bluuebunny/crossref_metadata_2025 huggingface dataset:
Myostatin Inhibition Using ActRIIB-mFc Does Not Produce Weight Gain or Strength in the Nebulin Conditional KO Mouse
Authors: Tinklenberg Jennifer A , Siebers Emily M , Beatka Margaret J , Fickau Brittany A , Ayres Samuel , Meng Hui , Yang Lin , Simpson Pippa , Granzier Henk L , Lawlor Michael W
Published: December 2018

Mutations in at least 12 genes are responsible for a group of congenital skeletal muscle diseases known as nemaline myopathies (NMs). NMs are associated with a range of clinical symptoms and pathological changes often including the presence of cytoplasmic rod-like structures (nemaline bodies) and myofiber hypotrophy. Our recent work has identified a variable degree of behavioral benefit when treating 2 NM mouse models due to mutations in Acta1 with myostatin inhibition. This study is focused on the effects of delivering ActRIIB-mFc (Acceleron; a myostatin inhibitor) to the nebulin conditional knockout KO (Neb cKO) mouse model of NM. Treatment of Neb cKO mice with ActRIIB-mFc did not produce increases in weight gain, strength, myofiber size, or hypertrophic pathway signaling. Overall, our studies demonstrate a lack of response in Neb cKO mice to myostatin inhibition, which differs from the response observed when treating other NM models.
The Top News Stories of 2018: Women's Health
Authors: McSpedon Corinne
Published: December 2018

Maternal mortality rates remain a top concern.
The Lifelong Reverberations of Toxic Stress
Authors: Sofer Dalia
Published: December 2018

Children are vulnerable to the long-term consequences of adverse childhood experiences.
Low-Dose Aspirin Use Associated with Lower Ovarian Cancer Risk
Authors: Rosenberg Karen , Mechcatie Elizabeth
Published: December 2018

According to this study:

Regular use of low-dose aspirin is associated with a lower risk of ovarian cancer.

Long-term, high-quantity use of nonaspirin analgesics may increase ovarian cancer risk.
Increased Seizure Risk After Phototherapy for Jaundice
Authors: Rosenberg Karen , Mechcatie Elizabeth
Published: December 2018

According to this study:

Infants—particularly boys—exposed to phototherapy for jaundice are at increased risk for epilepsy in childhood.
A Mother and a Nurse
Authors: Rodriguez Kristy
Published: December 2018

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog will be a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.
Basophil activation testing in occupational respiratory allergy to low molecular weight compounds
Authors: Vera-Berrios Rosialzira Natasha , Feary Johanna , Cullinan Paul
Published: December 2018

Purpose of review

There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies.

Recent findings

BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex.

There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use.
Effect of Audibility and Suprathreshold Deficits on Speech Recognition for Listeners With Unilateral Hearing Loss
Authors: Bost Tim J. M. , Versfeld Niek J. , Goverts S. Theo
Published: December 2018

Objectives:

We examined the influence of impaired processing (audibility and suprathreshold processes) on speech recognition in cases of sensorineural hearing loss. The influence of differences in central, or top-down, processing was reduced by comparing the performance of both ears in participants with a unilateral hearing loss (UHL). We examined the influence of reduced audibility and suprathreshold deficits on speech recognition in quiet and in noise.

Design:

We measured speech recognition in quiet and stationary speech-shaped noise with consonant–vowel–consonant words and digital triplets in groups of adults with UHL (n = 19), normal hearing (n = 15), and bilateral hearing loss (n = 9). By comparing the scores of the unaffected ear (UHL+) and the affected ear (UHL−) in the UHL group, we were able to isolate the influence of peripheral hearing loss from individual top-down factors such as cognition, linguistic skills, age, and sex.

Results:

Audibility is a very strong predictor for speech recognition in quiet. Audibility has a less pronounced influence on speech recognition in noise. We found that, for the current sample of listeners, more speech information is required for UHL− than for UHL+ to achieve the same performance. For digit triplets at 80 dBA, the speech recognition threshold in noise (SRT) for UHL− is on average 5.2 dB signal to noise ratio (SNR) poorer than UHL+. Analysis using the speech intelligibility index (SII) indicates that on average 2.1 dB SNR of this decrease can be attributed to suprathreshold deficits and 3.1 dB SNR to audibility. Furthermore, scores for speech recognition in quiet and in noise for UHL+ are comparable to those of normal-hearing listeners.

Conclusions:

Our data showed that suprathreshold deficits in addition to audibility play a considerable role in speech recognition in noise even at intensities well above hearing threshold.
High-glucose Induced Mitochondrial Dynamics Disorder of Spinal Cord Neurons in Diabetic Rats and its Effect on Mitochondrial Spatial Distribution
Authors: Chen Ling , Huang Jie , Li Xiao-Cheng , Liu Si-Yang , Li Yun-Hong , Wang Qiang , Yang Ji-juan , Cao Hui-Mei , Hu Qi-Kuan , He Lan-Jie
Published: December 2018

Study Design.

A randomized, double-blind, controlled trial.

Objective.

Few studies have investigated the changes in mitochondrial dynamics in spinal cord neurons. Meanwhile, the distribution of mitochondria in axons remains unclear. In the present study, the investigators attempted to clarify these questions and focused in observing the changes in mitochondrial spatial distribution under a high-glucose environment.

Summary of Background Data.

Mitochondrial dynamics disorder is one of the main mechanisms that lead to nervous system diseases due to its adverse effects on mitochondrial morphology, function, and axon distribution. High-glucose stress can promote the increase in mitochondrial fission of various types of cells.

Methods.

The lumbar spinal cord of type 1 diabetic Sprague-Dawley rats at 4 weeks was observed. VSC4.1 cells were cultured and divided into three groups: normal control group, high-glucose intervention group, and high-glucose intervention combined with mitochondrial fission inhibitor Mdivi-1 intervention group. Immunohistochemistry and immunofluorescence methods were used to detect the expression of mitochondrial marker VDAC-1 in the spinal cord. An electron microscope was used to observe the number, structure, and distribution of mitochondria. Western blot was used to detect VDAC-1, fusion protein MFN1, MFN2, and OPA1, and fission protein FIS1 and DRP1. Living cell mitochondrial staining was performed using MitoTracker. Laser confocal microscopy and an Olympus live cell workstation were used to observe the mitochondrial changes.

Results.

The mitochondrial dynamics of spinal cord related neurons under an acute high-glucose environment were significantly unbalanced, including a reduction of fusion and increase of fission. Hence, mitochondrial fission has the absolute advantage. The total number of mitochondria in neuronal axons significantly decreased.

Conclusion.

Increased mitochondrial fission and abnormal distribution occurred in spinal cord related neurons in a high-glucose environment. Mdivi-1 could significantly improve these disorders of mitochondria in VSC4.1 cells. Mitochondrial division inhibitors had a positive significance on diabetic neuropathy.

Level of Evidence: N/A
Sex Differences in Opioid Use in Patients With Symptomatic Lumbar Stenosis or Spondylolisthesis Undergoing Lumbar Decompression and Fusion
Authors: Adogwa Owoicho , Davison Mark A. , Vuong Victoria , Desai Shyam A. , Lilly Daniel T. , Moreno Jessica , Cheng Joseph , Bagley Carlos
Published: December 2018

Study Design.

Retrospective analysis.

Objective.

To investigate sex differences in opioid use after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis.

Summary of Background Data.

Recent studies have demonstrated higher prevalence of chronic pain states and greater pain sensitivity among women compared with men. Furthermore, differences in responsivity to pharmacological and non-pharmacological treatments have been observed. Whether sex differences in perioperative opioid use exists in patients undergoing lumbar fusion for symptomatic stenosis or spondylolisthesis remains unknown.

Methods.

An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index 1,2, or 3-level index lumbar decompression and fusion procedures between 2007 and 2016. Records were searchable by International Classification of diseases diagnosis and procedure codes, and generic drug codes specific to Humana. Opioid use 6-months prior to through 2-years after index surgery was assessed. The primary outcome was sex differences in opioid use after index lumbar surgery. The secondary outcome was independent predictors of prolonged opioid use after lumbar fusion.

Results.

Of the 13,257 participants (females: 7871, 59.8%), 58.4% of women used opioids compared with 56.9% of men prior to index surgery. At 1-year after surgery, continuous opioid use was observed in 67.1% of women compared with 64.2% of men (P < 0.001). Within 2-years postoperatively, opioid use was observed in 83.1% of women versus 82.5% men. In a multivariate logistic regression analysis, female sex (odds ration [OR] 1.14, 95% confidence interval [CI]: 1.058–1.237), obesity (OR 1.10, 95% CI: 1.004–1.212), and preoperative narcotic use (OR 3.43, 95% CI: 3.179–3.708) was independently associated with prolonged (>1 yr) opioid use after index surgery.

Conclusion.

We observed a higher prevalence of chronic opioid use among women following lumbar fusion surgery. Female sex was independently associated with prolonged opioid use after index surgery.

Level of Evidence: 3
Tobacco Use During Pregnancy
Authors: CRUME TESSA
Published: December 2018

Smoking during pregnancy is the most common preventable cause of infant morbidity and mortality. Cessation by the third trimester has consistently been associated with improved birth outcomes; however, the majority of women who obtain cessation during pregnancy, relapse in the first year postpartum. The majority of women who smoke during pregnancy developed their addiction to tobacco in early life, thus the need to intervene in the familial transmission of nicotine dependence is clear. This review discusses the epidemiology of tobacco use amongst pregnant women and factors associated with cessation. Specific intervention strategies are discussed and recommendations are provided to clinicians.
Participation Trends of Ultra Endurance Events
Authors: Scheer Volker
Published: December 2018

Ultra endurance events are defined as sporting activities lasting >6 hours and include events such as ultramarathon foot races, ultra triathlons, ultra distance swimming, ultra cycling, and cross-country skiing. Popularity in these events has risen especially over the last 25 years with increasing participation notably in ultramarathon races where an exponential increase in participation has been observed. This is in large part due to the increasing popularity and participation of women and master athletes in these events. Other endurance sports have seen similar increases but overall numbers are much lower compared with ultramarathon events.
Fueling and Recovery
Authors: Patton Katherine
Published: December 2018

As ultra-endurance races continue to rise in popularity, it is critical that athletes understand how to nourish their bodies with proper amounts of calories from carbohydrate, protein, and fat. The importance of carbohydrate for fueling endurance exercise and protein for recovery is well established; however, the role of fat is debated. Specific amounts of carbohydrate per kilogram of body weight are recommended for before, during, and after ultra-endurance exercise. Total grams of protein per day and after exercise are established. After carbohydrate and protein needs are determined the balance of calories typically come from fat. Using fat for energy during endurance exercise is not a new concept, but continues to be studied as way of fueling while sparing muscle glycogen.
Cardiac Risk of Extreme Exercise
Authors: Sharalaya Zarina , Phelan Dermot
Published: December 2018

Habitual moderate intensity exercise is a vital component of a healthy lifestyle. For most of the population, increasing exercise duration and intensity beyond current recommendations appears to impart additional cardiovascular benefits; however, recent data has raised the possibility of an inflection point after which additional exercise no longer imparts benefit and may even result in negative cardiovascular outcomes. Exercise at the extremes of human endurance places a large hemodynamic stress on the heart and results in occasionally profound cardiac remodeling in order to accommodate the huge increases in cardiac output demanded by such endeavors. These changes have the potential to become maladaptive and heighten the risk of various arrhythmias, influence the rate of coronary atherosclerosis, and alter the risk of sudden cardiac death. Herein, we will discuss the potential negative impact of extreme exercise on cardiovascular risk.
Common and Uncommon Injuries in Ultra-endurance Sports
Authors: Almekinders Louis C. , Engle Charles R.
Published: December 2018

Ultra-endurance sports are associated with prolonged physical exercise both during training and competition. Musculoskeletal injuries are common as a result of the repetitive physical stresses. Stress fractures in the weight-bearing bones should always be suspected when ultra-endurance athletes present with pain over bony structures. Most stress fractures can be treated with activity modifications but some such as femoral neck and tibial shaft stress fractures may require operative fixation. The knee seems to be the most frequent source of injuries in ultra-endurance athletes. Patellofemoral symptoms from tendon injuries or chondral problems are common injuries and can be challenging to treat. Lower leg, ankle, and foot injuries also make up a significant portion of the ultra-endurance injuries. Peritendinitis of the extensor tendons at the extensor retinaculum of the anterior ankle or “ultramarathoner’s ankle” seems to be a unique injury associated with ultramarathons. Other lower leg injuries include medial tibial stress syndrome (MTSS) and chronic exercise-induced compartment syndrome (CECS).
Proper Hydration During Ultra-endurance Activities
Authors: Hoffman Martin D.
Published: December 2018

The health and performance of ultra-endurance athletes is dependent on avoidance of performance limiting hypohydration while also avoiding the potentially fatal consequences of exercise-associated hyponatremia due to overhydration. In this work, key factors related to maintaining proper hydration during ultra-endurance activities are discussed. In general, proper hydration need not be complicated and has been well demonstrated to be achieved by simply drinking to thirst and consuming a typical race diet during ultra-endurance events without need for supplemental sodium. As body mass is lost from oxidation of stored fuel, and water supporting the intravascular volume is generated from endogenous fuel oxidation and released with glycogen oxidation, the commonly promoted hydration guidelines of avoiding body mass losses of >2% can result in overhydration during ultra-endurance activities. Thus, some body mass loss should occur during prolonged exercise, and appropriate hydration can be maintained by drinking to the dictates of thirst.
Depression in Ultra-endurance Athletes, A Review and Recommendations
Authors: Onate John
Published: December 2018

Depression affects 6.7% of the adult population each year and studies indicate the annual prevalence is similar or even higher in athletes. It is often insidious and not recognized. There continues to be stigma and misunderstanding about the disorder that is a barrier to getting an accurate diagnosis and effective treatment. It is important for people living with depression to get professional help because the condition itself can be disabling, increases risk of suicide, and reduces quality of life. There is some evidence that depression and suicide risk is higher in endurance athletes such as track and field, marathoner, and ultramarathoners. There have been studies of athletes looking at rates reporting depressive symptoms and on factors in suicide attempts in the athletes. Studies have reviewed risk factors unique to athletes for depression. This article will review depression in the endurance athlete and approaches in treatment in that population.
Short article: Willingness to undergo colonoscopy with virtual reality instead of procedural sedation and analgesia
Authors: Blokzijl Susanne J. , Lamberts Kirsten F. , van der Waaij Laurens A. , Spikman Jacoba M.
Published: December 2018

Objective

This study explored the willingness of patients to start colonoscopy with virtual reality (VR) instead of procedural sedation and analgesia (PSA), as well as their motives and characteristics. There is a growing interest in colonoscopy without PSA. Offering VR as a distraction technique instead of PSA may increase the percentage of colonoscopies without PSA.

Patients and methods

A survey with demographic, colonoscopy-related and psychology-related questions was completed by 326 adults referred for colonoscopy with PSA.

Results

Overall, 25.7% reported to be willing to start with VR instead of PSA. Main reasons for this choice were receiving as little medication as possible, resuming daily life activities faster and participating in traffic independently afterwards. Logistic regression analysis showed that significant predictors of the willingness to use VR were male sex, higher educational level and absence of worries about the outcome of the colonoscopy.

Conclusion

If VR turns out to be effective in the future, present results may be useful to customize patient information to help patients choosing VR.
Management of Familial Adenomatous Polyposis in Children and Adolescents
Authors: Hyer Warren , Cohen Shlomi , Attard Thomas , Vila‐Miravet Victor , Pienar Corina , Auth Marcus , Septer Seth , Hawkins Jackie , Durno Carol , Latchford Andrew
Published: December 2018

Familial adenomatous polyposis (FAP) is a well‐described inherited syndrome, characterized by the development of hundreds to thousands of adenomas in the colorectum, with implications in children and adolescents. Almost all adult patients will develop colorectal cancer if they are not identified and treated early enough. Identifying and screening for FAP commences in adolescence. The syndrome is inherited as an autosomal dominant trait and caused by mutations in the adenomatous polyposis (APC) gene. This European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) position paper provides a guide for diagnosis, assessment, and management of FAP in children and adolescents.

This is the first position paper regarding FAP published by ESPGHAN. Literature from PubMed, Medline, and Embase was reviewed and in the absence of evidence, recommendations reflect the opinion of paediatric and adult experts involved in the care of polyposis syndromes. Because many of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, these of the recommendations are supported on expert opinion. This position paper will instruct on the appropriate management and timing of procedures in children and adolescents with FAP.
Transcranial Doppler Evaluation in Takayasu Arteritis With Oculo-Cerebrovascular Complications
Authors: Christiansen Michael E. , O’Carroll Cumara B. , Kumar Gyanendra , Larsen Brandon T. , Dumitrascu Oana M.
Published: December 2018

Introduction:

Takayasu arteritis is a large-vessel vasculitis that may cause oculo-cerebral ischemia. We report a patient with visual loss as initial manifestation, and discuss transcranial Doppler (TCD) findings before and after surgical revascularization.

Case Description:

A 19-year-old female developed episodes of transient positional right vision loss, progressing to permanent right vision loss and bright light-induced left amaurosis. Examination demonstrated subclavian bruits, palpable epigastrium aortic pulsation, faint radial pulses, right retinal pallor, arteriolar narrowing, and bilateral boxcarring. Head and neck computed tomography angiogram demonstrated left subclavian origin and right common carotid artery occlusion, and severe innominate and left common carotid artery stenosis. TCD demonstrated right ophthalmic artery flow reversal and nonpulsatile waveforms with dampened spectra in the right anterior circulation. Corticosteroids, methotrexate, infliximab, and dual-antiplatelet therapy were initiated. Eleven weeks later, the patient underwent ascending aortic aneurysm repair and bilateral carotid artery bypass with an aortic graft. Pathology was consistent with chronic active Takayasu arteritis. Two weeks postoperatively, left eye visual symptoms resolved; right visual loss persisted. Postoperative TCD showed marked improvement in cerebral perfusion.

Conclusions:

Retinal ischemia in young women should prompt emergent inflammatory and systemic vascular evaluation. In our subject, prolonged right retinal ischemia had dismal prognosis despite carotid-aortic revascularization, whereas left retinal boxcarring reversed. Surgical revascularization is recommended for severely symptomatic oculo-cerebrovascular disease, once inflammation is better controlled with immunosuppressive therapy. TCD documented the presence and monitored the subsequent resolution of blood flow changes causing retinal and brain hypoxia.
Radiologic and Histopathologic Features in an Intracranial Localized Castleman Disease
Authors: Escribano Paredes J. Bernardo , Carrasco Moro Rodrigo , López Gutiérrez María , Arias Héctor Pian , García-Cosío Mónica , García Madrona Sebastián , Nedkova Hristova Velina , Martínez Poles Javier , Francisco Javier Buisán Catevilla
Published: December 2018

Introduction:

Castleman disease (CD) is a rare pathologic process of unknown etiology, characterized by non-neoplastic lymph node enlargement. Two distinct histologic patterns are recognized; the hyaline-vascular type and the less common plasma cells type. Another intermediate type has been described. The clinical features are classified into 2 categories, localized (unicentric) and generalized (multicentric), the later associated with systemic manifestations and poor prognosis. CD affecting the central nervous system is extremely rare. We report a new case of localized intracranial CD and we accomplish a review of the literature.

Case Report:

A 30-year-old man presented with a generalized tonic-clonic seizure. Computerized tomography and magnetic resonance imaging showed a small mass in the right temporoparietal convexity with homogenous enhancement after contrast administration. Extensive vasogenic edema in comparison with the size of the mass was also identified and based on the neuroradiologic finding, a suspected diagnosis of meningoangiomatosis was formulated. The mass was completely resected and his histologic examination identified the hyaline-vascular type of CD. One year after surgery, the patient remains seizure free, without evidence of systemic involvement or recurrence of the mass.

Conclusions:

Our case and review of the literature show the value of the extensive brain edema on neuroimaging finding to the differential diagnosis for a solitary mass arising from the meninges. We emphasize on the need for histologic examination when the diagnosis of meningioma is not entirely clear.
Type and Duration of Exercise in the SAMMPRIS Trial
Authors: Turan Tanya N. , Al Kasab Sami , Nizam Azhar , Hannah Jessica , Gordon Neil , Lynn Michael J. , Derdeyn Colin P. , Fiorella David , Janis L. Scott , Lane Bethany F. , Montgomery Jean , Chimowitz Marc I.
Published: December 2018

Background:

Analyses from the Stenting and Aggressive Medical management for prevention of Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial showed that good control of vascular risk factors (systolic blood pressure, low-density lipoprotein, and exercise) was associated with fewer vascular events and exercise had the biggest impact on the outcome. We sought to determine the type and duration of exercise performed by SAMMPRIS patients during the trial.

Methods:

SAMMPRIS aggressive medical management included a telephonic lifestyle modification program, INTERVENT, that was provided free of charge to all subjects during the study. We analyzed self-reported data collected by INTERVENT on the patients’ type and duration of exercise from baseline (n=394) to 3 years (n=132). We calculated the mean duration for each exercise type at each time period and then compared the change in exercise duration from baseline using paired t tests and Wilcoxon signed-rank tests.

Results:

Walking was the most common form of exercise at all time points, as measured by both the duration of exercise and the number of patients performing the exercise. The mean duration of walking and other aerobic activities increased significantly from baseline to all other time points.

Conclusions:

The type of self-reported exercise performed by SAMMPRIS patients included mostly walking or other aerobic activity and increased significantly during follow-up.
Can Admission BNP Level Predict Outcome After Intravenous Thrombolysis in Acute Ischemic Stroke?
Authors: Gupta Harsh V. , Finlay Christopher W. , Jacob Sajish , Raina Sunil K. , Lee Ricky W. , Hinduja Archana
Published: December 2018

Objective:

Our study aimed to determine the prognostic value of elevated Brain Natriuretic Peptide (BNP) among patients who received intravenous thrombolysis (IVT) in acute ischemic stroke (AIS).

Background:

The elevation in BNP level is correlated with infarct size, poststroke mortality, and CHADS2 score. Currently, there is a lack of validated biomarker to predict the outcome in patients with acute ischemic stroke, and there is a complex interaction amongst multiple variables.

Design/Methods:

A retrospective review of medical records of patients admitted to our institution with acute ischemic stroke was performed. The patients who received intravenous thrombolysis were selected for analysis and divided into 2 groups based on the level of BNP. We compared the baseline demographics, past medical history, stroke etiology, discharge disposition, and 3-month mRS between both groups. Multivariate logistic regression analysis was performed to identify the predictors of poor outcome following intravenous thrombolysis in acute ischemic stroke.

Results:

A total of 90 patients were recruited in the study; 53 patients were found to have an elevated BNP (high BNP was defined as >100 pg/mL) level, whereas 37 had low BNP levels. Our study showed that patients with elevated BNP were more likely to have an elevation in admission and discharge NIHSS, serum creatinine, left atrial size, and blood glucose (P<0.05). Atrial fibrillation and cardioembolic strokes were seen most often in the population with elevated BNP (P<0.05). The patients with elevated BNP were less likely to be discharged home, and 3-month mRS was found to be higher, but these were not significant. On multivariate analysis, elevated BNP was not found to be an independent factor for poor outcome.

Conclusions:

Elevated BNP level was not found to be an independent marker of poor outcome in AIS patients following IVT.
A Comparison of the Clinical Characteristics and Outcomes of Cryptococcal Meningitis in HIV-negative Individuals With and Without Immunosuppression
Authors: Li Min , Chen Zhuolin , Xu Li , Gan Zhouqing , Peng Fuhua , Liu Jia
Published: December 2018

Cryptococcal meningitis (CM) is found to occur in immunosuppressed patients and those who are immunocompetent. This study aimed to compare the presentation and outcome of CM in patients who are human immunodeficiency virus (HIV) negative with and without immunosuppression. We reviewed 255 clinical records from patients with CM who are HIV negative. The demographic and clinical characteristics, cerebrospinal fluid profiles, brain magnetic resonance imaging, treatment, and outcomes of these individuals were retrospectively analyzed. Among the 255 patients with CM, 91 (35.7%) appeared immunocompetent. CM was present in a younger population in the immunocompetent group (above 50 y, 19.8% vs. 32.3%, P=0.026), with higher initial complaints of visual and auditory symptoms (45.1% vs. 27.4%, P=0.004; 19.8% vs. 9.1%, P=0.016; respectively) and higher cerebrospinal fluid white blood cell counts (30.8% vs. 45.1%, P=0.009) compared with the immunocompromised patients. In addition, the immunocompetent patients had a higher proportion of normal brain images than did the immunocompromised patients (10% vs. 2%, P=0.028). There were no differences in hospital mortality and satisfactory outcomes between the groups (mortality: 10.9% vs. 7.0%, P=0.416; satisfactory outcomes: 76.4% vs. 80.2%, P=0.585). We found significant differences between the immunocompetent and HIV-negative immunocompromised patients; however, there were fewer differences between the groups than expected. Further studies assessing the immune responses in both groups should be performed.
A Novel Method for Optical Distortion Quantification
Authors: Gerton Katherine M. , Novar Brenda J. , Brockmeier William , Putnam Christopher
Published: December 2018

SIGNIFICANCE

Optical distortion is the image degradation of a visual target induced by a transparent material. Current Air Force evaluation of distortion is an entirely qualitative assessment of the acceptability of image distortion. The novel, quantitative technique described here is capable of identifying 0.1% distortion across an array of optical samples.

PURPOSE

Optical distortion is the effect by which a transparent object spatially warps the perception of a visual target. All U.S. Air Force visors are required to pass military standards outlined in MIL-DTL-43511D (2006). Although specifications for the optical distortion setup and critical areas of vision are outlined, the evaluation technique is entirely qualitative, with a panel of several human evaluators assessing the distortion acceptability. The evaluation is not explicitly tied to a visual acceptability rating and has variable levels of consistency over time or across evaluators and a fabrication tolerance limit of 3% distortion.

METHODS

The technique proposed in this article is a modification to the recommended optical tester used to analyze distortion patterns. An image-processing algorithm was developed to analyze patterns of Ronchi grid distortion mathematically to provide a quantitative approach that can subsequently be tied to visual metrics.

RESULTS

This effort developed and refined an algorithm that allowed for a standardized assessment creation of high-resolution distortion maps from digital images. A 1-inch-diameter region imaged through ophthalmic material allowed for two-dimensional median filtering down to 15-pixel areas with enhanced contrast between grid lines leading to possible resolution capabilities of 0.10% distortion.

CONCLUSIONS

Quantification of the standard for measuring optical distortion is the initial step toward determining the effects of distortions on human visual performance metrics. The future goal for this effort will focus on obtaining empirical results from human experimental efforts and relating the distortion location and magnitude to effects on visual performance activities.
Case Report: Primary Conjunctival Non-Hodgkin Marginal Zone Lymphoma
Authors: Bennett Loren W.
Published: December 2018

SIGNIFICANCE

Ophthalmic manifestations of non-Hodgkin lymphoma are rare, and the diagnosis can be delayed because of nonspecific symptoms and a tendency to mimic the appearance of other ocular diseases. Suspicious presentations will require confirmation of the lymphoma through surgical biopsy.

PURPOSE

The purpose of this study was to present an isolated conjunctival non-Hodgkin marginal zone lymphoma without systemic involvement, which was successfully managed with external beam radiation.

CASE REPORT

A 49-year-old man reported a red, temporal bulbar conjunctival growth on the left eye for several weeks, which was initially treated as a nodular episcleritis. When the condition did not resolve, a subsequent biopsy diagnosed a low-grade non-Hodgkin marginal zone lymphoma; further testing found no systemic involvement. No intraocular involvement was noted, and B-scan ultrasound and magnetic resonance imaging did not demonstrate any uveal or orbital extension. A trial of doxycycline did not lead to regression, and the isolated lesion was observed. Because of possible slow growth, the lesion was eventually treated with external beam radiation, which resulted in significant tumor regression. Four years after the radiotherapy, the tumor has not recurred, and there has been no systemic involvement.

CONCLUSIONS

This case of a low-grade extranodal marginal zone lymphoma on the temporal conjunctiva represents a less common variation of the classic fornix-based presentation. It is not unusual for conjunctival lymphomas to masquerade as another clinical entity, sometimes making the initial diagnosis challenging. If a patient does not respond as expected to conventional therapy, a biopsy to rule out malignancy should be considered.
A National Snapshot of Patient-Reported Outcomes Comparing Types of Abdominal Flaps for Breast Reconstruction
Authors: Atisha Dunya M. , Tessiatore Kristen M. , Rushing Christel N. , Dayicioglu Deniz , Pusic Andrea , Hwang Shelley
Published: December 2018

Background:

This study aimed to identify differences in patient-reported abdominal well-being, satisfaction, and quality of life in women with muscle-preserving free abdominal versus pedicle transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction.

Methods:

Women with a history of breast cancer surgery were recruited from the Army of Women foundation to take the BREAST-Q and a background questionnaire. Descriptive statistics and regression analyses were used to compare abdominal physical well-being, breast satisfaction, chest physical, psychosocial well-being, and sexual well-being in women undergoing free versus pedicle TRAM flaps.

Results:

Of 657 women, 273 (41 percent) underwent free flap surgery and 384 (58 percent) underwent pedicle TRAM flap surgery. Compared with unilateral pedicle TRAM flaps, those with unilateral free flaps scored an average of 9.5 points higher (95 percent CI, 5.4 to 13.6; p < 0.0001) and those with bilateral free flaps reported no difference in physical well-being of the abdomen. Compared with bilateral pedicle TRAM flaps, the following groups scored higher in physical well-being of the abdomen: unilateral free flaps, an average of 17.4 (95 percent CI, 11.5 to 23.3; p < 0.0001); bilateral free flaps, an average of 6.8 (95 percent CI, 0.3 to 13.3; p = 0.04); and unilateral pedicle TRAM flaps, an average of 7.9 (95 percent CI, 2.4 to 13.4; p = 0.005) higher. Women with bilateral pedicle flaps reported sexual well-being scores 7.4 (95 percent CI, 0.6 to 14.3; p = 0.03) and 6.8 (95 percent CI, 0.3 to 13.2; p = 0.04) points lower than those with unilateral free and unilateral pedicle flaps.

Conclusions:

Muscle-preserving techniques result in improved abdominal wall function and decreased morbidity compared with pedicle TRAM flap reconstruction. These data highlight the importance of offering patients the option of microsurgical techniques.
Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip Plasty in Asians
Authors: Jung Jae-A , Kim Ki-Bum , Park Hyun , Dhong Eun-Sang , Han Seung-Kyu , Kim Woo-Kyung
Published: December 2018

Background:

The objective of this study was to illustrate a novel technique for lifting of the aging upper lip with nasal tip plasty in Asians. With this procedure, a shortening of the philtrum, an increase of the vermilion, and a natural and nicer mouth can be obtained, with increase of the tip of the nose simultaneously.

Methods:

Thirty patients were the subjects of this study. Incisions were made bilaterally beginning at the alar fold, entering nostrils, and rising medially on the skin below the lower margin of the medial crura. Excess skin of the philtrum was eliminated in two separate pieces and the muscle was suspended to the base of the nose with interrupted stitches.

Results:

All patients expressed a high degree of satisfaction. The average ratio between the L1 reference line and the height of the upper lip measurement preoperatively was 0.43 ± 0.05. This ratio was improved postoperatively to an average of 0.32 ± 0.05. The nasolabial angle was 91.31 ± 4.19 degrees before surgery and 105.62 ± 5.04 degrees after surgery. The angle of the upper lip was 48.97 ± 2.41 degrees before surgery and 38.21 ± 3.34 degrees after surgery.

Conclusions:

Lip lift is an effective tool for correcting a natural tendency of the upper lip to cover the upper teeth during aging. There is a dramatic improvement in the patient’s facial aesthetic appearance during smiling and at rest. The authors strongly recommend this technique as part of the surgical procedure to achieve a youthful face.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Combining Abdominal Flaps and Implants in the Breast Reconstruction Patient: A Systematic and Retrospective Review of Complications and Outcomes
Authors: Black Cara K. , Graziano Francis D. , Fan Kenneth L. , Defazio Michael V. , Nahabedian Maurice Y.
Published: December 2018

Background:

Implants offer a method for augmenting abdominal flaps in the setting of deficient volume in breast reconstruction. They may be placed immediately at the time of reconstruction or on a delayed basis. The authors seek to compare outcomes from a single surgeon and previously published studies.

Methods:

A systematic review was performed, querying multiple databases. A retrospective review was conducted for patients who underwent abdominally based flap breast reconstruction and implant placement between July of 2005 and August of 2015 performed by the senior author (M.Y.N.).

Results:

A systematic review of the literature yielded four articles, for a total of 96 patients (142 breasts) included for systematic review. Eighty-seven breasts (61 percent) were reconstructed with immediate implant at the time of flap reconstruction and 55 breasts (39 percent) had a staged approach to implant placement. Complications were noted in 28 breasts (32 percent) following immediate placement and in 10 breasts (18 percent) following staged placement. A total of 53 patients (79 breasts) were retrospectively reviewed, all of whom underwent reconstruction in a staged manner. Twelve breasts (15 percent) were found to have a flap- or implant-related complication; 97.5 percent of implants/flap reconstructions were successful, with a 54 percent revision rate. When pooling systematic and retrospective data, there was a significant difference in complication rates between the staged and immediate reconstruction cohorts (p < 0.001) in favor of the staged approach.

Conclusions:

The literature supports a higher rate of implant-related complications following immediate implantation at the time of flap reconstruction. The authors’ experience with implant placement highlights the safety and effectiveness of the staged approach.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Associations Between Cannabis Use and Cardiometabolic Risk Factors: A Longitudinal Study of Men
Authors: Meier Madeline H. , Pardini Dustin , Beardslee Jordan , Matthews Karen A.
Published: December 2018

Objective

This study tested longitudinal associations between cannabis use and cardiometabolic risk factors that underlie the development of cardiovascular diseases.

Methods

Participants were men from the youngest cohort of the Pittsburgh Youth Study who were followed prospectively from approximately age 7 to 32 years (N = 253). Frequency of cannabis use was assessed yearly from approximately ages 12 to 20 years and again at approximately ages 26, 29, and 32 years. The following cardiometabolic risk factors were assessed during a laboratory visit at approximately age 32 years: body mass index (BMI), waist-hip ratio, high- and low-density lipoprotein cholesterol, triglycerides, fasting glucose, insulin resistance, blood pressure, interleukin 6, and C-reactive protein.

Results

Greater cannabis exposure was associated with relatively lower BMI (β = −0.31, p < .001), smaller waist-hip ratio (β = −0.23, p = .002), better high- (β = 0.14, p = .036) and low-density lipoprotein cholesterol (β = −0.15, p = .026), lower triglycerides (β = −0.17, p = .009), lower fasting glucose (β = −0.15, p < .001) and insulin resistance (β = −0.21, p = .003), lower systolic (β = −0.22, p < .001) and diastolic blood pressure (β = −0.15, p = .028), and fewer metabolic syndrome criteria (β = −0.27, p < .001). With exception of BMI, cannabis users' mean levels on cardiometabolic risk factors were generally below clinical cutoffs for high risk. Most associations between cannabis use and cardiometabolic risk factors remained after adjusting for tobacco use, childhood socioeconomic status, and childhood health. However, after adjusting for adult BMI, these associations were no longer apparent, and mediation tests suggested that cannabis users' relatively lower BMI might explain their lower levels of risk on other cardiometabolic risk factors.

Conclusions

Cannabis use is associated with lower BMI, and lower BMI is related to lower levels of risk on other cardiometabolic risk factors.
Accelerated Segmented Diffusion-Weighted Prostate Imaging for Higher Resolution, Higher Geometric Fidelity, and Multi-b Perfusion Estimation
Authors: Aksit Ciris Pelin , Chiou Jr-yuan George , Glazer Daniel I. , Chao Tzu-Cheng , Tempany-Afdhal Clare M. , Madore Bruno , Maier Stephan E.
Published: December 2018

Purpose

The aim of this study was to improve the geometric fidelity and spatial resolution of multi-b diffusion-weighted magnetic resonance imaging of the prostate.

Materials and Methods

An accelerated segmented diffusion imaging sequence was developed and evaluated in 25 patients undergoing multiparametric magnetic resonance imaging examinations of the prostate. A reduced field of view was acquired using an endorectal coil. The number of sampled diffusion weightings, or b-factors, was increased to allow estimation of tissue perfusion based on the intravoxel incoherent motion (IVIM) model. Apparent diffusion coefficients measured with the proposed segmented method were compared with those obtained with conventional single-shot echo-planar imaging (EPI).

Results

Compared with single-shot EPI, the segmented method resulted in faster acquisition with 2-fold improvement in spatial resolution and a greater than 3-fold improvement in geometric fidelity. Apparent diffusion coefficient values measured with the novel sequence demonstrated excellent agreement with those obtained from the conventional scan (R
2 = 0.91 for b
max = 500 s/mm2 and R
2 = 0.89 for b
max = 1400 s/mm2). The IVIM perfusion fraction was 4.0% ± 2.7% for normal peripheral zone, 6.6% ± 3.6% for normal transition zone, and 4.4% ± 2.9% for suspected tumor lesions.

Conclusions

The proposed accelerated segmented prostate diffusion imaging sequence achieved improvements in both spatial resolution and geometric fidelity, along with concurrent quantification of IVIM perfusion.
The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery
Authors: Rollins Katie E. , Javanmard-Emamghissi Hannah , Acheson Austin G. , Lobo Dileep N.
Published: December 2018

Objectives:

To compare the impact of the use of oral antibiotics (OAB) with or without mechanical bowel preparation (MBP) on outcome in elective colorectal surgery.

Summary Background Data:

Meta-analyses have demonstrated that MBP does not impact upon postoperative morbidity or mortality, and as such it should not be prescribed routinely. However, recent evidence from large retrospective cohort and database studies has suggested that there may be a role for combined OAB and MBP, or OAB alone in the prevention of surgical site infection (SSI).

Methods:

A meta-analysis of randomized controlled trials and cohort studies including adult patients undergoing elective colorectal surgery, receiving OAB with or without MBP was performed. The outcome measures examined were SSI, anastomotic leak, 30-day mortality, overall morbidity, development of ileus, reoperation and Clostridium difficile infection.

Results:

A total of 40 studies with 69,517 patients (28 randomized controlled trials, n = 6437 and 12 cohort studies, n = 63,080) were included. The combination of MBP+OAB versus MBP alone was associated with a significant reduction in SSI [risk ratio (RR) 0.51, 95% confidence interval (CI) 0.46–0.56, P < 0.00001, I2 = 13%], anastomotic leak (RR 0.62, 95% CI 0.55–0.70, P < 0.00001, I2 = 0%), 30-day mortality (RR 0.58, 95% CI 0.44–0.76, P < 0.0001, I2 = 0%), overall morbidity (RR 0.67, 95% CI 0.63–0.71, P < 0.00001, I2 = 0%), and development of ileus (RR 0.72, 95% CI 0.52–0.98, P = 0.04, I2 = 36%), with no difference in Clostridium difficile infection rates. When a combination of MBP+OAB was compared with OAB alone, no significant difference was seen in SSI or anastomotic leak rates, but there was a significant reduction in 30-day mortality, and incidence of postoperative ileus with the combination. There is minimal literature available on the comparison between combined MBP+OAB versus no preparation, OAB alone versus no preparation, and OAB versus MBP.

Conclusions:

Current evidence suggests a potentially significant role for OAB preparation, either in combination with MBP or alone, in the prevention of postoperative complications in elective colorectal surgery. Further high-quality evidence is required to differentiate between the benefits of combined MBP+OAB or OAB alone.