bluuebunny/crossref_metadata_2025 huggingface dataset:
Dementia and cardiovascular diseases
Authors: Strandberg Timo , Nieminen Tuomo
Published: March 2018

Dementia is the end-stage of cognitive dysfunction, a syndrome where memory and/or other cognitive functions have progressively deteriorated. Dementia is typically a syndrome of older age and numbers are increasing due to the enlarging geriatric population. However, the age-adjusted incidence of dementia has been reported to be falling, implicating its risk to be modifiable. The causes and severity of dementia are very heterogeneous. Currently, Alzheimer disease (AD) is the most common specific diagnosis, but in old age, vascular cognitive impairment and dementia (VCID), and particularly a condition featuring both VCID and AD (mixed disease), is becoming increasingly important. However, any aetiology that damages the functions of the brain can cause clinical dementia. As vascular lesions in the brain become common with increasing age, the role of cardiovascular disease as a principal or contributing factor to dementias is probably underestimated. A complex and poorly understood balance between damaging and protecting factors is at the core of the disease. The diagnosis of cognitive dysfunction in older patients is predominantly clinical, and different aetiologies may give a similar phenotype. Currently, no curative treatment exist for dementia, whether AD or VCID, and treatment is symptomatic and supportive; however, it is important to treat concomitant diseases and cardiovascular disease risks optimally. Prevention of dementia is increasingly important, as it has been estimated that 30–60% of dementia could be preventable. As cardiovascular disease risk factors predispose also to AD diagnosed in clinical terms, the notion ‘what is good for the heart is good for the brain’ seems appropriate.
Special situations in the elderly: sport, physical activity, and travel
Authors: Kostka Joanna , Koziarska-Rościszewska Małgorzata , Kostka Tomasz
Published: March 2018

The number of physically active and travelling older people is gradually increasing. Regular physical activity can bring significant health benefits to people of all ages. On the other hand, due to concomitant chronic disease and age-related changes, older athletes are at higher risk of both acute adverse events and overuse injuries. Therefore, general medical and cardiovascular evaluation is recommended before initiation of a training programme. Similarly, it is necessary to perform a medical assessment of older subjects concerning fitness for travel and possible medical consequences. A pre-travel visit should allow individual physical and mental limitations for travel to be discussed and provide a patient with necessary prophylaxis, such as vaccinations or malaria prevention. Special problems in older athletes and travellers with chronic diseases should be taken into consideration (e.g. the risk of venous thromboembolism during prolonged exercise or travel in hot environment). Older adults with concomitant co-morbidities constitute a growing percentage of subjects participating in sports or undertaking travel. Although they are at higher risk of cardiovascular complications, a general recommendation to ‘avoid inactivity’ may be nowadays be put forward.
Heart Teams in grown-up congenital heart disease
Authors: Abdelghani Mohammad , Nassif Martina , Blom Nico A. , Koolbergen David R. , Mulder Barbara J. M. , de Winter Robbert J.
Published: March 2018

Patients with grown-up congenital heart disease (GUCH) constitute an expanding population. This population presents in such a way that is different from children with congenital heart disease and from adults with acquired heart disease and therefore requires a specialized multidisciplinary care. In addition to a specialized GUCH cardiologist, imaging specialists, interventional cardiologists, and GUCH surgeons constitute the backbone of the GUCH Heart Team. The aim of this integrative care is to secure a good quality of social, practical, and private life of the patient and, at the same time, minimize the number of interventions in a lifetime.
Introduction and general comments
Authors: Iung Bernard , Kappetein Pieter
Published: March 2018

Valvular heart disease (VHD) is frequent is industrialized countries and its prevalence increases with age due to the predominance of degenerative aetiology. Clinical approach is paramount for evaluation of the patient’s history, symptoms and for the detection of VHD by auscultation. Echocardiography plays a major role in diagnosis and assessment of severity and prognosis. Other investigations are mainly non-invasive and include stress testing, multimodality imaging and biomarkers. Risk stratification is essential to weigh the risk of intervention against the expected natural history of VHD. It should include risk scores, keeping in mind their limitations, in particular in the elderly. Heart valve centres are required to deliver high-quality care and provide adequate training. Non-vitamin K antagonist oral anticoagulants may be used in patients with atrial fibrillation and aortic stenosis, aortic regurgitation, mitral regurgitation, or aortic bioprostheses beyond 3 months after implantation, but are contraindicated in mitral stenosis and mechanical valves.
Aortic stenosis
Authors: Baumgartner Helmut , Walther Thomas
Published: March 2018

The diagnosis of severe aortic stenosis requires consideration of AVA together with flow rate, pressure gradients (the most robust measurement), ventricular function, size and wall thickness, degree of valve calcification and blood pressure, as well as functional status. The assessment of the severity of aortic stenosis in patients with low gradient and preserved ejection fraction remains particularly challenging. The strongest indication for intervention remain symptoms of aortic stenosis (spontaneous or on exercise testing). The presence of predictors of rapid symptom development can justify early surgery in asymptomatic patients, particularly when surgical risk is low. Although current data favour TAVI in elderly patients who are at increased risk for surgery, particularly when a transfemoral access is possible, the decision between TAVI and SAVR should be made by the Heart Team after careful, comprehensive evaluation of the patient, weighing individually risk and benefit.
Mitral regurgitation
Authors: Rosenhek Raphael , De Bonis Michele
Published: March 2018

Mitral regurgitation is the second most frequent indication for valve surgery in Europe. Echocardiography is essential to assess the aetiology of mitral regurgitation, as well as valve anatomy and function. An integrative approach is needed to assess the severity of mitral regurgitation. Indication for intervention in primary mitral regurgitation is guided by symptoms and risk stratification that includes the assessment of ventricular function and size, atrial fibrillation, systolic pulmonary pressure, and LA size. Surgical mitral valve repair is the preferred method of treatment, particularly in degenerative mitral regurgitation due to its excellent early and late results. However outcomes depend on surgeon experience and centre-related volume. In secondary mitral regurgitation, there is no conclusive evidence for a survival benefit after mitral valve intervention. Mitral surgery is recommended concomitantly in patients with an indication for coronary surgery. Percutaneous edge-to-edge repair may be considered in patients at high surgical risk, avoiding futility.
Tricuspid regurgitation
Authors: Lancellotti Patrizio , De Bonis Michele
Published: March 2018

Tricuspid stenosis is a rare condition, whereas tricuspid regurgitation is more frequent, especially in its secondary form. For appropriate management, secondary tricuspid regurgitation has to be clearly distinguished from primary tricuspid regurgitation. Similar to mitral regurgitation, primary tricuspid regurgitation requires intervention sufficiently early to avoid secondary damage of the RV, which is associated with poor outcome. Secondary tricuspid regurgitation should be liberally treated at the time of left-sided valve surgery. Consideration of isolated surgery of secondary tricuspid regurgitation after previous left-sided valve surgery requires comprehensive assessment of the underlying disease, pulmonary haemodynamics, and RV function.
Tricuspid stenosis
Authors: De Bonis Michele , Lancellotti Patrizio
Published: March 2018

Tricuspid stenosis is often combined with tricuspid regurgitation, most frequently of rheumatic origin. The choice between repair or valve replacement depends on valve anatomy and surgical expertise. Even though this is still a matter of debate, biological prostheses for valve replacement are usually preferred over mechanical ones.
Combined and multiple valve diseases
Authors: De Bonis Michele , Lancellotti Patrizio
Published: March 2018

Management of multiple valve disease is dictated by the pathology of the valve which is predominantly involved. As a general rule, in combined lesions, valvular heart disease is considered severe even if both stenosis and regurgitation are only of moderate severity, and pressure gradients become of major importance for assessment. However more data on the natural history and the impact of intervention on outcome are required to better define the indications for intervention.
HE 0430–2457: a post-merger extremely low-mass pre-white dwarf in a wide binary posing as an extreme horizontal branch star
Authors: Vos Joris , Zorotovic Monica , Vučković Maja , Schreiber Matthias R , Østensen Roy
Published: March 2018

We report the discovery of HE 0430–2457, the first extremely low-mass pre-white dwarf (ELM pre-WD) in a long period binary (P = 771 ± 3 d). The spectroscopic parameters of the primary are determined to be Teff = 26 200 ± 1500 K and log g = 5.40 ± 0.35, placing it in the region occupied by core He-burning hot subdwarf B stars. By comparing the spectroscopic parameters of the K-type companion to stellar models, and using the mass ratio, the mass of the hot primary is determined to be 0.23 M⊙. Given that this is too low for core He-burning, the primary in HE 0430–2457 is not an extreme horizontal branch (EHB) star but a pre-WD of the ELM type. As the lifetime of ELM pre-WDs in this region of the Hertzsprung Russel diagram populated by EHBs is thought to be very short, they are not considered to be part of the observed EHBs. However, the discovery of this system indicates that the percentage of ELM pre-WDs in the observed EHB population might be higher than previously thought. Binary evolution models indicate that HE 0430–2457 is likely formed by a merger of the inner binary in a hierarchical triple system.
Deep Brain Stimulation of the Pedunculopontine Nucleus Area in Parkinson Disease: MRI-Based Anatomoclinical Correlations and Optimal Target
Authors: Goetz Laurent , Bhattacharjee Manik , Ferraye Murielle U , Fraix Valérie , Maineri Carina , Nosko Daniela , Fenoy Albert J , Piallat Brigitte , Torres Napoléon , Krainik Alexandre , Seigneuret Eric , David Olivier , Parent Martin , Parent André , Pollak Pierre , Benabid Alim -Louis , Debu Bettina , Chabardès Stéphan
Published: March 2018

BACKGROUND

Experimental studies led to testing of deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) as a new therapy to treat freezing of gait (FOG) in Parkinson disease (PD). Despite promising initial results fueling a growing interest toward that approach, several clinical studies reported heterogeneity in patient responses. Variation in the position of electrode contacts within the rostral brainstem likely contributes to such heterogeneity.

OBJECTIVE

To provide anatomoclinical correlations of the effect of DBS of the caudal mesencephalic reticular formation (cMRF) including the PPN to treat FOG by comparing the normalized positions of the active contacts among a series of 11 patients at 1- and 2-yr follow-up and to provide an optimal target through an open-label study.

METHODS

We defined a brainstem normalized coordinate system in relation to the pontomesencephalic junction. Clinical evaluations were based on a composite score using objective motor measurements and questionnaires allowing classification of patients as “bad responders” (2 patients), “mild responders” (1 patient) and “good responders” (6 patients). Two patients, whose long-term evaluation could not be completed, were excluded from the analysis.

RESULTS

Most effective DBS electrode contacts to treat FOG in PD patients were located in the posterior part of the cMRF (encompassing the posterior PPN and cuneiform nucleus) at the level of the pontomesencephalic junction.

CONCLUSION

In the present exploratory study, we performed an anatomoclinical analysis using a new coordinate system adapted to the brainstem in 9 patients who underwent PPN area DBS. We propose an optimal DBS target that allows a safe and efficient electrode implantation in the cMRF.
The Application of the Novel Grading Scale (Lawton-Young Grading System) to Predict the Outcome of Brain Arteriovenous Malformation
Authors: Hafez Ahmad , Koroknay-Pál Päivi , Oulasvirta Elias , Elseoud Ahmed Abou , Lawton Michael T , Niemelä Mika , Laakso Aki
Published: March 2018

BACKGROUND

A supplementary grading scale (Supplemented Spetzler-Martin grade, Supp-SM) was introduced in 2010 as a refinement of the SM system to improve preoperative risk prediction of brain arteriovenous malformations (AVMs).

OBJECTIVE

To determine the ability to predict surgical outcomes using the Supp-SM grading scale.

METHODS

This retrospective study was conducted on 200 patients admitted to the Helsinki University Hospital between 2000 and 2014. The validity of the Supp-SM and SM grading systems was compared using the area under the receiver operating characteristic (AUROC) curves, with respect to the change between preoperative and early (3-4 mo) as well as final postoperative modified Rankin Scale (mRS) scores.

RESULTS

The performance of the Supp-SM was superior to that of the SM grading scale in the early follow-up (3-4 mo): AUROC = 0.57 (95% confidence interval [CI]: 0.49-0.65) for SM and AUROC = 0.67 (95% CI: 0.60-0.75) for Supp-SM. The Supp-SM performance continued improving over SM at the late follow-up: AUROC = 0.63 (95% CI: 0.55-0.71) for SM and AUROC = 0.70 (95% CI: 0.62-0.77) for Supp-SM. The perforating artery supply, which is not part of either grading system, plays an important role in the early follow-up outcome (P = .008; odds ratio: 2.95; 95% CI: 1.32-6.55) and in the late follow-up outcome (P < .001; odds ratio: 5.89; 95% CI: 2.49-13.91).

CONCLUSION

The Supp-SM grading system improves the outcome prediction accuracy and is a feasible alternative to the SMS, even for series with higher proportion of high-grade AVMs. However, perforators play important role on the outcome.
Jean Baudrillard
Authors: Pawlett William
Published: March 2018

Jean Baudrillard (1929–2007) was a prolific writer, the author of over thirty major works, and he influenced many academic disciplines including communication studies, sociology, political theory, media and cultural studies, art and photography, and design and architecture. His writing strategy was one of radical critique, escalation, and provocation and he reveled in poetic reversal, irony, and antagonistic hypotheses. After early experimental writing, Baudrillard engaged with sociological theory, influenced by his colleague Henri Lefebrve (1901–1991). Yet, Baudrillard quickly broke with Lefebvre’s position, rejecting his argument for the emancipatory potential of technology, and turned to a wider-ranging critique of the dominant theoretical positions of the time: Marxism, psychoanalysis, semiotics, and cybernetic communications theory. Baudrillard, influenced by Marcel Mauss (1872–1950) and Georges Bataille (1897–1962), expounded a “radical utopia” in the notion of “symbolic exchange” to counter these theories. Symbolic exchange concerns the reciprocal circulation of gifts, goods, meanings, and affects such that accumulation and possession become impossible or are annulled. For Baudrillard, symbolic exchange constitutes a fundamental challenge to economic thinking, attacking economic rationality at the level of meaning, signification and the form of communication—all of which are based on accumulation and possession—where critical theory merely critiques particular ideological contents, structures, or positions. He then explored variations on the theme of symbolic exchange with a more metaphysical writing style, developing the themes of seduction, fatal strategies, and the transparency of evil. Baudrillard traveled very widely and published a series of works documenting his experiences. His later writing was concerned with the themes of duality, disappearance, and the impact of technology.
Ellen Key
Authors: Jansson Hedda , Ceccarelli Luisa
Published: March 2018

Ellen Key (1849–1926) was a Swedish teacher, adult educator, philosopher, writer, and social and peace activist who claimed freedom of speech and press. She was one of the first women in Sweden to promote women’s rights of property and dress reform. She prophesized in her lectures and pamphlets that the 20th century would be the century of the child, just as the 19th century had been the century of the woman. She was actively involved in promoting what she outlined as the “evolution of mind and culture” through education. Her name is linked mainly to her famous collection of socio-pedagogical essays called Barnets århundrade (The Century of the Child) (Key 1900, cited under Pedagogy), which was first published in 1900 and soon became an international bestseller, translated in sixteen languages. The title has been quoted in many essays and became a label for designing the 20th century child pedagogy. Key called for the protection of mothers and children and promoted a natural approach of childrearing, along with the belief that children should be treated as individuals. She stood up for the freedom of expression and with her original new ethics model she intended to improve the child’s well-being and the education system. From 1899 to 1910, she traveled unceasingly throughout Great Britain, Central Europe, and Italy to visit new places, hold lectures in feminist circles, build cross-border friendships, and develop a cosmopolitan world view. After she retired to her house in Sweden, which she built with the proceeds from sales of her writings and lectures, she continued to care for her international relationships through massive exchanges of letters. Her archive, preserved at the Royal Library in Stockholm, contains around ten thousand letters, one hundred notebooks, and a wide array of manuscripts. She wrote about fifty books and pamphlets and held hundreds of lectures during a period of fifty years. Main topics of her theoretical framework are the promotion of a new ethics based on love and a philosophy of life she defined “livstro” (life faith), as well as the spread of a natural approach of childcare based on the enhancement of the mother–child relationship and a child-centered pedagogy. She also highlighted the importance of beauty and freedom for the education of children and adults and gave input for social welfare policies in the Nordic countries and later in the rest of Europe during the 20th century.
Industrial Ecology
Authors: Chertow Marian , Lifset Reid , Yang Tom
Published: March 2018

Industrial ecology (IE) tracks physical resource flows of industrial and consumer systems at a variety of spatial scales, drawing on environmental and social science, engineering, management, and policy analysis. Prescriptively, IE seeks to reduce environmental impacts and the pressure on natural resources while maintaining function for human well-being, by stressing the importance of production choices to extend the life of embedded materials and energy, emphasizing circular rather than linear flows, and decoupling economic growth from resource use. IE has been described as a “post-modern science” that synthesizes multiple perspectives in theory and problem solving, often simultaneously, as a multidisciplinary, interdisciplinary, and transdisciplinary field. The unusual name “industrial ecology” derives from a metaphor with the biological ecosystem and borrows on several fronts, such as its focus on resource cycling, multi-scalar systems, material and energy stocks and flows, and food webs. Over time concepts from other sciences have also been weaved into industrial ecology. The intellectual roots of industrial ecology date back to the 19th century, and some seminal methods were published in the 1960s and 1970s. It took until the early 1990s, however, before a scientific field began to take shape. Since its early days, industrial ecology has become more robust through database development, deeper mathematical modeling, collaboration among natural, physical, and social scientists, and extension of theory on its own and in dialogue with other allied fields. At the same time, industrial ecology increasingly contributes insights to environmental management and policy, on issues ranging from climate change, to biodiversity loss, water, and more. Despite its youth, breadth, and intersection with other disciplines, industrial ecology can lay claim to several subfields as being within its ambit: industrial symbiosis, which studies the exchange of byproducts and sharing of resources among industrial actors; socioeconomic metabolism and material flows analysis, focusing on the stocks and flows of various materials through society; life-cycle assessment, examining the environmental impact of a material, product, or system across its entire life cycle; environmental input-output analysis, broadly focused on the environmental impact of entire sectors of the economy; sustainable urban systems, with focus on metabolism of resources at the urban scale; and resource productivity and circular economy, addressing the effectiveness of resource use while decreasing its impact. In addition to these core subfields, other topics are more loosely linked with industrial ecology, including green chemistry, life-cycle engineering, social ecology, design for environment, and ecological economics.
People Analytics
Authors: Caughlin David E.
Published: March 2018

People analytics refers to the systematic and scientific process of applying quantitative or qualitative data analysis methods to derive insights that shape and inform employee-related business decisions and performance. More specifically, people analytics can be described as the process of collecting, analyzing, and reporting people-related data for the purpose of improving decision making, achieving strategic objectives, and sustaining a competitive advantage. In other words, people analytics involves scientific organizational research. As a field, people analytics has emerged as an extension of traditional human resources (HR) metrics and reporting, such as annualized turnover rate and cost per hire. Further, as an interdisciplinary field, people analytics integrates decades of science and practice in the areas of industrial and organizational psychology, organizational behavior, human resource management, statistics, mathematics, information systems and management, data science, finance, law, and ethics. Other related terms include HR analytics, human capital analytics, workforce analytics, and talent analytics. A major emphasis of people analytics is on making more effective data-driven HR decisions to realize organizational strategic objectives and to achieve a competitive advantage. Although the concepts and practices underlying people analytics are not entirely new, recent advances in computing power and information systems have brought people analytics to a wider audience via more affordable information system and enterprise resource planning platforms, and more powerful mathematical and statistical programs. Moreover, the growing scholarly and business interest in people analytics is based, in part, on the emergence of HR as a strategic business partner in organizations and the growing emphasis placed on making data-driven decisions in HR. Finally, people analytics can be differentiated into three levels of increasing complexity and organizational value: (a) descriptive analytics describe what has already happened in the organization, (b) predictive analytics predict what will or could happen in the organization, and (c) prescriptive analytics take data-analytic findings and use them to improve decisions and to make specific actions.
Boxing
Authors: Rondinone Troy
Published: March 2018

Latino pugilists have long participated in the development of the “sweet science” of professional boxing. Beginning at the close of the 19th century, when boxing became professionalized thanks to the implementations of new regulations, Latino boxers quickly rose to prominence in the Southwest, though racial restrictions would impose difficulties in the upward move to national fame and major titles. The historical factors contributing to the rise of Latino boxing include the incorporation of regional boxing institutions in official governing bodies, migrations of workers into the United States, the increasing visibility of Latinos in US popular culture, changing laws and social mores, and the general growth of the popularity of the sport throughout much of the 20th century. From the emergence of featherweight champion Solomon Garcia Smith in 1890s through the explosion of international celebrities like Oscar De La Hoya in the late 20th century to the presence of many Latinos in the world ranks today, Latino boxers have made an important mark on the boxing scene. Indeed, in recent decades, a “Latinization” of boxing is evident, as more and more Latinos dominate the various weight divisions. Though less discussed in the academic literature, Latinas have also entered the boxing ring and have made an important place for themselves in the sport.
Corynebacterium Bone and Joint Infection (BJI): A Retrospective Cohort Study in a Reference Center for BJI Management
Authors: Ferry Tristan , Chauvelot Pierre , Triffault-Fillit Claire , Braun Evelyne , Perpoint Thomas , Laurent Frederic , Fessy Michel-Henri , Lustig Sébastien , Chidiac Christian , Valour Florent ,   Lyon BJI Study group
Published: March 2018

Background

Corynebacterium is a rare etiologic agent of BJI. We aimed to describe this rare clinical condition and to assess treatment failure determinants.

Methods

All adult patients with proven Corynebacterium BJI (i.e., consistent clinical/radiological signs, AND ≥2 reliable positive bacteriological samples, AND treated as such) were included in a retrospective cohort study. After cohort description, determinants of treatment failure (i.e., infection persistence, relapse, requirement of additional surgical procedure, and BJI-related death) were determined using stepwise logistic regression and Kaplan-–Meier curve analysis.

Results

The 51 included BJI were more frequently chronic (88.2%), orthopaedic device related (ODI, 74.5%) and polymicrobial (78.4%). Surgery was performed in 92.2% of cases, and considered as appropriate in 76.5% of them. The main first-line antimicrobials were glycopeptides (68.6%), β-lactams (50%), and/or clindamycin (10.0%). Three (5.9%) patients received daptomycin as part of first-line regimen, and 8 (15.7%) at any point of treatment. After a follow-up of 60.7 (IQR 30.1–115.1) weeks, 20 (39.2%) treatment failures were observed, including 4 (20%) Corynebacterium-documented relapse. Independent risk factors were initial biological inflammatory syndrome (OR 16.1; P = 0,030) and inappropriate surgical management (OR 7.481; P = 0.036). Interestingly, all patients receiving daptomycin as part of first-line regimen failed (P < 0.001), including one patient with a Corynebacterium-documented relapse with a daptomycin increased MIC. Among patients with ODI, survival curve analysis disclosed a worst prognosis in case of prosthetic joint infection (P = 0.030), unappropriate surgical management (P = 0.029) and daptomycin use as first-line regimen (P < 0.001).

Conclusion

Corynebacterium BJI is a poorly known condition, frequently chronic, and polymicrobial. An important rate of failure was observed, associated with inappropriate surgical management and daptomycin use as part of first-line regimen. As described for other clinical conditions such as infective endocarditis, daptomycin should be avoid or used in combination therapy to prevent resistance selection and treatment failure.

Disclosures

T. Ferry, HERAEUS: Consultant, Speaker honorarium. S. Lustig, Heraeus: Consultant, Consulting fee
Survey, Identification, and Characterization of Cylindrocarpon-Like Asexual Morphs in Spanish Forest Nurseries
Authors: Mora-Sala Beatriz , Cabral Ana , León Maela , Agustí-Brisach Carlos , Armengol Josep , Abad-Campos Paloma
Published: March 2018

Cylindrocarpon-like asexual morphs infect herbaceous and woody plants, mainly in agricultural scenarios, but also in forestry systems. The aim of the present study was to characterize a collection of Cylindrocarpon-like isolates recovered from the roots of a broad range of forest hosts from nurseries showing decline by morphological and molecular studies. Between 2009 and 2012, 17 forest nurseries in Spain were surveyed and a total of 103 Cylindrocarpon-like isolates were obtained. Isolates were identified based on DNA sequences of the partial gene regions histone H3 (his3). For the new species, the internal transcribed spacer and intervening 5.8S nrRNA gene (ITS) region, β-tubulin (tub2), and translation elongation factor 1-α (tef1) were also used to determine their phylogenetic position. Twelve species belonging to the genera Cylindrodendrum, Dactylonectria, and Ilyonectria were identified from damaged roots of 15 different host genera. The species C. alicantinum, D. macrodidyma, D. novozelandica, D. pauciseptata, D. pinicola, D. torresensis, I. capensis, I. cyclaminicola, I. liriodendri, I. pseudodestructans, I. robusta, and I. rufa were identified. In addition, two Dactylonectria species (D. hispanica sp. nov. and D. valentina sp. nov.), one Ilyonectria species (I. ilicicola sp. nov.), and one Neonectria species (N. quercicola sp. nov.) are newly described. The present study demonstrates the prevalence of this fungal group associated with seedlings of diverse hosts showing decline symptoms in forest nurseries in Spain.
Management and treatment of animal bites
Authors: Hurt John B. , Maday Kristopher R.
Published: March 2018

Animal bites account for 1% of ED visits and more than $50 million in healthcare costs annually in the United States. Managing bite wounds can be challenging and providers must consider the patient's tetanus status, species of animal inflicting the bite, and infection risk. This article describes treatment and care of bites and when rabies prophylaxis is indicated.
Update on surgical site infections
Authors: Borchardt Roy A. , Tzizik Dan
Published: March 2018

Surgical site infections (SSIs) occur near or at the incision site and/or deeper underlying tissue spaces and organs within 30 days of a surgical procedure (or up to 90 days for implanted prosthetics). SSIs are the most common healthcare-associated infections experienced by patients who undergo surgery, increase overall cost and length of hospital stay, and are largely preventable. This article reviews the recently updated CDC guidelines for preventing SSIs.
Removing Barriers and Facilitating Access: Increasing the Number of Physicians With Disabilities
Authors: Meeks Lisa M. , Herzer Kurt , Jain Neera R.
Published: March 2018

Nearly one-fifth of the U.S. population has a disability, and many of these Americans experience disparities in the health care they receive. In part, these health care disparities result from a lack of understanding about disability by health care providers. The education of physicians is grounded in a biomedical model that emphasizes pathology, impairment, or dysfunction, rather than a social model of disability that focuses on removing barriers for individuals with disabilities and improving their capabilities. According to a recent report, only 2.7% of medical students disclosed having disabilities—far fewer than the proportion of people with disabilities in the U.S. population. Including students and other trainees with disabilities—those with lived experiences of disability who can empathize with patients and serve as an example for their peers—in medical education is one mechanism to address the health care disparities faced by individuals with disabilities. At present, medical students and residents with disabilities face structural barriers related to policies and procedures, clinical accommodations, disability and wellness support services, and the physical environment. Additionally, many face cultural barriers related to the overarching attitudes, beliefs, and values prevalent at their medical school. In this Commentary, the authors review the state of disability in medical education and training, summarize key findings from an Association of American Medical Colleges special report on disability, and discuss considerations for medical educators to improve inclusion, including emerging technologies that can enhance access for students with disabilities.
The Pseudo-Pelger Huët Cell as a Retrospective Dosimeter: Analysis of a Radium Dial Painter Cohort
Authors: Goans Ronald E. , Toohey Richard E. , Iddins Carol J. , McComish Stacey L. , Tolmachev Sergei Y. , Dainiak Nicholas
Published: March 2018

Recently, the pseudo-Pelger Huët anomaly in peripheral blood neutrophils has been described as a new radiation-induced, stable biomarker. In this study, pseudo-Pelger Huët anomaly was examined in peripheral blood slides from a cohort of 166 former radium dial painters and ancillary personnel in the radium dial industry, 35 of whom had a marrow dose of zero above background. Members of the radium dial painter cohort ingested 226Ra and 228Ra at an early age (average age 20.6 ± 5.4 y; range 13–40 y) during the years 1914–1955. Exposure duration ranged from 1–1,820 wk with marrow dose 1.5–6,750 mGy. Pseudo-Pelger Huët anomaly expressed as a percentage of total neutrophils in this cohort rises in a sigmoidal fashion over five decades of red marrow dose. Six subjects in this cohort eventually developed malignancies: five osteosarcomas and one mastoid cell neoplasm. The pseudo-Pelger Huët anomaly percentage in these cases of neoplasm increases with marrow dose and is best fit with a sigmoid function, suggestive of a threshold effect. No sarcomas are seen for a marrow dose under 2 Gy. These results indicate that pseudo-Pelger Huët anomaly in peripheral blood is a reasonable surrogate for the estimation of alpha dose to bone marrow in historic radiation cases. Hypotheses are discussed to explain late (months to years), early (hours to days), and intermediate (weeks to months) effects of ionizing radiation, respectively, on the expression of genes encoding inner nuclear membrane proteins and their receptors, on the structure and function of nuclear membrane proteins and lipids, and on cytokinesis through chromatin bridge formation.
Vortioxetine Disposition in Obesity
Authors: Greenblatt David J. , Harmatz Jerold S. , Chow Christina R.
Published: March 2018

Background

Obesity and depression are common comorbid conditions. The objective of the study was to evaluate the effect of obesity on the pharmacokinetics of the serotonergic antidepressant vortioxetine.

Methods

Vortioxetine pharmacokinetics were evaluated in 16 otherwise healthy obese volunteers (mean weight, 119 kg; mean body mass index (BMI) 41.8 kg/m2) and in 14 normal-weight subjects (mean weight, 68 kg; mean BMI, 23.0 kg/m2) matched for age. All subjects received a single 5-mg oral dose of vortioxetine once daily for 29 days. Pre-dose plasma vortioxetine concentrations were measured during the 29 days of dosing, and during a 4-week washout period after the last dose. Full 24-hour profiles were obtained after the first and last doses.

Results

Vortioxetine accumulated extensively over the 29 days; the accumulation ratio was not significantly different between obese and control groups (means: 5.24 and 4.46, respectively). Steady-state concentration (Css) and steady-state clearance also did not differ between groups. However mean washout half-life (T1/2) was significantly prolonged in obese vs. control subjects (3.26 days vs. 2.21 days,P< 0.01). Up to 89% of the individual variability in T1/2was explained by the product of Cssand numeric indicators of the degree of obesity.

Conclusions

The half-life of vortioxetine washout after discontinuation of therapy is significantly prolonged in obese individuals compared to normal weight controls. To avoid a potential risk of serotonin syndrome, obese patients who plan to change their medication from vortioxetine to a monoamine oxidase inhibitor (MAOI) should extend the time between vortioxetine discontinuation and MAOI initiation beyond what is recommended in the product label.
Effects of Intranasal Oxytocin Administration on Sexual Functions in Healthy Women
Authors: Kruger Tillmann H.C. , Deiter Frank , Zhang Yuanyuan , Jung Stefanie , Schippert Cordula , Kahl Kai G. , Heinrichs Markus , Schedlowski Manfred , Hartmann Uwe
Published: March 2018

Purpose

The neuropeptide oxytocin (OXT) has a variety of physiological functions in maternal behavior and attachment including sexual behavior. Based on animal research and our previous human studies, we set out to investigate intranasal administration of OXT and hypothesized that OXT should be able to modulate sexual function in women.

Methods

In a double-blind, placebo-controlled, crossover laboratory setting, the acute effects of intranasal administered OXT (24 international units) on sexual drive, arousal, orgasm, and refractory aspects of sexual behavior were analyzed in 27 healthy females (mean age ± SD, 27.52 ± 8.04) together with physiological parameters using vaginal photoplethysmography.

Findings

Oxytocin administration showed no effect on subjective sexual parameters (eg, postorgasmic tension; P = 0.051). Physiological parameters (vaginal photoplethysmography amplitude and vaginal blood volume) showed a response pattern towards sexual arousal but were not affected by OXT.

Implications

Using a well-established laboratory paradigm, we did not find that intranasal OXT influences female sexual parameters. Also, sexual drive and other functions were not affected by OXT. These findings indicate that OXT is not able to significantly increase subjective and objective parameters of sexual function in a setting with high internal validity; however, this might be different in a more naturalistic setting.
Maternal Antidepressant Use During Pregnancy and the Risk of Attention-Deficit/Hyperactivity Disorder in Children
Authors: Uguz Faruk
Published: March 2018

Purpose

This study reviewed the current literature examining the potential relationship between use of antidepressants during pregnancy and attention-deficit/hyperactivity disorder (ADHD) in children.

Methods

PubMed was searched for English language reports between January 1, 1995, and July 31, 2017, by using combinations of the key words pregnancy, antidepressants, selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), children, offspring, and ADHD. Studies that reported association between ADHD in children and use of antidepressant in pregnant women were included in the review.

Results

A total of 7 relevant studies that met the review criteria were examined. The studies reported that compared with nonusers adjusted risks of ADHD in children were 1.2 to 1.6 for the use of any antidepressant, 0.91 to 1.66 for selective serotonin reuptake inhibitors, 1.1 to 1.4 for selective serotonin-norepinephrine reuptake inhibitors, and 1.1 to 1.8 for tricyclic antidepressants. There was some scientific evidences suggesting a connection between antidepressant use during all trimesters of pregnancy and increased risk of ADHD in children. In addition, the study results suggest that underlying maternal anxiety or depressive disorders may also contribute to increased risk of ADHD.

Implications

Although some studies have suggested a moderately increased risk of ADHD in children with maternal antidepressant use during pregnancy, based on limitations and results of the studies, this review concluded that there is no strong evidence to suggest a causal link.
The Relationship of Prosthetic Sock Ply Thickness to Percentage of Transtibial Limb Volume Outside of the Socket
Authors: Jasken Jenna , Hall Michelle
Published: March 2018

Introduction

Prosthetic socks are typically used to accommodate volume fluctuations throughout the day. Clinically, prosthetists often use sock ply thickness to assess the fit of a prosthetic socket and the amount of volume reduction necessary for the next socket iteration. This is done by using various sock plies to determine the proper socket fit. The amount of volume reduction needed for a specific sock ply fit is unclear.

Objective

This preliminary study aimed to measure the relationship between sock ply and percentage of volume change.

Methods

The Rodin4D scanner was used to scan three transtibial sample foam models. Each model had an appropriately sized liner, which was scanned as a baseline measurement. Each sock ply combination (one, two, three, five, one + one, one + two, two + three, two + one, and three + two) was scanned six times per model. Scan order was randomly assigned for each model.

Results

Significant differences in volume change were found between one-ply (5.188%) and three-ply (10.42%) and five-ply (8.83%) socks, but not two-ply socks (7.15%). A significant volume increase was shown for the use of multiple socks (three + two ply, 18.33%, or two + three ply, 18.33%) compared with a single five-ply sock (8.83%). However, no significant differences were found in a similar comparison of a single three-ply sock (10.42%) versus the one + two–ply (11.68%) or two + one–ply (11.57%) socks.

Conclusion

Our results showed that the use of multiple socks for the same ply, specifically the order of socks donned for the two + three ply and three + two ply, resulted in greater volume than a single sock of the same ply (i.e., five ply). The volumetric change for five-ply is significantly different from one-ply, but not from two-ply and three-ply socks. A limitation of this study was that the scans were completed on foam models with the point of measurement at the distal patella causing potential for the posterior wall to be outside of the socket. This may change on a human subject. The percentage of volume changes based on sock ply thickness that were determined from this study may be used as a starting point for prosthetists during modifications, but further research is needed to determine how this volume changes within the socket.
Anterior Cruciate Ligament Injuries in the National Hockey League: Epidemiology and Performance Impact
Authors: Longstaffe Robert , Leiter Jeff , MacDonald Peter
Published: March 2018

Objective:

To determine the incidence of anterior cruciate ligament (ACL) injuries in the National Hockey League (NHL) and to examine the effects of this injury on return-to-play status and performance.

Design:

Case series; level of evidence, 4.

Methods:

This was a 2-phase study. Phase I used the NHL electronic injury surveillance system and Athlete Health Management System to collect data on ACL injuries and man games lost over 10 seasons (2006/2007-2015/2016). Data collected in phase I were received in deidentified form. Phase II examined the performance impact of an ACL injury. Players were identified through publically available sources, and performance-related statistics were analyzed. Data collected in phase II were not linked to data collected in phase I. A paired t test was used to determine any difference in the matching variables between controls and cases in the preinjury time period. A General linear model (mixed) was used to determine the performance impact.

Results:

Phase I: 67 ACL injuries occurred over 10 seasons. The incidence for all players was 0.42/1000 player game hours (forward, 0.61; defenseman, 0.32, goalie, 0.08) and by game exposure was 0.2/1000 player game exposures (forward, 0.33; defenseman, 0.11; goalie, 0.07). Forwards had a greater incidence rate of ACL tears with both game hours and game exposures when compared with defensemen and goalies (P < 0.001, <0.001; P = 0.008, <0.001, respectively). Phase II: 70 ACL tears (60 players) were identified. Compared with controls, players who suffered an ACL tear demonstrated a decrease in goals/season (P < 0.04), goals/game (P < 0.015), points/season (0.007), and points/game (0.001). Number of games and seasons played after an ACL injury did not differ compared with controls (P = 0.068, 0.122, respectively).

Conclusions:

Anterior cruciate ligament injuries occur infrequently, as it relates to other hockey injuries. Despite a high return to play, the performance after an ACL injury demonstrated a decrease in points and goals per game and per season.
Sedative and Analgesic Drug Sequestration After a Single Bolus Injection in an Ex Vivo Extracorporeal Membrane Oxygenation Infant Circuit
Authors: Nasr Viviane G. , Meserve Jonathan , Pereira Luis M. , Faraoni David , Brediger Steve , Goobie Susan , Thiagarajan Ravi , DiNardo James A.
Published: March 2018

Patient sedation and analgesia on extracorporeal membrane oxygenation (ECMO) is vital for safety and comfort. However, adsorption to the circuit may alter drug pharmacokinetics and remains poorly characterized. This study characterizes drug adsorption of morphine, fentanyl, midazolam, and dexmedetomidine in an ex vivo infant ECMO circuit utilizing polymethylpentene (PMP) membrane oxygenator (MO) with protein-bounded polyvinylchloride (PVC) tubing. Twelve closed-loop ex vivo ECMO circuits were prepared using P.h.i.s.i.o (phosphorylcholine)-coated PVC tubing (Sorin Group USA, Inc.) and a Quadrox-iD pediatric polymethylpentene MO (Maquet Cardiopulmonary AG). Once the circuits were primed and running, a single medication was injected as a bolus into the circuit with three circuits per drug. Drug samples were drawn following injection, at 2, 5, 15, 30, 60, 120 minutes and at 4, 12, 24, 36, and 48 hours and analyzed using ultra high-performance liquid chromatography with mass spectrometry. Compared with morphine, the other drugs are highly sequestered with fentanyl 68.5%, dexmedetomidine 50.8%, and midazolam 26.2% affecting the availability of free drug in the circuit. Sequestration of fentanyl, midazolam, and dexmedetomidine in an ECMO circuit with P.h.i.s.i.o-coated PVC tubing and PMP MO may limit drug delivery to infants. Future in vivo studies are needed to determine the clinical impact of sequestration.