bluuebunny/crossref_metadata_2025 huggingface dataset:
Precarity, Inequality, and the Problem of Agency in the Study of the Life Course
Authors: Dannefer Dale , Huang, MGS Wenxuan
Published: December 2017

Although long neglected, the themes of inequality and the differentiating consequences of structurally organized constraints and opportunities for individuals have recently become a major theme of scholars in aging and life-course studies. Beyond the evidence of intracohort patterns of cumulative dis/advantage in health and resources, recent societal trends of increasing inequality have added another dimension of theoretical interest and practical urgency to these concerns. These trends have been noteworthy both for the dramatic increase and for their planetary breadth, affecting Asia and Europe as well as America. Both researchers and popular writers have observed the growing importance of the precariat, an emerging subpopulation with tenuous connection to the primary economy encompasses individuals of every age. At the same time, individual agency and related concepts such as “choice” and “decision-making” continue regularly to appear as featured terms in studies of life course and related fields. Such concepts accord a strong explanatory force to the individual, and continue to be widely accepted as unproblematic and legitimate. This article examines the relevance of these two domains of life-course scholarship in analyzing an urgent contemporary problem—struggles associated with the “transition to adulthood” and the situation of young adults. Young people confronting this transition have been the focus of both the celebration of agency and of the growing attention on inequality and adversity and its effects on vulnerable periods and key transitions in the life course. Their situation provides an opportunity to resolve some of the tensions between perspectives that emphasize agency and those that emphasize inequality.
Construction of the third-generation Zea mays haplotype map
Authors: Bukowski Robert , Guo Xiaosen , Lu Yanli , Zou Cheng , He Bing , Rong Zhengqin , Wang Bo , Xu Dawen , Yang Bicheng , Xie Chuanxiao , Fan Longjiang , Gao Shibin , Xu Xun , Zhang Gengyun , Li Yingrui , Jiao Yinping , Doebley John F , Ross-Ibarra Jeffrey , Lorant Anne , Buffalo Vince , Romay M Cinta , Buckler Edward S , Ware Doreen , Lai Jinsheng , Sun Qi , Xu Yunbi
Published: December 2017

Background

Characterization of genetic variations in maize has been challenging, mainly due to deterioration of collinearity between individual genomes in the species. An international consortium of maize research groups combined resources to develop the maize haplotype version 3 (HapMap 3), built from whole-genome sequencing data from 1218 maize lines, covering predomestication and domesticated Zea mays varieties across the world.

Results

A new computational pipeline was set up to process more than 12 trillion bp of sequencing data, and a set of population genetics filters was applied to identify more than 83 million variant sites.

Conclusions

We identified polymorphisms in regions where collinearity is largely preserved in the maize species. However, the fact that the B73 genome used as the reference only represents a fraction of all haplotypes is still an important limiting factor.
Psychometric Evaluation of the E-cigarette Dependence Scale
Authors: Morean Meghan E , Krishnan-Sarin Suchitra , Sussman Steve , Foulds Jonathan , Fishbein Howard , Grana Rachel , O’Malley Stephanie S
Published: December 2017

Introduction

Psychometrically sound measures of e-cigarette dependence are lacking.

Methods

We modified the PROMIS Item Bank v1.0—Smoking: Nicotine Dependence for All Smokers for use with e-cigarettes and evaluated the psychometrics of the 22-, 8-, and 4-item adapted versions, referred to as The E-cigarette dependence scale (EDS). Adults (1009) who reported using e-cigarettes at least weekly completed an anonymous survey in summer 2016 (50.2% male, 77.1% White, mean age 35.81 [10.71], 66.4% daily e-cigarette users, 72.6% current cigarette smokers). Psychometric analyses included confirmatory factor analysis, internal consistency, measurement invariance, examination of mean-level differences, convergent validity, and test-criterion relationships with e-cigarette use outcomes.

Results

All EDS versions had confirmable, internally consistent latent structures that were scalar invariant by sex, race, e-cigarette use (nondaily/daily), e-liquid nicotine content (no/yes), and current cigarette smoking status (no/yes). Daily e-cigarette users, nicotine e-liquid users, and cigarette smokers reported being more dependent on e-cigarettes than their counterparts. All EDS versions correlated strongly with one another, evidenced convergent validity with the Penn State E-cigarette Dependence Index and time to first e-cigarette use in the morning, and evidenced test-criterion relationships with vaping frequency, e-liquid nicotine concentration, and e-cigarette quit attempts. Similar results were observed when analyses were conducted within subsamples of exclusive e-cigarette users and duals-users of cigarettes and e-cigarettes.

Conclusions

Each EDS version evidenced strong psychometric properties for assessing e-cigarette dependence in adults who either use e-cigarette exclusively or who are dual-users of cigarettes and e-cigarettes. However, results indicated little benefit of the longer versions over the 4-item EDS, which provides an efficient assessment of e-cigarette dependence.

Implications

The availability of the novel, psychometrically sound EDS can further research on a wide range of questions related to e-cigarette use and dependence. In addition, the overlap between the EDS and the original PROMIS that was developed for assessing nicotine dependence to cigarettes provides consistency within the field.
AIDS-Defining Illnesses at Initial Diagnosis of HIV in a Large Guatemalan Cohort
Authors: Reinhardt Samuel W , Spec Andrej , Meléndez Johanna , Alonzo Cordon Andrea , Ross Ian , Powderly William G , Mejia Villatoro Carlos
Published: December 2017

Background

Anecdotal evidence suggests that a high proportion of patients diagnosed with HIV in Guatemala present with AIDS. There remain limited data on the epidemiology of AIDS-defining illnesses (ADIs) in Central America.

Methods

We conducted a retrospective cohort study of all patients living with HIV at the largest HIV clinic in Guatemala. Charts were analyzed for clinical and demographic data. Presence of an ADI was assessed by US Centers for Disease Control definitions; patients who presented with an ADI were compared with those without ADI using descriptive statistics.

Results

Of 3686 patients living with HIV, 931 (25.3%) had an ADI at HIV diagnosis, 748 (80.3%) of whom had CD4 counts lower than 200 cells/mm3. Those with ADIs were more likely to be male (67.5% vs 54.6%; P < .0001) and heterosexual (89.4% vs 85.0%; P = .005). The most common ADIs were Mycobacterium tuberculosis (55.0%), Pneumocystis jirovecii pneumonia (13.7%), esophageal candidiasis (13.4%), and histoplasmosis (11.4%). Histoplasmosis and HIV wasting syndrome were both more common among rural patients.

Conclusions

In this large Guatemalan cohort of patients currently living with HIV, a significant portion presented with an ADI. These data inform the most common ADIs diagnosed among survivors, show that histoplasmosis is more commonly diagnosed in rural patients, and suggest that HIV wasting syndrome may reflect missed histoplasmosis diagnoses.
Pedicled Vascularized Bone Grafts for Posterior Occipitocervical and Cervicothoracic Fusion: A Cadaveric Feasibility Study
Authors: Bohl Michael A , Mooney Michael A , Catapano Joshua S , Almefty Kaith K , Turner Jay D , Chang Steve W , Preul Mark C , Reece Edward M , Kakarla U Kumar
Published: December 2017

BACKGROUND

Arthrodesis is critical for achieving favorable outcomes in reconstructive spine surgery. Vascularized bone grafts (VBGs) have been successfully used to augment fusion rates in a variety of skeletal pathologies, and pedicled VBG has numerous advantages over free transfer VBG. Pedicled VBG has not previously been described for the posterior occipitocervicothoracic spine.

OBJECTIVE

To identify, describe, and assess potential donor sites for pedicled VBGs from occiput to T12 using a cadaver model and to describe important technical considerations for graft harvest and placement.

METHODS

A multidisciplinary team of plastic surgeons and neurosurgeons hypothesized that it is feasible to rotate a pedicled VBG from the occiput to T12 via a posterior approach. In 6 cadavers, 3 VBG donor sites were identified as anatomically feasible: occiput, scapula, and rib.

RESULTS

Split- and full-thickness occipital VBGs were mobilized on a semispinalis pedicle. Occipital VBGs could be mobilized from occiput to T1 and span up to 4 levels. Scapular VBGs were mobilized on a subscapular pedicle and could be mobilized from occiput to T7 and span up to 8 levels. Rib VBGs were mobilized on subcostal pedicles and could be mobilized from C6 to T12. Ribs T2 to T4 and T11 and T12 could cover 2 levels, and ribs T5 to T10 could cover 3 levels. The first rib was anatomically unsuitable as a VBG due to its primarily ventral course.

CONCLUSION

Pedicled VBGs can feasibly be applied to posterior spinal arthrodesis from occiput to T12. Patients at high risk for nonunion may benefit from this strategy.
The Competitive Landscape of High-Frequency Trading Firms
Authors: Boehmer Ekkehart , Li Dan , Saar Gideon
Published: December 2017

We examine product differentiation in the high-frequency trading (HFT) industry, where the “products” are secretive proprietary trading strategies. We demonstrate how principal component analysis can be used to detect underlying strategies common to multiple HFT firms and show that there are three product categories with distinct attributes. We study how HFT competition in each product category affects the market environment and present evidence that indicates how it influences the short-horizon volatility of stocks as well as the viability of trading venues.

Received October 10, 2016; editorial decision September 30, 2017 by Editor Itay Goldstein. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Pedicle Subtraction Osteotomy Versus Multiple Posterior Column Osteotomies in Severe and Rigid Neuromuscular Scoliosis
Authors: Bekmez Senol , Ozhan Mehmet , Olgun Zeynep Deniz , Suzer Anil , Ayvaz Mehmet , Demirkiran Halil Gokhan , Karaagaoglu Ergun , Yazici Muharrem
Published: December 2017

Study Design.

Retrospective analysis.

Objective.

The aim of this study is to compare the safety and efficacy of the apical pedicle subtraction osteotomy (PSO) technique with multiple posterior column osteotomies (PCOs) in nonambulatory patients with severe, rigid neuromuscular scoliosis.

Summary of Background Data.

Neuromuscular scoliosis frequently causes intolerance to sitting due to pelvic obliquity, trunk decompensation, and associated back and rib impingement pain which diminish the patient's functional capacity. In the case of rigid curves, spinal osteotomy techniques are occasionally required for effective correction.

Methods.

We retrospectively reviewed our patients with severe and rigid neuromuscular scoliosis with associated pelvic obliquity who were treated with posterior instrumented fusion extending to pelvis with more than 1-year postoperative follow-up. We compared radiological and clinical results of PSO and multiple PCO techniques in severe rigid neuromuscular scoliosis with pelvic obliquity of more than 15° in traction radiograph under general anesthesia. Hospital records were also reviewed for operative time, intraoperative blood loss, amount of blood transfusion, duration of hospital stay, and complications.

Results.

There were 12 patients in the PSO group and 10 patients in the PCO group. There was no significant difference between groups in terms of major curve magnitude, sagittal parameters or pelvic obliquity. Although not statistically significant, PSO technique did trend toward better scoliosis correction (post-op Cobb angle 56.1° vs. 66.7° [P = 0.415]). PSO technique provided a significantly better correction in pelvic obliquity (59% vs. 84%) (P = 0.001). There was no significant difference in average intraoperative blood loss, transfusion, and operative times including anesthesia time, hospital stay, or complications.

Conclusion.

PSO may be an option in correction of severe and rigid neuromuscular scoliosis. It provides better correction of pelvic obliquity without increasing operative time, need for transfusion, or duration of hospitalization as compared to multiple apical PCO technique. Traction radiograph under general anesthesia is a valuable tool in surgical decision making.

Level of Evidence: 4
Investigation of the Effect of Cervical Radiculopathy on Peripheral Nerves of the Upper Extremity With High-Resolution Ultrasonography
Authors: Metin Ökmen Burcu , Ökmen Korgün , Altan Lale
Published: December 2017

Study Design.

Prospective, cross-sectional observational study.

Objective.

We aimed to investigate the effects of chronic cervical radiculopathy (CR) on the cross-sectional area (CSA) values of the cervical nerve roots (CNRs), median, ulnar, and radial nerves with high-resolution ultrasonography.

Summary of Background Data.

Symptomatic nerve roots are wider than asymptomatic nerve roots due to the presence of edema. Peripheral nerves have also been shown to develop edema, fibrosis, and changes distal to the affected nerve as a result of mechanical compression. In addition according to “double-crush syndrome” hypothesis, the peripheral nerves are more sensitive to pressure, and a proximal nerve lesion makes the distal segment of the nerve more susceptible to anatomic deterioration by causing interruption in the axoplasmic conduction due to compression.

Methods.

Forty patients with chronic CR were included to the study. Both affected CNRs and the contralateral nerve roots (control group) were evaluated with high-resolution ultrasonography. Ulnar and median nerve CSA measurements were performed at four measurement points and radial nerve measurements at a single measurement point.

Results.

CSA measurements were statistically significantly higher at the CNR of the affected side compared to the unaffected side. There was no statistically significant difference when affected and unaffected sides were compared in terms of measurements performed from median, ulnar, and radial nerves at all measurement points.

Conclusion.

The results of the present study indicate that the changes in the CNR caused by CR do not have any effect on the peripheral nerves. We did not find any affection in peripheral nerve CSA that might have been suggestive of double-crush syndrome in CR.

Level of Evidence: 2
Renal Tubular Cell Mitochondrial Dysfunction Occurs Despite Preserved Renal Oxygen Delivery in Experimental Septic Acute Kidney Injury
Authors: Arulkumaran Nishkantha , Pollen Sean , Greco Elisabetta , Courtneidge Holly , Hall Andrew M. , Duchen Michael R. , Tam Frederick W. K. , Unwin Robert J. , Singer Mervyn
Published: December 2017

Objective:

To explain the paradigm of significant renal functional impairment despite preserved hemodynamics and histology in sepsis-induced acute kidney injury.

Design:

Prospective observational animal study.

Setting:

University research laboratory.

Subjects:

Male Wistar rats.

Intervention:

Using a fluid-resuscitated sublethal rat model of fecal peritonitis, changes in renal function were characterized in relation to global and renal hemodynamics, and histology at 6 and 24 hours (n = 6–10). Sham-operated animals were used as comparison (n = 8). Tubular cell mitochondrial function was assessed using multiphoton confocal imaging of live kidney slices incubated in septic serum.

Measurements and Main Results:

By 24 hours, serum creatinine was significantly elevated with a concurrent decrease in renal lactate clearance in septic animals compared with sham-operated and 6-hour septic animals. Renal uncoupling protein-2 was elevated in septic animals at 24 hours although tubular cell injury was minimal and mitochondrial ultrastructure in renal proximal tubular cells preserved. There was no significant change in global or renal hemodynamics and oxygen delivery/consumption between sham-operated and septic animals at both 6- and 24-hour timepoints. In the live kidney slice model, mitochondrial dysfunction was seen in proximal tubular epithelial cells incubated with septic serum with increased production of reactive oxygen species, and decreases in nicotinamide adenine dinucleotide and mitochondrial membrane potential. These effects were prevented by coincubation with the reactive oxygen species scavenger, 4-hydroxy-2,2,6,6-tetramethyl-piperidin-1-oxyl.

Conclusions:

Renal dysfunction in sepsis occurs independently of hemodynamic instability or structural damage. Mitochondrial dysfunction mediated by circulating mediators that induce local oxidative stress may represent an important pathophysiologic mechanism.
Effect of a National Standard for Deteriorating Patients on Intensive Care Admissions Due to Cardiac Arrest in Australia
Authors: Jones Daryl , Bhasale Alice , Bailey Michael , Pilcher David , Anstey Matthew H.
Published: December 2017

Objectives:

To assess whether a national standard for improving care of deteriorating patients affected ICU admissions following cardiac arrests from hospital wards.

Design:

Retrospective study assessing changes from baseline (January 1, 2008, to June 30, 2010), rollout (July 1, 2010, to December 31, 2012), and after (January 1, 2013, to 31 December 31, 2014) national standard introduction. Conventional inferential statistics, interrupted time series analysis, and adjusted hierarchical multiple logistic regression analysis.

Setting:

More than 110 ICU-equipped Australian hospitals.

Patients or Subjects:

Adult patients (≥ 18 yr old) admitted to participating ICUs.

Interventions:

Introducing a national framework to improve care of deteriorating patients including color-coded observation charts, mandatory rapid response system, enhanced governance, and staff education for managing deteriorating patients.

Measurements and Main Results:

Cardiac arrest–related ICU admissions from the ward decreased from 5.6% (baseline) to 4.9% (rollout) and 4.1% (intervention period). Interrupted time series analysis revealed a decline in the rate of cardiac arrest–related ICU admissions in the rollout period, compared with the baseline period (p = 0.0009) with a subsequent decrease in the rate in the intervention period (p = 0.01). Cardiac arrest–related ICU admissions were less likely in the intervention period compared with the baseline period (odds ratio, 0.85; 95% CI, 0.78–0.93; p = 0.001), as was in-hospital mortality from cardiac arrests (odds ratio, 0.79; 95% CI, 0.65–0.96; p = 0.02).

Conclusions:

Introducing a national standard to improve the care of deteriorating patients was associated with reduced cardiac arrest–related ICU admissions and subsequent in-hospital mortality of such patients.
Determinants of Health-Related Quality of Life After ICU: Importance of Patient Demographics, Previous Comorbidity, and Severity of Illness
Authors: Griffith David M. , Salisbury Lisa G. , Lee Robert J. , Lone Nazir , Merriweather Judith L. , Walsh Timothy S.
Published: December 2017

Objectives:

ICU survivors frequently report reduced health-related quality of life, but the relative importance of preillness versus acute illness factors in survivor populations is not well understood. We aimed to explore health-related quality of life trajectories over 12 months following ICU discharge, patterns of improvement, or deterioration over this period, and the relative importance of demographics (age, gender, social deprivation), preexisting health (Functional Comorbidity Index), and acute illness severity (Acute Physiology and Chronic Health Evaluation II score, ventilation days) as determinants of health-related quality of life and relevant patient-reported symptoms during the year following ICU discharge.

Design:

Nested cohort study within a previously published randomized controlled trial.

Setting:

Two ICUs in Edinburgh, Scotland.

Patients:

Adult ICU survivors (n = 240) who required more than 48 hours of mechanical ventilation.

Interventions:

None.

Measurements and Main Results:

We prospectively collected data for age, gender, social deprivation (Scottish index of multiple deprivation), preexisting comorbidity (Functional Comorbidity Index), Acute Physiology and Chronic Health Evaluation II score, and days of mechanical ventilation. Health-related quality of life (Medical Outcomes Study Short Form version 2 Physical Component Score and Mental Component Score) and patient-reported symptoms (appetite, fatigue, pain, joint stiffness, and breathlessness) were measured at 3, 6, and 12 months. Mean Physical Component Score and Mental Component Score were reduced at all time points with minimal change between 3 and 12 months. In multivariable analysis, increasing pre-ICU comorbidity count was strongly associated with lower health-related quality of life (Physical Component Score β = –1.56 [–2.44 to –0.68]; p = 0.001; Mental Component Score β = –1.45 [–2.37 to –0.53]; p = 0.002) and more severe self-reported symptoms. In contrast, Acute Physiology and Chronic Health Evaluation II score and mechanical ventilation days were not associated with health-related quality of life. Older age (β = 0.33 [0.19–0.47]; p < 0.001) and lower social deprivation (β = 1.38 [0.03–2.74]; p = 0.045) were associated with better Mental Component Score health-related quality of life.

Conclusions:

Preexisting comorbidity counts, but not severity of ICU illness, are strongly associated with health-related quality of life and physical symptoms in the year following critical illness.
Systematic Review and Meta-Analysis of Procalcitonin-Guidance Versus Usual Care for Antimicrobial Management in Critically Ill Patients: Focus on Subgroups Based on Antibiotic Initiation, Cessation, or Mixed Strategies*
Authors: Lam Simon W. , Bauer Seth R. , Fowler Robert , Duggal Abhijit
Published: December 2017

Objective:

Numerous studies have evaluated the use of procalcitonin guidance during different phases of antibiotics management (initiation, cessation, or a combination of both) in patients admitted to ICUs. Several meta-analyses have attempted to generate an overall effect of procalcitonin-guidance on patient outcomes. However, combining studies from different phases of antibiotics management may not be appropriate due to the risk of clinical heterogeneity. The purpose of this systematic review and meta-analysis was to evaluate the effect of procalcitonin-guided strategies in different phases of antibiotics use.

Data Sources:

We searched MEDLINE and EMBASE from inception until November 1, 2017.

Study Selection:

We included randomized controlled trials that evaluated procalcitonin guidance compared with usual care for management of antibiotics in critically ill adult patients.

Data Extraction:

We extracted study details, patient characteristics, procalcitonin algorithm, and outcomes.

Data Synthesis:

We included 15 studies, from 1,624 abstracts identified based on our search strategy (three initiation, nine cessation, and three mixed). The pooled risk ratio for short-term mortality for the initiation, cessation, and mixed procalcitonin strategies were 1.00 (95% CI, 0.86–1.15,;p = 0.91), 0.87 (95% CI, 0.77–0.98; p = 0.02), and 1.01 (95% CI, 0.80–1.29; p = 0.93), respectively. Procalcitonin for cessation and mixed strategies was associated with decrease antibiotics duration (–1.26 d [p < 0.001] and –3.10 d [p =0.04], respectively). No differences were observed in other outcome measures.

Conclusion:

When evaluating all studies of procalcitonin-guided antibiotics management in critically ill patients, no difference in short-term mortality was observed. However, when only examining procalcitonin-guided cessation of antibiotics, lower mortality was detected. Future studies should focus specifically on procalcitonin for the cessation of antibiotics in critically ill patients.
Medical Versus Surgical ICU Obese Patient Outcome: A Propensity-Matched Analysis to Resolve Clinical Trial Controversies
Authors: De Jong Audrey , Verzilli Daniel , Sebbane Mustapha , Monnin Marion , Belafia Fouad , Cisse Moussa , Conseil Matthieu , Carr Julie , Jung Boris , Chanques Gérald , Molinari Nicolas , Jaber Samir
Published: December 2017

Objectives:

To determine the short- and long-term mortality of obese ICU patients following medical as opposed to surgical admission and the relation between obesity and mortality.

Design:

Retrospective analysis of prospectively collected data, using a propensity score–matched analysis of patients with medical or surgical admission.

Setting:

One French mixed medical-surgical ICU.

Patients:

Critically ill obese patients (body mass index ≥ 30 kg/m2) and nonobese patients admitted during a 14-year period.

Interventions:

None.

Measurements and Main Results:

Seven-hundred ninety-one obese patients and 4,644 nonobese patients were included, 338 (43%) and 2,367 (51%) medical and 453 (57%) and 2,277 (49%) surgical obese and nonobese patients, respectively. Mortality was significantly higher in medical than in surgical obese patients in ICU (25% vs 12%; p < 0.001) and up to 365 days (36% vs 18%; p < 0.001) post ICU admission. One-to-one propensity score matching generated 260 pairs with well-balanced baseline characteristics. After matching on propensity score, mortality was still significantly higher in medical patients both in the ICU (21% vs 13%; p = 0.03) and up to 365 days (30% vs 20%; p = 0.01) post ICU admission. Obesity was not significantly associated with mortality both in univariate analysis (140 obese patients [15%] in the dead group vs 651 [14%] in the alive group; p = 0.72) and multivariate analysis (odds ratio, 1.09 [95% CI, 0.86–1.38]; p = 0.49) after adjustment for Simplified Acute Physiology Score II, age, category of admission, history of cardiac disease, and history of respiratory disease.

Conclusions:

After careful matching, the data suggest that ICU mortality in obese population was higher in the medical group than in the surgical group and remains significantly higher 365 days post ICU admission.
Chloride and Other Electrolyte Concentrations in Commonly Available 5% Albumin Products
Authors: Lai Alison T. , Zeller Michelle P. , Millen Tina , Kavsak Peter , Szczeklik Wojciech , Elahie Allahna , Alhazzani Waleed , D’Aragon Frederick , Jaeschke Roman , Lamontagne Francois , Karachi Timothy , Cook Deborah , Meade Maureen , Rochwerg Bram
Published: December 2017

Objective:

Use of hyperchloremic IV fluids for resuscitation in sepsis may be associated with increased mortality and use of renal replacement therapy. After crystalloids, 5% human albumin represents the second most common resuscitation fluid in the ICU. Its chloride concentration is rarely considered in the clinical setting. This study quantifies previously undocumented chloride concentrations of three 5% albumin solutions using biochemical analysis.

Design:

We performed blinded analysis of the electrolyte concentration of albumin samples obtained directly from the national blood supplier (Canadian Blood Services). Two-tailed independent t tests were performed for all possible comparative analyses. Analysis of variance testing was performed for relevant three-way comparisons. Significance threshold was set at p less than 0.05.

Setting:

All samples were analyzed in the core laboratory at an academic hospital associated with McMaster University in Hamilton, Ontario, Canada.

Subjects:

We analyzed 65 albumin samples from three available brands obtained through Canadian Blood Services. They include Plasbumin (n = 21), Alburex (n = 24), Octalbin (n = 20).

Intervention:

Laboratory technologists blinded to product identification measured the concentration of electrolytes, extended electrolytes, lactate, and albumin of each sample using the Abbott ARCHITECT c8000 chemistry analyzer.

Measurements and Main Results:

The mean chloride concentration of Plasbumin, Alburex, and Octalbin, respectively, were 109.4 mmol/L (sd, 1.3), 123.6 mmol/L (sd, 1.3), and 136.8 mmol/L (sd, 0.4). The mean sodium concentration of Plasbumin, Alburex, and Octalbin, respectively, were 139.6 mmol/L (sd, 1.6), 137.3 mmol/L (sd, 2.2), and 149.4 mmol/L (sd, 0.5). The chloride and sodium concentration differed significantly for all two-way comparisons (p < 0.0001) and multiple comparison testing (p < 0.0001).

Conclusion:

This study is the first to identify and document a statistically significant variability in the chloride concentration of available 5% albumin products. This study has also informed a pilot randomized controlled trial examining the effect of administering high chloride versus low chloride fluids in critically ill patients with sepsis.
Temporal Trends in Healthcare Costs and Outcome Following ICU Admission After Traumatic Brain Injury
Authors: Raj Rahul , Bendel Stepani , Reinikainen Matti , Hoppu Sanna , Luoto Teemu , Ala-Kokko Tero , Tetri Sami , Laitio Ruut , Koivisto Timo , Rinne Jaakko , Kivisaari Riku , Siironen Jari , Higgins Alisa , Skrifvars Markus B.
Published: December 2017

Objective:

To assess temporal trends in 1-year healthcare costs and outcome of intensive care for traumatic brain injury in Finland.

Design:

Retrospective observational cohort study.

Setting:

Multicenter study including four tertiary ICUs.

Patients:

Three thousand fifty-one adult patients (≥ 18 yr) with significant traumatic brain injury treated in a tertiary ICU during 2003–2013.

Intervention:

None.

Measurements and Main Results

: Total 1-year healthcare costs included the index hospitalization costs, rehabilitation unit costs, and social security reimbursements. All costs are reported as 2013 U.S. dollars ($). Outcomes were 1-year mortality and permanent disability. Multivariate regression models, adjusting for case-mix, were used to assess temporal trends in costs and outcome in predefined Glasgow Coma Scale (3–8, 9–12, and 13–15) and age (18–40, 41–64, and ≥ 65 yr) subgroups. Overall 1-year survival was 76% (n = 2,304), and of 1-year survivors, 37% (n = 850) were permanently disabled. Mean unadjusted 1-year healthcare cost was $39,809 (95% CI, $38,144–$41,473) per patient. Adjusted healthcare costs decreased only in the Glasgow Coma Scale 13–15 and 65 years and older subgroups, due to lower rehabilitation costs. Adjusted 1-year mortality did not change in any subgroup (p < 0.05 for all subgroups). Adjusted risk of permanent disability decreased significantly in all subgroups (p < 0.05).

Conclusion:

During the last decade, healthcare costs of ICU-admitted traumatic brain injury patients have remained largely the same in Finland. No change in mortality was noted, but the risk for permanent disability decreased significantly. Thus, our results suggest that cost-effectiveness of traumatic brain injury care has improved during the past decade in Finland.
Prevalence of Anxiety and Depression Symptomatology in Adolescents Faced With the Hospitalization of a Loved One in the ICU*
Authors: Fergé Jean-Louis , Le Terrier Christophe , Banydeen Rishika , Kentish-Barnes Nancy , Derancourt Christian , Jehel Louis , Moroy Anne , Valentino Ruddy , Mehdaoui Hossein
Published: December 2017

Objective:

ICU experience is linked to anxiety and depression symptomatology in family members of patients. Minors may be forbidden from visiting. To bring practices in line with evidence, we determined the prevalence of anxiety and depression symptomatology in adolescents visiting a relative in the ICU.

Design:

One-year prospective observational monocenter study.

Setting:

Medical-surgical ICU, University Hospital of Martinique.

Patients:

Forty-one patients intubated for more than 2 days; 53 adolescents (12–17 yr) first- to third-degree relatives in regular contact (minimum once a month) with patient before hospitalization.

Interventions:

Adolescents with unrestricted ICU access completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluation (Hospital Anxiety and Depression Scale) before the patient’s 15th day of hospitalization and extubation.

Measurements and Main Results:

Forty adolescents (75.5%) visited their relative. Possible and probable anxiety and depression symptomatology prevalence was 35.9% and 18.9%, respectively, with no significant difference according to ICU visiting status. Most (80%) reported a lack of information, 40% insufficient consideration, and 27.5% misunderstood the reason for hospitalization. Two (5%) regretted visiting. Probable anxiety and depression symptomatology was associated with first-degree relationship (odds ratio, 9.1 [95% CI, 1.1–78.9]; p = 0.045), past exposure to a traumatic event (odds ratio, 8.7 [1.1–69.0]; p = 0.040) and past sense of threat (odds ratio, 10.4 [1.1–94.5]; p = 0.038).

Conclusions:

Anxiety and depression symptomatology is common in adolescent family members of ICU patients. An open visiting policy for adolescents is recommended, with visit planning, information meetings, and individual support from ICU staff.
Direct Immunofluorescence as a Helpful Tool for the Differential Diagnosis of Oral Lichen Planus and Oral Lichenoid Lesions
Authors: Yamanaka Yasmin , Yamashita Maurício , Innocentini Lara M. A. , Macedo Leandro D. , Chahud Fernando , Ribeiro-Silva Alfredo , Roselino Ana Maria , Rocha Maria José A. , Motta Ana Carolina
Published: December 2017

A great number of lichenoid lesions have overlapping clinicopathological features, so the use of adjunct tests to establish definitive diagnosis is recommended for correct management and prognosis of the lesions. In this context, direct immunofluorescence (DIF) can be a useful tool. Thus, this study aimed to characterize the clinical, histopathological, and DIF pattern in patients with oral lichen planus (OLP) and patients with oral lichenoid lesions (OLLs). Patients with OLP and patients with OLL were characterized and compared with patients with mucous membrane pemphigoid, pemphigus vulgaris, and fibrous hyperplasia through a cross-sectional study. Patients with OLP (n = 30) and patients with OLL (n = 26) were mostly white women in the fifth decade of age, with reticular lesions mainly on the buccal mucosa. All patients with OLP and half of the patients with OLL showed liquefaction degeneration at the basal cell layer and a band-like lymphocytic infiltrate in the subepithelial tissue. Twenty-two patients with OLP (73.3%), 10 with OLL (38.4%), 25 with mucous membrane pemphigoid (96.1%), and all with pemphigus vulgaris (100%) had positive DIF. There was no positive DIF in patients with fibrous hyperplasia. The most frequent DIF pattern in patients with OLP and patients with OLL was linear fibrinogen at the basement membrane zone, and a logistic regression model for positive DIF found statistically significant difference in OLP versus OLL (odds ratio, 3.73; confidence interval, 1.23–11.38). Although clinical and histopathological features are sufficient for diagnosing most of the patients with OLP and OLL, DIF is a key tool in differentiating some lichenoid lesions and could improve the diagnosis of OLP and OLL, especially in lesions showing typical clinical and histological features of OLP.
Psoriasiform Graft-Versus-Host Disease: Report and Brief Review of the Literature
Authors: Vernali Steven , Vertes George Eva , Gonzalez Santiago Tania , Motaparthi Kiran
Published: December 2017

Graft-versus-host disease (GVHD) is the primary cause of morbidity and non–relapse-related mortality after hematopoietic stem cell transplantation. GVHD is classically divided into acute and chronic forms; acute cutaneous GVHD presents as a morbilliform eruption, whereas chronic cutaneous GVHD presents with lichen planus–like or sclerodermoid morphology. Psoriasiform GVHD is a rarely described subtype that is challenging to distinguish clinically from psoriasis. In addition to classic psoriasiform histologic findings, demonstration of an often subtle vacuolar interface dermatitis and lymphocyte satellitosis are helpful for discrimination. Herein, the authors describe psoriasiform GVHD and review the clinicopathologic findings of this unusual variant. With the appropriate clinical findings, psoriasiform GVHD should be considered in the histologic differential diagnosis of a mixed tissue reaction pattern with both psoriasiform and interface changes.
Late-Stage Erythema Elevatum Diutinum Mimicking a Fibroblastic Tumor: A Potential Pitfall
Authors: Llamas-Velasco Mar , Stengel Berhard , Pérez-González Yosmar Carolina , Mentzel Thomas
Published: December 2017

Erythema elevatum diutinum (EED) is a rare dermatosis with evolving histopathological features that vary according to the age of the lesions, with a variable fibrosis and a fascicled proliferation of spindle cells in late phases. The authors present an otherwise healthy 57-year-old woman with multiple indurated nodules on the inner aspect of both feet. Skin biopsy showed storiform interlacing bundles of spindled cells with plump nuclei and some areas with neutrophils and leukocytoclasia. CD34 and S100 were negative. This case is noteworthy clinically due to its location and its histopathological presentation that comprises a wide differential diagnosis, including inflammatory pseudotumor, dermatofibrosarcoma protuberans, superficial nodular fasciitis, hyalinized leiomyoma, sclerosing spindle cell perineuroma, and sclerotic fibroma. The authors have reviewed the main histopathological and immunohistochemical features that help in the differential diagnosis of this rare variant of EED. A careful search for leukocytoclasia and neutrophilic vasculitis is mandatory to establish the right diagnosis of nodular or late-stage EED and avoid the pitfall of considering this a neoplastic process.
Vascular Reconstruction in a Neonate after Iatrogenic Injury during Cardiac Catheterization
Authors: Amaro Emilie , Pophal Stephen , Zoldos Jozef
Published: December 2017

As technology and interventional techniques continue to evolve, both the volume and complexity of cardiac catheterizations will increase, leading to a rise in the number of complications. One of the most morbid complications of cardiac catheterization is vascular injury. We report the case of a 31-day-old, 3.0-kg infant with hypoplastic left heart syndrome who experienced a left common iliac artery disruption during cardiac catheterization resulting in a retroperitoneal hemorrhage. The extent of the vascular injury combined with the vessel caliber posed a technically challenging surgical scenario. Ultimately, the vascular supply to the left lower extremity was reconstructed by the plastic surgery team with a reverse autologous vein graft. To our knowledge, this multidisciplinary approach with the involvement of plastic surgery represents a unique case.
CLINICAL FINDINGS IN TRIAMCINOLONE-ASSOCIATED MACULOPATHY
Authors: Fine Howard F. , Reshef Edith R. , Prenner Jonathan L. , Shah Sumit P. , Grossniklaus Hans E. , Roth Daniel B.
Published: December 2017

Purpose:

To describe a crystalline retinopathy observed in patients greater than 1 year after intravitreal injection of triamcinolone acetonide (IVTA).

Methods:

A retrospective, interventional, noncomparative, single-center case series of patients who received IVTA and developed subsequent crystalline retinopathy lasting greater than 1 year after injection.

Results:

Eighteen eyes of 16 patients in which preretinal crystals were observed >1 year after IVTA were included in the study, with a mean follow-up (range) of 5.8 years (1.1–9.2) after IVTA. The crystals were refractile, not visible on fluorescein nor indocyanine green angiography, exhibited slow dissolution and movement, and were occasionally distributed in a circular fashion. Optical coherence tomography confirmed the preretinal and/or subhyaloid location of crystals.

Conclusion:

Macular crystals can persist for years after IVTA. The crystals localize to the preretinal or subhyaloid space, are angiographically silent, can exhibit slow dissolution and movement, may be distributed in a circular fashion reflecting the bursa premacularis, and appear nonpathologic.
IMAGING OF PIGMENT EPITHELIAL DETACHMENTS WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Tan Anna C. S. , Freund K. Bailey , Balaratnasingam Chandrakumar , Simhaee Daniel , Yannuzzi Lawrence A.
Published: December 2017

Purpose:

To investigate the utility of optical coherence tomography angiography (OCTA) for detecting pathologic vascularization within pigment epithelial detachments (PEDs).

Methods:

This was a retrospective, cross-sectional, consecutive case series. Multimodal imaging (structural OCT, fluorescein, and indocyanine green angiography) was used as the gold standard to classify PEDs as nonvascularized or vascularized. Optical coherence tomography angiography imaging of the PED was subsequently and independently evaluated to classify PEDs as vascularized or nonvascularized. Specifically, OCTA images were evaluated for the presence of abnormal flow on cross-sectional OCTA and the presence of a vascular complex on en face OCTA. Comparisons between OCTA and the gold standard were determined.

Results:

Sixty-four eyes of 49 patients were evaluated. A total of 18 eyes were classified as nonvascularized PED, and 46 eyes were classified as vascularized PED using the gold standard. Optical coherence tomography angiography was found to have a sensitivity of 76%, specificity of 61%, positive predictive value of 83%, and negative predictive value of 50% for detecting vascularized PEDs. False positive cases in the nonvascularized PED group were due to projection or flow artifacts from hyperreflective material overlying the PED. False negative cases were seen in eyes with minimal exudation on structural OCT and also those manifesting retinal pigment epithelial tears.

Conclusion:

Our proposed two-step approach of OCTA interpretation, first using cross-sectional OCTA and then en face OCTA, may allow the detection of vascularization within PEDs and, in some cases, reduce the need for conventional angiography. Increased awareness about potential artifacts and limitations of OCTA may help clinicians interpret OCTA more accurately.
Assessment of the Importance of Tympanic Membrane Mechanoreceptors on Eustachian Tube Function Based on Pressure Chamber Measurements
Authors: Meyer Moritz F. , Schoch Anja , Jansen Stefanie , Hüttenbrink Karl-Bernd , Beutner Dirk
Published: December 2017

Introduction:

Previously, it was demonstrated how the Eustachian tube (ET) opening function can be influenced by middle ear pressure and movement of the tympanic membrane via neural control. Mechanoreceptors on the tympanic membrane may be part of the afferent arc and could influence the middle ear pressure by activating the musculus veli palatini as part of a reflex.

Methods:

In a hypo and hyperbaric pressure chamber, 17 participants (34 ears) were twice exposed to a standardized pressure profile of pressure decrease and increase. The ET function reflecting parameters—ET opening pressure (ETOP), ET opening duration (ETOD), and ET opening frequency (ETOF)—were determined before and after local anesthesia of the right tympanic membrane.

Results:

After pressure exposure by pressure increase (active induced equalization) and pressure decrease (passive equalization) there was no significant difference between the mean value of ETOP, ETOD, and ETOF before and after local anesthesia of the right tympanic membrane on the right (anesthetized) or left side (not anesthetized).

Conclusion:

These results may lead to the hypothesis that tympanic membrane mechanoreceptors may play a minor role in regulating the ET function in humans.
DNA polymorphisms predict time to progression from uncomplicated to complicated Crohn’s disease
Authors: Pernat Drobež Cvetka , Repnik Katja , Gorenjak Mario , Ferkolj Ivan , Weersma Rinse K. , Potočnik Uroš
Published: December 2017

Objective

Most patients with Crohn’s disease (CD) are diagnosed with the uncomplicated inflammatory form of the disease (Montreal stage B1). However, the majority of them will progress to complicated stricturing (B2) and penetrating (B3) CD during their lifetimes. The aim of our study was to identify the genetic factors associated with time to progression from uncomplicated to complicated CD.

Patients and methods

Patients with an inflammatory phenotype at diagnosis were followed up for 10 years. Genotyping was carried out using Illumina ImmunoChip. After quality control, association analyses, Bonferroni’s adjustments, linear and Cox’s regression, and Kaplan–Meier analysis were carried out for 111 patients and Manhattan plots were constructed.

Results

Ten years after diagnosis, 39.1% of the patients still had the inflammatory form and 60.9% progressed to complicated disease, with an average time to progression of 5.91 years. Ileal and ileocolonic locations were associated with the complicated CD (P=1.08E−03). We found that patients with the AA genotype at single-nucleotide polymorphism rs16857259 near the gene CACNA1E progressed to the complicated form later (8.80 years) compared with patients with the AC (5.11 years) or CC (2.00 years) genotypes (P=3.82E−07). In addition, nine single-nucleotide polymorphisms (near the genes RASGRP1, SULF2, XPO1, ZBTB44, HLA DOA/BRD2, HLA DRB1/HLA DQA1, PPARA, PUDP, and KIAA1614) showed a suggestive association with disease progression (P<10−5). Multivariate Cox’s regression analysis on the basis of clinical and genetic data confirmed the association of the selected model with disease progression (P=5.73E−16).

Conclusion

Our study confirmed the association between the locus on chromosome 1 near the gene CACNA1E with time to progression from inflammatory to stricturing or penetrating CD. Predicting the time to progression is useful to the clinician in terms of individualizing patients’ management.
Polyp detection rate may predict adenoma detection rate: a meta-analysis
Authors: Niv Yaron
Published: December 2017

Background

Adenoma detection rate (ADR) is defined as the number of colonoscopies with at least one adenoma, expressed as the ratio of the total number of colonoscopies performed. Recently, an application of a conversion factor to estimate the ADR from the polyp detection rate (PDR) was described.

Aim

In this meta-analysis, we examined the correlation between ADR and PDR in the published studies and assessed the relative ratio of these ratios for a better and more accurate estimation.

Methods

English Medical literature searches were performed for ‘PDR’ AND ‘ADR’. A meta-analysis was carried out for papers that fulfilled the inclusion criteria using comprehensive meta-analysis software.

Results

Twenty-five studies and 42 sets of data, including 31 623 patients, from nine countries published till 31 August 2017, were found. Funnel plot did not indicate a significant publication bias. relative ratio for ADR calculated from PDR was 0.688, 95% confidence intervals: 0.680–0.695, P value of less than 0.0001 in the meta-analysis fixed model. Heterogeneity (the proportion of inconsistency in individual studies) between studies was significant, with Q=492.753, d.f. (Q) 41, P<0.0001, and I
2 91.679.

Conclusion

We found the ratio of 0.688 can be used to calculate ADR from PDR for the individual endoscopist or for a group of endoscopists before receiving the formal results from the pathology department.