bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe Respiratory Failure, Extracorporeal Membrane Oxygenation, and Intracranial Hemorrhage*
Authors: Lockie Christopher J. A. , Gillon Stuart A. , Barrett Nicholas A. , Taylor Daniel , Mazumder Asif , Paramesh Kaggere , Rowland Katie , Daly Kathleen , Camporota Luigi , Meadows Christopher I. S. , Glover Guy W. , Ioannou Nicholas , Langrish Christopher J. , Tricklebank Stephen , Retter Andrew , Wyncoll Duncan L. A.
Published: July 2017

Objectives:

For patients supported with veno-venous extracorporeal membrane oxygenation, the occurrence of intracranial hemorrhage is associated with a high mortality. It is unclear whether intracranial hemorrhage is a consequence of the extracorporeal intervention or of the underlying severe respiratory pathology. In a cohort of patients transferred to a regional severe respiratory failure center that routinely employs admission brain imaging, we sought 1) the prevalence of intracranial hemorrhage; 2) survival and neurologic outcomes; and 3) factors associated with intracranial hemorrhage.

Design:

A single-center, retrospective, observational cohort study.

Setting:

Tertiary referral severe respiratory failure center, university teaching hospital.

Patients:

Patients admitted between December 2011 and February 2016.

Intervention:

None.

Measurements and Main Results:

Three hundred forty-two patients were identified: 250 managed with extracorporeal support and 92 managed using conventional ventilation. The prevalence of intracranial hemorrhage was 16.4% in extracorporeal membrane oxygenation patients and 7.6% in conventionally managed patients (p = 0.04). Multivariate analysis revealed factors independently associated with intracranial hemorrhage to be duration of ventilation (d) (odds ratio, 1.13 [95% CI, 1.03–1.23]; p = 0.011) and admission fibrinogen (g/L) (odds ratio, 0.73 [0.57–0.91]; p = 0.009); extracorporeal membrane oxygenation was not an independent risk factor (odds ratio, 3.29 [0.96–15.99]; p = 0.088). In patients who received veno-venous extracorporeal membrane oxygenation, there was no significant difference in 6-month survival between patients with and without intracranial hemorrhage (68.3% vs 76.0%; p = 0.350). Good neurologic function was observed in 92%.

Conclusions:

We report a higher prevalence of intracranial hemorrhage than has previously been described with high level of neurologically intact survival. Duration of mechanical ventilation and admission fibrinogen, but not exposure to extracorporeal support, are independently associated with intracranial hemorrhage.
Phenotypes and Characterization of COPD
Authors: Raskin Jonathan , Marks Ted , Miller Albert
Published: July 2017

Phenotyping and the characterization of chronic obstructive pulmonary disease (COPD) is currently an active area of interest. The perspectives gleaned from evaluating COPD in the context of exercise lend new insights into this endeavor. Pulmonary rehabilitation centers are uniquely positioned to generate such clinical observations and have enhanced an understanding of the disease processes that are involved in COPD. This review and commentary discusses the various patterns of exercise intolerance and characterizes COPD from the perspectives of clinicians caring for persons with COPD.
Differential Pulmonary Rehabilitation Outcomes in Patients With and Without COPD
Authors: Nguyen Lam-Phuong , Beck Emily , Cayetano Katherine , Li Chin-Shang , Hardin Kimberly
Published: July 2017

Purpose:

Individuals with all forms of pulmonary disease are referred for pulmonary rehabilitation. This study examines pulmonary rehabilitation outcomes between individuals with chronic obstructive lung disease (COPD) and non-COPD disease and the impact of gender.

Methods:

This is a retrospective study at a tertiary center. The primary endpoint was the difference in 6-min walk test distance. Secondary measurements included treadmill and NuStep minutes; biceps curls and front arm raises load; quality of life measured by the St George's Respiratory Questionnaire; and University of California San Diego-Shortness of Breath Questionnaire (UCSD-SOBQ) scores.

Results:

Eighty patients were included: 38 men (23 COPD, 15 non-COPD) and 42 women (31 COPD, 11 non-COPD). There was a statistically significant improvement in 6-min walk test distances pre- to post–pulmonary rehabilitation for all participants, P = .0003. Although both the COPD and non-COPD groups demonstrated overall improvement (P < .0004 and P = .02, respectively), subgroup analysis showed no statistically significant change in the non-COPD group when divided by gender. There was a significant statistical improvement in lower and upper extremity strength in all participants. Only women with COPD showed a statistically significant improvement with respect to overall quality of life as measured by St. George's Respiratory Questionnaire (P = .01). Women showed significant improvement in their depression score, as well as a trend toward improvement in the University of California San Diego-Shortness of Breath Questionnaire, while only men with COPD showed any improvement in their sleep quality measured by the Pittsburgh Sleep Quality Index.

Conclusions:

Pulmonary rehabilitation results in different but improved outcomes regardless of gender or disease state.
The Community Balance and Mobility Scale
Authors: Martelli Luke , Saraswat Dave , Dechman Gail , Giacomantonio Nicholas B. , Grandy Scott A.
Published: July 2017

Purpose:

Many patients participating in cardiac rehabilitation (CR) programs have decreased balance. This is a concern, as it may affect their ability to optimally perform physical exercise in CR and thus decrease CR efficacy. Despite this concern, balance is typically not assessed as part of CR intake. This may be attributable to the fact that a suitable balance assessment tool has not been identified for higher-functioning CR patients. A potential solution to this issue is using the Community Balance and Mobility Scale (CBMS), which has been used to assess balance in higher-functioning clinical populations; however, its use in a CR population has never been investigated. Therefore, the purpose of this study was to determine the reliability and validity of the CBMS for assessing balance in CR patients.

Methods:

Fifty-three participants were recruited from local CR programs to perform the CBMS. Dynamic posturography was also measured in a subset of participants (n = 31) using the Limits of Stability (LOS) test.

Results:

Analysis of CBMS scores revealed that the mean CBMS score was 61.9 ± 16.2 (out of 96) and that no floor or ceiling effects were observed for any participants. CBMS scores were significantly correlated with the LOS results (0.41-0.53). Interrater reliability between novice and expert testers was strong (r = 0.95), with all differences falling within the 95% limits of agreement.

Conclusion:

Overall, these results suggest that the CBMS is a valid tool to measure balance in CR patients and can be reliably administered by health care professionals with minimal training.
Refractive Surgery: Malpractice Litigation Outcomes
Authors: Custer Benjamin L. , Ballard Steven R. , Carroll Robert B. , Barnes Scott D. , Justin Grant A.
Published: July 2017

Purpose:

To review data on malpractice claims related to refractive surgery to identify common allegations and injuries and financial outcomes.

Methods:

The WestlawNext database was reviewed for all malpractice lawsuits/settlements related to refractive eye surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes.

Results:

A total of 167 cases met the inclusion criteria, of which 108 cases (64.7%) were found to be favorable and 59 cases (35.3%) unfavorable to the defendant. A total of 141 cases were tried by a jury with 108 cases (76.4%) favorable and 33 cases (23.6%) unfavorable to the defendant. Laser in situ keratomileusis was performed in 127 cases (76%). The most common allegations were negligence in treatment or surgery in 127 cases (76%) and lack of informed consent in 83 cases (49.7%). For all cases, the need for future surgery (P = 0.0001) and surgery resulting in keratoconus (P = 0.05) were more likely to favor the plaintiff. In jury verdict decisions, cases in which failure to diagnose a preoperative condition was alleged favored the defendant (P = 0.03), whereas machine malfunction (P = 0.05) favored the plaintiff. After adjustment for inflation, the overall mean award was $1,287,872. Jury verdicts and settlements led to mean awards of $1,604,801 and $826,883, respectively.

Conclusions:

Malpractice litigation in refractive surgery tends to favor the defendant. However, large awards and settlements were given in cases that were favorable to the plaintiff. The need for future surgery and surgery leading to keratoconus increased the chance of an unfavorable outcome.
Correlation of Corneal Biomechanical Stiffness With Refractive Error and Ocular Biometry in a Pediatric Population
Authors: Matalia Jyoti , Francis Mathew , Gogri Pooja , Panmand Pratibha , Matalia Himanshu , Roy Abhijit Sinha
Published: July 2017

Purpose:

To assess the correlation between corneal biomechanical stiffness and refractive error (RE) in the pediatric population.

Methods:

A total of 733 pediatric eyes were included in the study retrospectively. All eyes underwent corneal tomography (Pentacam), RE assessment, and air-puff deformation (Corvis-ST). Waveform analyses of deformation provided corneal stiffness (CS) and extraocular tissue stiffness (EOS). Eyes were subgrouped into emmetropia [manifest refraction spherical equivalent (MRSE) ∼ 0 D], hyperopia (MRSE > 0 D), myopia I (MRSE between 0 D and −3 D), myopia II (MRSE between −3 D and −6 D), and myopia III (MRSE greater than −6 D) for multivariate analyses. Ocular biometry variables [age, intraocular pressure (IOP), central corneal thickness (CCT), corneal astigmatism, anterior chamber depth, and RE] were used as covariates. The apparent elastic modulus (E) was defined as the ratio of CS and CCT.

Results:

All groups had similar age, CCT, and IOP (P > 0.05). CS was the only parameter to differ between all the grades of myopia (P < 0.0001). CS was lower by 3.72%, 6.84%, and 10.68% in myopia I, II, and III eyes, respectively, relative to emmetropic eyes. EOS increased by 11.15%, 22.60%, and 28.5%, respectively. Multivariate regression revealed age, IOP, CCT, corneal astigmatism, anterior chamber depth, and RE as significant predictors of CS, with a high coefficient of regression (R2 = 0.66). Corneal E negatively correlated with the grade of myopia.

Conclusions:

CS and EOS correlated negatively and positively with the grade of myopia, respectively. Ocular biometry variables were significant predictors of both CS and EOS. The decrease in CS was attributed to that in elastic modulus.
Long-Term Evaluation of Specular Microscopic Changes Following Nd:YAG Iridotomy in Chronic Primary Angle-Closure Glaucoma Eyes
Authors: Sihota Ramanjit , Agarwal Esha , James Mathew , Verma Meena , Kumar Lalit , Dada Tanuj , Gupta Viney , Kapoor Kulwant Singh
Published: July 2017

Aim:

The aim of this study was to evaluate specular microscopy of chronic primary angle-closure glaucoma (CPACG) eyes at least 1 year after Nd:YAG iridotomy, and compare them with CPACG eyes without an iridotomy and age-matched, normal eyes.

Patients and Method:

Consecutive patients of CPACG at the Glaucoma service were screened. All patients underwent slit-lamp biomicroscopy, +90 D examination, and applanation tonometry. A total of 100 eyes of 100 consecutive patients of CPACG with an Nd:YAG iridotomy performed ≥1 year before, who met all inclusion/exclusion criteria, 60 consecutive CPACG eyes without an iridotomy, and 60 age and refraction-matched control eyes were enrolled. A specular microscopy was performed in one eye of each patient by an observer masked to diagnosis.

Results:

CPACG patients had a mean age of 62±8 years, a mean intraocular pressure of 18±5.3 mm Hg, a mean specular count of 2536±224 cells/mm2, and mean duration after iridotomy of 3.2±2 years. There was a significant correlation of specular endothelial counts with age (r=−0.39; P<0.001) and interval after iridotomy (r=−0.25; P=0.01). CPACG eyes without an iridotomy had a mean age of 62±5 years and a mean specular count of 2469±199 cells/mm2. Normal control eyes with a mean age of 61±6 years had a mean specular count of 2729±299 cells/mm2. There was no significant difference in specular count between CPACG eyes with or without an iridotomy (P=0.19); however, both CPACG groups had a specular count significantly lower than controls (P=0.01 and 0.02, respectively). There was no statistically significant difference seen in polymegathism (coefficient of variation) and pleomorphism (% of hexagonal cells) in endothelial cells among the 3 groups.

Conclusions:

An Nd:YAG iridotomy in CPACG eyes did not lead to any significant changes in central corneal specular microscopy in the long term as compared with patients who did not undergo iridotomy. Eyes with CPACG, without and after an iridotomy, had a lower specular count compared with age-matched controls.
Phenotype of Same-Day–Discharge Patients After Percutaneous Coronary Intervention
Authors: Ramharrack Donna V. , Jurgens Corrine Y. , Shlofmitz Richard A.
Published: July 2017

Background:

Overnight observation is the standard of care for uncomplicated elective percutaneous coronary intervention (PCI). However, same-day discharge (SDD) is reportedly safe using predetermined criteria and patient risk categories. Characteristics of patients with SDD have not yet been described.

Objective:

The purpose of this study was to describe the phenotype of patients appropriate for SDD after PCI without predetermined criteria and patient risk categories.

Methods:

Analysis of PCI registry data was conducted on patients (n = 2174) who underwent elective and nonelective PCI between January 2012 and June 2014. Preliminary analysis included descriptive statistics, t tests, and χ2 tests. All variables were analyzed using random forest plot to determine importance of predictors of SDD followed by confirmatory logistic regression.

Results:

Random forest plot indicated 6 predictors of SDD. Confirmatory logistic regression using a model with all 6 predictors indicated that the model was able to distinguish between patients with SDD and overnight observation after PCI and was statistically significant (χ2(7.12, N = 2174) = 511.12, P < .005). Strongest predictors of SDD were stable angina (odds ratio, 5.93 [95% confidence interval, 1.316–26.712]; P = .020) followed by non-ST elevation myocardial infarction/high-risk unstable angina (odds ratio, 1.66 [95% confidence interval, 1.239–2.225]; P = .001). Readmission within 24 hours of SDD after PCI was low at 0.91%.

Conclusions:

Age, access site, complexity, and number of lesions stented did not preclude SDD. A broader range of patients, particularly patients in higher risk categories (non-ST elevation myocardial infarction and unstable angina), are candidates for SDD.
No Seasonal Changes in Cognitive Functioning Among High School Football Athletes: Implementation of a Novel Electrophysiological Measure and Standard Clinical Measures
Authors: Broglio Steven P. , Williams Richelle , Rettmann Ashley , Moore Brandon , Eckner James T. , Meehan Sean
Published: July 2017

Objective:

To evaluate neuroelectric and cognitive function relative to a season of football participation. Cognitive and neuroelectric function declines are hypothesized to be present in football athletes.

Design:

Observational.

Setting:

Athletic fields and research laboratory.

Patients (or Participants):

Seventy-seven high school athletes (15.9 + 0.9 years, 178.6 + 7.2 cm, 74.4 + 14.7 kg, and 0.8 + 0.8 self-reported concussions) participating in football (n = 46) and noncontact sports (n = 31).

Interventions (or Assessment of Risk Factors):

All athletes completed preseason, midseason, and postseason assessments of cognitive and neuroelectric function, self-reported symptoms, and quality of life. All athletes participated in their respective sports without intervention, while head impact exposure in football athletes was tracked using the Head Impact Telemetry System.

Main Outcome Measures:

Cognitive performance was based on Cogstate computerized cognitive assessment tool processing speed, attention, learning, working memory speed, and working memory accuracy scores. ElMindA brain network activation amplitude, synchronization, timing and connectivity brain network activation scores demarcated neuroelectric performance. Quality of life was assessed on the Health Behavior Inventory and Satisfaction with Life Scale and symptoms on the SCAT3 inventory.

Results:

Football and control sport athletes did not show declines in cognitive or neuroelectric function, quality-of-life measures, or symptom reports across a season of sport participation.

Conclusions:

These findings refute the notion that routine football participation places athletes at risk for acute cognitive declines. The lack of impairment may be associated with no association with head impacts and cognitive function, increased physical activity offsetting any declines, and/or test sensitivity. How these findings are associated with long-term cognitive function is unknown.
Visual Processing Recruits the Auditory Cortices in Prelingually Deaf Children and Influences Cochlear Implant Outcomes
Authors: Liang Maojin , Chen Yuebo , Zhao Fei , Zhang Junpeng , Liu Jiahao , Zhang Xueyuan , Cai Yuexin , Chen Suijun , Li Xianghui , Chen Ling , Zheng Yiqing
Published: July 2017

Objective:

Although visual processing recruitment of the auditory cortices has been reported previously in prelingually deaf children who have a rapidly developing brain and no auditory processing, the visual processing recruitment of auditory cortices might be different in processing different visual stimuli and may affect cochlear implant (CI) outcomes.

Methods:

Ten prelingually deaf children, 4 to 6 years old, were recruited for the study. Twenty prelingually deaf subjects, 4 to 6 years old with CIs for 1 year, were also recruited; 10 with well-performing CIs, 10 with poorly performing CIs. Ten age and sex-matched normal-hearing children were recruited as controls. Visual (“sound” photo [photograph with imaginative sound] and “nonsound” photo [photograph without imaginative sound]) evoked potentials were measured in all subjects. P1 at Oz and N1 at the bilateral temporal-frontal areas (FC3 and FC4) were compared.

Results:

N1 amplitudes were strongest in the deaf children, followed by those with poorly performing CIs, controls and those with well-performing CIs. There was no significant difference between controls and those with well-performing CIs. “Sound” photo stimuli evoked a stronger N1 than “nonsound” photo stimuli. Further analysis showed that only at FC4 in deaf subjects and those with poorly performing CIs were the N1 responses to “sound” photo stimuli stronger than those to “nonsound” photo stimuli. No significant difference was found for the FC3 and FC4 areas. No significant difference was found in N1 latencies and P1 amplitudes or latencies.

Conclusion:

The results indicate enhanced visual recruitment of the auditory cortices in prelingually deaf children. Additionally, the decrement in visual recruitment of auditory cortices was related to good CI outcomes.
Novel targets for anticoagulants lacking bleeding risk
Authors: Bickmann Julia K. , Baglin Trevor , Meijers Joost C.M. , Renné Thomas
Published: July 2017

Purpose of review

Arterial and venous thromboembolic diseases are associated with significant morbidity and mortality and present a major medical burden. Currently used anticoagulants for the prevention or treatment of thromboembolic events including heparins, vitamin K-antagonists and inhibitors of thrombin or factor Xa target enzymes of the coagulation cascade that are critical for fibrin formation. However, fibrin is also necessary for hemostatic mechanisms to terminate blood loss at injury sites. As a result currently used anticoagulants substantially raise the risk of bleeding and are associated with an increase in potentially life-threatening hemorrhage, partially offsetting the benefits of reduced thrombosis.

Recent findings

Within the last decade, experimental and preclinical data have revealed the existence of coagulation mechanisms that principally differ in thrombosis and haemostasis. Some coagulation proteins including, XI and XII have a differential role in haemostasis and thrombosis. Targeting these proteins may provide an opportunity to prevent thromboembolic disease without causing bleeding.

This review summarizes recent studies on selective targeting of coagulation proteins that may allow prevention and treatment of thrombosis without causing bleeding. These novel approaches present a possibility for selective interference with fibrin formation in pathologic thrombosis that may lead to a new generation of safe anticoagulant drugs.
Physical Activity and Survival in Women With Advanced Breast Cancer
Authors: Palesh Oxana , Kamen Charles , Sharp Susan , Golden Ashleigh , Neri Eric , Spiegel David , Koopman Cheryl
Published: July 2017

Background:

Several empirical investigations have attempted to characterize the effect of physical activity on cancer mortality, but these investigations have rarely focused on patients with advanced breast cancer.

Objective:

The current study examined the hypothesis that greater physical activity is associated with longer survival among women with advanced breast cancer.

Methods:

We conducted a secondary data analysis of a prospective study of 103 patients with stage IV (n = 100) or locally recurrent (n = 3) breast cancer involved in a group psychotherapy trial. Physical activity was assessed at baseline using the Seven-Day Physical Activity Recall questionnaire, and patients were followed until April 1, 2016, at which time 93 of 103 had died.

Results:

Greater physical activity level at baseline was significantly associated with longer subsequent survival time in a Cox proportional hazards model (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.84–0.97; P < .01). Engaging in 1 additional hour per day of moderate activity reduced the hazard of subsequent mortality by 23% (HR, 0.77; 95% CI, 0.65–0.92; P < .01). These results remained significant even after controlling for demographic, medical, cancer, depression, and cortisol variables (HR, 0.91; 95% CI, 0.84–0.99; P < .05).

Conclusions:

Women with advanced breast cancer who engaged in physical activity for 1 or more hours per day at baseline had an increased likelihood of survival compared with those who exercised less than 1 hour per day.

Implications for Practice:

Nurses should consider recommending moderate physical activity for women with advanced breast cancer. Randomized trials of physical activity interventions for this population are needed.
The Effects on Children’s Anxiety and Quality of Life of a Psychoeducational Program for Families Living With Parental Cancer and Their Network
Authors: Hauken May Aasebø , Pereira Mariana , Senneseth Mette
Published: July 2017

Background:

Families living with parental cancer report lack of social support. The Cancer PEPSONE Program (CPP) was developed to bridge the gap between the families and their network.

Objective:

The aims of this study were to study the effect of the CPP on children’s anxiety and quality of life (QOL) and examine the association between the CPP’s effect on their well parents’ received social support, QOL, and psychological distress and the children’s anxiety and QOL.

Methods:

The CPP, a psychoeducational program for the families and their social network, was evaluated using a randomized controlled trial design. The children and their well parents completed questionnaires measuring QOL, psychological distress, and social support at baseline and after 3 and 6 months.

Results:

Thirty-five families were enrolled (18 intervention, 17 controls). The CPP stabilized the children’s family function, although the family function largely (d = 0.86) decreased in the control group (P = .018). No significant effects were found on anxiety, overall QOL, or QOL subdimensions. Significant correlations were documented between the children’s levels of anxiety and the well parents’ received social support (r = −0.196, P < .001), QOL (r = −0.138, P < .05), and psychological distress (r = 0.166, P < .05).

Conclusions:

The CPP seems to stabilize the children's perceived family function but did not target the other outcomes. Further studies with larger samples are needed.

Implications for Clinical Practice:

Optimizing social network for families living with parental cancer may support the family’s function. Actions should be initiated to increase the well parents’ social support, QOL, and psychological distress, which may also benefit the children.
Longitudinal Findings on Changes in and the Link Between HIV-Related Communication, Risky Sexual Behavior, and Relationship Status in Men Who Have Sex With Men Living With HIV
Authors: Serovich Julianne M. , Laschober Tanja C. , Brown Monique J. , Kimberly Judy A.
Published: July 2017

Background

Reducing the risk of HIV transmission among men who have sex with men (MSM) is a national health priority. This study longitudinally examined changes in and the link between HIV-related communication, unprotected anal intercourse (UAI), and relationship status among MSM.

Methods

Data were obtained from 337 MSM living with HIV who participated in a randomized controlled study. Approximately equal percentages of men were randomized to either the disclosure intervention group or the attention control case management group. Repeated measures were collected at 5 time points for 12 months and included health-protective sexual communication (HPSC), HIV disclosure, insertive and receptive UAI, and relationship status. Data were analyzed using mixed-effects models.

Results

Independent of the treatment condition, HPSC and HIV disclosure increased over time; insertive UAI showed a curvilinear pattern but no significant decrease over time. Relationship status was related to HIV-related communication and UAI. Greater HPSC was related to less insertive and receptive UAI; disclosure was positively related to insertive UAI.

Conclusions

Based on the findings, prevention programs should continue to focus on improving HIV-related communication among MSM and consider relationship status in prevention messages. Intervention studies are needed to continue to identify and test factors that help reduce risky sexual behaviors.
Aberrometry Repeatability and Agreement with Autorefraction
Authors: Nguyen Mylan T. , Berntsen David A.
Published: July 2017

SIGNIFICANCE

Commercially available aberrometers are essential to clinical studies evaluating refractive error and image quality. The Discovery System (Innovative Visual Systems, Elmhurst, IL) is a promising clinical instrument that allows investigators to export aberration data for research and analysis purposes. An assessment of the Discovery System’s performance is essential to the interpretation of the data obtained.

PURPOSE

The aims of this study were to determine the between-visit repeatability of refractive error and higher-order aberration measurements with the Discovery System and to examine between-instrument agreement of refractive error measurements with the Discovery System and Grand Seiko WAM-5500 open-field autorefractor (Grand Seiko Co., Hiroshima, Japan).

METHODS

Cycloplegic refractive error values from the Discovery System (over a 3-mm pupil) and the Grand Seiko autorefractor were converted to power vectors (M, J
0, and J
45), and averaged. Zernike coefficients were also calculated by the Discovery System over a 6-mm pupil through the sixth radial order. Between-visit repeatability and agreement were evaluated using Bland-Altman difference-versus-mean plots. A t-test compared each mean difference (bias) to zero, and the 95% limits of agreement were calculated.

RESULTS

Twenty-five young adults with a mean (±SD) cycloplegic spherical-equivalent refractive error of −2.91 ± 1.85 diopters (D) (range, −6.96 to +0.74 D) were enrolled. There were no significant between-visit differences with the Discovery System for M, J
0, J
45, third- through sixth-order root mean square (RMS), higher-order RMS, or spherical aberration (all P > .30), and the repeatability for defocus and higher-order RMS were ±0.31 D and ±0.095 μm, respectively, for a 6-mm pupil. At a 3-mm pupil, the Discovery System, on average, measured slightly more positive values than the Grand Seiko for M (0.28 D), J
0 (0.11 D), and J
45 (0.12 D; all P < .005).

CONCLUSIONS

The Discovery System was very repeatable and would be an appropriate instrument to measure cycloplegic refractive error and higher-order aberration changes in adults. Small differences in refractive error were found between the Discovery System and Grand Seiko.
Effect of Self-efficacy Intervention on Quality of Life of Patients With Intestinal Stoma
Authors: Xu Shujuan , Zhang Zhiyun , Wang Aimei , Zhu Jiangyun , Tang Hongzhi , Zhu Xiaoli
Published: July 2017

Colorectal carcinoma is one of the most common malignancies worldwide and the most prevalent cause of cancer mortality in China. The Miles operation and permanent colostomy are effective treatment. However, these affect the quality of life of patients as they alter normal defecation. Self-efficacy is used to define an individuals' assessments of their ability to perform a specific behavior successfully. It is regarded as an important belief that can predict health behaviors. The aim of this study was to explore the effect of a self-efficacy intervention on the quality of life of patients with a permanent colostomy. Forty-eight patients in treatment for permanent colostomy surgery were divided into the control and intervention groups. The control group received routine nursing; the intervention group was exposed to a 3-month self-efficacy intervention, as well as routine nursing. The two groups completed the Chinese version of a self-efficacy questionnaire at 10 days, 1 month, and 3 months after surgery. Three months after surgery, the two groups also completed a quality-of-life questionnaire. There were significant differences in the quality of life between the two groups. The self-efficacy intervention nursing method improved self-efficacy and the quality of life of patients with intestinal stoma and is worthy of clinical utilization and application.
Atrial Natriuretic Peptide: A Potential Early Therapy for the Prevention of Multiple Organ Dysfunction Syndrome Following Severe Trauma
Authors: Zhang Rong-Wei , Liu Li-Li , Zeng Lan-Lan , Li Rui-Jie , Shen Ye-Hua , Zhang Bin , Liu Zi-Zhuo , Chen Meng-Fei , Jiang Sheng-Mao , Jiang Li-Bing , Zhao Xiao-Gang , Jiang Shou-Yin
Published: July 2017

Trauma remains a tremendous medical burden partly because of increased expenditure for the management of multiple organ dysfunction syndrome (MODS) developed during hospital stay. The intestinal barrier injury continues to be a second insult resulting in MODS which currently lacks efficient strategies for prevention. Recent studies have uncovered multi-organ protective benefits of atrial natriuretic peptide (ANP) in cardiovascular disease. However, the role of ANP in the prevention of MODS following severe trauma has not been understood. In our laboratory study, 1-h infusion of exogenous ANP during hemorrhagic shock following severe trauma induced high-level expression of endogenous serum ANP after 24 h, this effect was related to the improved level of functional biomarkers in multiple organs. Such phenomenon has not been found in other laboratories. A thorough literature review consequently was performed to uncover the potential mechanisms, to appraise therapy safety, and to propose uncertainties. In severe trauma, short-term exogenous ANP therapy during hemorrhagic shock may promote sustained endogenous expression of ANP from intestinal epithelium through activating a positive feedback loop mechanism involving phospholipase C-γ1 and reactive oxygen species crosstalk. This feedback loop may prevent MODS through multiple signaling pathways. Administration of ANP during hemorrhagic shock is thought to be safe. Further studies are required to confirm our proposed mechanisms and to investigate the dose, duration, and timing of ANP therapy in severe trauma.
Clinical Outcomes of Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy: A Multicenter Study
Authors: Sugiyama Masahiko , Oki Eiji , Ogaki Kippei , Morita Masaru , Sakaguchi Yoshihisa , Koga Satoshi , Saeki Hiroshi , Maehara Yoshihiko
Published: July 2017

Purpose:

To examine the short-term outcomes of intracorporeal anastomosis during totally laparoscopic total gastrectomy retrospectively at multiple institutions.

Patients and Methods:

We collected data of the patients who had undergone totally laparoscopic total gastrectomy at 4 institutions. All patients received an intracorporeal esophagojejunostomy.

Results:

Of the 215 patients evaluated, 147 underwent functional end-to-end anastomosis (FEEA) as the intracorporeal esophagojejunostomy (FEEA group), and 68 patients received a circular stapler anastomosis (Circular group). The rate of tumor invasion to the esophagus was significantly higher in the Circular group than in the FEEA group (33% vs. 6%, respectively; P<0.0001). Univariate and multivariate analyses revealed that the circular stapler anastomosis and high preoperative BMI were statistically significant risk factors for postoperative leakage. However, the rates of complications and mortality were not significantly different between groups.

Consideration:

Our results showed that each type of esophagojejunostomy is safe and feasible for patients with gastric cancer with acceptable morbidity and mortality.
Assessment of Weight Loss With the Intragastric Balloon in Patients With Different Degrees of Obesity
Authors: Nunes Gabriel C. , Pajecki Denis , de Melo Maria E. , Mancini Marcio C. , de Cleva Roberto , Santo Marco A.
Published: July 2017

Introduction:

The intragastric balloon (IGB) is an endoscopic device for the treatment of obesity. Best results are observed in patients who follow a dietary program but few studies have assessed the results of this treatment in patients with different degrees of obesity.

Aim:

The aim of this study is to compare the efficacy of IGB in patients with different degrees of obesity.

Method:

A total of 2002 patients with IGB were retrospectively evaluated and were divided into groups according to initial body mass index (BMI) range, as follows: group 1, 27 to 29.9 kg/m2; group 2, 30 to 34.9 kg/m2; group 3, 35 to 39.9 kg/m2; group 4, 40 to 44.9 kg/m2; group 5, ≥45 kg/m2. Weight was assessed in 3 different times: before (T0), 1 month (T1), 6 months (T2), and 6 months after removal of the IGB (T3).

Results:

A total of 946 patients lost follow-up. Overall, 40 (3.78%) removed the device before programmed by intolerance, and 1016 patients completed the 6-month treatment. The mean weight loss was 18.9%, excess weight loss 60.1% and an BMI reduction of 6.76 points. 6 months after removal of the balloon 842 patients had continued follow-up (82.8%). At this time, weight loss was 19.84%, excess weight loss was 59.49%, and BMI reduction of 7.06 points. In all groups there was statistical difference between the times T0 and T1 and between T1 and T2 (P<0.001). There was no statistical difference between T2 and T3, in any group.

Conclusion:

IGB provided sustained weight loss in patients who remained in dietary follow-up for 1 year.
Laparoscopic Pancreaticoduodenectomy: A Single Team Preliminary Experience
Authors: Duan Xiaohui , Jiang Bo , Zhou Lixue , Yang Jianhui , Tian Bingzhang , Wen Huiming , Mao Xianhai
Published: July 2017

Objective:

The present study aimed to describe the authors’ experience and the perioperative outcome for laparoscopic pancreaticoduodenectomy (LPD).

Materials and Methods:

Perioperative clinical data of 57 consecutive pancreaticoduodenectomy (PD) procedures performed from January 2014 to May 2016 in the Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital were retrospectively analyzed.

Results:

The median of operative time was 315 minutes (range, 220 to 575 min) and the median of intraoperative estimated blood loss was 200 mL (range, 100 to 550 mL). Conversion to open PD was required in 3 patients (5.3%) as a result of difficult dissection. Hand-assisted LPD was used in 2 patients (3.5%). Mean length of hospital stay was 14.8 days (8 to 29 d). Cumulative surgery-related morbidity was 28.1%, included bleeding (n=4), pancreatic ﬁstula (n=3), biliary ﬁstula (n=1), delayed gastric emptying (n=1), intra-abdominal infection (n=3), pulmonary infection (n=3), and ileus (n=1). Postoperative severe complications (Clavien≥III) were detected in 4 patients (7.0%) including 1 intra-abdominal infection, 2 postoperative bleeding event, and 1 afferent delayed gastric emptying. Three patients required reoperation. There was no 30-day or in-hospital mortality. Pathologic diagnoses were pancreatic ductal adenocarcinoma (n=5), ampullary adenocarcinoma (n=10), duodenal adenocarcinoma (n=24), distal common bile duct cancer (n=13), atypical hyperplasia of bile duct (n=2), and chronic pancreatitis (n=3). No patient had margin positive resection; the number of harvested lymph nodes were (16.7±4.2), the number of positive lymph nodes were (1.3±1.1).

Conclusions:

LPD, although complicated and difficult, serve as a safe and effective method for experienced surgeons.
A Prospective Randomized Controlled Trial Comparing Quality of Life Following Endoscopic Totally Extraperitoneal (TEP) Versus Open Stoppa Inguinal Hernioplasty
Authors: Kushwaha Jitendra K. , Enny Loreno E. , Anand Akshay , Sonkar Abhinav A. , Kumar Awanish , Pahwa Harvinder S.
Published: July 2017

In inguinal hernia surgery, quality of life (QOL) has emerged as a striking issue. Evidence suggests better QOL of patients operated with laparoscopic procedure as compared with open anterior hernia repairs. However data are scarce with relation to open posterior repair in terms of QOL issues. A prospective randomized single-blind study from November 2014 to October 2015 including all patients who underwent elective primary endoscopic [totally extraperitoneal (TEP)] or open Stoppa inguinal hernia repair was undertaken. Mean operating time, intraoperative and postoperative complications, and QOL using short form-36 and Carolinas equation of QOL were analyzed. Physical functioning, mental health, bodily pain, and general health showed advantages of TEP over Stoppa repair in first month of postoperative period. Postoperative prediction of hernia discomfort after 1 year was found to be significantly more in Stoppa repair. Complications were slightly higher with open repair. To conclude TEP is associated with significant increased operative time, better QOL in early postoperative period, and less predicted discomfort after 1 year of surgery.
Is Single-incision Laparoscopic Cholecystectomy Feasible for Acute Cholecystitis? A Consecutive Study of 60 Cases
Authors: Koizumi Noriaki , Kobayashi Hiroki , Takagi Tsuyoshi , Fukumoto Kanehisa
Published: July 2017

The feasibility of single-incision laparoscopic cholecystectomy (SIL-C) for patients with acute cholecystitis were evaluated based on the timing of operation after onset of symptoms. Sixty patients with acute cholecystitis who underwent SIL-C were divided into 2 groups according to the timing of operation: group E included 23 patients who underwent SIL-C within 72 hours, and group O included 37 patients who underwent SIL-C later. There were no statistical differences between group E and group O in clinicopathologic characteristics. Group E demonstrated significantly shorter operating time and less blood loss than group O. Although the incidences of additional port(s) requirements were not significantly different, 8 patients in group O required open conversion, indicating significantly higher rate. As group E demonstrated favorable surgical outcomes compared with group O, SIL-C for acute cholecystitis seems to be a feasible therapeutic procedure when performed within 72 hours as updated Tokyo Guidelines recommended.
But will they evenwearit? Exploring the tolerability of social communication coaching smartglasses in children and adults with autism
Authors: Keshav Neha U. , Salisbury Joseph P. , Vahabzadeh Arshya , Sahin Ned T.
Published: July 2017

Introduction

Augmented reality smartglasses are an emerging technology that are under investigation as a social communication aid for children and adults with autism spectrum disorder (ASD), and as a research tool to aid with digital phenotyping. Tolerability of this wearable technology in people with ASD is an important area for research, especially as these individuals may experience sensory, cognitive, and attentional challenges.

Aims

The aim of this study was to assess the tolerability and usability of a novel smartglasses system that has been designed as a social communication aid for children and adults with autism (theBrain Power Autism System;BPAS). BPAS runs on Google Glass Explorer Edition and other smartglasses, utilizes both augmented reality and affective artificial intelligence, and helps users learn key social and emotional skills.

Method

Twenty-one children and adults with ASD across a spectrum of severity used BPAS for a coaching session. The user’s tolerability to the smartglasses was determined through caregiver report, and user being able to wear the smartglasses for one-minute (initial tolerability threshold), and for the entire duration of the coaching session (whole session tolerability threshold).

Results

Nineteen out of 21 users (90.5%) demonstrated tolerability on all three measures. Caregivers reported 21 out of 21 users (100%) as tolerating the experience, while study staff found only 19 out of 21 users managed to demonstrate initial tolerability (90.5%). Of the 19 users who demonstrated initial tolerability, all 19 were able to use the smartglasses for the entire session (whole session tolerability threshold) (n= 19 of 19, 100%). Caregiver’s reported that 19 out of 21 users (90.5%) successfully used BPAS, and users surpassed their caregiver’s expectations in 15 of 21 cases (71.4%). Users who could communicate reported BPAS as being comfortable (94.4%).

Discussion

This preliminary report suggests that BPAS is well tolerated and usable to a diverse age- and severity-range of people with ASD. This is encouraging as these devices are being developed as assistive technologies for people with ASD. Further research should focus on improving smartglasses design and exploring their efficacy in helping with social communication in children and adults with ASD.
Engrailed homeoprotein blocks degeneration in adult dopaminergic neurons through LINE-1 repression
Authors: Blaudin de Thé François-Xavier , Rekaik Hocine , Peze-Heidsieck Eugenie , Massiani-Beaudoin Olivia , Joshi Rajiv L. , Fuchs Julia , Prochiantz Alain
Published: July 2017

LINE-1 mobile genetic elements have shaped the mammalian genome during evolution. A minority of them have escaped fossilization which, when activated, can threaten genome integrity. We report that LINE-1 are expressed in substantia nigra ventral midbrain dopaminergic neurons, a class of neurons that degenerate in Parkinson disease. InEngrailed-1heterozygotes, these neurons show a progressive degeneration that starts at 6 weeks of age, coinciding with an increase in LINE-1 expression. Similarly, DNA damage and cell death, induced by an acute oxidative stress applied to embryonic midbrain neurons in culture or to adult midbrain dopaminergic neuronsin vivo, are accompanied by enhanced LINE-1 expression. Reduction of LINE-1 activity through (i) direct transcriptional repression by Engrailed, (ii) a siRNA directed against LINE-1, (iii) the nucleoside-analogue reverse transcriptase inhibitor stavudine and (iv) viral Piwil1 expression, protects against oxidative stressin vitroandin vivo. We thus propose that LINE-1 overexpression triggers oxidative stress-induced DNA strand breaks and that an Engrailed adult function is to protect mesencephalic dopaminergic neurons through the repression of LINE-1 expression.
The largest SWI/SNF polyglutamine domain is a pH sensor
Authors: Gutiérrez J. Ignacio , Brittingham Greg , Wang Xuya , Fenyö David , Holt Liam J.
Published: July 2017

Polyglutamines are known to form aggregates in pathogenic contexts, such as in Huntington’s disease, however little is known about their role in normal biological processes. We found that a polyglutamine domain in the SNF5 subunit of the yeast SWI/SNF complex, histidines within this sequence, and transient intracellular acidification are required for efficient transcriptional regulation during carbon starvation. We hypothesized that a pH-driven oligomerization of the SNF5 polyglutamine region is required for transcriptional reprogramming. In support of this idea, we found that a synthetic spidroin domain from spider silk, which is soluble at pH 7 but oligomerizes at pH ~ 6.3, could partially complement the function of the SNF5 polyglutamine. These results suggest that the SNF5 polyglutamine domain acts as a pH-driven transcriptional regulator.
Dynamics of brain activity reveal a unitary recognition signal
Authors: Weidemann Christoph T. , Kahana Michael J.
Published: July 2017

Dual-process models of recognition memory typically assume that independent familiarity and recollection signals with distinct temporal profiles can each lead to recognition (enabling two routes to recognition), whereas single-process models posit a unitary “memory strength” signal. Using multivariate classifiers trained on spectral EEG features, we quantified neural evidence for recognition decisions as a function of time. Classifiers trained on a small portion of the decision period performed similarly to those also incorporating information from previous time points indicating that neural activity reflects an integrated evidence signal. We propose a single-route account of recognition memory that is compatible with contributions from familiarity and recollection signals, but relies on a unitary evidence signal that integrates all available evidence.
A model-based clustering method to detect infectious disease transmission outbreaks from sequence variation
Authors: McCloskey Rosemary M , Poon Art FY
Published: July 2017

Clustering infections by genetic similarity is a popular technique for identifying potential outbreaks of infectious disease, in part because sequences are now routinely collected for clinical management of many infections. A diverse number of nonparametric clustering methods have been developed for this purpose. These methods are generally intuitive, rapid to compute, and readily scale with large data sets. However, we have found that nonparametric clustering methods can be biased towards identifying clusters of diagnosis — where individuals are sampled sooner post-infection — rather than the clusters of rapid transmission that are meant to be potential foci for public health efforts. We develop a fundamentally new approach to genetic clustering based on fitting a Markov-modulated Poisson process (MMPP), which represents the evolution of transmission rates along the tree relating different infections. We evaluated this model-based method alongside five nonparametric clustering methods using both simulated and actual HIV sequence data sets. For simulated clusters of rapid transmission, the MMPP clustering method obtained higher mean sensitivity (85%) and specificity (91%) than the nonparametric methods. When we applied these clustering methods to published HIV-1 sequences from a study cohort of men who have sex with men in Seattle, USA, we found that the MMPP method categorized about half (46%) as many individuals to clusters compared to the other methods, and that the MMPP clusters were more consistent with transmission outbreaks. This new approach to genetic clustering has significant implications for the application of pathogen sequence analysis to public health, where it is critical to robustly and accurately identify clusters for the most cost-effective deployment of resources.