bluuebunny/crossref_metadata_2025 huggingface dataset:
The national question, partition and geopolitics in the 21st century: the Cyprus problem, the social question and the politics of reconciliation
Authors: Trimikliniotis Nicos
Published: July 2018

This paper examines the ‘Cyprus problem’, a protracted modern conflict over a de facto divided island in the eastern Mediterranean, seeking to explore radical potentialities. The paper examines the parameters for resolution set 40 years ago with the agreement to establish a bizonal bicommunal federation. The paper connects the global and regional factors to forces within Cyprus to the dialectic between the forces sustaining division versus those driving towards resolution. It then locates the specific ‘national question’ within a broader reading of geopolitical and social questions in our turbulent times. To appreciate the continuities and ruptures, the ‘Cyprus problem is placed within a frame connecting the old national questions in the imperialist era to current debates over ethnic divisions/conflicts, as they manifest themselves within rekindled social/economic and regional geopolitical contestations. The paper reading the potential for resolution as a transitional process connecting the internal dynamics (nationalism, class, and politics) to imperial/geopolitical ones. This reading provides the analytical lenses to appreciate the potentialities empowering social and political forces within Cyprus. In doing so that we may unlock the social imaginaries to overcome the current divide, as essential elements of vision(s) for social(ist) transformation(s). Focusing on the oldest political and the largest Left-wing force, AKEL, the paper addresses three challenges for the Left: Transcending the compartmentalization of the national question from geopolitics and the social question; enhancing the reunification and reconciliation politics; federating and reconciling from below to push for solution by expanding the ‘third space’ for an anti-nationalist counter-hegemony.
Supplier Relationship Management towards Quality Management System of Indian automotive manufacturing industry - A Total Interpretive Structural Modeling approach
Authors: Pothal L K , Tripathy S , Satapathy S
Published: July 2018

This research paper identifies Supplier Relationship Management (SRM) as a significant factor influencing quality development of products in automobile sector. SRM is a crucial methodology to achieve mutual gains by companies and their suppliers. The supplier may be having different business culture than the company. The business culture and environment differs from organization to organization. SRM provides a common platform for exchange of knowledge, ideas, goals, etc. for the company and its suppliers which enhance processes like material handling, procurement and goods management. SRM impacts product quality directly and in a positive way. Finally, through Interpretive Structural Modeling (ISM), different manufacturing and quality issues are identified at different levels & their contributions, which ultimately construct the direction towards Quality Management System (QMS) and then through Total Interpretive Structural Modeling(TISM) the developed model is logically modified.
Research on Multi-source Energy Consumption Characteristics of CNC Machine Tool Processing System
Authors: Zhou Yan , Tan Chong
Published: July 2018

CNC machine tools are a complex and variable system with a large number of energy-consuming components and the energy consumption type covers the field of electromechanical liquid. Therefore, it is of great significance to study the energy consumption of CNC machine tools in order to find energy conservation and emission reduction, improve resource utilization, reduce environmental pollution, and promote green manufacturing. This paper analyzes the energy consumption form and characteristics of a typical machine tool, combines the machining status of the machine tool, and studies the various energy-consuming components of the machine tool, establishes the power balance equations of each state, and the specific energy consumption and energy efficiency model of the machine tool. The model combines the energy consumption characteristics and machining status of the machine tool, and lays a theoretical foundation for the research of the energy of the CNC machine tool.
A genome-wide microRNA screen identifies regulators of tetraploid cell proliferation
Authors: Vittoria Marc A. , Shenk Elizabeth M. , O’Rourke Kevin P. , Bolgioni Amanda F. , Lim Sanghee , Kacprzak Victoria , Quinton Ryan J. , Ganem Neil J.
Published: July 2018

Tetraploid cells, which are most commonly generated by errors in cell division, are genomically unstable and have been shown to promote tumorigenesis. Recent genomic studies have estimated that ∼40% of all solid tumors have undergone a genome-doubling event during their evolution, suggesting a significant role for tetraploidy in driving the development of human cancers. To safeguard against the deleterious effects of tetraploidy, nontransformed cells that fail mitosis and become tetraploid activate both the Hippo and p53 tumor suppressor pathways to restrain further proliferation. Tetraploid cells must therefore overcome these antiproliferative barriers to ultimately drive tumor development. However, the genetic routes through which spontaneously arising tetraploid cells adapt to regain proliferative capacity remain poorly characterized. Here, we conducted a comprehensive gain-of-function genome-wide screen to identify microRNAs (miRNAs) that are sufficient to promote the proliferation of tetraploid cells. Our screen identified 23 miRNAs whose overexpression significantly promotes tetraploid proliferation. The vast majority of these miRNAs facilitate tetraploid growth by enhancing mitogenic signaling pathways (e.g., miR-191-3p); however, we also identified several miRNAs that impair the p53/p21 pathway (e.g., miR-523-3p), and a single miRNA (miR-24-3p) that potently inactivates the Hippo pathway via down-regulation of the tumor suppressor gene NF2. Collectively, our data reveal several avenues through which tetraploid cells may regain the proliferative capacity necessary to drive tumorigenesis.
Characterization of Five Molecular Markers for Pathotype Identification of the Clubroot PathogenPlasmodiophora brassicae
Authors: Zheng Jing , Wang Xuliang , Li Qian , Yuan Shu , Wei Shiqing , Tian Xiyu , Huang Yun , Wang Wenming , Yang Hui
Published: July 2018

Clubroot disease is an important disease on cruciferous crops caused by Plasmodiophora brassicae infections. The pathotypes have been classified based on the reactions of differential hosts. However, molecular markers of particular pathotypes for P. brassicae are limited. In this study, we found five genetic markers in association with different pathotypes. Different gene expression patterns among different pathotypes (P4, P7, P9, and P11) were assayed according to the transcriptome data. The assay indicated that molecular markers PBRA_007750 and PBRA_009348 could be used to distinguish P11 from P4, P7, and P9; PBRA_009348 and Novel342 could distinguish P9 from P4, P7, and P11; and PBRA_008439 and Novel342 could represent a kind of P4. Polymerase chain reaction cycles ranging from 25 to 30 were able to identify the predominant pathotype in general. Therefore, these molecular markers would be a valuable tool to identify and discriminate pathotypes in P. brassicae population.
Exercise Reverses Nociceptive Sensitization, Upregulated Neuropeptide Signaling, Inflammatory Changes, Anxiety, and Memory Impairment in a Mouse Tibia Fracture Model
Authors: Shi Xiaoyou , Guo Tian-zhi , Li Wenwu , Sahbaie Peyman , Rice Kenner C. , Sulima Agnieszka , Clark J. David , Kingery Wade S.
Published: July 2018

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

This study tested the hypothesis that ad lib running wheel exercise in a tibia fracture model of complex regional pain syndrome can reverse hindlimb nociceptive sensitization and inflammation in mice.

Methods

Three weeks after tibia fracture, the cast was removed and hindlimb von Frey thresholds and unweighting were tested; the mice were then randomized to either ad lib access to a running wheel for 4 weeks or no wheel access. After 4 weeks the behavioral testing was repeated and then skin, sciatic nerve, and spinal cord tissues collected for polymerase chain reaction and enzyme immunoassay measurements of neuropeptide and inflammatory mediator levels. A similar protocol was used in fracture mice treated with exercise for 4 weeks, and then the running wheel was removed for 2 weeks. Memory and anxiety were measured in both groups with use of open-field, zero-maze, and novel-objects recognition assays.

Results

At 7 weeks postfracture the mice with no wheel access exhibited hindlimb allodynia and unweighting, anxiety, memory loss, upregulated spinal neuropeptide signaling, and increased hind paw and spinal inflammatory mediator expression, but the postfracture mice allowed to exercise for 4 weeks exhibited none of these changes (n = 12/cohort). When exercise was stopped for 2 weeks after 4 weeks of running, hindlimb allodynia and unweighting were rekindled, and this nociceptive sensitization was associated with increased sciatic nerve neuropeptide levels and hind paw skin interleukin 6 and nerve growth factor expression (n = 12/cohort).

Conclusions

Daily exercise reversed nociceptive sensitization, inflammation, anxiety, and memory loss after tibia fracture.
Impact of the Choice of Risk Model for Identifying Low-risk Patients Using the 2014 American College of Cardiology/American Heart Association Perioperative Guidelines
Authors: Glance Laurent G. , Faden Eric , Dutton Richard P. , Lustik Stewart J. , Li Yue , Eaton Michael P. , Dick Andrew W.
Published: July 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

The 2014 American College of Cardiology Perioperative Guideline recommends risk stratifying patients scheduled to undergo noncardiac surgery using either: (1) the Revised Cardiac Index; (2) the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator; or (3) the Myocardial Infarction or Cardiac Arrest calculator. The aim of this study is to determine how often these three risk-prediction tools agree on the classification of patients as low risk (less than 1%) of major adverse cardiac event.

Methods

This is a retrospective observational study using a sample of 10,000 patient records. The risk of cardiac complications was calculated for the Revised Cardiac Index and the Myocardial Infarction or Cardiac Arrest models using published coefficients, and for the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator using the publicly available website. The authors used the intraclass correlation coefficient and kappa analysis to quantify the degree of agreement between these three risk-prediction tools.

Results

There is good agreement between the American College of Surgeons National Surgical Quality Improvement Program and Myocardial Infarction or Cardiac Arrest estimates of major adverse cardiac events (intraclass correlation coefficient = 0.68, 95% CI: 0.66 to 0.70), while only poor agreement between (1) American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator and the Revised Cardiac Index (intraclass correlation coefficient = 0.37; 95% CI: 0.34 to 0.40), and (2) Myocardial Infarction or Cardiac Arrest and Revised Cardiac Index (intraclass correlation coefficient = 0.26; 95% CI: 0.23 to 0.30). The three prediction models disagreed 29% of the time on which patients were low risk.

Conclusions

There is wide variability in the predicted risk of cardiac complications using different risk-prediction tools. Including more than one prediction tool in clinical guidelines could lead to differences in decision-making for some patients depending on which risk calculator is used.
Appropriate MRI Evaluation of Lisfranc Ligaments: How to Avoid Missing Ligamentous Lisfranc Injuries
Authors: Bateni Cyrus , Kahlon Sukraj , Kreulen Christopher
Published: July 2018

Knowledge of injuries at the tarsal metatarsal joints continues to evolve. Fractures and ligamentous injuries at the tarsal metatarsal joints, also known as the Lisfranc joint complex, are uncommon yet can be of great clinical significance. The initial radiographic findings, suspected mechanism of injury, and physical examination findings can result in varying diagnoses and recommendations. Subtle or ligamentous injuries can be missed and result in the potential of midfoot instability and rapid progression to posttraumatic osteoarthritis. The imaging features of injury at the Lisfranc joint are reviewed, and guidance is provided as to the appropriate use and interpretation of weight bearing radiographs, computed tomography, and magnetic resonance imaging. This will include a description on the utilization of magnetic resonance imaging in evaluating ligamentous Lisfranc injuries to aid clinicians in successfully diagnosing a ligamentous or subtle injury.
Cosmetic and Functional Outcomes of Second Intention Healing for Mohs Defects of the Lips
Authors: Donigan Jessica M. , Millican Eric A.
Published: July 2018

BACKGROUND

The lips are a common location for skin cancer and thus for Mohs micrographic surgery (MMS). There are few studies looking at second intention healing of Mohs defects of the lips, and none have used a scar assessment scale.

OBJECTIVE

To evaluate the acceptability of second intention healing of the vermilion lips following MMS using a patient questionnaire and the Patient and Observer Assessment Scale (POSAS).

METHODS

Eligible patients were found through chart review. A patient questionnaire and the patient scale of the POSAS were performed over the phone. For patients who were able to come to clinic, the observer scale of the POSAS was performed.

RESULTS

Forty-seven phone interviews and 21 clinic assessments were performed. Overall, patients noted excellent functional outcomes, and good to excellent cosmetic outcomes, and were satisfied with healing time. There was not a significant difference between the patient and observer total scores (p = .63) or overall scores (p = .59).

CONCLUSION

Second intention healing can have satisfactory functional and cosmetic outcomes and healing times with few complications and should be considered for surgical defects on the vermilion lips as large as 2.8 cm2 even when there is involvement of the cutaneous lip and muscular layer.
Tracking Changes in Vaccine Attitudes and Decisions: Results from 2008 and 2016 Parental Surveys
Authors: Grossman Zachi , Hadjipanayis Adamos , Degani Avi , Somekh Eli
Published: July 2018

To monitor parental vaccine attitudes, a survey was conducted in 2008 and in 2016. In both years (90%–89%) reported full immunization of their children, and a stable majority (71%–66%) supported documentation of vaccination before entering kindergarten. However, a declining confidence in official recommendations from 87% to 72% (P < 0.0001) in 2008 and 2016, respectively, was documented, requiring effort to rebuild it.
Fluorescent Detection of Merlin-deficient Schwann Cells and Primary Human Vestibular Schwannoma Cells Using Sodium Fluorescein
Authors: Perez Enrique R. , Bracho Olena , Ein Liliana , Szczupak Mikhaylo , Monje Paula V. , Fernandez-Valle Cristina , Alshaiji Abdulaziz , Ivan Michael , Morcos Jacques , Liu Xue-Zhong , Hoffer Michael , Eshraghi Adrien , Angeli Simon , Telischi Fred , Dinh Christine T.
Published: July 2018

Hypothesis:

Merlin-deficient Schwann cells (MD-SC) and primary human vestibular schwannoma (VS) cells exhibit selective uptake of sodium-fluorescein (SF), allowing for fluorescent detection and improved visualization of tumor cells, when compared with Schwann cells (SC).

Background:

SF is a fluorescent compound used for fluorescence-guided resection of gliomas. The utility of SF for VS surgery has not been assessed.

Methods:

Mouse MD-SCs and rat SCs were cultured on 96-well plates at different cell densities and treated with SF at several drug concentrations and durations. Relative fluorescence units (RFU) were measured using a fluorometer to determine optimal treatment parameters in vitro. Subsequently, a four-point Likert scale for fluorescence visualization of pelleted cells was created and validated. Blinded observers rated SF-treated primary human VS and SC cultures, which were developed from deidentified specimens obtained from live and cadaveric donors, respectively.

Results:

In contrast to SCs that showed low levels of fluorescence, MD-SCs demonstrated dose-dependent increases in RFUs when treated with incremental dosages of SF as well as longer treatment and fluorescent excitation times. In addition, RFUs were higher at greater MD-SC densities. The Likert scale for fluorescence visualization was validated using nine blinded observers and there were excellent inter- and intrarater reliabilities (intraclass coefficients of 0.989 and >0.858, respectively). Using the Likert scale, human VS treated with SF received higher scores than human SCs (p < 0.001).

Conclusion:

Mouse MD-SC and human VS cells demonstrate preferential uptake of SF when compared with normal primary SCs. Observers detected differences in fluorescence using the validated Likert scale. Further investigations into the utility of SF-guidance in VS surgery are warranted.
Sudden Sensorineural Hearing Loss Predicts Ischemic Stroke: a Longitudinal Follow-Up Study
Authors: Kim So Young , Lim Jae-Sung , Sim Songyong , Choi Hyo Geun
Published: July 2018

Objectives:

To investigate the risk of stroke in SSNHL patients.

Study Design:

A longitudinal follow-up cohort study.

Setting:

The Korean National Health Insurance Service-National Sample Cohort from 2002 to 2013.

Patients:

The 4,944 SSNHL participants were matched with 19,776 controls for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia. The SSNHL subjects were diagnosed (International Classification of Disease [ICD]-10: H91.2), underwent an audiometry examination, and were treated with steroids. The history of hemorrhagic stroke, ischemic stroke, hypertension, diabetes, dyslipidemia, ischemic heart disease, and depression was investigated based on the ICD-10.

Main Outcome Measures:

The hazard ratios (HRs) for hemorrhagic and ischemic stroke were analyzed using a Cox proportional hazard model. Subgroup analyses were conducted according to age (< 50 vs. ≥ 50 yr old) and sex.

Results:

Participants diagnosed with ischemic stroke included 4.2% of SSNHL subjects and 3.5% of control subjects (p = 0.013). The adjusted HR of SSNHL for ischemic stroke was 1.22 (95% confidence interval [95% CI] = 1.05 – 1.43, p = 0.012). The ≥ 50-year-old male SSNHL subgroup showed 1.40 adjusted HRs for ischemic stroke (95% CI = 1.10 – 1.78, p = 0.006). The rate of hemorrhagic stroke was 0.7% for SSNHL and 0.6% for control subjects. SSNHL did not elevate the risk of hemorrhagic stroke (p = 0.310).

Conclusion:

SSNHL elevated the risk of ischemic stroke in the general population. Older males with SSNHL demonstrated a high risk for ischemic stroke; however, SSNHL did not increase the risk of hemorrhagic stroke.
Clinical and Health System Determinants of Venous Thromboembolism Event Rates After Hip Arthroplasty
Authors: Januel Jean-Marie , Romano Patrick S. , Couris Chantal M. , Hider Phil , Quan Hude , Colin Cyrille , Burnand Bernard , Ghali William A.
Published: July 2018

Background:

Routinely collected hospital data provide increasing opportunities to assess the performance of health care systems. Several factors may, however, influence performance measures and their interpretation between countries.

Objective:

We compared the occurrence of in-hospital venous thromboembolism (VTE) in patients undergoing hip replacement across 5 countries and explored factors that could explain differences across these countries.

Methods:

We performed cross-sectional studies independently in 5 countries: Canada; France; New Zealand; the state of California; and Switzerland. We first calculated the proportion of hospital inpatients with at least one deep vein thrombosis (DVT) or pulmonary embolism by using numerator codes from the corresponding Patient Safety Indicator. We then compared estimates from each country against a reference value (benchmark) that displayed the baseline risk of VTE in such patients. Finally, we explored length of stay, number of secondary diagnoses coded, and systematic use of ultrasound to detect DVT as potential factors that could explain between-country differences.

Results:

The rates of VTE were 0.16% in Canada, 1.41% in France, 0.84% in New Zealand, 0.66% in California, and 0.37% in Switzerland, while the benchmark was 0.58% (95% confidence interval, 0.35–0.81). Factors that could partially explain differences in VTE rates between countries were hospital length of stay, number of secondary diagnoses coded, and proportion of patients who received lower limb ultrasound to screen for DVT systematically before hospital discharge. An exploration of the French data showed that the systematic use of ultrasound may be associated with over detection of DVT but not pulmonary embolism.

Conclusions:

In-hospital VTE rates after arthroplasty vary widely across countries, and a combination of clinical, data-related, and health system factors explain some of the variations in VTE rates across countries.
Gaze Performance Adjustment During Needlestick Application
Authors: Sanchez Yerly Paola , Wilson-Keates Barbara , Conway Adam , Zheng Bin
Published: July 2018

Background

Novice health care students suffer more needlestick injuries (NSIs) than experts. NSIs may be prevented by learning experts' behavior during this procedure. Eye tracking offers the possibility to study both experts' and novices' eye behavior during this task.

Purpose

The aim of this study was to offer novel information about the understanding of eye behavior in human errors during handling needles.

Methods

A group of third-year nursing students performed 3 subcutaneous injections in a simulated abdominal pad while their eye behavior was recorded. Similarly, the gaze patterns of experts were recorded and then compared with the novices.

Results

Total task time for experts was faster than that for novices (P < .001), but both groups showed similar accuracy (P = .959). However, novices demonstrated gazing longer at the syringe rather than the abdominal pad compared with experts (P = .009). Finally, experts demonstrated fewer attention switches than novices (P = .002).

Conclusion

Novices demonstrated more tool-tracking eye behaviors with longer dwelling time and attentional switches than did experts, which may translate into errors in clinical performance with needles.
Cutaneous Non-Neural Granular Cell Tumors Harbor Recurrent ALK Gene Fusions
Authors: Cohen Jarish N. , Yeh Iwei , Jordan Richard C. , Wolsky Rebecca J. , Horvai Andrew E. , McCalmont Timothy H. , LeBoit Philip E.
Published: July 2018

Non-neural granular cell tumor (NNGCT; also known as primitive polypoid granular cell tumor) is a rare neoplasm composed of large ovoid cells with abundant granular cytoplasm, variable nuclear pleomorphism, and the potential for regional lymph node spread. In contrast to conventional granular cell tumor (GCT), NNGCT lacks S100 expression and can exhibit greater nuclear atypia and mitotic activity. Therefore, we investigated clinicopathologic features of 12 NNGCT, and also used next-generation sequencing to identify potential driver events in a subset of NNGCT and 6 GCT. NNGCT demonstrated mild-to-moderate nuclear pleomorphism, variable mitotic activity (0 to 10/10 high-power fields), and were S100−. Genetic analysis of 5 cutaneous NNGCT revealed gene fusions involving the anaplastic lymphoma kinase gene (ALK) in 3 cases (60%). Specifically, an interstitial deletion of chromosome 2 resulting in an in-frame fusion of dyanactin 1 (DCTN1) toALKwas identified in 2 cases, and a translocation resulting in a fusion between sequestosome 1 (SQSTM1) on chromosome 5 andALKwas identified in one case. Two of 6 GCT (33%) showed gains of chromosome 7. No other molecular or chromosomal alterations were detected in NNGCT and GCT. ALK immunohistochemistry revealed weak-to-moderate positivity in 4/9 cutaneous NNCGT (44%) including all 3 tumors withALKfusions. Three oral NNGCT lacked ALK expression. NNGCT with ALK immunostaining did not have morphologic features distinguishing them from those without ALK staining. Our results demonstrate that a subset of NNGCT harborALKfusions, suggest that NNGCT are molecularly diverse, and further substantiate NNGCT as distinct from GCT.
Acquired Cystic Disease-associated Renal Cell Carcinoma (ACKD-RCC)-like Cysts
Authors: Sun Yue , Argani Pedram , Tickoo Satish K. , Epstein Jonathan I.
Published: July 2018

Acquired cystic disease-associated renal cell carcinoma (ACKD-RCC), originally described by Tickoo and colleagues, is found exclusively in patients with end-stage renal disease. Tickoo and colleagues noted: “Many of the tumors (16 of 24 dominant tumors) appeared to arise in a cyst, most often completely filling the cystic space. The cells lining such cysts were morphologically similar to those in the rest of the tumor.” Subsequent literature lacks analysis of cysts lined by cells identical to ACKD-RCC, yet lacking areas of solid growth. The current study evaluates 16 cases ACKD-RCC-like cysts. All specimens were nephrectomies and occurred in the setting of end-stage renal disease. Of the 16 cases, 9 were in men. Patient’s ages ranged from 32 to 66 years (median: 57). The cysts ranged in size from 0.2 to 2.5 cm. Twelve cases had unilateral cysts with the remaining 4 seen in both kidneys. Nine cysts were multilocular, 6 unilocular, and 1 consisted of closely clustered cysts. The atypical cysts showed architectural variation. One cyst was lined by a single layer of atypical cells (1/16), whereas in the majority these were either focally lined by 2 to 4 cell layers of atypical cells (6/16 cases) or showed occasional short papillary formations (9/16). Calcium oxalate crystals were noted in cyst walls in 7/16 cases. A total of 12/16 cases had separate RCCs (2 cases with 2 RCCs each; 1 case with 3). Carcinoma ranged in size from 3 mm to 5 cm in the largest dimension: 4 were pT1 ACKD-RCC; 5 were pT1 papillary RCC; 5 were pT1 clear cell papillary RCC; 1 was pT3 clear cell RCC; and 1 pT1 unclassified. Our study formally analyzes for the first time in the literature atypical cysts lined with vacuolated cells with eosinophilic cytoplasm that are likely the earliest precursors of ACKD-RCC. When these cysts are encountered, especially ones that are multilocular or clustered, they may be misdiagnosed as ACKD-RCC. ACKD-RCC-like cysts should be recognized as a distinct entity from ACKD-RCC, defined by the lack of any solid nodular growth within the cyst.
Outcomes of Corticosteroid Treatment for Trigger Finger by Stage
Authors: Shultz Kevin J. , Kittinger Janae L. , Czerwinski Wendy L. , Weber Robert A.
Published: July 2018

Background:

Although steroid injection remains a common first-line treatment of trigger finger, clinical experience suggests that not all cases of trigger finger respond the same. The purpose of this study was to use a classification system for trigger finger that is simple and reproducible, and produces clearly definable, clinically relevant cutoff points to determine whether responsiveness to steroid injection correlates to clinical staging.

Methods:

The authors conducted a prospectively collected longitudinal study of trigger finger patients separated into four stages of severity. Each subject received a single injection of 6 mg of dexamethasone acetate. One-month outcomes were analyzed to evaluate the efficacy of steroid injection. These outcomes were further stratified based on baseline characteristics and stage of triggering.

Results:

A total of 99 digits and 69 subjects were included. Two variables were found to be significant in predicting response to initial injection: (1) multiple affected digits and (2) stage severity. Patients with multiple involved fingers were 5.8 times more likely to have no resolution of symptoms compared with those with a single affected finger. For every level of stage increase, the odds doubled for having no resolution of symptoms.

Conclusions:

Steroid injection remains a viable first-line option for patients presenting with mild triggering (stage 1 and 2). For more severe triggering (stage 3 and 4) or multiple affected digits, the success of steroid injection is significantly lower at 1 month. For the latter patients, surgery may be a more reasonable initial treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Aesthetic Comparison of Two Different Types of Web-Space Reconstruction for Finger Syndactyly
Authors: Yuan Frank , Zhong Lin , Chung Kevin C.
Published: July 2018

Background:

Syndactyly reconstruction incorporates techniques of applying skin grafts or dorsal advancement flaps without the use of skin grafts. Comparative outcome studies of these two approaches are lacking. The authors’ study compares the long-term aesthetic outcomes of these two flap techniques.

Methods:

Forty-five patients were included in the authors’ study. The methods of reconstruction used were a dorsally based rectangular flap with skin graft from the groin and a dorsal pentagonal advancement flap without skin grafting. Eighteen independent raters completed a visual analogue scale and a unique classification scale to subjectively assess aesthetic outcomes. The authors used univariate analyses to determine which variables significantly influenced the outcome score. The authors then used multivariable regression models to compare the two flap types.

Results:

Dorsally based rectangular flaps with skin graft had statistically significantly better visual analogue scale scores and greater odds of receiving an “excellent” rating compared with dorsal pentagonal advancement flaps.

Conclusions:

Despite the use of skin grafting, with its associated donor-site morbidity, dorsal rectangular flaps may offer better overall aesthetic outcomes for patients. Future comparative studies should incorporate functional and patient-reported outcomes to better assess the optimal reconstruction type.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
A Global Research Agenda for Pediatric HIV
Authors: Penazzato Martina , Irvine Cadi , Vicari Marissa , Essajee Shaffiq M. , Sharma Aditi , Puthanakit Thanyawee , Abrams Elaine J. , Doherty Meg
Published: July 2018

Background:

Despite progress, 2016 still saw 160,000 new infections and 120,000 AIDS-related deaths among children. Evidence gaps on how to best diagnose, treat, and deliver services to children living with HIV remain. A global research prioritization exercise was undertaken by WHO and CIPHER to focus research efforts in the context of diminishing resources.

Methods:

The Child Health and Nutrition Research Initiative methodology was adapted and used, as described by Irvine et al.
1
Outcomes were reviewed by an expert group and 5 priority themes identified for testing, antiretroviral treatment, and service delivery, accounting for existing policies, published literature and ongoing research.

Results:

A total of 749 questions were submitted by 269 individuals from 62 countries. For HIV testing, priority themes included strategies and interventions to improve access, uptake and linkage to care, including with novel diagnostic tools and entry points beyond antenatal care. For treatment, priorities included strategies to improve adherence, short- and long-term outcomes and management of coinfections, optimal drug formulations, and early ART. For service delivery, priorities included strategies or interventions to improve access, uptake and retention in care, including psychosocial and family support and approaches to HIV disclosure and reduction of stigma and discrimination.

Conclusions:

This is the largest Child Health and Nutrition Research Initiative exercise undertaken in HIV. The results provide guidance to focus future research in pediatric HIV for impact. Global commitment to support priority research, adequate investment, and strong leadership is urgently needed to improve the health and well-being of children living with and affected by HIV.
A Global Research Agenda for Adolescents Living With HIV
Authors: Armstrong Alice , Nagata Jason M. , Vicari Marissa , Irvine Cadi , Cluver Lucie , Sohn Annette H. , Ferguson Jane , Caswell Georgina , Njenga Lucy Wanjiku , Oliveras Carlo , Ross David , Puthanakit Thanyawee , Baggaley Rachel , Penazzato Martina
Published: July 2018

Background:

Despite growing interest in undertaking research in adolescent HIV, the current pace of interventional research in particular remains very low compared with the needs of adolescents living with HIV (ALHIV). More robust evidence is needed to inform innovative and targeted interventions that bridge research gaps, inform policy, and improve outcomes for adolescents. A global research prioritization exercise was undertaken by WHO and CIPHER to focus efforts on priority research in the context of diminishing resources.

Methods:

The Child Health and Nutrition Research Initiative (CHNRI) methodology was adapted and used. Outcomes were reviewed by an expert group and 5 priority themes identified for testing, treatment, and service delivery, accounting for existing policies, published literature, and ongoing research.

Results:

A total of 986 research questions were submitted by 323 individuals from 67 countries. For HIV testing, priority themes included strategies and interventions to improve access, uptake, and linkage to care, and self-testing, particularly for key populations. For treatment, priorities included strategies to monitor and improve adherence, novel drug delivery systems, preventions and management of coinfections, optimal drug sequencing, and short- and long-term outcomes. For service delivery, priorities included service delivery models across the cascade, strategies to improve retention in care and sexual and reproductive health, support for pregnant ALHIV, and the provision of psychosocial support.

Conclusions:

This prioritized research agenda assists in focusing future research in ALHIV and will help to fill critical knowledge gaps. Key stakeholders, donors, program managers, and researchers should all support these priority questions and themes to collaboratively drive the adolescent HIV research agenda forward.
Using Observational Data to Inform HIV Policy Change for Children and Youth
Authors: Sohn Annette H. , Judd Ali , Mofenson Lynne , Vicari Marisa , Jerene Degu , Leroy Valeriane , Bekker Linda-Gail , Davies Mary-Ann
Published: July 2018

Observational data characterizing the pediatric and adolescent HIV epidemics in real-world settings are critical to informing clinical guidelines, governmental HIV programs, and donor prioritization. Global expertise in curating and analyzing these data has been expanding, with increasingly robust collaborations and the identification of gaps in existing surveillance capacity. In this commentary, we describe existing sources of observational data for children and youth living with HIV, focusing on larger regional and global research cohorts, and targeted surveillance studies and programs. Observational data are valuable resources to cross-validate other research and to monitor the impact of changing HIV program policies. Observational studies were among the first to highlight the growing population of children surviving perinatal HIV and transitioning to adolescence and young adulthood, and have raised serious concerns about high rates of treatment failure, loss to follow-up, and death among older perinatally infected youth. The use of observational data to inform modeling of the current global epidemic, predict future patterns of the youth cascade, and facilitate antiretroviral forecasting are critical priorities and key end products of observational HIV research. Greater investments into data infrastructure are needed at the local level to improve data quality and at the global level to faciliate reliable interpretation of the evolving patterns of the pediatric and youth epidemics. Although this includes harmonized data forms, use of unique patient identifiers to allow for data linkages across routine data sets and electronic medical record systems, and competent data managers and analysts are essential to make optimal use of the data collected.
Nothing About Us Without RIGHTS—Meaningful Engagement of Children and Youth: From Research Prioritization to Clinical Trials, Implementation Science, and Policy
Authors: Oliveras Carlo , Cluver Lucie , Bernays Sarah , Armstrong Alice
Published: July 2018

This article presents a new agenda for the meaningful engagement of youth in guiding research and policy. It has been codeveloped with youth, adolescents, and children who are living with and affected by HIV. We set out 6 basic requirements (we call them RIGHTS) that hold across clinical trials, observational studies, implementation science, service delivery, and policy development. These requirements are based on a literature review and in-depth consultations with children, adolescents, and youth, which have taken place over a decade in the HIV/AIDS epidemic. Youth engagement must be adequately Resourced with time, training, technical support, and funds. It must be Impactful, with youth informed of how their inputs have been directly used in research, policy, and programming. It must be Genuine, with youth understanding the intentions of the project and choosing to take part. It is essential that we ensure that participation is Harmless, and that it is responsive to the emotional and mental health needs of youth. Processes of participation should be Teen friendly, designed to be enjoyable and relevant to youth priorities. Finally, regarding Skills building, participation should allow for the competencies and skills developed to be recognized in youth education and career experience (without advertising the HIV aspect if this is inappropriate for young people). We propose that these 6 basic requirements be endorsed by all research organizations, and that they become a core component of research in the HIV response.
Experience With the Use of Rituximab for the Treatment of Rheumatoid Arthritis in a Tertiary Hospital in Spain
Authors: Cañamares Iciar , Merino Leticia , López Jorge , Llorente Irene , García-Vadillo Alberto , Ramirez Esther , López-Bote Juan Pedro , Benedí Juana , Muñoz-Calleja Cecilia , Álvaro-Gracia José M. , Castañeda Santos , González-Álvaro Isidoro
Published: July 2018

Background/Objective

There is evidence supporting that there are no relevant clinical differences between dosing rituximab 1000 mg or 2000 mg per cycle in rheumatoid arthritis (RA) patients in clinical trials, and low-dose cycles seem to have a better safety profile. Our objective was to describe the pattern of use of rituximab in real-life practice conditions.

Methods

Rituximab for RA in clinical practice (RITAR) study is a retrospective cohort study from 2005 to 2015. Eligibility criteria were RA adults treated with rituximab for active articular disease. Response duration was the main outcome defined as months elapsed from the date of rituximab first infusion to the date of flare. A multivariable analysis was performed to determine the variables associated with response duration.

Results

A total of 114 patients and 409 cycles were described, 93.0% seropositive and 80.7% women. Rituximab was mainly used as second-line biological therapy. On demand retreatment was used in 94.6% of cases versus fixed 6 months retreatment in 5.4%. Median response duration to on demand rituximab cycles was 10 months (interquartile range, 7–13). Multivariable analysis showed that age older than 65 years, number of rituximab cycles, seropositivity, and first- or second-line therapy were associated with longer response duration. The dose administered at each cycle was not significantly associated with response duration.

Conclusions

Our experience suggests that 1000 mg rituximab single infusion on demand is a reasonable schedule for long-term treatment of those patients with good response after the first cycles, especially in seropositive patients and when it is applied as a first- or second-line biological therapy.
Phenytoin Could Potentially Increase Hepatic Clearance of 99mTc-Sestamibi in Myocardial Perfusion Imaging
Authors: Kavanal Anwin Joseph , Singh Deepa , Sood Ashwani , Parmar Madan , Mittal Bhagwant Rai
Published: July 2018

Myocardial perfusion imaging (MPI) is one of the most commonly used nuclear medicine imaging modalities for coronary artery disease evaluation and risk stratification. The authors present incidental image findings in a patient who underwent MPI twice because of development of seizures just before the first SPECT-MPI acquisition. The projection images for first MPI done without medication (phenytoin) showed the retention of hepatic tracer activity. After a few days from restarting of phenytoin, the repeat MPI showed complete hepatic clearance of tracer. This case highlights the possible pharmacokinetic interaction between phenytoin intake and 99mTc-sestamibi, resulting in faster hepatic clearance of the radiotracer.
Utility of Timed Up and Go in Outpatient Cardiology Clinics
Authors: Albarrati Ali , Nazer Rakan
Published: July 2018

Purpose

The aim of the study was to examine if the Timed Up and Go (TUG) Test would be a feasible, reproducible, and valid measure in patients post-coronary artery bypass grafting (CABG).

Design

Cross-sectional study, controls and patients post-CABG, outpatient clinic.

Methods

Participants performed the TUG Test and the 6-Minute Walking Distance (6MWD) Test. Reliability was measured within observer on two occasions.

Findings

Patients and controls were similar in age. The patients had greater TUG mean (SD) of 14.4 seconds (4.9 seconds) and lower 6MWD of 358 m (76 m) compared with TUG of 8.2 seconds (2.7 seconds) and 6MWD of 487 m (56 m) in controls. In patients, intraclass correlation for the TUG was .98 (95% CI [.96, .98]) between the measurements. In patients, there was a high correlation between the TUG Test and the 6MWD Test, r = −.70, p < .001.

Conclusion

The TUG Test demonstrated to be a feasible, reproducible, and valid measure in patients post-CABG.

Clinical Relevance

The TUG Test could serve as a screening tool for physical performance in clinics.
Recurrent or De Novo Allograft Steatosis and Long-term Outcomes After Liver Transplantation
Authors: Narayanan Praveena , Mara Kristin , Izzy Manhal , Dierkhising Ross , Heimbach Julie , Allen Alina M. , Watt Kymberly D.
Published: July 2018

Background

Hepatic steatosis is strongly associated with cardiovascular disease in the general population. Whether recurrent or de novo, it can occur in the allograft, but the impact on survival and long-term clinical outcomes remains unclear. In this study, we aim to determine both the frequency and impact of allograft steatosis on long-term posttransplant outcomes.

Methods

A retrospective review of 588 adult liver transplant (LT) recipients (1999-2006) was performed. Cox regression analysis (time-dependent) was used to evaluate differences in time to steatosis post-LT, patient survival, and cardiovascular outcomes.

Results

Mean age 51.9 ± 10.6 years, 64.6% males, underlying nonalcoholic steatohepatitis (NASH) (9.4%), previous tobacco (52%), pre-LT diabetes mellitus (30.3%), pre-LT hypertension (23.2%), and known cardiovascular disease (9.7%). Overall, 254 recipients developed allograft steatosis (at 10 years: 77.6% NASH recipients, 44.7% Non-NASH recipients). Risk factors for allograft steatosis were female sex (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.09-2.00; P = 0.014), hepatitis C virus diagnosis (HR, 2.49; 95% CI, 1.77-3.94; P < 0.001), and time-dependent BMI (per unit: HR, 1.08; 95% CI, 1.05-1.10; P < 0.001). Allograft steatosis was not associated with post-LT survival (P = 0.25) nor cardiovascular events (HR, 1.08; 95% CI, 0.73-1.59; P = 0.70). Underlying NASH associated with cardiovascular events (HR, 2.04; 95% CI, 1.37-3.04; P < 0.001).

Conclusions

Allograft steatosis is common but not associated with survival or cardiovascular events in this study. Larger prospective studies are needed to better define the natural history of allograft steatosis.
Deciphering the Contribution of γδ T Cells to Outcomes in Transplantation
Authors: McCallion Oliver , Hester Joanna , Issa Fadi
Published: July 2018

γδ T cells are a subpopulation of lymphocytes expressing heterodimeric T-cell receptors composed of γ and δ chains. They are morphologically and functionally heterogeneous, innate yet also adaptive in behavior, and exhibit diverse activities spanning immunosurveillance, immunomodulation, and direct cytotoxicity. The specific responses of γδ T cells to allografts are yet to be fully elucidated with evidence of both detrimental and tolerogenic roles in different settings. Here we present an overview of γδ T-cell literature, consider ways in which their functional heterogeneity contributes to the outcomes after transplantation, and reflect on methods to harness their beneficial properties.
Viral Respiratory Tract Infection During the First Postoperative Year Is a Risk Factor for Chronic Rejection After Lung Transplantation
Authors: Magnusson Jesper , Westin Johan , Andersson Lars-Magnus , Lindh Magnus , Brittain-Long Robin , Nordén Rickard , Riise Gerdt C.
Published: July 2018

Background

Chronic lung allograft dysfunction (CLAD) is the major limiting factor for long-term survival in lung transplant recipients. Viral respiratory tract infection (VRTI) has been previously associated with CLAD development. The main purpose of this study was to evaluate the long-term effects of VRTI during the first year after lung transplantation in relation to CLAD development.

Method

Ninety-eight patients undergoing lung transplantation were prospectively enrolled between 2009 and 2012. They were monitored for infections with predefined intervals and on extra visits during the first year, the total follow-up period ranged between 5 and 8 years. Nasopharyngeal swab and bronchoalveolar lavage samples were analyzed using a multiplex polymerase chain reaction panel for respiratory pathogens. Data regarding clinical characteristics and infectious events were recorded.

Results

Viral respiratory tract infection during the first year was identified as a risk factor for long-term CLAD development (P = 0.041, hazard ratio 1.94 [1.03-3.66]) in a time-dependent multivariate Cox regression analysis. We also found that coronavirus in particular was associated with increased risk for CLAD development. Other identified risk factors were acute rejection and cyclosporine treatment.

Conclusions

This study suggests that VRTI during the first year after lung transplantation is associated with long-term CLAD development and that coronavirus infections in particular might be a risk factor.