bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaginal Cleansing Before Cesarean Delivery
Authors: Caissutti Claudia , Saccone Gabriele , Zullo Fabrizio , Quist-Nelson Johanna , Felder Laura , Ciardulli Andrea , Berghella Vincenzo
Published: August 2017

OBJECTIVE:

To assess the efficacy of vaginal cleansing before cesarean delivery in reducing postoperative endometritis.

DATA SOURCES:

MEDLINE, Ovid, EMBASE, Scopus, Clinicaltrials.gov, and Cochrane Library were searched from their inception to January 2017.

METHODS OF STUDY SELECTION:

Selection criteria included all randomized controlled trials comparing vaginal cleansing (ie, intervention group) with a control group (ie, either placebo or no intervention) in women undergoing cesarean delivery. Any method of vaginal cleansing with any type of antiseptic solution was included. The primary outcome was the incidence of endometritis. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of relative risk (RR) with 95% CI.

TABULATION, INTEGRATION, AND RESULTS:

Sixteen trials (4,837 women) on vaginal cleansing immediately before cesarean delivery were identified as relevant and included in the review. In most of the included studies, 10% povidone–iodine was used as an intervention. The most common way to perform the vaginal cleansing was the use of a sponge stick for approximately 30 seconds. Women who received vaginal cleansing before cesarean delivery had a significantly lower incidence of endometritis (4.5% compared with 8.8%; RR 0.52, 95% CI 0.37–0.72; 15 studies, 4,726 participants) and of postoperative fever (9.4% compared with 14.9%; RR 0.65, 95% CI 0.50–0.86; 11 studies, 4,098 participants) compared with the control group. In the planned subgroup analyses, the reduction in the incidence of endometritis with vaginal cleansing was limited to women in labor before cesarean delivery (8.1% compared with 13.8%; RR 0.52, 95% CI 0.28–0.97; four studies, 440 participants) or those with ruptured membranes (4.3% compared with 20.1%; RR 0.23, 95% CI 0.10–0.52; three studies, 272 participants).

CONCLUSION:

Vaginal cleansing immediately before cesarean delivery in women in labor and in women with ruptured membranes reduces the risk of postoperative endometritis. Because it is generally inexpensive and a simple intervention, we recommend preoperative vaginal preparation before cesarean delivery in these women with sponge stick preparation of povidone–iodine 10% for at least 30 seconds. More data are needed to assess whether this intervention may be also useful for cesarean deliveries performed in women not in labor and for those without ruptured membranes.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO International prospective register of systematic reviews, https://www.crd.york.ac.uk/PROSPERO/, CRD42017054843.
Socioeconomic Status As a Risk Factor for Unintended Pregnancy in the Contraceptive CHOICE Project
Authors: Iseyemi Abigail , Zhao Qiuhong , McNicholas Colleen , Peipert Jeffrey F.
Published: August 2017

OBJECTIVE:

To evaluate the association of low socioeconomic status as an independent risk factor for unintended pregnancy.

METHODS:

We performed a secondary analysis of data from the Contraceptive CHOICE project. Between 2007 and 2011, 9,256 participants were recruited and followed for up to 3 years. The primary outcome of interest was unintended pregnancy; the primary exposure variable was low socioeconomic status, defined as self-report of either receiving public assistance or having difficulty paying for basic necessities. Four contraceptive groups were evaluated: 1) long-acting reversible contraceptive method (hormonal or copper intrauterine device or subdermal implant); 2) depot medroxyprogesterone acetate injection; 3) oral contraceptive pills, a transdermal patch, or a vaginal ring; or 4) other or no method. Confounders were adjusted for in the multivariable Cox proportional hazard model to estimate the effect of socioeconomic status on risk of unintended pregnancy.

RESULTS:

Participants with low socioeconomic status experienced 515 unintended pregnancies during 14,001 women-years of follow-up (3.68/100 women-years; 95% CI 3.37–4.01) compared with 200 unintended pregnancies during 10,296 women-years (1.94/100 women-years; 95% CI 1.68–2.23) among participants without low socioeconomic status. Women with low socioeconomic status were more likely to have an unintended pregnancy (unadjusted hazard ratio [HR] 1.8, 95% CI 1.5–2.2). After adjusting for age, education level, insurance status, and history of unintended pregnancy, low socioeconomic status was associated with an increased risk of unintended pregnancy (adjusted HR 1.4, 95% CI 1.1–1.7).

CONCLUSION:

Despite the removal of cost barriers, low socioeconomic status is associated with a higher incidence of unintended pregnancy.
Maternal and Infant Outcomes After Human Papillomavirus Vaccination in the Periconceptional Period or During Pregnancy
Authors: Lipkind Heather S. , Vazquez-Benitez Gabriela , Nordin James D. , Romitti Paul A. , Naleway Allison L. , Klein Nicola P. , Hechter Rulin C. , Jackson Michael L. , Hambidge Simon J. , Lee Grace M. , Sukumaran Lakshmi , Kharbanda Elyse O.
Published: August 2017

OBJECTIVE:

To evaluate whether quadrivalent human papillomavirus vaccine (4vHPV) administered during the periconceptional period or during pregnancy was associated with increased risks for adverse obstetric events, adverse birth outcomes, or selected major structural birth defects.

METHODS:

We conducted a retrospective, observational cohort study using administrative and health care data from the Vaccine Safety Datalink. Insured women 13–27 years old with singleton pregnancies and a live birth from January 1, 2007, through September 1, 2013, who received 4vHPV during the periconceptional period (2 weeks before to 2 weeks after their last menstrual period), during pregnancy, or during both periods combined were compared with women who had a live birth during the same time period and received 4vHPV 4–18 months before their last menstrual period. We examined risks of gestational diabetes, hypertensive disorders of pregnancy, chorioamnionitis, preterm birth, small-for-gestational-age birth, and selected major structural birth defects in offspring. We estimated relative risks associated with receipt of 4vHPV during the periconceptional period, during pregnancy, and both exposure periods combined using a generalized linear model with Poisson distribution including a propensity score that included relevant maternal demographic and pregnancy characteristics.

RESULTS:

Of 92,579 potentially eligible pregnant women, 720 received 4vHPV during the periconceptional period, 638 received 4vHPV during pregnancy, and 8,196 received 4vHPV during the comparison period. Administration of 4vHPV during pregnancy was not associated with increased risk of adverse obstetric events, birth outcomes. Preterm birth occurred in 7.9% of pregnancies with vaccine exposures during pregnancy compared with 7.6% of pregnancies with vaccination in the comparison period (adjusted relative risk 0.97, 95% CI 0.72–1.3). Major structural birth defects were diagnosed in 2.0% of pregnancies with vaccine exposure during pregnancy compared with 1.8% of pregnancies with vaccine exposure during the comparison period (adjusted prevalence ratio 1.0, 95% CI 0.52–1.9). Results were similar for 4vHPV exposure during the periconceptional period.

CONCLUSION:

Quadrivalent HPV vaccine inadvertently administered in pregnancy or during the periconceptional period was not associated with adverse pregnancy or birth outcomes.
A Transperineal Approach to Hysterectomy of a Retained Didelphic Uterine Horn
Authors: Mullen Mary M. , Kuroki Lindsay M. , Hunt Steven R. , Ratkowski Kristy L. , Mutch David G.
Published: August 2017

BACKGROUND:

Gynecologic surgeries are performed through abdominal, vaginal, laparoscopic, or robot-assisted laparoscopic routes. However, if the pelvis is not accessible by one of these routes, there are no published reports to guide pelvic surgeons.

CASE:

A 34-year-old conjoined twin status postseparation with uterine didelphys and absence of her left colon and sacrum underwent hemihysterectomy, at which time her müllerian anomaly was unknown. She re-presented with vaginal bleeding and pain eventually attributed to a retained uterine horn. Conservative management failed. Given dense adhesions, traditional approaches to hysterectomy were not successful. She underwent a transperineal hemisupracervical hysterectomy.

CONCLUSION:

We propose a novel approach to the pelvis to guide surgeons when traditional approaches are not feasible. We also describe an instance of a retained uterine didelphys horn.
Neonatal Morbidity of Small- and Large-for-Gestational-Age Neonates Born at Term in Uncomplicated Pregnancies
Authors: Chauhan Suneet P. , Rice Madeline Murguia , Grobman William A. , Bailit Jennifer , Reddy Uma M. , Wapner Ronald J. , Varner Michael W. , Thorp John M. , Leveno Kenneth J. , Caritis Steve N. , Prasad Mona , Tita Alan T. N. , Saade George , Sorokin Yoram , Rouse Dwight J. , Tolosa Jorge E. ,   MSCE, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: August 2017

OBJECTIVE:

To compare morbidity among small-for-gestational-age (SGA; birth weight less than the 10th percentile for gestational age), appropriate-for-gestational-age (AGA; birth weight 10th to 90th percentile; reference group), and large-for-gestational-age (LGA; birth weight greater than the 90th percentile) neonates in apparently uncomplicated pregnancies at term (37 weeks of gestation or greater).

METHODS:

This secondary analysis, derived from an observational obstetric cohort of 115,502 deliveries, included women with apparently uncomplicated pregnancies of nonanomalous singletons who had confirmatory ultrasound dating no later than the second trimester and who delivered between 37 0/7 and 42 6/7 weeks of gestation. We used two different composite neonatal morbidity outcomes: hypoxic composite neonatal morbidity for SGA and traumatic composite neonatal morbidity for LGA neonates. Log Poisson relative risks (RRs) with 95% CIs adjusted for potential confounding factors (nulliparity, body mass index, insurance status, and neonatal sex) were calculated.

RESULTS:

Among the 63,436 women who met our inclusion criteria, SGA occurred in 7.9% (n=4,983) and LGA in 8.3% (n=5,253). Hypoxic composite neonatal morbidity was significantly higher in SGA (1.1%) compared with AGA (0.7%; adjusted RR 1.44, 95% CI 1.07–1.93) but similar between LGA (0.6%) and AGA (adjusted RR 0.84, 95% CI 0.58–1.22). Traumatic composite neonatal morbidity was significantly higher in LGA (1.9%) than AGA (1.0%; adjusted RR 1.88, 95% CI 1.51–2.34) but similar in SGA (1.3%) compared with AGA (adjusted RR 1.28, 95% CI 0.98–1.67).

CONCLUSION:

Among women with uncomplicated pregnancies, hypoxic composite neonatal morbidity is more common with SGA neonates and traumatic–composite neonatal morbidity is more common with LGA neonates.
What Is New in Evaluation of Asymptomatic Microscopic Hematuria in Women?
Authors: Kenton Kimberly
Published: August 2017

This month we focus on current research in asymptomatic microscopic hematuria. Dr. Kenton discusses four recent publications, which are concluded with a “bottom line” that is a take-home message. A complete reference for each can be found on Box 1 on this page along with direct links to abstracts.
Clinical spectrum of anti-Jo-1-associated disease
Authors: Monti Sara , Montecucco Carlomaurizio , Cavagna Lorenzo
Published: August 2017

Purpose of review

To provide the most recent evidence on anti-Jo-1 syndrome.

Recent findings

Several new evidences on anti-Jo-1 syndrome have recently emerged. It has been clearly established that, at disease onset, the classic clinical triad (arthritis, myositis and interstitial lung disease – ILD) is only rarely observed. Indeed, disease onset with an isolated arthritis is common. Patients presenting with an isolated manifestation are at high risk for the subsequent occurrence of initially lacking triad findings. Moreover, the ex-novo occurrence of accompanying features such as Raynaud's phenomenon, mechanic's hands and fever during follow-up is a strong risk factor for the occurrence of overt antisynthetase syndrome (ASSD) with further triad manifestations. Several contributions on ILD involvement and prognosis have been published, as well as the distinctive muscle MRI characteristics compared with healthy controls, and a novel definition of a rare skin manifestation (hiker's feet).

Recent evidence has shed a light on the need for a better understanding of the clinical course, imaging modalities and prognosis of anti-Jo-1 syndrome, providing some relevant elements to allow early diagnosis of this often unrecognized disease.
Strength of Occipital Hair as an Explanation for Pilonidal Sinus Disease Caused by Intruding Hair
Authors: Doll Dietrich , Bosche Friederike D. , Stauffer Verena K. , Sinicina Inga , Hoffmann Sebastian , van der Zypen Dominic , Luedi Markus M.
Published: August 2017

BACKGROUND:

Pilonidal sinus disease is thought to be caused by intrusion of hair into healthy skin; loose hair in the intergluteal fold is thought to promote disease. However, compelling evidence to support these postulates is lacking; the cause of pilonidal sinus disease remains uncertain.

OBJECTIVE:

To determine whether particular properties of hair are associated with susceptibility to pilonidal sinus disease, we compared physical properties of hairs of patients with pilonidal sinus disease with hairs from control subjects who were matched for sex, BMI, and age.

DESIGN:

This was an experimental study with establishment of a mechanical strength test for single hairs to quantify the maximum vertical force that a hair could exert, following tests of strength of occipital, lumbar, and intergluteal hair.

SETTINGS:

Hair from patients with pilonidal sinus disease and matched control subjects were harvested from patients of the St. Marienhospital Vechta Department of Procto-Surgery.

PATIENTS:

A total of 17 adult patients with pilonidal sinus disease and 217 control subjects were included.

MAIN OUTCOME MEASURES:

ANOVA and intraclass and interclass variations of data gained from mechanical strength tests of occipital, lumbar, and intergluteal hair were included.

RESULTS:

Vertical hair strength was significantly greater in patients with pilonidal sinus disease. Occipital hair exhibited 20% greater, glabella sacralis 1.1 times greater, and intergluteal hair 2 times greater strength in patients with pilonidal sinus disease than in matched control subjects (all p = 0.0001). In addition, patients with pilonidal sinus disease presented with significantly more hair at the glabella sacralis and in the intergluteal fold.

LIMITATIONS:

The study was limited by its relatively small number of patients from a specific cohort of European patients.

CONCLUSIONS:

Occipital hair exhibited considerable vertical strength. Because occipital hair exerted the greatest force and cut hair fragments were found in the pilonidal nest in large quantities, these data suggest that pilonidal sinus disease is promoted by occipital hair. See Video Abstract at http://links.lww.com/DCR/A435.
Surgical Site Infection in Colorectal Surgery: A Study in Antibiotic Duration
Authors: Dornfeld Mark , Lovely Jenna K. , Huebner Marianne , Larson David W.
Published: August 2017

BACKGROUND:

Despite distant historical studies that demonstrated the adequacy of preoperative antibiotic prophylaxis, current surgical practice continues to use antibiotics for postoperative coverage up to 24 hours.

OBJECTIVE:

The aim of this study was to evaluate a change in antibiotic prophylaxis duration and its effect on surgical site infection in a high-volume modern colorectal practice.

DESIGN:

A case-controlled series retrospectively reviewed outcomes through a prospective validated data base.

SETTING:

The study was conducted at Mayo Clinic, Rochester, Minnesota.

PATIENTS:

A total of 965 patients were evaluated. Our study analyzed patient outcomes related to surgical site infection comparing cohort 1 (2012–2013), which had the same antibiotic coverage preoperatively up to 24 hours postoperatively, and cohort 2 (2014–2015), which eliminated postoperative doses and relied solely on pre- and intraoperative dosing duration.

MAIN OUTCOME MEASURES:

The primary outcomes of this study are superficial and deep surgical site infection.

RESULTS:

There were no differences identified for superficial or deep surgical site infection rates between cohorts. Before the change in antibiotic dosing duration (2012–2013), 28 of 493 patients (5.7%) vs after the practice change (2014–2015), 25 of 472 patients (5.3%) were reported to have superficial or deep surgical site infection (p = 0.794).

LIMITATIONS:

This study is limited by its retrospective design within a single institution.

CONCLUSION:

These equivalent results present an opportunity for surgeons to reconsider optimal antibiotic duration and minimize unnecessary antibiotic dosing. See Video Abstract at http://links.lww.com/DCR/A322.
Hypothyroidism Potentially Linked to Cutaneous Squamous Cell Carcinoma: Retrospective Study at a Single Tertiary Academic Medical Center
Authors: Ahadiat Omeed , Higgins Shauna , Trodello Cameron , Talmor Guy , Kokot Niels , Wysong Ashley
Published: August 2017

BACKGROUND

There are multiple known risk factors for the development of cutaneous squamous cell carcinoma (SCC).

OBJECTIVE

To determine whether patients with cutaneous SCC have a higher prevalence of hypothyroidism than the general US population.

MATERIALS AND METHODS

A retrospective review was performed for patients seen at the University of Southern California with cutaneous SCC. Chart review was performed for the presence of hypothyroidism and thyroid replacement therapy before the diagnosis of SCC for each patient. Multiple prevalence studies were gathered from the literature for comparison, reporting the prevalence of overt and subclinical hypothyroidism in the general US population and/or elderly US population.

RESULTS

Of the 265 patients diagnosed with SCC of the skin, 61 (23%) of patients were found to have a preceding diagnosis of hypothyroidism. The prevalence of hypothyroidism among the population of SCC patients was significantly greater than the prevalence of hypothyroidism (overt and subclinical) in any general and/or elderly US population reported.

CONCLUSION

Patients with SCC of skin are more likely to have a history of hypothyroidism than the general population. The authors conclude that hypothyroidism may be linked to the development of cutaneous SCC.
Microneedling: A Review and Practical Guide
Authors: Alster Tina S. , Graham Paul M.
Published: August 2017

BACKGROUND

Microneedling is a relatively new treatment option in dermatology and has been touted for a broad range of applications including skin rejuvenation, acne scarring, rhytides, surgical scars, dyschromia, melasma, enlarged pores, and transdermal drug delivery. The significant increase in minimally invasive procedures that has been reported over the past several years suggest that microneedling may occupy a specific niche for patients who desire measurable clinical results from treatments with little to no recovery.

OBJECTIVE

To review the published medical literature relating to microneedling in dermatology and provide a practical guide for its use in clinical practice.

MATERIALS AND METHODS

A thorough literature search of microneedling in dermatology using PubMed was conducted, and all references pertaining to skin scarring and rejuvenation were reviewed. Based on the information presented in these publications and the authors' clinical experience, a microneedling technique is outlined for clinical practice. Pretreatment recommendations, intraoperative technique and treatment end points, and postoperative considerations are outlined.

RESULTS

Microneedling produces substantial clinical improvement of scars, striae, and rhytides with expedient recovery and limited side effects. Controlled dermal wounding and stimulation of the wound healing cascade enhances collagen production and is likely responsible for the clinical results obtained.

CONCLUSION

Microneedling is a safe, minimally invasive, and effective esthetic treatment for several different dermatologic conditions including acne and other scars, rhytides, and striae. Given its expedient post-treatment recovery, limited side effect profile, and significant clinical results, microneedling is a valuable alternative to more invasive procedures such as laser skin resurfacing and deep chemical peeling.
SURGICAL OUTCOMES IN EYES WITH EXTREMELY HIGH MYOPIA FOR MACULAR HOLE WITHOUT RETINAL DETACHMENT
Authors: Wu Tsung-Tien , Kung Ya-Hsin , Chang Chih-Yao , Chang Shu-Ping
Published: August 2017

Purpose:

The authors evaluated surgical outcomes in eyes with extremely high myopia for macular hole (MH) without retinal detachment.

Methods:

In this retrospective study, 14 eyes with axial lengths of ≥30.0 mm underwent vitrectomy and internal limiting membrane (ILM) peeling with or without inverted ILM flap insertion for MH without retinal detachment (October 2009–June 2016). Outcome measures were MH closure confirmed by optical coherence tomography, best-corrected visual acuity, and complications.

Results:

The mean axial length was 30.69 ± 0.76 mm. The overall final closure rate was 85.7% (12/14 eyes); the mean follow-up was 17.29 (±20.20) months. Primary anatomical MH closure after 1 operation was achieved in three of eight eyes (37.5%) without an inverted ILM flap and was achieved in six of six eyes (100%) with inverted ILM flap insertion (P = 0.031). There was no reopening of MH during follow-up. Mean visual acuity improved significantly from 1.10 ± 0.43 logarithm of the minimum angle of resolution (Snellen equivalent, 20/254) to 0.84 ± 0.50 logarithm of the minimum angle of resolution (Snellen equivalent, 20/138) (P = 0.046; 2-tailed, paired t-test). Only 1 eye developed an MH-associated retinal detachment 4.5 years after previously failed MH surgery; reattachment was achieved after a second operation.

Conclusion:

Patients with extremely high myopia obtained anatomical and functional improvements from MH surgery; inverted ILM flap insertion achieved significantly higher primary success rates in MH closure.
Utility of Flexible Bronchoscopic Cryobiopsy for Diagnosis of Diffuse Parenchymal Lung Diseases
Authors: Lentz Robert J. , Taylor Trevor M. , Kropski Jonathan A. , Sandler Kim L. , Johnson Joyce E. , Blackwell Timothy S. , Maldonado Fabien , Rickman Otis B.
Published: August 2017

Background:

Initial reports of transbronchial cryobiopsy for diffuse parenchymal lung disease (DPLD) suggest the diagnostic yield approaches that of surgical lung biopsy (SLB) with an excellent safety profile. Centers performing cryobiopsy differ significantly in procedure technique; an optimal technique minimizing complications but still capable of diagnosing a wide range of DPLDs has not been established. We evaluated our practice of flexible bronchoscopic cryobiopsy in a primarily outpatient setting for patients who required a tissue diagnosis for DPLD of uncertain etiology.

Methods:

Consecutive patients with indeterminate DPLD who underwent bronchoscopic cryobiopsy at a large academic medical center from January 2012 to August 2015 were retrospectively analyzed. Rates of confident histopathologic diagnosis, confident multidisciplinary consensus diagnosis, management change, and complications were determined.

Results:

One hundred four cases were identified. Confident histopathologic diagnoses were established in 44% (46/104) and confident multidisciplinary consensus diagnoses in 68% (71/104). Usual interstitial pneumonia (19/104) and idiopathic pulmonary fibrosis (22/104) were the most common histopathologic and consensus diagnoses, respectively. Five subjects proceeded to SLB after cryobiopsy which was diagnostic in 3. Results of cryobiopsies changed management in 70% (73/104). Complications occurred in 8 cases with no death.

Conclusions:

Cryobiopsy during outpatient flexible bronchoscopy facilitated confident multidisciplinary consensus diagnosis of DPLD in more than two thirds of cases, and appears sufficient to establish the histopathologic diagnosis of usual interstitial pneumonia, with a complication rate that compares favorably to that reported for SLB.
Audiometric Outcomes Following Endoscopic Ossicular Chain Reconstruction
Authors: Yawn Robert J. , Hunter Jacob B. , O’Connell Brendan P. , Wanna George B. , Killeen Daniel E. , Wick Cameron C. , Isaacson Brandon , Rivas Alejandro
Published: August 2017

Objective:

To evaluate the audiometric outcomes following endoscopic ossicular chain reconstruction (OCR).

Study Design:

Retrospective case series.

Setting:

Two tertiary referral centers.

Patients:

Sixty two ears with ossicular discontinuity.

Intervention(s):

Endoscopic and microscopic OCR in patients with ossicular discontinuity.

Main Outcome Measures:

Bone and air pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS).

Results:

Sixty two ears were included for analysis. Patients that underwent ossiculoplasty were subdivided based on prosthesis type (total ossicular replacement prosthesis [TORP] and partial ossicular replacement prosthesis [PORP], primary and staged ossiculoplasties, and surgical approach [microscopic and total endoscopic]). Forty two ears required PORP reconstructions, while 20 ears required TORP reconstructions. The microscope was used to reconstruct the ossicular chain in 31 cases, while an exclusive endoscopic approach was used in the remaining 31 patients. Controlling for the prosthesis, there were no significant postoperative differences in bone PTA, air PTA, and ABG between primary and staged ossiculoplasties, or surgical approach.

Conclusions:

Controlling for the type of prosthesis, there were no significant differences in hearing outcomes with respect to staged ossicular chain reconstruction or whether the endoscope or microscope was used for visualization. Thus, in this series, endoscopic OCR yields similar audiometric outcomes when compared with microscopic OCR.
The Seasonal Variation of Benign Paroxysmal Positional Vertigo
Authors: Meghji Sheneen , Murphy Declan , Nunney Ian , Phillips John S.
Published: August 2017

Objective:

Benign paroxysmal positional vertigo (BPPV) is characterized by recurrent episodes of positional vertigo due to dislodged otoconia debris within the semicircular canals. Many studies have proposed a correlation between Vitamin-D deficiency and recurrent BPPV. In the UK, serum Vitamin-D falls during the winter, reaching its lowest level in May and it is highest level in September. We hypothesize that if there is a relationship between BPPV and Vitamin-D levels, one would expect to see a seasonal variation in the incidence of BPPV among UK residents.

Methods:

A retrospective review of clinic letters and general practitioner referrals for patients presenting to a University Otolaryngology department over a 4-year period. Patients were divided into two groups: those presenting during the months associated with low serum Vitamin-D levels, and those presenting during the months associated with high serum Vitamin-D levels.

Results:

Three hundred thirty-nine patients were identified with posterior canal BPPV as a consequence of having had a positive Dix-Hallpike maneuver recorded in the clinical notes between October 2012 and October 2016. A Wilcoxon rank-sum test demonstrated there to be a statistically significant difference between the low serum Vitamin-D group and the high serum Vitamin-D group (p 
= 0.0367).

Conclusion:

The results confirm that there is a seasonal variation in the incidence of BPPV. This study is important as it adds to the mounting literature suggesting an association between serum Vitamin-D levels and BPPV. Second, it suggests a therapeutic strategy to improve outcomes in affected patients. Third, it adds significance to the hypothesized role of calcium metabolism for the development of inner ear disease.
Intracanalicular Vestibular Schwannomas: Initial Clinical Manifestation, Imaging Classification, and Risk Stratification for Management Proposal
Authors: Younes Elias , Montava Marion , Bachelard-Serra Mathilde , Jaloux Laurent , Salburgo Florent , Lavieille Jean Pierre
Published: August 2017

Introduction:

There is no consensus about the use of observation as a therapeutic modality for intracanalicular vestibular schwannoma (ICVS). The objective of this study was to describe tumor evolution, its correlation with initial size, stage of vestibular schwannoma, clinical presentation and to propose a risk classification for tumor growth with a therapeutic decision algorithm.

Methods:

Fifty-three patients with ICVS were followed prospectively from 2010 to 2015. The mean follow-up was 32 months. Patients underwent clinical examination, audiogram, magnetic resonance imaging at 6, 12, and then 12 months intervals within the first 5 years of initial diagnosis. We analyzed the patient's clinical course, audiologic changes, initial tumor location, and correlation of different parameters with ICVS growth.

Results:

Fourteen patients (26%) deteriorated their hearing level and 17 patients (27%) showed tumor growth during the follow-up period. Growth was noted during the first year of observation in 13 patients (76.5%). Considering initial presentation: tumor size, intracanalicular staging, and hearing level, patients with larger vestibular schwannoma, extension to the fundus regardless of tumor size, higher initial pure-tone average, and speech recognition test showed a significantly higher rate of tumor growth. ICVS evolution was not correlated with hearing deterioration with time.

Discussion:

We should consider observation a therapeutic modality. We valid the intrameatal staging as prognostic factor and propose a stratification of patients into low, moderate, or high risk for potential tumor growth to guide the initial management of ICVS.
A New Slim Modiolar Electrode Array for Cochlear Implantation: A Radiological and Histological Study
Authors: Iso-Mustajärvi Matti , Matikka Hanna , Risi Frank , Sipari Sini , Koski Teemu , Willberg Tytti , Lehtimäki Antti , Tervaniemi Jyrki , Löppönen Heikki , Dietz Aarno
Published: August 2017

Hypothesis:

To explore the results of a new slim modiolar electrode array (SMA) with respect to intracochlear placement and trauma evaluated by detailed radiologic imaging and histology.

Background:

Hearing and structure preservation is the goal of cochlear implantation for advanced hearing outcomes. Currently, this is most consistently achieved with thin lateral wall electrodes. Modiolar electrodes are located nearer the modiolus and may provide some electrophysiological advantages, but have a greater tendency for causing insertion trauma.

Methods:

The SMA was implanted in 20 fresh-frozen human temporal bones (TB). All TBs were scanned pre- and postoperatively with cone beam computed tomography. For atraumatic insertion, the round window approach was preferred. Scalar localization and trauma were analyzed by three-dimensional image fusion reconstructions of the pre- and postimplant scans. The TBs underwent histologic examination to validate the radiologic findings.

Results:

Insertion through the round window was performed in 19 TBs and through a cochleostomy in one TB. In one TB trauma in the form of scala translocation was identified radiologically and histologically. In the remaining TBs there was no insertion trauma. Adequate modiolar localization of the SMA was found in 19 of 20 TBs. The mean angular insertion depth was 400 degrees without correlation to cochlea size. There was no significant statistical difference between the radiological and histological measurements of electrode localization.

Conclusion:

The SMA showed consistent and atraumatic insertion results in TBs. Pre- and postimplant cone beam computed tomography with image fusion was shown to be very accurate for the assessment of electrode position and insertion trauma.
The Care of the Postliver Transplant Patient
Authors: Russo Mark W.
Published: August 2017

Since 1988 nearly 150,000 liver transplants have been performed in the United States. Over the past 3 decades the indications for liver transplant have changed from end-stage liver disease from alcohol and cholestatic liver diseases to hepatitis C and most recently nonalcoholic fatty liver disease. Liver transplant recipients are living longer with 10-year survival rates exceeding 60%. Gastroenterologists are likely to encounter or consult on postliver transplant recipients as they live longer and seek care closer to home. Complications after liver transplant are related to immunosuppression, malignancy, recurrent disease, and conditions associated with metabolic syndrome. This review will discuss postliver transplant care and complications in liver transplant recipients.
Nurse Manager Engagement
Authors: Conley Karen A.
Published: August 2017

OBJECTIVE

This study provided insight into the level of engagement of nurse managers (NMs) and strategies used to achieve and sustain engagement in acute care settings.

BACKGROUND

Nurse managers have a significant role in staff satisfaction and unit outcomes and therefore need to be engaged in their work to influence others. Little is known about the level of individual NM engagement and strategies they use to remain engaged.

METHODS

A mixed methods approach was used to elicit information about NM engagement. This study used a sample of 47 NMs to measure their level of engagement, and for those achieving scores indicating high levels of engagement, interviews were conducted, and a content analysis was completed to identify themes.

RESULTS

Results showed that there were significantly higher levels of NM engagement among those managers who had been practicing as nurse leaders for a longer period and also those who had advanced degrees. Qualitative review revealed the themes of expert communication, autonomy, and influence as the key factors driving NM engagement.

CONCLUSIONS

The role of the nurse executive in NM engagement is significant in supporting educational advancement and retention, both of which proved to have an impact on the level of engagement.
Diffusion Basis Spectral Imaging Detects Ongoing Brain Inflammation in Virologically Well-Controlled HIV+ Patients
Authors: Strain Jeremy F. , Burdo Tricia H. , Song Sheng-Kwei , Sun Peng , El-Ghazzawy Omar , Nelson Brittany , Westerhaus Elizabeth , Baker Laurie , Vaida Florin , Ances Beau M.
Published: August 2017

Inflammation occurs after HIV infection and persists, despite highly active antiretroviral therapy (HAART). Diffusion tensor imaging (DTI) measures HIV-associated white matter changes, but can be confounded by inflammation. Currently, the influence of inflammation on white matter integrity in well-controlled HIV+ patients remains unknown. We used diffusion basis spectral imaging (DBSI)-derived cellularity to isolate restricted water diffusion associated with inflammation separated from the anisotropic diffusion associated with axonal integrity. Ninety-two virologically suppressed HIV+ patients on HAART and 66 HIV uninfected (HIV−) controls underwent neuropsychological performance (NP) testing and neuroimaging. NP tests assessed multiple domains (memory, psychomotor speed, and executive functioning). DTI- and DBSI-derived fractional anisotropy (FA) maps were processed with tract-based spatial statistics for comparison between both groups. Cellularity was assessed regarding age, HIV status, and NP. Within the HIV+ cohort, cellularity was compared with clinical (HAART duration) and laboratory measures of disease (eg, CD4 cell current and nadir). NP was similar for both groups. DTI-derived FA was lower in HIV+ compared with HIV− individuals. By contrast, DBSI-derived FA was similar for both groups. Instead, diffuse increases in cellularity were present in HIV+ individuals. Observed changes in cellularity were significantly associated with age, but not NP, in HIV+ individuals. A trend level association was seen between cellularity and HAART duration. Elevated inflammation, measured by cellularity, persists in virologically well-controlled HIV+ individuals. Widespread cellularity changes occur in younger HIV+ individuals and diminish with aging and duration of HAART.
Biogeochemical modelling of dissolved oxygen in a changing ocean
Authors: Andrews Oliver , Buitenhuis Erik , Le Quéré Corinne , Suntharalingam Parvadha
Published: August 2017

Secular decreases in dissolved oxygen concentration have been observed within the tropical oxygen minimum zones (OMZs) and at mid- to high latitudes over the last approximately 50 years. Earth system model projections indicate that a reduction in the oxygen inventory of the global ocean, termed ocean deoxygenation, is a likely consequence of on-going anthropogenic warming. Current models are, however, unable to consistently reproduce the observed trends and variability of recent decades, particularly within the established tropical OMZs. Here, we conduct a series of targeted hindcast model simulations using a state-of-the-art global ocean biogeochemistry model in order to explore and review biases in model distributions of oceanic oxygen. We show that the largest magnitude of uncertainty is entrained into ocean oxygen response patterns due to model parametrization ofpCO2-sensitive C : N ratios in carbon fixation and imposed atmospheric forcing data. Inclusion of apCO2-sensitive C : N ratio drives historical oxygen depletion within the ocean interior due to increased organic carbon export and subsequent remineralization. Atmospheric forcing is shown to influence simulated interannual variability in ocean oxygen, particularly due to differences in imposed variability of wind stress and heat fluxes.

This article is part of the themed issue ‘Ocean ventilation and deoxygenation in a warming world’.
Salmonella Oranienburg haemorrhagic cystitis in an immunocompetent young male
Authors: Teh Jiasian , Quinlan Mark , Bolton Damien
Published: August 2017

Introduction. Non-typhoidal salmonella (NTS) bacteriuria is extremely rare. Haemorrhagic cystitis is defined by urinary symptoms including haematuria, frequency, urgency and dysuria. Reports of haemorrhagic cystitis caused by NTS are exceptionally uncommon, especially in immunocompetent, young, male patients.

Case presentation. A 27-year-old male with no past medical history presented to the Emergency Department with a 24 h history of visible haematuria having returned five days earlier from a five month trip across South America. He also reported one week of suprapubic pain with associated dysuria, frequency, difficulty voiding and fevers. A non-contrast abdominal and pelvic CT scan showed a grossly thick-walled bladder with marked peri-vesical stranding, strongly suggestive of cystitis, with an unremarkable appearance of the remainder of the urinary tract. Urine culture at presentation subsequently grew Salmonella Oranienburg. The patient reported total symptomatic relief following just one week of oral antibiotics with no recurrence to date.

Conclusion. NTS urinary tract infection (UTI), especially in healthy young people, is very rare. In such cases, the existence of underlying diseases must be considered, especially diabetes mellitus, urological abnormalities and immunosuppression. However, a diagnosis of NTS UTI should also be among the differentials in those presenting with acute urinary symptoms preceded by gastrointestinal upset, especially following travel in underdeveloped countries. Antibiotic therapy is invariably indicated and close follow-up is warranted due to the risk of several potentially serious complications.
Identification of different putative outer membrane electron conduits necessary for Fe(III) citrate, Fe(III) oxide, Mn(IV) oxide, or electrode reduction byGeobacter sulfurreducens
Authors: Otero Fernanda Jiménez , Chan Chi Ho , Bond Daniel R.
Published: August 2017

At least five gene clusters in theGeobacter sulfurreducensgenome encode putative ‘electron conduits’ implicated in electron transfer across the outer membrane, each containing a periplasmic multihemec-type cytochrome, integral outer membrane anchor, and outer membrane redox lipoprotein(s). Markerless single gene cluster deletions and all possible multiple deletion combinations were constructed and grown with soluble Fe(III) citrate, Fe(III)- and Mn(IV)-oxides, and graphite electrodes poised at +0.24 V and −0.1 V vs. SHE. Different gene clusters were necessary for reduction of each electron acceptor. During metal oxide reduction, deletion of the previously describedomcBCcluster caused defects, but deletion of additional components in an ΔomcBCbackground, such asextEFG, were needed to produce defects greater than 50% compared to wild type. Deletion of all five gene clusters abolished all metal reduction. During electrode reduction, only the ΔextABCDmutant had a severe growth defect at both redox potentials, while this mutation did not affect Fe(III)-oxide, Mn(IV)-oxide, or Fe(III) citrate reduction. Some mutants containing only one cluster were able to reduce particular terminal electron acceptors better than wild type, suggesting routes for improvement by targeting specific electron transfer pathways. Transcriptomic comparisons between fumarate and electrode-based growth showed all of theseextclusters to be constitutive, and transcriptional analysis of the triple-deletion strain containing onlyextABCDdetected no significant changes in expression of known redox proteins or pili components. These genetic experiments reveal new outer membrane conduit complexes necessary for growth ofG. sulfurreducens, depending on the available extracellular electron acceptor.
dRNA-seq implicates sulfide as master regulator of S(0) metabolism inChlorobaculum tepidumand other green sulfur bacteria
Authors: Hilzinger Jacob M. , Raman Vidhyavathi , Shuman Kevin E. , Eddie Brian J. , Hanson Thomas E.
Published: August 2017

The green sulfur bacteria (Chlorobiaceae) are anaerobes that use electrons from reduced sulfur compounds (sulfide, S(0), and thiosulfate) as electron donors for photoautotrophic growth.Chlorobaculum tepidum, the model system for theChlorobiaceae, both produces and consumes extracellular S(0) globules depending on the availability of sulfide in the environment. These physiological changes imply significant changes in gene regulation, which has been observed when sulfide is added toCba. tepidumgrowing on thiosulfate. However, the underlying mechanisms driving these gene expression changes, i.e. specific regulators and promoter elements involved, have not yet been defined. Here, differential RNA-seq (dRNA-seq) was used to globally identify transcript start sites (TSS) that were present during growth on sulfide, biogenic S(0), and thiosulfate as sole electron donors. TSS positions were used in combination with RNA-seq data from cultures growing on these same electron donors to identify both basal promoter elements and motifs associated with electron donor dependent transcriptional regulation. These motifs were conserved across homologousChlorobiaceaepromoters. Two lines of evidence suggest that sulfide mediated repression is the dominant regulatory mode inCba. tepidum. First, motifs associated with genes regulated by sulfide overlap key basal promoter elements. Second, deletion of the gene CT1277, encoding a putative regulatory protein, leads to constitutive over-expression of the sulfide:quinone oxidoreductase CT1087 in the absence of sulfide. The results suggest that sulfide is the master regulator of sulfur metabolism inCba. tepidumand theChlorobiaceae. Finally, the identification of basal promoter elements with differing strengths will further the development of synthetic biology inCba. tepidumand perhaps otherChlorobiaceae.

Importance

Elemental sulfur is a key intermediate in biogeochemical sulfur cycling. The photoautotrophic green sulfur bacteriumChlorobaculum tepidumboth produces and consumes elemental sulfur depending on the availability of sulfide in the environment. Our results reveal transcriptional dynamics ofChlorobaculum tepidumon elemental sulfur, and increase our understanding of the mechanisms of transcriptional regulation governing growth on different reduced sulfur compounds. This study identifies new genes and sequence motifs that likely play significant roles in the production and consumption of elemental sulfur. Beyond this focused impact, this study paves the way for the development of synthetic biology inChlorobaculum tepidumand otherChlorobiaceaeby providing a comprehensive identification of promoter elements to control gene expression, a key element of strain engineering.
De NovoPrediction of Human Chromosome Structures: Epigenetic Marking Patterns Encode Genome Architecture
Authors: Di Pierro Michele , Cheng Ryan R. , Lieberman Aiden Erez , Wolynes Peter G. , Onuchic José N.
Published: August 2017

Inside the cell nucleus, genomes fold into organized structures that are characteristic of cell type. Here, we show that this chromatin architecture can be predictedde novousing epigenetic data derived from ChIP-Seq. We exploit the idea that chromosomes encode a one-dimensional sequence of chromatin structural types. Interactions between these chromatin types determine the three-dimensional (3D) structural ensemble of chromosomes through a process similar to phase separation. First, a recurrent neural network is used to infer the relation between the epigenetic marks present at a locus, as assayed by ChIP-Seq, and the genomic compartment in which those loci reside, as measured by DNA-DNA proximity ligation (Hi-C). Next, types inferred from this neural network are used as an input to an energy landscape model for chromatin organization (MiChroM) in order to generate an ensemble of 3D chromosome conformations. After training the model, dubbed MEGABASE (Maximum Entropy Genomic Annotation from Biomarkers Associated to Structural Ensembles), on odd numbered chromosomes, we predict the chromatin type sequences and the subsequent 3D conformational ensembles for the even chromosomes. We validate these structural ensembles by using ChIP-Seq tracks alone to predict Hi-C maps as well as distances measured using 3D FISH experiments. Both sets of experiments support the hypothesis of phase separation being the driving process behind compartmentalization. These findings strongly suggest that epigenetic marking patterns encode sufficient information to determine the global architecture of chromosomes and thatde novostructure prediction for whole genomes may be increasingly possible.