90 distinct studies that reported LVAD infections and outcomes. Younger age and higher body mass index were associated with higher rates of LVAD infections. Driveline infections were the most common infection reported and the easiest to treat with fewest long-term consequences. Bloodstream infections were not reported as often, but they were associated with stroke and mortality. Treatment strategies varied and did not show a consistent best approach. LVAD infections are a significant cause of morbidity and mortality in LVAD patients. Most research comes from secondary analyses of other LVAD studies. The lack of infection-oriented research leaves several areas understudied. In particular, bloodstream infections in this population merit further research. Providers need more research studies to make evidence-based decisions about the prevention and treatment of LVAD infections.
Physical Activity Protects Against the Risk of Erosive Esophagitis on the Basis of Body Mass Index
Authors: Pyo Jeung Hui , Kim Ji Won , Kim Tae Jun , Lee Hyuk , Min Yang Won , Min Byung-Hoon , Lee Jun Haeng , Rhee Poong-Lyul , Jung Sin-Ho , Cha Kyeong Min , Kang Mira , Kim Jee Eun , Choi Yoon-Ho , Kim Jae J.
Published: November 2017

Goal:

To determine whether physical activity lowers the risk for erosive esophagitis on the basis of body mass index (BMI).

Background:

Although previous studies have shown that physical activity is closely associated with erosive esophagitis, these data may be confounded by obesity.

Study:

In this retrospective study, we included 182,409 patients who underwent an upper endoscopy and were diagnosed with erosive esophagitis. The impact of the amount and intensity of physical activity on the risk for erosive esophagitis was analyzed based on BMI groups. Subjects were classified into three BMI groups with equal numbers in each group.

Results:

Overall, 10.3% (n=18,859) of patients were diagnosed with erosive esophagitis. After adjusting for confounding factors, a greater amount of exercise [lower tertile: odd ratio (OR), 0.86; 95% confidence interval (CI), 0.77-0.96; middle tertile: OR, 0.91; 95%, CI 0.84-1.00; upper tertile: OR, 0.79; 95% CI, 0.73-0.85) and increased exercise intensity (lower tertile, moderate: OR, 0.61; 95% CI, 0.52-0.71; vigorous: OR, 0.51; 95% CI, 0.44-0.58; middle tertile, moderate: OR, 0.62; 95% CI, 0.55-0.70; vigorous: OR, 0.58; 95% CI, 0.51-0.65; upper tertile, moderate: OR, 0.58; 95% CI, 0.53-0.65; vigorous: OR, 0.58; 95% CI, 0.53-0.64) was associated with a decreased risk for erosive esophagitis in all 3 BMI groups. In addition, we observed that increased physical activity intensity notably decreased the risk for erosive esophagitis in subjects performing lesser physical activity, but slightly decreased the risk for erosive esophagitis in subjects performing more physical activity.

Conclusion:

Physical activity is inversely associated with erosive esophagitis.
Randomized Controlled Clinical Trial on Value of Domperidone in Functional Abdominal Pain in Children
Authors: Karunanayake Amaranath , Devanarayana Niranga M. , de Silva Asita , Gunawardena Sampath , Rajindrajith Shaman
Published: November 2017

Objectives:

The aim of the study was to evaluate the therapeutic effect of domperidone on children with abdominal pain predominant functional gastrointestinal disorders (AP‐FGIDs).

Methods:

One hundred children (aged 5–12 years) fulfilling Rome III criteria for AP‐FGIDs were randomized into 8 weeks of domperidone or placebo treatment. Primary outcomes defined were cure and patient‐reported general improvement. Secondary outcomes were reduction in the severity of abdominal pain and increase in gastric motility. Patients were followed up for 6 months.

Results:

Eighty‐nine (42 in placebo group, 47 in domperidone group) completed the trial at 8 weeks. Seventy‐nine completed the 6‐month follow‐up. When primary outcomes were assessed at 8 weeks, 37 (74%) in the domperidone group and 25 (50%) in the placebo group showed patient‐reported general improvement (P = 0.013), whereas no significant difference was observed in cure (22 [44%] vs 14 [28%] P = 0.09). At 6‐month follow‐up 30 (60%) in the domperidone group and 19 (38%) in the placebo group reported cure (P = 0.028), whereas 44 (88%) in the domperidone group and 33 (66%) in the placebo group showed patient‐reported general improvement (P = 0.009). When assessing secondary outcomes at 8 weeks, the domperidone group reported significant reduction in the severity of abdominal pain (54.1% vs 24.7%, P = 0.008) and an increase in the antral motility index (27.5% vs 7.2%, P = 0.029). None of the patients reported intervention‐related adverse effects.

Conclusions:

Domperidone may be a safe and effective therapeutic modality to achieve a lasting remission of symptoms in children with AP‐FGIDs.
Clear Liquid Versus Low‐fibre Diet in Bowel Cleansing for Colonoscopy in Children
Authors: Mytyk Aleksandra , Lazowska‐Przeorek Izabella , Karolewska‐Bochenek Katarzyna , Kakol Dariusz , Banasiuk Marcin , Walkowiak Jaroslaw , Albrecht Piotr , Banaszkiewicz Aleksandra
Published: November 2017

Objectives:

In light of a paucity of data on the role of diet in colonoscopy preparation in paediatric population, the present study was designed to compare the effectiveness of clear liquid and low‐fibre diets for breakfast and lunch on the day preceding colonoscopy in children.

Methods:

This prospective, randomised trial was conducted at the Department of Paediatric Gastroenterology and Nutrition in Warsaw, Poland. Eligible patients, referred for colonoscopies, were 6 to 18 years old. Patients were randomly divided into 2 groups: the first received a clear liquid diet and the second a low‐fibre diet on the day before colonoscopy. In the afternoon, all participants were asked to drink polyethylene glycol with electrolytes at a dose of 66 mL/kg to a maximum of 4 L. The effectiveness of bowel cleansing was measured using the Boston Bowel Preparation Scale (BBPS). The preparation tolerance was assessed by parents and children using a visual analogue scale. Adverse effects were reported.

Results:

In total, 184 patients were enrolled. Of those, 96 received the clear liquid diet and 88—the low‐fibre diet. The mean age of both groups was 15 years. There were no differences between the 2 study groups in age, weight, and sex, as well as in total BBPS score (BBPS ≥ 5 96.6% vs 95.1%, P = 0.5). The frequency of adverse effects was similar in both groups; nausea was the most common (P = 0.8).

Conclusions:

Clear liquid and low‐fibre diets administered to children the day before colonoscopy demonstrated similar bowel cleansing effectiveness.
Understanding Medication Schedules: Do Pictograms Help?
Authors: Leong Madeline , Tam Vernissia , Xu Timothy , Peters Matthew
Published: November 2017

Background

Previous studies suggest that pictograms may improve patients' understanding of medication schedules. Understanding a medication schedule is a necessary first step for medication adherence.

Objective

This study aimed to determine if pictograms improved patients' ability to correctly fill a pillbox.

Design

This is a randomized, controlled, crossover pilot study.

Participants

This study involves 30 patients on the medical wards of an urban, tertiary care center.

Main Measures

The PillBox Test required participants to fill a 7-day pillbox with pill-sized colored beads. Participants were randomized to either the control or the experimental condition first. In the control condition, a standard pillbox was used with text instructions on the pill bottles. In the experimental condition, a pictogram pillbox was used with text and pictogram instructions on the pill bottles.

Key Results

There was no significant difference in passing on text or pictogram PillBox Test based on the order of group administration. However, 77% of participants reported that pictograms helped them understand medication instructions, 67% of participants preferred pictograms, and 93% felt pictograms should be used on all medication labels.

Conclusions

In this pilot study, the use of pictograms did not significantly improve participants' ability to correctly fill a pillbox. However, most participants preferred pictograms to text labels. Further research is needed to determine the efficacy of pictograms in specific populations.
Outcomes of a Multicenter Training Program in Laparoscopic Pancreatoduodenectomy (LAELAPS-2)
Authors: de Rooij Thijs , van Hilst Jony , Topal Baki , Bosscha Koop , Brinkman David J. , Gerhards Michael F. , de Hingh Ignace H. , Karsten Tom M. , Lips Daan J. , Luyer Misha D. , Marsman Hendrik A. , van Rijssen L. Bengt , Steen M. Willemijn , Busch Olivier R. , Festen Sebastiaan , Besselink Marc G.
Published: November 2017

Objective:

The aim of the study was to assess feasibility and outcomes of a multicenter training program in laparoscopic pancreatoduodenectomy (LPD).

Background:

Whereas expert centers have reported promising outcomes of LPD, nationwide analyses have raised concerns on its safety, especially during the learning curve. Multicenter, structured LPD training programs reporting outcomes including the first procedures are lacking. No LPD had been performed in the Netherlands before this study.

Methods:

During 2014–2016, 8 surgeons from 4 high-volume centers completed the Longitudinal Assessment and Realization of Laparoscopic Pancreatic Surgery (LAELAPS-2) training program in LPD, including detailed technique description, video training, and proctoring. In all centers, LPD was performed by 2 surgeons with extensive experience in pancreatic and laparoscopic surgery. Outcomes of all LPDs were prospectively collected.

Results:

In total, 114 patients underwent LPD. Median pancreatic duct diameter was 3 mm [interquartile range (IQR = 2–4)] and pancreatic texture was soft in 74% of patients. The conversion rate was 11% (n = 12), median blood loss 350 mL (IQR = 200–700), and operative time 375 minutes (IQR = 320–431). Grade B/C postoperative pancreatic fistula occurred in 34% of patients, requiring catheter drainage in 22% and re-operation in 2%. A Clavien-Dindo grade ≥ III complication occurred in 43% of patients. Median length of hospital stay was 15 days (IQR = 9–25). Overall, 30-day and 90-day mortality were both 3.5%. Outcomes were similar for the first and second part of procedures.

Conclusions:

This LPD training program was feasible and ensured acceptable outcomes during the learning curve in all centers. Future studies should determine whether such a training program is applicable in other settings and assess the added value of LPD.
Implementation of a Blood Management Program at a Tertiary Care Hospital
Authors: Gani Faiz , Cerullo Marcelo , Ejaz Aslam , Gupta Pranjal B. , Demario Vincent M. , Johnston Fabian M. , Frank Steven M. , Pawlik Timothy M.
Published: November 2017

Background:

Patient blood management (PBM) programs represent a perioperative bundle of care that aim to reduce or eliminate unnecessary transfusions.

Objective:

To evaluate the impact of a PBM program on transfusion practices and clinical outcomes at a single surgical department at a tertiary care hospital in the United States.

Methods:

This pre-post, cross-sectional study was performed using data from 17,114 patients undergoing gastrointestinal surgery between 2010 and 2013. Multivariable regression analysis was used to evaluate the impact of implementing a PBM program on transfusion practices and perioperative clinical outcomes.

Results:

Implementation of the PBM program was associated with a reduction in the proportion of patients receiving packed red blood cell (PRBC) using a liberal trigger hemoglobin concentration (pre-PBM vs post-PBM: trigger ≥8.0 g/dL: 20.2% vs 15.3%, P < 0.001), as well as an increase in the proportion of patients receiving PRBC using a restrictive trigger hemoglobin concentration (trigger <7.0 g/dL: 37.1% vs 46.4%, P < 0.001). The proportion of patients overtransfused to a target hemoglobin concentration of 9.0 g/dL (54.8% vs 43.9%, P < 0.001) or 10.0 g/dL (22.3% vs 15.8%, P < 0.001) also decreased following implementation of the PBM program. On multivariable analysis, implementation of the PBM program was associated with 23% lower odds of receiving PRBC transfusion (odds ratio = 0.77, 95% confidence interval 0.657–0.896, P = 0.001); hospital length-of-stay, postoperative morbidity, and postoperative mortality were unchanged (all P > 0.05).

Conclusions:

Implementation of a PBM program was associated with fewer patients receiving PRBC transfusion using a liberal trigger hemoglobin concentration and fewer patients being “overtransfused,” without any detectable change in length-of-stay, morbidity or mortality. PBM programs can be safely implemented across hospitals and should be used to improve quality and reduce unnecessary transfusions.