bluuebunny/crossref_metadata_2025 huggingface dataset:
Status of the River Krishna: Water quality and riverine environment in relation to fisheries
Authors: Das A. K. , Manna R. K. , Rao D. S. K. , Jha B. C. , Naskar M. , Sharma A. P.
Published: October 2017

The River Krishna, the second largest peninsular river of India, was investigated during pre-monsoon, monsoon, and post-monsoon seasons to improve the understanding of its ecology through analysis of physical and chemical parameters of water and sediment. Important tributaries of the river were also studied simultaneously to understand their influence on the main stream of the River Krishna. In addition to 25 sampling sites along the main stream of the River Krishna, sampling was also done in 13 important tributaries at sites upstream of the confluence point. Dams, barrages and anicuts have visible impacts on all of the observed physical and chemical properties of water and soil. Statistical analysis revealed that water parameters have a strong association with sediment parameters. However, the study was unable to find any relation between primary production and water quality parameters. Fish species distribution was strongly influenced by temperature and water depth, as well as specific conductivity, as observed through Canonical Correspondence Analysis.
Do the rivers of Chota Nagpur Dry Forests (Jharkhand), Damodar and Subarnarekha differ in biodiversity of aquatic macrozoobenthos, functional feeding groups and biological water quality?
Authors: Nesemann Hasko F. , Sharma Gopal , Kumar Ram , Sheetal Ashish , Roy Saryu
Published: October 2017

The Damodar and Subarnarekha Rivers are the first and second largest running waters of Jharkhand, having variable river bed morphology with naturally hard substrates. The riverine biodiversity is outstanding, as it includes endemic taxa on species and subspecies levels. Aquatic habitats are mostly colonized by native species. Macrozoobenthic animals are important bioindicators of the habitat quality of the river and are used for rapid assessment of river quality globally. In order to have preliminary information on the biodiversity of macrobenthos, the first survey was undertaken to find the impact of domestic pollution, mining, and thermal power plants on the aquatic life of the Damodar in May 2004. On the basis of our observations and species records, systematic field sampling for macro-benthic invertebrates in the Damodar and Subarnarekha Rivers was conducted from 2007 to 2012 during different hydrological conditions to cover the seasonal variation. Synoptic sampling was done to allow comparison between the two rivers. Aquatic invertebrate fauna has been inventoried with 124 identified taxa. The highest proportion of functional feeding groups recorded were detritivores, followed by carnivores and herbivores, respectively. This present study demonstrates the seasonal disappearance of macrozoobenthic invertebrates caused by urban and industrial pollution and that the fauna of the two main rivers of Jharkhand are similar in species inventory. This reflects the ecological conditions of the shared ecoregion known as Chota Nagpur Dry Forests. The results of the present research provide an essential database to evaluate the future environmental impact of restoration and changes in water quality.
River Ganges – Historical, cultural and socioeconomic attributes
Authors: Kumar Dilip
Published: October 2017

The River Ganges (also referred to as Ganga) is a symbol of faith, hope, culture and sanity, as well as a source of livelihood for millions since time immemorial. She is the centre of social and religious tradition in the Indian sub-continent and particularly sacred in Hinduism. The very special faith and respect for the River Ganges in India are as old as Indian culture itself. These are amply reflected in such ancient Indian scriptures as: Vedas, Puranas, Mahabharata, Ramayana and several others. In fact, respect for Ganga is a part of Indian identity and the very symbol of Indian culture. The history of Ganga in nurturing culture and civilizations is appreciated through fostering native culture in its basin, shifting of the Indus-Sarasvati basin civilization into its fold, and promoting integration of cultures to develop Indian civilization. The Ganges alone drains an area of over a million square kilometers. Its extensive basin accounts for one-fourth of India's water resources and is home to more than 407 million Indians, or some one-third of India's population. The Ganges basin, with its fertile soil, is a significant contributor to the agricultural economies of both India and Bangladesh. The Ganges and its tributaries provide a perennial source of irrigation to a large area, in addition to recharging the groundwater table all along their course. By supporting agriculture, animal husbandry and fisheries, tourism, river-based trade and transport, the river contributes significantly to the livelihood, food and nutritional security of about one-third of Indian and two-thirds of the Bangladeshi population. This article attempts to present a macro view of the Ganges and provide a broader context encompassing its historical, spiritual, cultural and socioeconomic attributes and considerations which often remain untouched in scientific papers.
Relative currents
Authors: Gupta Radhika
Published: October 2017

In this paper we define currents relative to a free factor system. We prove that a fully irreducible outer automorphism relative to a free factor system acts with uniform north-south dynamics on a subspace of the space of projective relative currents.
Fisher-Kolmogorov type perturbations of the relativistic operator: differential vs. difference
Authors: Jebelean Petru , Şerban Călin
Published: October 2017

We are concerned with the existence of multiple periodic solutions for differential equations involving Fisher-Kolmogorov perturbations of the relativistic operator of the form
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="minus left-bracket phi left-parenthesis u Superscript prime Baseline right-parenthesis right-bracket Superscript prime Baseline equals lamda u left-parenthesis 1 minus StartAbsoluteValue u EndAbsoluteValue Superscript q Baseline right-parenthesis comma">

−

[
ϕ
(

u
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]

′

=
λ
u
(
1
−

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q

)
,

\begin{equation*} -\left [\phi (u’)\right ]’=\lambda u(1-|u|^q), \end{equation*}

as well as for difference equations, of type
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="minus normal upper Delta left-bracket phi left-parenthesis normal upper Delta u left-parenthesis n minus 1 right-parenthesis right-parenthesis right-bracket equals lamda u left-parenthesis n right-parenthesis left-parenthesis 1 minus StartAbsoluteValue u left-parenthesis n right-parenthesis EndAbsoluteValue Superscript q Baseline right-parenthesis semicolon">

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Δ

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;

\begin{equation*} -\Delta \left [\phi (\Delta u(n-1))\right ]=\lambda u(n)(1-|u(n)|^q); \end{equation*}

here

q
>
0

q>0

is fixed,

Δ
\Delta

is the forward difference operator,

λ
>
0

\lambda >0

is a real parameter and

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=

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1
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\begin{equation*} \displaystyle \phi (y)=\frac {y}{\sqrt {1- y^2}}\quad (y\in (-1,1)). \end{equation*}

The approach is variational and relies on critical point theory for convex, lower semicontinuous perturbations of

C
1

C^1

-functionals.
Assessing privacy risks in population health publications using a checklist-based approach
Authors: O’Keefe Christine M , Ickowicz Adrien , Churches Tim , Westcott Mark , O’Sullivan Maree , Khan Atikur
Published: October 2017

Objective

Recent growth in the number of population health researchers accessing detailed datasets, either on their own computers or through virtual data centers, has the potential to increase privacy risks. In response, a checklist for identifying and reducing privacy risks in population health analysis outputs has been proposed for use by researchers themselves. In this study we explore the usability and reliability of such an approach by investigating whether different users identify the same privacy risks on applying the checklist to a sample of publications.

Methods

The checklist was applied to a sample of 100 academic population health publications distributed among 5 readers. Cohen’s κ was used to measure interrater agreement.

Results

Of the 566 instances of statistical output types found in the 100 publications, the most frequently occurring were counts, summary statistics, plots, and model outputs. Application of the checklist identified 128 outputs (22.6%) with potential privacy concerns. Most of these were associated with the reporting of small counts. Among these identified outputs, the readers found no substantial actual privacy concerns when context was taken into account. Interrater agreement for identifying potential privacy concerns was generally good.

Conclusion

This study has demonstrated that a checklist can be a reliable tool to assist researchers with anonymizing analysis outputs in population health research. This further suggests that such an approach may have the potential to be developed into a broadly applicable standard providing consistent confidentiality protection across multiple analyses of the same data.
OneFlorida Clinical Research Consortium: Linking a Clinical and Translational Science Institute With a Community-Based Distributive Medical Education Model
Authors: Shenkman Elizabeth , Hurt Myra , Hogan William , Carrasquillo Olveen , Smith Steven , Brickman Andrew , Nelson David
Published: October 2017

Problem

Developing a national pragmatic clinical trial infrastructure is central to understanding the effectiveness of interventions applied under usual conditions and where people receive health care. To address this challenge, three Florida universities—the University of Florida Clinical and Translational Science Institute, Florida State University (with its community-based distributive medical education model), and the University of Miami—created (2010–2013) a statewide consortium, the OneFlorida Clinical Research Consortium, to support the conduct of pragmatic clinical trials and provide mentored research experiences for medical and graduate students in real-world practice settings.

Approach

OneFlorida has four programs, which report to a steering committee with membership from each partner, community members, and the state Medicaid agency and Department of Health to ensure shared governance. The Clinical Research Program provides support to conduct research in the network and uses champions to engage community clinicians. The Citizen Scientist Program has community members who provide input on health topics of importance to them, study design, recruitment and retention strategies, and the interpretation of findings. The Data Trust Program contains electronic health record and health care claims data for 10.6 million Floridians. The Minority Education Program, in collaboration with three historically black colleges and universities, offers minority junior faculty mentoring in pragmatic clinical trials and implementation science.

Outcomes

OneFlorida has implemented 27 studies with diverse patient populations and in diverse community practice settings.

Next Steps

To identify evidence-based best practices from the clinical trials conducted in the network, foster their implementation, and expand research training opportunities.
Patient and Parent Satisfaction With Sling Use After Pediatric Upper Extremity Fractures: A Randomized Controlled Trial of a Customized Cast-Sling Versus Standard Cast and Sling
Authors: Cruz Aristides I. , DeFroda Steven F. , Gil Joseph A. , Hansen Heather , Bolous Alexandre , Procaccini Michaela , Zonfrillo Mark R.
Published: October 2017

Background:

Long arm cast immobilization after operative and nonoperative treatment of pediatric upper extremity fractures is common. The use of a sling to aid in carrying the casted extremity as well as provide further immobilization is also common practice. Off-the-shelf slings vary in quality and fit, can be confusing for parents/patients to apply, and lead to frustration and dissatisfaction with its use. The purpose of this investigation was to compare patient/parent centered outcomes after the use of a customized sling compared with a standard sling by utilizing a prospective, randomized-controlled trial. We hypothesized that patients and their parents would find the “Providence” Pedi Cast-Sling (PPCS) to be more convenient and be more satisfied with its use compare with a standard sling.

Methods:

Eligible subjects included patients 0 to 18 years old, evaluated at an urban, tertiary care pediatric emergency department (ED), who sustained an upper extremity fracture that required placement of a long-arm cast. Exclusion criteria were: open fractures; fractures at multiple levels; fractures requiring urgent/emergent surgery; admitted patients; bivalved casts. Patients were randomized to receive a standard sling or a PPCS. Questionnaires assessing patient/parent satisfaction, preferences, sling-use, and pain level were collected at patients’ first follow-up visit.

Results:

A total of 100 patients were randomized with 71 questionnaires available for analysis (39 standard sling vs. 32 PPCS). There were statistically significant differences for satisfaction scores for all related questions between patients who received a PPCS compared with a standard sling. Patients and their parents were more likely to choose the PPCS (P=0.001), were more satisfied with the PPCS (P<0.006), and reported the PPCS to be more convenient than a standard sling (P<0.001). Patients who received a PPCS wore the sling for a greater number of hours during the day (10.3±7.1 h) compared with those who received a standard sling (5.9±5.0 h) (P=0.004).

Conclusions:

The “Providence” Pedi Cast-Sling is a superior alternative to an off-the-shelf sling when used after the application of a long-arm cast providing greater convenience, compliance, and satisfaction to both patients and families.

Level of Evidence:

Level I—Prospective randomized-controlled trial.
Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures
Authors: Hughes Meghan , Dua Karan , O’Hara Nathan N. , Brighton Brian K. , Ganley Theodore J. , Hennrikus William L. , Herman Martin J. , Hyman Joshua E. , Lawrence J. Todd , Mehlman Charles T. , Noonan Kenneth J. , Otsuka Norman Y. , Schwend Richard M. , Shrader M. Wade , Smith Brian G. , Sponseller Paul D. , Abzug Joshua M.
Published: October 2017

Background:

Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures.

Methods:

A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making.

Results:

Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=−0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making.

Conclusions:

There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes.

Level of Evidence:

Level V.
Early Behavioral Risks of Childhood and Adolescent Daytime Urinary Incontinence and Nocturnal Enuresis
Authors: Vasconcelos Monica M. A. , East Patricia , Blanco Estela , Lukacz Emily S. , Caballero Gabriela , Lozoff Betsy , Gahagan Sheila
Published: October 2017

Objective:

To investigate whether infant temperament and childhood internalizing, externalizing, and inattention symptoms increase the likelihood of daytime urinary incontinence or nocturnal enuresis at 10 years and adolescence (11.9–17.8 years).

Method:

Data were from a longitudinal cohort of 1119 healthy Chilean children. We assessed behavioral symptoms at infancy, 5 years, and 10 years and their relationship with subsequent daytime urinary incontinence and nocturnal enuresis.

Results:

Daytime urinary incontinence and nocturnal enuresis occurred in, respectively, 3.3% and 11.4% at 10 years and 1.1% and 2.7% at adolescence. Difficult infant temperament was associated with increased odds of 10-year daytime urinary incontinence. Inattention at 5 years was associated with increased odds for nocturnal enuresis at 10 years and adolescence. Internalizing and externalizing symptoms at 5 years were associated with increased odds of 10-year daytime urinary incontinence and nocturnal enuresis. Internalizing and externalizing symptoms at 10 years were associated with adolescent nocturnal enuresis.

Conclusion:

Temperament and internal/externalizing symptoms may be risk factors for school-age and adolescent urinary incontinence.
Encopresis Plus?
Authors: Cormier DePorres , Reilly Marie , Young Amy , Augustyn Marilyn
Published: October 2017

CASE:

Dexter is a 12-year-old boy who presents with his maternal grandmother for follow-up to primary care for secondary encopresis. Dexter presented, 18 months ago, with a 3-month history of secondary encopresis. At that time, a comprehensive assessment revealed functional constipation resulting in encopresis. Dexter's symptoms resolved with a combination of medication management and behavioral strategies; laxatives were discontinued 12 months ago.

Dexter's grandmother reports that for the past 6 months, her grandson developed encopresis once again. However, she notes that, although Dexter had small-volume episodes of soiling in the past, he is now passing fully formed stools into his underwear. These episodes usually occur once a day, either at home or at school. Frustrated, Dexter's grandmother has transitioned him to adult diapers.

Dexter denies hematochezia, pain, dysuria, hematuria, urinary incontinence, dietary changes, or weight loss. He passes soft stool in his underwear once daily without blood or pain. When interviewed alone, Dexter denies drug use, depression, or significant social stressors. Surprisingly, he seems unconcerned about depression, drugs and social stress, and frequently laughs when discussing them. His physical examination, including a rectal examination, is normal.

Dexter's medical history is notable for attention-deficit hyperactivity disorder, treated with stimulant medication. He was toilet trained at 3 years without any difficulty. He lives with his grandmother, who is his legal guardian; his mother has chronic mental health problems and substance abuse. Dexter maintains regular contact with his mother and reports that their relationship is positive.

Dexter's grandmother is extremely distressed by his current presentation and notably, Dexter is not. What would you do next?
Inhibiting social support from massage-like stroking increases morphine dependence
Authors: Bates M.L. Shawn , Emery Michael A. , Wellman Paul J. , Eitan Shoshana
Published: October 2017

Our previous studies showed that altering solely the drug experience of the cage mates with which rodents are housed affects the development of morphine dependence. In this study, we used designer receptors exclusively activated by designer drugs to artificially increase or decrease the activity of peripheral dorsal root ganglia sensory neurons expressing the G-protein-coupled receptor MRGPRB4. This is because sensory MRGPRB4-expressing neurons were shown to specifically detect the sensation of massage-like stroking resulting from social grooming, which is an important affiliative social behavior in the rodent. Blocking the sensation of social grooming in morphine-treated mice housed with drug-naive mice (i.e. morphine cage mates) significantly increased the display of jumping behavior in morphine-withdrawn animals. Activating the sensation of social grooming in morphine-treated animals housed solely with other morphine-treated animals (i.e. morphine only) did not significantly alter the display of jumping behavior in morphine-withdrawn animals. Repetitive jumping behaviors have been shown to correlate with morphine dependence. Thus, this study showed a role of social grooming in the protective effect of being housed with drug-naive mice on the development of morphine dependence. It further confirms a role of social support in the development of substance use problems.
Taking the Tube: From Normal Fallopian Tube Epithelium to Ovarian High-grade Serous Carcinoma
Authors: TONE ALICIA A.
Published: October 2017

Detailed pathologic studies over the past decade suggest a distal fallopian tube origin for the majority of “ovarian” high-grade serous carcinomas (HGSC). This review will summarize molecular alterations observed in tubal precursors for HGSC, namely p53 signatures and serous tubal intraepithelial carcinomas, and in nonmalignant fallopian tube epithelial cells obtained from women at increased genetic risk for HGSC. Recent experiments investigating the impact of follicular fluid exposure and retrograde menstruation on tumor development in the fallopian tube will also be discussed. These data will be reconciled with traditional ovarian cancer risk factors related to reproductive history.
The Future of Cesarean Delivery Rates in the United States
Authors: CLAPP MARK A. , BARTH WILLIAM H.
Published: October 2017

The US cesarean delivery rate remains 30%–32%. Increases in maternal age, obesity, and diabetes put upward pressure on this rate. Alternatives to cesarean delivery, vaginal birth after cesarean (VBAC), and operative vaginal delivery, are underutilized and there are substantial challenges to their resurgence. Practice guidelines offer promise, but demonstrate only minor reductions in cesarean delivery. We estimate that the overall rate in the US will remain 27%–30% for the immediate future. As more states move to recognize the independent practice of midwifery and more payers seek lower cost options for childbirth, we anticipate the overall rate will drop to 20% or 25%, but not for another 15 years or more.
Riluzole Serum Concentration in Pediatric Patients Treated for Obsessive-Compulsive Disorder
Authors: Grant Paul , Farmer Cristan , Song Jane , Kish Timothy , Swedo Susan
Published: October 2017

Purpose/Background

The goals of this study were to determine whether pediatric serum concentration of riluzole is similar to that observed in adults and to determine whether riluzole serum concentration is associated with adverse effects or efficacy in children and adolescents with treatment-refractory obsessive-compulsive disorder.

Methods/Procedures

Data were drawn from previously published studies: 1 open-label trial and 1 randomized controlled trial with an open-label extension phase. Serum was drawn at 24, 36, and 52 weeks in 37 patients who were taking approximately 100 mg riluzole daily (mean dose at 24 weeks, 99 ± 28 mg).

Findings/Results

Across all samples, serum riluzole concentration ranged from 7 to 963 ng/mL. At week 24 (n = 37), the median concentration was 76 ng/mL (interquartile range, 53–172 ng/mL). Within-patient concentration was relatively stable. One subject who had the highest serum concentration levels during the study developed pancreatitis after exiting the study. The patient had recently added fluvoxamine to the riluzole regimen. Controlling for concomitant fluvoxamine (in 6 participants) and time of draw, serum riluzole concentration was not associated with obsessive-compulsive disorder symptom severity, nor was it associated with adverse effect profile.

Implications/Conclusions

The dose of riluzole used in these pediatric subjects seems to have achieved serum concentration levels similar to those observed in adults. However, as previously reported in adults, the serum concentration had no discernable relationship to efficacy or adverse effects.
Sedation Practice in Extracorporeal Membrane Oxygenation–Treated Patients with Acute Respiratory Distress Syndrome: A Retrospective Study
Authors: deBacker Julian , Tamberg Erik , Munshi Laveena , Burry Lisa , Fan Eddy , Mehta Sangeeta
Published: October 2017

Our objective was to characterize sedation management in adult patients with severe respiratory distress syndrome (ARDS) treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). We conducted a retrospective chart review of these patients treated at Toronto General Hospital between January 2012 and October 2015. Medications administered (sedative, analgesic, paralytic, and antipsychotic), sedation depth (Sedation Agitation Scale [SAS] score) delirium assessments, and mobilization were recorded daily. Forty-five adults (33 males, median age 47 years; interquartile range [IQR], 35–56]) with ARDS (median PaO2/FiO2 71; IQR 59–83) because of respiratory infection (91%) were treated with VV-ECMO for a median of 11 days (IQR, 7–17). After ECMO initiation, 96% patients were deeply sedated (SAS score < 3) with continuous infusions of midazolam (49%), propofol (18%), or both (29%) and 98% were receiving opioid infusions (93% fentanyl). Patients were deeply sedated for a median of 6 days (IQR, 3–10) after cannulation before transitioning to intermediate or light sedation (SAS score ≥ 3). Before ECMO discontinuation, 77% of surviving patients were intermediately or lightly sedated, 20% were receiving no sedatives, and 9% were receiving no opioids. During ECMO, 58% had positive delirium assessment and 24% experienced agitation (SAS ≥ 6). During ECMO support, 71% received physical therapy that occurred after a median of 7 days (IQR, 4–12) after cannulation. In conclusion, we found that although patients were deeply sedated for a prolonged duration after VV-ECMO initiation, many were able to safely achieve light sedation and active mobilization.
Leaflet Kinematics of Mechanical and Bioprosthetic Aortic Valve Prostheses
Authors: Vennemann Bernhard , Rösgen Thomas , Heinisch Paul Philipp , Obrist Dominik
Published: October 2017

The hemodynamic performance of artificial aortic valves (AVs) and the probability for structural valve deterioration can be linked to the valve kinematics. Comparability among different studies is limited because of variations in the experimental setups and physiologic boundary conditions. This study presents results of kinematic measurements of bioprosthetic and mechanical AVs that were tested in an identical experimental setting such that they can be directly compared with each other. The kinematics of AVs is typically presented in the form of the geometric orifice area and its temporal evolution. These parameters cannot capture asynchronous leaflet motion and out-of-plane leaflet velocity. In this work, each leaflet was tracked individually for a more detailed understanding of the leaflet kinematics, asynchronous leaflet motion, and leaflet tip velocities. A bioprosthetic valve, Edwards INTUITY (EINT), and two mechanical valves, Medtronic ADVANTAGE (MADV) and a Lapeyre-Triflo FURTIVA (TFUR), were tested in a compliant model of the aortic root in a physiologic flow loop. TFUR and MADV opened alike with maximum leaflet tip velocities of 0.77 and 0.66 m/s, respectively. The opening of EINT showed significantly higher local in-plane leaflet velocities of more than 2 m/s. EINT and TFUR exhibited similar early and slow closure. MADV closed significantly later with increased velocity. TFUR had a median maximum leaflet tip velocity of 0.39 m/s during valve closure and that of MADV was 0.83 m/s, whereas EINT exhibited a median maximum local in-plane leaflet velocity of 0.37 m/s. EINT experienced leaflet fluttering during systole with a flapping frequency of 36 Hz.
Determinants of Improvement in Cardiopulmonary Exercise Testing After Left Ventricular Assist Device Implantation
Authors: Rosenbaum Andrew N. , Dunlay Shannon M. , Pereira Naveen L. , Allison Thomas G. , Maltais Simon , Stulak John M. , Joyce Lyle D. , Kushwaha Sudhir S.
Published: October 2017

Although improvement in cardiac output and hemodynamic parameters is routinely demonstrated in patients implanted with continuous-flow left ventricular assist devices (CF-LVADs), improvement in exercise capacity is inconsistently seen. Our purpose was to determine whether native cardiac factors, LVAD factors, or comorbid factors were associated with lack of improvement. Review of all patients undergoing preimplant cardiopulmonary exercise testing (CPET) and CPET on LVAD therapy at one institution was performed between 2007 and 2014 (n = 49). Comprehensive assessment of echocardiographic parameters, right heart catheterization data, medications, and comorbid illness was undertaken. There was no mean improvement in peak oxygen consumption (VO2; 11.8–12.4 ml/kg/min; p = 0.26), although exercise time (5.1 [46% predicted] to 5.8 min [56% predicted]; p = 0.02) and nadir of the ratio of minute ventilation to carbon dioxide production slope (VE/VCO2; 39–36; p = 0.001) improved. Factors most strongly associated with improvement in VO2 were Heartmate II pulsatility index (PI; R = 0.48; p = 0.001), power (R = −0.40; p = 0.009), pump flow (R = −0.40; p = 0.008), and pump speed (R = −0.32; p = 0.04). Peak heart rate (HR) was also associated with improvement in VO2 (R = 0.41; p = 0.004). Left ventricular ejection fraction (LVEF; R = 0.004; p = 0.77), right ventricular (RV) function (R = 0.22; p = 0.28), and aortic valve opening (R = 0.20; p = 0.57) were not associated with improvement in VO2. Our data suggest that less reliance on LVAD support was modestly associated with improvement in exercise capacity. Further studies should seek to determine the optimal level of device support prospectively in relation to exercise capacity.
Hepatitis C virus infection and risk of Parkinson’s disease: a systematic review and meta-analysis
Authors: Wijarnpreecha Karn , Chesdachai Supavit , Jaruvongvanich Veeravich , Ungprasert Patompong
Published: October 2017

Background/objective

Hepatitis C virus (HCV) infection is one of the most common infections worldwide. Recent epidemiologic studies have suggested that patients with HCV infection might be at an increased risk of Parkinson’s disease. However, the data on this relationship remain inconclusive. This meta-analysis was conducted with the aim to summarize all available evidence.

Patients and methods

A literature search was performed using MEDLINE and EMBASE database from inception to May 2017. Studies that reported relative risks, odd ratios (ORs), or hazard ratios comparing the risk of Parkinson’s disease among HCV-infected patients versus participants without HCV infection were included. Pooled OR and 95% confidence interval were calculated using a random-effect, generic inverse variance method.

Results

Of 468 studies, five studies with 323 974 participants met our eligibility criteria and were included in the analysis. We found a higher risk of Parkinson’s disease among patients with chronic HCV infection compared with participants without HCV infection with the pooled OR of 1.35 (95% confidence interval: 1.19–1.52). The statistical heterogeneity of this study was insignificant (I
2=3%). The main limitation of this meta-analysis was the limited accuracy of diagnosis in the primary studies as they were coding-based studies.

Conclusion

This study demonstrated a higher risk of Parkinson’s disease among HCV-infected patients. Further studies are required to clarify how this risk should be addressed in the clinical picture.
Shear-wave elastography for the assessment of liver fibrosis in liver transplant recipients treated for hepatitis C virus recurrence
Authors: Korda David , Lenard Zsuzsanna M. , Gerlei Zsuzsanna , Jakab Zsuzsanna , Haboub-Sandil Anita , Wagner Laszlo , Varga Marina , Cseprekal Orsolya , Marton Adrienn , Horvathy Denes , Takacs Szabolcs , Doros Attila , Mathe Zoltan
Published: October 2017

Objectives

Direct-acting antiviral agents have revolutionized hepatitis C therapy, and are also found to be effective in the liver transplant setting. The extent of liver fibrosis influences patient management and is used to monitor therapeutic effects. Shear-wave elastography (SWE) is a relatively new imaging-based method that has not yet been studied extensively in liver transplant patients. Our aim was to study the effect of direct-acting antivirals in heaptitis C recurrence on liver stiffness determined by SWE.

Patients and methods

A total of 23 liver transplant patients with hepatitis C recurrence were enrolled in this prospective study. The patients underwent 24 weeks of ombitasvir/paritaprevir/ritonavir+dasabuvir±ribavirin combination therapy. Elastographic examinations, serological tests and laboratory tests were performed, and serum biomarkers of liver fibrosis were calculated the day before treatment (baseline) and at the end of the treatment.

Results

All our patients became hepatitis C virus RNA negative by the end of the treatment. Median liver stiffness values decreased significantly after treatment compared with baseline (8.72±3.77 vs. 7.19±2.4 kPa; P<0.001). Among the studied laboratory values, a significant decrease was observed in the levels of alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase, whereas international normalized ratio levels increased. Serum biomarkers, namely aspartate aminotransferase-to-platelet ratio index and Fibrosis-4, decreased significantly after treatment compared with baseline.

Conclusion

In the present study, SWE was succesfully used to monitor the beneficial therapeutic effects of direct-acting antivirals in hepatitis C recurrence following liver transplantation. We believe that SWE is a useful noninvasive diagnostic tool in the follow-up of hepatitis C treatment in liver transplant patients.
13-93B3 Bioactive Glass: a New Scaffold for Transplantation of Stem Cell-Derived Chondrocytes
Authors: Gunhan Kivanc , Bariskan Serkan , Uz Uzdan , Vatansever Seda , Kivanc Mujde
Published: October 2017

Research using animal models gives human trials hope for recovery in many fields of regenerative medicine, although they are sometimes poor predictors for human experiences. Our goal was to investigate whether rat chondrocytes, differentiated from adipose-derived stem cells, could be transplanted using a new, easily shaped, bioactive glass scaffold, and to show the immunohistochemical results. Intraperitoneal and retroperitoneal adipose tissue was extracted from 6 male Wistar albino type rats. The fatty tissue samples were fragmented and incubated. Chondrogenic differentiation was carried out and collagen type II, bFGF, and Sox-9 immunohistochemical characterization analysis was performed. Differentiated chondrocytes were implanted on 13-93B3 bioactive glass scaffolds and transplanted into the right ears of the rats. As control, only the biomaterial was transplanted into the left ears of the rats. After 1 month, the rats were sacrificed and transplantation areas were examined immunohistochemically. Histological examination of control samples from the left ears revealed that the biomaterial was covered with connective tissue, its general structure was preserved, and resorption of the scaffold had started. In specimens from the right ears, the biomaterial was covered with connective tissue, its structure was preserved, cartilage cells were present around the biomaterial, and the presence of cartilage tissue was demonstrated immunohistochemically. In conclusion, 13-93B3 bioactive glass scaffold contributed to the formation of new collagen and the survival of chondrocytes, and is a promising new biomaterial that will prove very useful in regenerative medicine.
The Etiology of Neuronal Development in Craniosynostosis: A Working Hypothesis
Authors: Brooks Eric D. , Beckett Joel S. , Yang Jenny , Timberlake Andrew T. , Sun Alexander H. , Chuang Carolyn , Persing John A.
Published: October 2017

Craniosynostosis is one of the most common craniofacial conditions treated by neurologic and plastic surgeons. In addition to disfigurement, children with craniosynostosis experience significant cognitive dysfunction later in life. Surgery is performed in infancy to correct skull deformity; however, the field is at a crossroads regarding the best approach for correction. Since the cause of brain dysfunction in these patients has remained uncertain, the role and type of surgery might have in attenuating the later-observed cognitive deficits through impact on the brain has been unclear. Recently, however, advances in imaging such as event-related potentials, diffusion tensor imaging, and functional MRI, in conjunction with more robust clinical studies, are providing important insight into the potential etiologies of brain dysfunction in syndromic and nonsyndromic craniosynostosis patients. This review aims to outline the cause(s) of such brain dysfunction including the role extrinsic vault constriction might have on brain development and the current evidence for an intrinsic modular developmental error in brain development. Illuminating the cause of brain dysfunction will identify the role of surgery can play in improving observed functional deficits and thus direct optimal primary and adjuvant treatment.
Outcomes of Titanium Mesh Cranioplasty in Pediatric Patients
Authors: Ma Irene T. , Symon Melissa R. , Bristol Ruth E. , Beals Stephen P. , Joganic Edward F. , Adelson P. David , Shafron David H. , Singh Davinder J.
Published: October 2017

Purpose:

Cranial defects in children have been repaired with various materials ranging from autologous bone to synthetic materials. There is little published literature on the outcomes of titanium mesh cranioplasty (TMC) in calvarial reconstruction in the pediatric population. This study evaluates a pediatric cohort who underwent calvarial defect reconstruction with titanium mesh and assesses the efficacy and outcomes of TMC.

Methods:

An Institutional Review Board approved retrospective review of patients ≤18 years of age who underwent cranioplasty from 1999 to 2014 at 2 centers was performed. The cohort undergoing TMC was studied.

Results:

A total of 159 cranioplasties were performed. Autologous reconstruction included 84 bone flap replacements and 36 split calvarial bone graft reconstructions. Six patients underwent PEEK implant reconstruction. Titanium mesh cranioplasty was performed on 33 patients. Two patients underwent 2 separate cranioplasties. The median age of patients was 6 years (19 months to 18 years). The most common underlying etiologies were congenital syndromes/craniosynostosis (13 patients), and trauma (11). The majority of patients had prior cranial surgeries (85%). Various types of titanium mesh were used with sizes ranging from 2×3 cm to 19×20 cm, with some patients requiring distinct areas of defect reconstruction. Perioperative complications were noted in 2 patients that subsequently improved. Two patients had late soft tissue problems with complications of wound infections requiring resection of a portion of the mesh. Patients were followed an average of 4 years (range 13 days to 6.8 years), with 2 patients lost to follow-up. Overall, all patients with follow-up achieved a cranial contour with good symmetry to the unaffected side, as well as effective protection to the brain.

Conclusions:

Titanium mesh cranioplasty is an effective option for correcting pediatric cranial defects when autologous bone availability is limited and soft tissue coverage allows placement of an implant. The interim outcome for these patients is favorable with few complications and no evidence of growth restriction in the authors’ series. Follow-up will be ongoing for these patients.
Mentor Tutoring: An Efficient Method for Teaching Laparoscopic Colorectal Surgical Skills in a General Hospital
Authors: Ichikawa Nobuki , Homma Shigenori , Yoshida Tadashi , Ohno Yosuke , Kawamura Hideki , Wakizaka Kazuki , Nakanishi Kazuaki , Kazui Keizo , Iijima Hiroaki , Shomura Hiroki , Funakoshi Tohru , Nakano Shiro , Taketomi Akinobu
Published: October 2017

Objective:

We retrospectively assessed the efficacy of our mentor tutoring system for teaching laparoscopic colorectal surgical skills in a general hospital.

Materials and Methods:

A series of 55 laparoscopic colectomies performed by 1 trainee were evaluated. Next, the learning curves for high anterior resection performed by the trainee (n=20) were compared with those of a self-trained surgeon (n=19).

Results:

Cumulative sum analysis and multivariate regression analyses showed that 38 completed cases were needed to reduce the operative time. In high anterior resection, the mean operative times were significantly shorter after the seventh average for the tutored surgeon compared with that for the self-trained surgeon. In cumulative sum charting, the curve reached a plateau by the seventh case for the tutored surgeon, but continued to increase for the self-trained surgeon.

Conclusions:

Mentor tutoring effectively teaches laparoscopic colorectal surgical skills in a general hospital setting.
Baseline Understanding of Urinary Incontinence and Prolapse in New Urogynecology Patients
Authors: Davidson Emily R.W. , Myers Erinn M. , De La Cruz Jacquia F. , Connolly AnnaMarie
Published: October 2017

Objectives

Investigators sought to assess whether age was related to patient understanding of pelvic floor disorders; given studies show that increased age is associated with lower health literacy.

Methods

This was a cross-sectional survey of new urogynecology patients. Enrolled participants completed a survey including demographics, history of urinary incontinence (UI) and pelvic organ prolapse symptoms and treatment, the Prolapse and Incontinence Knowledge Questionnaire (PIKQ), self-assessment of UI and prolapse knowledge, and a pelvic anatomy diagram to label. To achieve 80% power to detect a 2-point difference in PIKQ score, 33 subjects were required per age group (<65 and ≥65 years old).

Results

One hundred thirty-five of 160 new urogynecologic patients completed the survey (84% response rate). Thirty-seven participants were older than 65 years, and 98 were younger than 65 years. Total PIKQ scores (maximum, 24), the primary outcome, for the older and younger groups were 15.3 and 15.0, respectively (P = 0.7). The 2 groups self-rated UI and prolapse knowledge similarly, rating knowledge as excellent, very good, or good in 60% (P = 0.3) and 40% (P = 0.2) of subjects, respectively.

Conclusions

Baseline patient understanding of UI and pelvic organ prolapse was low as assessed by PIKQ score and was not influenced by age.
Treatment options for posttraumatic epilepsy
Authors: Zimmermann Lara L. , Martin Ryan M. , Girgis Fady
Published: October 2017

Purpose of review

Posttraumatic seizures (PTS) and posttraumatic epilepsy (PTE) are common and debilitating consequences of traumatic brain injury (TBI). Early PTS result in secondary brain injury by raising intracranial pressure and worsening cerebral edema and metabolic crisis. PTE is a localization-related epilepsy strongly associated with TBI severity, but risk factors for PTE and epileptogenesis are incompletely understood and are active areas of research. Medical management of PTS in adults and children is reviewed. Surgical options for posttraumatic drug-resistant epilepsy are also discussed.

Recent findings

Continuous electroencephalography is indicated for children and adults with TBI and coma because of the high incidence of nonconvulsive seizures, periodic discharges, and associated secondary brain injury in this population. Neuroinflammation is a central component of secondary brain injury and appears to play a key role in epileptogenesis. Levetiracetam is increasingly used for seizure prophylaxis in adults and children, but variability remains.

PTS occur commonly after TBI and are associated with secondary brain injury and worse outcomes in adults and children. Current medical and surgical management options for PTS and PTE are reviewed.
A test of four evolutionary hypotheses of pregnancy food cravings: evidence for the social bargaining model
Authors: Placek Caitlyn
Published: October 2017

The onset of cravings for items not typically desired is often considered a hallmark of pregnancy. Given the ubiquity of cravings, this phenomenon remains surprisingly understudied. The current study tested four hypotheses of pregnancy food cravings: behavioural immune system, nutrient seeking, resource scarcity and social bargaining. The research took place in Tamil Nadu, South India, with pregnant women residing in rural villages (
N 
= 94). Methods included structured interviews and anthropometric measures. Findings revealed that unripe mango and unripe tamarind were the two most frequently mentioned food cravings among this population, but were not sufficiently supported by the
a priori
models. Results confirmed that the social bargaining model was the best explanation for the etic category of toxic/pathogenic food items, suggesting that pregnant women crave dangerous foods when experiencing heightened social pressures. Finally, toxicity/pathogenicity was a confounding factor for the nutrient seeking and resource scarcity models, calling into question the validity of these models in adverse environments. Overall, these findings present important implications for research on pregnancy food cravings, such that in resource-scarce and pathogen-dense environments, cravings might target teratogenic items that signal a need for increased social support.
1-(2-aminophenyl)-1H-1,2,3-triazole-4-carboxylic acid: activity against Gram-positive and Gram-negative pathogens including
Vibrio cholerae
Authors: Maji Krishnendu , Haldar Debasish
Published: October 2017

We report a new synthetic aromatic ε-amino acid containing a triazole moiety with antimicrobial potential against Gram-positive, Gram-negative and pathogenic bacteria including
Vibrio cholerae
. Structure–property relationship studies revealed that all the functional groups are essential to enhance the antimicrobial activity. The 1-(2-aminophenyl)-1H-1,2,3-triazole-4-carboxylic acid was synthesized by click chemistry. From X-ray crystallography, the amino acid adopts a kink-like structure where the phenyl and triazole rings are perpendicular to each other and the amine and acid groups maintain an angle of 60°. The agar diffusion test shows that the amino acid has significant antibacterial activity. The liquid culture test exhibits that the minimum inhibitory concentration (MIC) value for
Bacillus subtilis
and
Vibrio cholerae
is 59.5 µg ml
−1
. FE-SEM experiments were performed to study the morphological changes of bacterial shape after treatment with compound
1
. The antimicrobial activity of the amino acid was further studied by DNA binding and degradation study, protein binding, dye-binding assay and morphological analysis. Moreover, the amino acid does not have any harmful effect on eukaryotes.