bluuebunny/crossref_metadata_2025 huggingface dataset:
Methodologic Validation of a Faster Pelvic Floor Test: Two Randomized Studies in Anal Acoustic Reflectometry
Authors: Nicholson James E. , Klarskov Niels , Heywood Nick A. , Sharma Abhiram , Kiff Edward S. , Telford Karen J.
Published: November 2018

BACKGROUND:

Anal acoustic reflectometry investigates the opening and closing function of the anal canal using reflected sound waves to measure a cross-sectional area at different pressures. Anal acoustic reflectometry is reliable and repeatable, distinguishes between continence and incontinence and between subgroups of incontinence, correlates with symptom severity, and does not distort the anal canal during investigation.

OBJECTIVE:

The purpose of this study was to validate anal acoustic reflectometry methodology by asking 2 questions: can anal acoustic reflectometry be used alongside manometry (order study) and can anal acoustic reflectometry be performed faster (filling study). The secondary aim was to assess the response of the anal canal to stretch using anal acoustic reflectometry.

DESIGN:

This research included 2 prospective randomized studies.

SETTINGS:

The study was conducted at a tertiary referral center.

PATIENTS:

Patients undergoing investigation for fecal incontinence were included.

INTERVENTION:

For the order study, patients were prospectively randomized to anal acoustic reflectometry, manometry, 2-minute rest and then manometry, anal acoustic reflectometry, or vice versa. For the filling study, patients were prospectively randomized to fast rate anal acoustic reflectometry (5 cm H2O/1 s), manometry, 2-minute rest and then manometry, normal rate anal acoustic reflectometry (5 cm H2O/3 s), or vice versa.

MAIN OUTCOME MEASURES:

The primary outcome was no difference in anal acoustic reflectometry or manometry variables. Demographic and clinical data were recorded.

RESULTS:

The order study included 30 patients with a median age of 63 years (range, 30–84 y); 77% were women. No difference was found among all of the variables of anal acoustic reflectometry and manometry regardless of which test was performed first. The filling study included 50 patients with a median age of 62 years (range, 30–78 y); 80% were women. No difference was found between fast and normal rates of anal acoustic reflectometry and manometry in any order.

LIMITATIONS:

This study was limited by its comparison with water-perfused manometry.

CONCLUSIONS:

Anal acoustic reflectometry and manometry can be performed at the normal or fast rate of anal acoustic reflectometry in any order. A fast rate of anal acoustic reflectometry did not augment the response of the anal canal to stretch as measured by anal acoustic reflectometry and manometry. This study validates a faster anal acoustic reflectometry technique and vindicates previous data. See Video Abstract at http://links.lww.com/DCR/A821.
Free Flap Transfer with Arteriovenous Loop Establishment for Upper Limb Salvage in a Crush Injury
Authors: Radwan Mohammad S. , Barakat Ammar Z. , Jaber Mohammad M. , Mashal Ashraf A.
Published: November 2018

Constructing arteriovenous (AV) loops saves a crushed limb when healthy recipient vessels are unavailable at the site of injury by supporting a transferred free flap. Literature about using AV loops in the upper limb defect is scarce. We present a case with a devastating upper limb crush injury that was successfully managed with fibula flap transfer preceded by AV loop construction. A 38-year-old woman was admitted to our hospital with severe crushing trauma to her right forearm and hand. There was significant skin loss with injuries to blood vessels and tendons. She underwent multiple staged operations beginning with repair of the ulnar artery, debridement of necrotic tissue, and placement of 2 K-wires to stabilize the bones. Thereafter, a long saphenous AV loop was constructed between the brachial artery and the basilic vein. Finally, transfer of the fibula flap to the forearm. We used the staged procedure to provide adequate time for the AV loop maturation and adaptation. At around the patient’s 7-month follow-up visit, her forearm and hand were stable, no complications related to the AV loop or the transferred fibula flap were noted. Utilizing AV loops to support transferred free flaps upper limb defects showed a promising successful outcome.
Outbreak of Yersiniabactin-producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit
Authors: Wisgrill Lukas , Lepuschitz Sarah , Blaschitz Marion , Rittenschober-Böhm Judith , Diab-El Schahawi Magda , Schubert Sören , Indra Alexander , Berger Angelika
Published: November 2018

Background:

The Gram-negative bacterium Klebsiella pneumoniae is a frequent pathogen causing outbreaks in neonatal intensive care units. Some Enterobacteriaceae can acquire the ability to sequester iron from infected tissue by secretion of iron-chelating compounds such as yersiniabactin. Here we describe an outbreak and clinical management of infections because of a highly virulent yersiniabactin-producing, nonmultiresistant K. pneumoniae strain in a neonatal intensive care unit. Outbreak investigation and effectiveness assessment of multidisciplinary infection control measurements to prevent patient-to-patient transmission of highly pathogenic K. pneumoniae were undertaken.

Methods:

Outbreak cases were identified by isolation of K. pneumoniae from blood or stool of infants. Clinical data were abstracted from medical charts. K. pneumoniae isolates were genotyped using whole genome sequencing, and yersiniabactin production was evaluated by luciferase assay.

Results:

Fourteen cases were confirmed with 8 symptomatic and 6 colonized patients. Symptomatic patients were infants of extremely low gestational and chronologic age with fulminant clinical courses including necrotizing enterocolitis and sepsis. Whole genome sequencing for bacterial isolates confirmed the presence of an outbreak. All outbreak isolates produced yersiniabactin.

Conclusions:

Yersiniabactin-producing K. pneumoniae can display a high pathogenicity in extremely premature infants with low chronologic age. This outbreak also underlines the considerable potential of today’s infection control systems for recognizing and controlling nosocomial infections in highly vulnerable populations.
Integrating Connection
Authors: Walbam Katherine M.
Published: November 2018

Attachment is considered a fundamental aspect of social and emotional development in children. Attachment is established, in part, through sensory processes, yet many children have unique sensory needs. The present study explores the association between sensory processing disorder and attachment by examining primary caregivers' perception of the attachment relationship with their children with SPD. Following a mixed-methods design, 24 self-identified primary caregivers completed 3 questionnaires: a demographic profile, a sensory processing profile, and an attachment-related questionnaire. Of those 24, 12 also completed a semistructured interview. The findings of this study suggest that a correlation exists between sensory processing and attachment measurement scores and specifically with 3 subscales of sensory processing: tactile sensitivity, auditory filtering, and responsiveness to stimuli. This correlation, however, appears to exist despite the fact that none of the children met the full criteria for insecure attachment, according to the attachment measure.
Treatment With Intravenous Alteplase for Acute Ischemic Stroke After Reversal of Dabigatran With Idarucizumab: A Case Study
Authors: Jala Sheila , O’Brien Elizabeth
Published: November 2018

Treatment options for anticoagulated patients presenting with ischemic stroke are limited. Off-label use of idarucizumab to rapidly reverse the anticoagulant effect of dabigatran may ensure eligibility for thrombolytic therapy with alteplase. This case describes a 77-year-old white male who presented to the hospital 89 minutes after sudden onset of right-sided hemiparesis, dysarthria, and facial palsy. Significant history included atrial fibrillation and previous right-sided cortical stroke. Medication reconciliation revealed he was taking dabigatran 150 mg twice a day, with the last dose being 179 minutes before presentation. Neuroimaging revealed no new infarct or hemorrhage, and 60 minutes after arrival, a decision was made to give idarucizumab to reverse the anticoagulant effect of dabigatran. In the absence of any contraindication, he was then treated with intravenous alteplase and idarucizumab. No adverse outcomes were noted, and at discharge, his new stroke symptoms were completely resolved.
Anti-Inflammatory Effect of Surfactant Lipid in the Vaginal Mucosa: A Pilot Study
Authors: MacNeill Colin , de Guzman Glendell S. , Lupo Kate , Umstead Todd , Phelps David S. , Floros Joanna
Published: November 2018

Objective

The aim of the study was to test the hypothesis that vaginal administration of surfactant lipids, which may counter-balance the proinflammatory effects of vaginal surfactant protein A, will decrease proinflammatory cytokines and increase anti-inflammatory cytokines in vaginal mucosal fluid in healthy women.

Materials and Methods

Three groups of healthy cycling women were randomized to receive vaginally a single dose of the following: (1) low-dose calfactant, a type of surfactant lipids, 0.8 mg/ml; (2) high-dose calfactant 8.0 mg/ml; or (3) placebo, at the time of resolution of menses. Vaginal mucosal fluid was collected before administration and also 1 and 8 days after administration of each treatment. After 1 mo, each group was randomized to each alternative treatment; thus, for a 3-month treatment period, each group received each of the 3 treatments. Vaginal fluid was tested using a Multiplex Immunoassay System. Cytokine concentrations on day 1 and day 8 were compared with day zero and tested for significance with the Student's t test.

Results

Six healthy subjects completed each treatment. Subjects given high-dose calfactant had, by day 8, a significant reduction in macrophage chemotactic protein-1 and interleukin 15 (IL-15) compared with low-dose calfactant or placebo. High-dose calfactant resulted in an increase in anti-inflammatory cytokines that trended toward significance on day 1 (IL-1RA) or day 8 (IL-10).

Conclusions

This pilot study in healthy women demonstrates that calfactant reduces proinflammatory cytokines and increases anti-inflammatory cytokines in the vagina. We propose that calfactant may be an effective vaginal anti-inflammatory therapy for inflammatory vaginitis and similar disorders for which current therapy is ineffective.
Therapeutic effectiveness of neuromuscular electrical stimulation for treating patients with chronic low back pain
Authors: Guo Peng , Wang Jian-wei , Tong An
Published: November 2018

This retrospective study investigated the effectiveness and safety of neuromuscular electrical stimulation (NMES) for patients with chronic low back pain (CLBP).

A total of 72 patients with CLBP were included in this retrospective study. All patients received usual care, and were assigned to a NMES group (n = 36) and a control group (n = 36). In addition, patients in the NMES group also received NMES for a total of 4 weeks. The primary outcome was pain intensity, measured by numerical rating scale (NRS). The secondary outcome was disability, assessed by the Roland–Morris Disability Questionnaire (RMDQ), and the Quebec Back Pain Disability Scale (QBPDS). The outcomes were evaluated before and after 4-week treatment.

After 4-week treatment, the patients in the NMES group did not show better effectiveness in pain intensity relief, as measured by NRS (P = .11); and disability improvement, as evaluated by the RMDQ (P = .14), and QBPDS (P = .33), when compared with the patients in the control group. Additionally, no adverse events related to the NNES were recorded.

The results of this study did not show promising effectiveness of NMES for patients with CLBP after 4-week treatment.
Extensive traumatic axonal injury of brain due to violence
Authors: Jang Sung Ho , Kim Seong Ho , Kwon Young Hyeon
Published: November 2018

Rationale:

Many studies using diffusion tensor imaging (DTI) have demonstrated traumatic axonal injury (TAI) in patients whose conventional brain magnetic resonance imaging (MRI) results are negative following head trauma. Injury mechanism for TAI in these patients has been mainly associated with motor vehicle accident, whereas very little is known about TAI by violence.

Patient concerns:

A 42-year-old male patient presented after experiencing head trauma due to violence. His face was hit several times by 2 men, and 1 of the men kicked the right side of the patient's head, after which the patient's left parietal area hit the ground while falling. After the head trauma, he felt mild motor weakness of the left upper and lower extremities and had mild articulation difficulty, cognitive dysfunction including memory impairment, and excessive daytime sleepiness.

Diagnoses:

The patient was diagnosed as TAI.

Interventions:

Clinical assessments and DTI were performed at 10 days after the head trauma.

Outcomes:

He showed mild left hemiparesis (5/4), mild dysarthria, mild cognitive abnormality (Clinical Dementia Rating: 0.5) and mild abnormality on the Epworth Sleepiness Scale (score: 12; cut-off score: 10, maximum score: 24). DTI showed the following configurational abnormalities: right corticospinal tract narrowing, left corticobulbar tract narrowing, discontinuations in the anterior portion of both cingula, discontinuation of the left fornical crus, non-reconstruction of the right dorsolateral prefronto-thalamic tract, and narrowing in both lower ventral ascending reticular activating systems.

Lessons:

Extensive TAI of various neural tracts was demonstrated by performing DTI of a patient with head trauma due to violence. Analysis of the neural tracts via DTI can be useful in detection of TAI in patients who show various neurological features following head trauma due to violence.
A case report on middle cerebral artery aneurysm treated by rapid ventricular pacing
Authors: Ping Yi , Gu Huahua
Published: November 2018

Rationale:

Cerebral aneurysm is a common cause of intracranial hemorrhage, stroke, and death. It is treated with vascular surgeries, such as coil embolism and artery clipping. However, surgery itself is a risk factor that may cause rupture of aneurysm, and leads to irreversible brain damage, and even death. Rapid ventricular pacing (RVP) is a procedure that temporarily lowers blood pressure by increasing heart rate and reducing ventricular filling time. RVP has been widely used to reduce blood vessel tension in many cardiovascular surgeries.

Patient concerns:

A 46-year-old man came to our hospital with intermittent right-side headache for 5 years, and left lower limb numbness for 3 months.

Diagnoses:

Magnetic resonance imaging (MRI) of the head and digital subtraction angiography confirmed the diagnosis of right middle cerebral artery (MCA) aneurysm.

Interventions:

Considering the large size of this MCA aneurysm, RVP was used to reduce blood pressure during MCA aneurysm repair, and to lower the risk of intracranial hemorrhage during procedure.

Outcomes:

Post procedure, there was no abnormality detected. Seven weeks after surgery, the patient's muscle tone of right side extremities were grade V and left side extremities were grade IV. Computed tomography angiography confirmed no MCA aneurysm.

Lessons:

In cases of aneurysm rupture, RVP will induce a transient “very low pressure” condition, and give a valuable time frame to clip the ruptured aneurysm. Therefore RVP is a safe and effective method to provide transient reduction of cardiac output in intracranial aneurysm patients.
Follow-up outcomes of chronic obstructive pulmonary disease patients who underwent dilatation and curettage with the Karakoca resector balloon
Authors: Karakoca Yalcin , Gogus Guler , Akduman Seha , Erturk Baykal
Published: November 2018

We previously reported satisfactory results with the Karakoca resector balloon in 10 patients with stage IV chronic obstructive pulmonary disease (COPD) who did not respond to medical treatment. In this article, we present the outcomes of the Karakoca resector balloon dilatation and curettage technique in a larger case series (n = 188).

A total of 188 COPD patients [mean age (SD): 69.2 (8.0) years; 46 females] classified as stage III to IV by the Global Initiative for Obstructive Lung Disease criteria underwent balloon desobstruction for segmental and subsegmental bronchi by therapeutic bronchoscopy. None of the patients could have achieved symptom relief even under high-dose inhaled bronchodilators and corticosteroids, oral corticosteroids, or oxygen and noninvasive mechanical ventilation therapy before the intervention. Forced expiratory volume in 1 s (FEV1) and oxygen saturation (SpO2) were measured, and modified Borg dyspnea scale (MBS) scores were determined before and 1 week and 1 month after the intervention.

All patients were active smokers and 80% had concomitant chronic diseases. After the intervention, there was a notable reduction in the oxygen need of the patients. Comparison of lung function tests 1 week after the procedure with results before the procedure showed significant improvements in FEV1, MBS, and SpO2 levels (P < 0.001 for each), and the improvements were maintained for the entire postprocedural month (P < 0.001 for each). Except for 4 males, all patients were free of symptoms.

These results confirmed our early observations that balloon dilatation and curettage is a safe and successful technique for medical treatment-resistant COPD.
Clinical effects of transforaminal and interlaminar percutaneous endoscopic discectomy for lumbar disc herniation
Authors: Jiang Xijia , Zhou Xindie , Xu Nanwei
Published: November 2018

The aim of this study is to observe the therapeutic effect of percutaneous endoscopic discectomy and its influencing factors for lumbar disc herniation and compare the advantages and disadvantages of transforaminal and interlaminar of percutaneous endoscopy.

Data from 143 patients with lumbar disc herniation were respectively collected, including demographic and clinical data. Study population were divided into curative effect group and poor curative effect group, and logistic regression was used to explore the influencing factors of curative effect. The operation data and pre-and post-operation scores were compared to explore the effect of transforaminal and interlaminar approach on surgery efficacy.

The rate of curative effect was 93.7%. 120 patients were classified as curative group and 23 patients were categorized as poor effective group. Univariate analysis found that the patients in the curative effect group tended to receive the interlaminar approach (58.3% vs 34.8%, P = .038). Multivariate logistic regression did not find operation approach was not related to curative effect of operation (transforaminal and interlaminar). But age ≥45 (odd risk (OR) = 6.43, P = .016), course of disease >12 month (OR = 3.77, P = .003), back and leg pain (OR = 3.46, P = .026), history of trauma (OR = 3.88, P = .014), Pfirrmann level IV (OR = 4.84, P = .004), and pre-Visual Analogue Scale (VAS) <5.3 (OR = 3.63, P = .015) were associated with operation efficacy. Compared with transforaminal group, the interlaminar group has less operative time (P = .000), less fluoroscopy time (P = .000), less puncture time (P = .000), less blood loss (P = .011).

The transforaminal or interlaminar did not affect the treatment efficacy of percutaneous endoscopic discectomy for lumbar disc herniation. The selection of surgery approach depended on anatomical structure and physiological characteristics. It should be noted that 45 years of age or older, in the course of more than 12 months, both lumbocrural pain and lumbar disc herniation with grade IV, with history of trauma, may have impact on the efficacy of surgery.
Five-year outcomes and predictive factors of transforaminal full-endoscopic lumbar discectomy
Authors: Ahn Yong , Lee Uhn , Kim Woo-Kyung , Keum Han Joong
Published: November 2018

Although several studies have reported the effectiveness of transforaminal full-endoscopic lumbar discectomy (TELD), no cohort study on the long-term outcomes of TELD has been conducted. Thus, this study aimed to evaluate the long-term clinical outcomes of TELD and to determine the factors predicting favorable outcome.

Five-year longitudinal data of 204 consecutive patients who underwent TELD were collected. Outcomes were assessed using the visual analog scale (VAS) pain score, Oswestry disability index (ODI), patient satisfaction rating, and the modified Macnab criteria.

The mean VAS score for leg pain improved from 7.64 at the baseline to 1.71, 0.81, 0.90, and 0.99 at postoperative 6 weeks, 1 year, 2 years, and 5 years, respectively (P <.001). The mean ODI improved from 67.2% at the baseline to 15.7%, 8.5%, 9.4%, and 10.1% at postoperative 6 weeks, 1 year, 2 years, and 5 years, respectively (P <.001). The overall patient satisfaction rate was 94.1%. Based on the modified Macnab criteria, 83.8% of patients had excellent or good results. In this study, younger patients with intracanal disc herniation tended to have better outcomes than elderly patients with foraminal/far-lateral disc herniation (P <.05).

Transforaminal endoscopic lumbar discectomy offers favorable long-term outcomes with minimal tissue damage. Postoperative pain and functional status may change over time. Proper patient selection remains essential for the success of this minimally invasive procedure.
Risk factors associated with clinical adjacent segment pathology following multi-level cervical fusion surgery
Authors: Kong Lingde , Sun Changjun , Kou Ningzhao , Bai Jiangbo , Zhang Jingtao , Lu Jian , Tian Dehu
Published: November 2018

Few clinical studies investigate risk factors associated with clinical adjacent segment pathology (CASP) following multi-level cervical fusion surgery. The aim is to record the incidence of postoperative CASP in patients after at least 2 years′ follow-up and to identify possible risk factors that may be associated with the CASP after multi-level cervical surgery.

We retrospectively reviewed patients who underwent multi-level cervical surgery in our hospital from January 2004 to February 2016. All patients underwent more than 2 years′ follow-up. The diagnosis of CASP is according to clinical symptoms as well as image findings. Potential risk factors were collected from demographic data and radiographic images.

A total of 301 patients after multi-level cervical surgery were analyzed. During follow-up, 28 patients (9.3%) were diagnosed as having CASP. Among these patients, 7 showed symptoms of CASP within 3 years after surgery, 6 showed symptoms between 3 and 5 years, 14 showed symptoms between 5 and 10 years, and the last one showed symptoms more than 10 years later. In the multivariate analysis, degeneration of adjacent segment (OR, 1.592; 95% CI, 1.113–2.277), decreased Cobb angle in fused vertebrae (OR, 2.113; 95% CI, 1.338–3.334) and decreased Cobb angle in cervical spine (OR, 1.896; 95% CI, 1.246–2.886) were correlated with the incidence of CASP during follow-up.

The incidence of CASP following multi-level cervical surgery was 9.3% with a mean of about 70 months′ follow-up. Patients with preoperative degeneration of adjacent segment and postoperative imbalance of sagittal alignment have a higher risk of developing CASP after multi-level cervical surgery.
Big City Health Officials' Conceptualizations of Health Equity
Authors: Henson Rosie Mae , McGinty Meghan , Juliano Chrissie , Purtle Jonathan
Published: November 2018

Context:

Senior health officials of local health departments are uniquely positioned to provide transformational leadership on health disparities and inequities.

Objective:

This study aimed to understand how senior health officials in large US cities define health equity and its relationship with disparities and characterize these senior health officials' perceptions of using health equity and disparity language in local public health practice.

Design:

In 2016, we used a general inductive qualitative design and conducted 23 semistructured interviews with leaders of large local health departments. Thematic content analysis was conducted using NVivo 11.

Participants:

A purposive sample of senior health officials from Big Cities Health Coalition cities.

Results:

Health equity was conceptualized fairly consistently among senior health officials in big cities. Core elements of these conceptualizations include social and economic conditions, the input and redistribution of resources, equity in practice, values of justice and fairness, and equity as an outcome to be achieved. Senior health officials saw health disparity and health inequity as distinct but related concepts. Relationships between concepts included disparities data to identify and prioritize inequities, inequities creating health disparities, health equity to eliminate disparities, and disparities becoming inequities when their root causes are unjust. Some respondents critiqued health equity terminology for representing a superficial change, being inaccessible, and being politically loaded.

Conclusions:

Understanding how senior health officials conceptualize health equity and disparities can focus policy priorities, resources, and the scope of work undertaken by local health departments. Having a common language for health equity allows for policy and resource advocacy to promote the health of marginalized populations.
An Examination of 4 Questions Assessing Self-reported Concussions Among High School Students Participating in Team Sports
Authors: DePadilla Lara , Miller Gabrielle F. , Jones Sherry Everett
Published: November 2018

Objective:

Current prevalence estimates of youth sports-related concussions are inconsistent because of variation in methodology and potentially unreported concussions.

Methods:

In 2013, Connecticut, Ohio, and Utah each added different questions that assessed self-reported concussions to the Youth Risk Behavior Survey. Two questions referenced recognition of a concussion by the student, 1 referenced identification by a doctor, and 1 referenced suspicion by a coach. Chi-square analyses were used to identify whether there was an association between demographic characteristics and the concussion questions among high school students who played on at least 1 sports team.

Results:

The percentage of students who reported concussions ranged from 17.6% to 20.1%.

Conclusions:

These estimates are higher than rates of concussions diagnosed in emergency departments or reported by athletic trainers but were similar across the 4 questions. The field would benefit from a better understanding of the impact of question wording and format on estimates of concussion prevalence.
Microtia Reconstruction in Hemifacial Microsomia Patients: Three Framework Coverage Techniques
Authors: Park Jung Youl , Park Chul
Published: November 2018

Background:

Microtia with hemifacial microsomia is difficult to treat because of skin volume deficiency. To provide further information for coverage techniques in microtia reconstruction, the authors have reviewed and analyzed patients who underwent surgery at their center.

Methods:

A total 52 patients with microtia with hemifacial microsomia who underwent reconstruction between 2006 and 2016 were involved. Patients were reviewed retrospectively by examining medical records and photographic data.

Results:

All reconstructed cases were followed for 6 months to 10 years (median, 33 months). The average (median) surgeon’s satisfaction score was 8.2 (median, 9) for the embedded and elevation technique (n = 23); 7.89 (median, 8) for the temporoparietal fascia flap technique (n = 10); and 6.30 (median, 7) for the subfascial expansion technique (n = 19). The median score difference between the embedding and subfascial expansion techniques was statistically significant (p = 0.03). Major factors that deteriorated aesthetic outcomes were large reconstructed ears (11 cases), cartilage framework resorption (11 cases), mismatched skin color (eight cases), different axis (seven cases), and different shapes (five cases). Mismatched skin color was significant in cases treated with the fascia flap technique (p < 0.0001), whereas cartilage framework resorption was significant in cases treated with the tissue expansion technique (p = 0.004).

Conclusions:

To obtain better aesthetic outcomes, the embedding technique should be used when the patient shows a mild to moderate degree of low hairline and usable remnant vestiges. In cases showing severe degrees of associated anomalies, the temporoparietal fascia flap technique should be used.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
A Pilot Randomized Trial Assessing the Effect of a Psychoeducational Intervention on Psychoneuroimmunological Parameters Among Patients With Nonmetastatic Breast Cancer
Authors: Stanzer Stefanie , Andritsch Elisabeth , Zloklikovits Silke , Ladinek Verena , Farkas Clemens , Augustin Thomas , Obermayer-Pietsch Barbara , Samonigg Hellmut , Bauernhofer Thomas
Published: November 2018

Objective

The aim of this study was to determine a potential benefit of the specific psychoeducational intervention “Learning to Live with Cancer” (LTLWC) for patients with operated nonmetastatic breast cancer, with respect to psychological variables and endocrine and immune parameters.

Methods

Fifty-two postmenopausal women with operated stage I to III breast cancer were randomized to either a breast cancer intervention group (BCIG, n = 30) who immediately began participating in the LTLWC intervention program or to a breast cancer control group (BCCG, n = 22). Matched healthy women were asked to participate as a noncancer comparison group (n = 26). All participants were evaluated at three different time points (t1–t3) using a set of standardized questionnaires and blood samples were taken to analyze immune cell subsets and stress hormone levels.

Results

A significant reduction in trait anxiety/State Trait Anxiety Inventory score was observed in the BCIG (t1: median = 35.0 [interquartile range = 28.0–38.0] versus t3: median = 26.0 [interquartile range = 18.5–37.0], p = .0001) compared with the BCCG (t1: median = 41.0 [interquartile range =32.75–49.0]; t3: median = 38.5 [interquartile range = 30.75–46.5], p = .01524; p interaction = .001). In parallel, a significant rise of serotonin levels (t1: median = 66.5 ng/ml [interquartile range = 11.50–106.00] versus t3: median = 80.5 ng/ml [interquartile range =59.00–118.00], p = .00008) as well as a significant reduction of the elevated number of Treg cells at baseline (t1: median = 4.45% [interquartile range = 4.00–5.33] versus t3: median = 2.80% [interquartile range = 2.68–3.13], p < .00001) were observed in the BCIG versus no change in the BCCG. A significant statistical association between reduced trait anxiety and decreased Treg cell number could be demonstrated in the BCIG (r = .62, p < .01).

Conclusions

The observed results of this study provide preliminary support for the efficacy of the LTLWC program in significantly improving psychoneuroimmunological parameters in patients with nonmetastatic breast cancer.
Dual-Tracer PET/CT Differentiates 2 Types of Primary Cancers and Metastases in a Patient With Crossed Fused Renal Ectopia
Authors: Ho Chi-lai , Chen Sirong , Leung Yim Lung , Cheng Kam Chau , Wong Yuet Hung
Published: November 2018

A patient was found incidentally on dual-tracer (11C-acetate [ACT] and 18F-FDG [FDG]) PET/CT for having crossed fused renal ectopia and 2 types of malignant tumors, colonic carcinoma and renal cell carcinoma (RCC), each having its own characteristic tracer avidity. Multiple liver metastases were also mutually exclusive, with a purely ACT-avid group of metastatic lesions from RCC and another FDG-avid group from colonic carcinoma. Bone and lung metastases, however, could not be readily distinguishable in terms of primary origins. Crossed fused renal ectopia is a rare anomaly, even rarer to have RCC coexisting with a second primary malignancy.
Laparoscopic Sleeve Gastrectomy has a Lower Risk of Postoperative Bleeding Than Laparoscopic Roux-en-Y Gastric Bypass
Authors: Zafar Syed Nabeel , Shockcor Nicole , Prasad Nikhil , Wise Eric S. , Jackson Hope T. , Kligman Mark
Published: November 2018

Measures to reduce postoperative bleeding (POB) after bariatric surgery is skewed toward laparoscopic sleeve gastrectomy (LSG). We use 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to characterize the differences in bleeding rates between LSG and laparoscopic Roux-en-Y gastric bypasses (LRYGB). Propensity score matching and multivariable logistic regressions tested for independent differences in POB rates. A total of 168,093 patients from 742 centers were identified in the data set. After selection 36,925 patients with LRYGB and 20,020 patients with LSG were included in the analysis. A total of 710 (1.25%) patient suffered a POB. The independent odds of POB were 38% lower for patients having LSG compared with those having LRYGB (odds ratio, 0.62; 95% confidence interval=0.51-0.76). This difference is more pronounced with intraoperative securing of the staple line. Appropriate measures to reduce POB after each type of bariatric procedure is warranted.
Translating Sexual Dysfunction: Does Language Impact Clinical Discussion of Painful Sex?
Authors: Eisenach Natalie , Zoorob Dani , Nazir Niaman , Pedraza Ruth , Swan Kimberly
Published: November 2018

Objectives

Dyspareunia and sexual dysfunction are estimated to affect up to 22% and 43% of women, respectively. There is concern that these statistics do not depict the true prevalence and that these conditions are frequently undiagnosed and untreated. By 2060, Latinos will make up 30% of the total population in the United States. Because our patient population becomes more diverse, we need to ensure that our healthcare practices accommodate the changes.

Methods

We surveyed a convenience sample of 107 English and 71 Spanish-speaking women, aged 18 to 45 years, at university-affiliated clinics to identify the prevalence of dyspareunia and sexual dysfunction within our community. In addition, we wanted to identify the rate that clinicians discuss painful sex with patients to identify whether language impacted communication. The surveys collected data on subjective reporting of pain with sex and objective identification of sexual dysfunction with the Female Sexual Function Index. Additional questions identified if subjects discussed pain with their clinician. These questions were analyzed between languages across all domains.

Results

A greater prevalence of both dyspareunia and sexual dysfunction was measured in our study population compared with previous reports (37.79% and 54.71%, respectively). Spanish-speaking women had significantly lower self-reported dyspareunia (28.99%) but scored significantly lower on the Female Sexual Function Index, qualifying for sexual dysfunction (63.24%). Spanish speakers discussed painful sex significantly less compared with the English cohort, but the overall discussion rate was only 17.26%.

Conclusions

These pilot data demonstrate a need for further research on language as a barrier to communication about sexual function in clinic.
Gaussian-distributed codon frequencies of genomes
Authors: Khomtchouk Bohdan B. , Nonner Wolfgang
Published: November 2018

DNA encodes protein primary structure using 64 different codons to specify 20 different amino acids and a stop signal. Frequencies of codon occurrence when ordered in descending sequence provide a global characterization of a genome’s preference (bias) for using the different codons of the redundant genetic code. Whereas frequency/rank relations have been described by empirical relations, here we propose a statistical model in which two different forms of codon usage co-exist in a genome. We investigate whether such a model can account for the range of codon usages observed in a large set of genomes from different taxa. The differences in frequency/rank relations across these genomes can be expressed in a single parameter, the proportion of the two codon compartments. One compartment uses different codons with weak bias according to a Gaussian distribution of frequency, the other uses different codons with strong bias. In prokaryotic genomes both compartments appear to be present in a wide range of proportions, whereas in eukaryotic genomes the compartment with Gaussian distribution tends to dominate. Codon frequencies that are Gaussian-distributed suggest that many evolutionary conditions are involved in shaping weakly-biased codon usage, whereas strong bias in codon usage suggests dominance of few evolutionary conditions.
Streptococcal phosphotransferase system imports unsaturated hyaluronan disaccharide derived from host extracellular matrices
Authors: Oiki Sayoko , Nakamichi Yusuke , Maruyama Yukie , Mikami Bunzo , Murata Kousaku , Hashimoto Wataru
Published: November 2018

Certain bacterial species target the polysaccharide glycosaminoglycans (GAGs) of animal extracellular matrices for colonization and/or infection. GAGs such as hyaluronan and chondroitin sulfate consist of repeating disaccharide units of uronate and amino sugar residues, and are depolymerized to unsaturated disaccharides by bacterial extracellular or cell-surface polysaccharide lyase. The disaccharides are degraded and metabolized by cytoplasmic enzymes such as unsaturated glucuronyl hydrolase, isomerase, and reductase. The genes encoding these enzymes are assembled to form a GAG genetic cluster. Here, we demonstrate theStreptococcus agalactiaephosphotransferase system (PTS) for import of unsaturated hyaluronan disaccharide.S. agalactiaeNEM316 was found to depolymerize and assimilate hyaluronan, whereas its mutant with a disruption in PTS genes included in the GAG cluster was unable to grow on hyaluronan, while retaining the ability to depolymerize hyaluronan. Using toluene-treated wild-type cells, the PTS import activity of unsaturated hyaluronan disaccharide was significantly higher than that observed in the absence of the substrate. In contrast, the PTS mutant was unable to import unsaturated hyaluronan disaccharide, indicating that the corresponding PTS is the only importer of fragmented hyaluronan, which is suitable for PTS to phosphorylate the substrate at the C-6 position. The three-dimensional structure of streptococcal EIIA, one of the PTS components, was found to contain a Rossman-fold motif by X-ray crystallization. Docking of EIIA with another component EIIB by modeling provided structural insights into the phosphate transfer mechanism. This study is the first to identify the substrate (unsaturated hyaluronan disaccharide) recognized and imported by the streptococcal PTS.

IMPORTANCE (118/120 words)

The PTS identified in this work imports sulfate group-free unsaturated hyaluronan disaccharide as a result of the phosphorylation of the substrate at the C-6 position.S. agalactiaecan be indigenous to animal hyaluronan-rich tissues owing to the bacterial molecular system for fragmentation, import, degradation, and metabolism of hyaluronan. Distinct from hyaluronan, most GAGs, which are sulfated at the C-6 position, are unsuitable for PTS due to its inability to phosphorylate the substrate. More recently, we have identified a solute-binding protein-dependent ABC transporter in a pathogenicStreptobacillus moniliformisas an importer of sulfated and non-sulfated fragmented GAGs without any substrate modification. Our findings regarding PTS and ABC transporter shed light on bacterial clever colonization/infection system targeting various animal GAGs.
Distinctions among electroconvulsion- and proconvulsant-induced seizure discharges and native motor patterns during flight and grooming: Quantitative spike pattern analysis inDrosophilaflight muscles
Authors: Lee Jisue , Iyengar Atulya , Wu Chun-Fang
Published: November 2018

InDrosophila, high-frequency electrical stimulation across the brain triggers a highly stereotypic repertoire of spasms known as electroconvulsive seizures (ECS). The distinctive ECS spiking discharges manifest across the nervous system and can be stably assessed throughout the seizure repertoire in the large indirect flight muscles (DLMs). ECS discharges in DLMs have been extensively used to monitor seizure activities, notably in stress (‘bang’)-sensitive mutants. However, the relationships between ECS-spike patterns and native motor programs, including flight and grooming, are not known and their similarities and distinctions remain to be characterized. We employed quantitative spike pattern analyses including: 1) overall firing frequency, 2) spike timing between contralateral fibers, and 3) short-term variability in spike interval regularity (CV2) and instantaneous firing frequency (ISI−1) to reveal distinctions amongst ECS discharges, flight and grooming motor patterns. We then examined DLM firing phenotypes in well-established mutants in excitatory cholinergic (Cha), inhibitory GABAergic (Rdl) and electrical (ShakB) synaptic transmission. The results provide an initial glimpse on the vulnerability of individual motor patterns to perturbations of respective synaptic transmission systems. We found marked alterations of ECS discharge spike patterns in terms of either seizure threshold, spike frequency or spiking regularity. In contrast, no gross alterations during grooming and only a minor reduction of firing frequency during Rdl mutant flight were observed, suggesting a role for GABAergic modulation of flight motor programs. Picrotoxin (PTX), a known pro-convulsant that inhibits GABAAreceptors, induced DLM seizure patterns that displayed some features, e.g. left-right coordination and ISI−1range, that could be found in flight or grooming, but distinct from ECS discharges. Our results indicate that these quantitative techniques may be employed to reveal overlooked relationships among aberrant motor patterns and native DLM motor programs in genetic and pharmacological analyses of underlying cellular and neural circuit function.
High-throughput genotyping of the spelt gene pool reveals patterns of agricultural history in Europe
Authors: Abrouk Michael , Stritt Christoph , Müller Thomas , Keller Beat , Roulin Anne C. , Krattinger Simon G.
Published: November 2018

Spelt, a close relative of hexaploid bread wheat and a dominant wheat subspecies cultivated in Europe before the 20thcentury, still plays an important role as a high-value niche product today. Compared to most other cereals, spelt has not been subjected to intensive breeding in the 20thcentury. Even today, mostly traditional landraces are cultivated on a regional scale. The traditional way of spelt cultivation has limited the extensive exchange of germ plasm and intermixing of genetic material, which makes spelt an ideal crop to study the early agricultural history of cereals in Europe. Here, we unraveled the population structure and agricultural history of spelt based on 22,999 high-quality SNPs obtained by genotyping-by-sequencing on 267 spelt accessions covering the entire cultivation range. SNP markers were aligned to the high-quality bread wheat reference genome, which allowed us to analyze individual subgenomes. Our analyses of genetic variation revealed that bread wheat and spelt are most likely of monophyletic origin, but that European spelt diverged from bread wheat by hybridization with tetraploid emmer wheats. Interestingly, spelt accessions from the Iberian Peninsula formed a separate clade that was distinct from the Central European accessions for all three subgenomes. Demographic modelling indicated that Iberian spelt was introduced into Europe independently from Central European spelt. Our analysis provides a comprehensive assessment of spelt diversity and history. The separate introduction of Iberian spelt is supported by recent molecular evidence of two independent prehistoric migrations of ancient farmers from the Near East into Europe.
Development of a New Method for the Highly Effective Identification of Cold Resistance in Living Avocado Varieties
Authors: Chunlin Zheng , Fan Wu , Cuiling Li , Wenli Peng , Shaofeng Zhang , Jingjie Zhu , Hao Jiang , Maofu Li
Published: November 2018

This paper first identified the cold resistance of 38 varieties of avocado by determining the semi-lethal low temperature (LT50) of the leaves using an electrical conductivity method in combination with a logistic function, and then analyzed the correlation between the LT50 of 27 varieties and the capacitance measured 9 different parts of the leaves in vivo, to explore the relationship between the cold resistance of various avocado varieties and the capacitance of different parts of avocado leaves, so as to develop a new method for highly effective identification of cold resistance of living avocado varieties. The results showed that various avocado varieties’ LT50 was significantly positively correlated with the capacitance of some parts of leaves, showing that the cold resistance of various avocado varieties was negatively correlated with the capacitance of various leaf parts. The results of mango variety trials conducted for comparison is coincident with the theoretical conclusion reached in the identification of the cold resistance of the avocado. So as to the study of the cold resistance of avocado and mango varieties, the capacitance of live mature leaves measured in the field can be used as a new method for the judgment of cold resistance.

Highlight

A new method for identification of avocado cold resistance through measuring the capacitance of different parts of leaves was developed. This method are simple, quick and efficient.
Direct air capture of CO2– topological analysis of the experimental electron density (QTAIM) of the highly insoluble carbonate salt of a 2,6-pyridine-bis(iminoguanidine), (PyBIGH2)(CO3)(H2O)4
Authors: Gianopoulos Christopher G. , Chua Zhijie , Zhurov Vladimir V. , Seipp Charles A. , Wang Xiaoping , Custelcean Radu , Pinkerton A. Alan
Published: November 2018

Chemical bonding and all intermolecular interactions in the highly insoluble carbonate salt of a 2,6-pyridine-bis(iminoguanidine), (PyBIGH2)(CO3)(H2O)4, recently employed in the direct air capture of CO2via crystallization, have been analyzed within the framework of the quantum theory of atoms in molecules (QTAIM) based on the experimental electron density derived from X-ray diffraction data obtained at 20 K. Accurate hydrogen positions were included based on an analogous neutron diffraction study at 100 K. Topological features of the covalent bonds demonstrate the presence of multiple bonds of various orders within the PyBIGH22+cation. Strong hydrogen bonds define ribbons comprising carbonate anions and water molecules. These ribbons are linked to stacks of essentially planar dications via hydrogen bonds from the guanidinium moieties and an additional one to the pyridine nitrogen. The linking hydrogen bonds are approximately perpendicular to the anion–water ribbons. The observation of these putative interactions provided motivation to characterize them by topological analysis of the total electron density. Thus, all hydrogen bonds have been characterized by the properties of their (3,−1) bond critical points. Weaker interactions between the PyBIGH22+cations have similarly been characterized. Integrated atomic charges are also reported. A small amount of cocrystallized hydroxide ion (∼2%) was also detected in both the X-ray and neutron data, and included in the multipole model for the electron-density refinement. The small amount of additional H+required for charge balance was not detected in either the X-ray or the neutron data. The results are discussed in the context of the unusually low aqueous solubility of (PyBIGH2)(CO3)(H2O)4and its ability to sequester atmospheric CO2.