bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Planting Date on Thrips (Thysanoptera: Thripidae) in Cotton
Authors: Kerns Cody D , Greene Jeremy K , Reay-Jones Francis P F , Bridges William C
Published: December 2018

At-plant applications of insecticides are the most common method to manage thrips in upland cotton, Gossypium hirstutum L. Because the primary pest species, tobacco thrips, Frankliniella fusca (Hinds), has developed resistance to commonly used neonicotinoid insecticides used in producing cotton, alternative control options are needed for sustainable thrips management programs. A 3-year study (2015–2017) showed that densities of thrips, feeding injury from thrips, cotton growth, and yield varied among 10 planting dates. Densities of thrips were lowest in seedling cotton planted after mid-May in all years. Thrips injury ratings in all years were highest in cotton planted in April, lowest in cotton planted in June, and below intermediate injury (intermediate corresponded to a 3 on the 0–5 scale) levels in cotton planted after mid-May. Cotton planted during May, rather than in April or June, had the highest yield potential, regardless of variety. Results of the study indicated that altering planting date could potentially be useful in mitigating injury and losses from thrips in upland cotton.
Clinical valve thrombosis and subclinical leaflet thrombosis in transcatheter aortic heart valves: clinical manifestations, diagnosis, and treatment
Authors: Rosseel Liesbeth , De Backer Ole , Søndergaard Lars
Published: December 2018

During the last decade, transcatheter aortic valve replacement (TAVR) has rapidly expanded as an alternative to surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic valve stenosis (AS) and increased surgical risk. In TAVR, a bioprosthetic valve is positioned within the stenotic native aortic valve. Although favorable short- and medium-term outcomes have been reported, thrombosis of the transcatheter heart valve (THV) has occurred, with two different entities being described: clinical valve thrombosis and subclinical leaflet thrombosis. In clinical valve thrombosis, an increase in transvalvular gradient appears as a result of obstructive thrombus formation, which eventually leads to symptoms of heart failure. Subclinical leaflet thrombosis is an incidental finding, characterized by a thin layer of thrombus covering the aortic site of the leaflet—called hypo-attenuating leaflet thickening (HALT)—as described on and defined by 4-dimensional computed tomography (4DCT) imaging. This phenomenon may affect motion of the leaflets and is then classified as hypo-attenuation affecting motion (HAM). Even in the case of HAM, the transvalvular pressure gradient remains within the normal range. Clinical valve thrombosis requires treatment, whereas the clinical impact and need for intervention in subclinical leaflet thrombosis is uncertain. Anticoagulant therapy protects against and resolves both clinical valve thrombosis and subclinical leaflet thrombosis, but studies exploring different antithrombotic strategies after TAVR are ongoing. This review summarizes currently available literature within the field of THV thrombosis and provides recommendations for a patient-tailored approach in TAVR patients, although guidelines are still lacking.
Uneven Patterns of Inequality: An Audit Analysis of Hiring-Related Practices by Gendered and Classed Contexts
Authors: Yavorsky Jill E
Published: December 2018

Despite women’s uneven entrances into male-dominated occupations, limited scholarship has examined whether and how employers in different occupational classes unevenly discriminate against women during early hiring practices. This article argues that intersecting gendered and classed features of occupations simultaneously shape hiring-related practices and generate uneven patterns of inequality. Using data derived from comparative white-collar (N = 3,044 résumés) and working-class (N = 3,258 résumés) correspondence audits and content-coded analyses of more than 3,000 job advertisements, the author analyzes early hiring practices among employers across two gendered occupational dimensions: (1) sex composition (male- or female-dominated jobs) and (2) gender stereotyping (masculinized or feminized jobs, based on the attributes that employers emphasize in job advertisements). Broadly, findings suggest a polarization of early sorting mechanisms in which discrimination against female applicants is concentrated in male-dominated and masculinized working-class jobs, whereas discrimination against male applicants at early job-access points is more widespread, occurring in female-dominated and feminized jobs in both white-collar and working-class contexts. Interestingly, discrimination further compounds for male and female applicants—depending on the classed context—when these occupational dimensions align in the same gendered direction (e.g., male-dominated jobs that also have masculinized job advertisements). These findings have implications for the study of gender and work inequality and indicate the importance of a multidimensional approach to hiring-related inequality.
Switching Immunosuppression From Cyclosporine to Tacrolimus in Kidney Transplant Recipients Based on CYP3A5 Genotyping
Authors: Wang Xuebin , Yang Yunyun , Liu Zhengyue , Xiao Chengwu , Gao Lihong , Zhang Wenjing , Zhang Wenwen , Wang Zhuo
Published: December 2018

Background:

Kidney transplant recipients on long-term cyclosporine (CsA) therapy may develop multiple adverse drug events, and immunosuppression conversion from CsA to tacrolimus (Tac) is an option. Genetic variations, especially cytochrome P450 (CYP) 3A5*3, affects Tac dosing. However, little information is available to guide the conversion with regards to patients' pharmacogenomics. We aimed to investigate whether CYP3A5, CYP3A4, and ABCB1 genotyping could contribute to a more precise and individualized initial dosing of Tac at the time of immunosuppressant conversion.

Methods:

Genotypes of 5 candidate genes (CYP3A5*3, CYP3A4*1G, ABCB1C1236T, ABCB1C3435T, and ABCB1G2677T/A) were investigated by polymerase chain reaction and restriction fragment-length polymorphism methods in 46 adult kidney transplant recipients requiring immunosuppressant conversion from CsA to TAC. Associations between these functional genetic polymorphisms and the dose-adjusted trough concentrations of CsA and Tac were evaluated, retrospectively.

Results:

Based on the linear regression analysis, CYP3A5 expressers (*1/*1 and *1/*3) had lower Tac dose-adjusted trough concentrations on days 7, 14, 21, and 28, and they required 1.40- to 1.75-fold higher daily dose to reach the target concentration compared with nonexpressers (*3/*3) on day 28 [0.07 (0.06–0.09) mg/kg/d versus 0.05 (0.02–0.06) mg/kg/d, P = 0.001]. CYP3A4*1G or ABCB1 genetic polymorphisms had no effect on the Tac dose-adjusted trough concentrations.

Conclusions:

Our preliminary study supports the use of CYP3A5 genotyping to guide the initial dosing of Tac when converting the immunosuppression therapy from CsA to Tac.
Targeted Proteomic Analysis Detects Acute T Cell–Mediated Kidney Allograft Rejection in Belatacept-Treated Patients
Authors: van der Zwan Marieke , Hesselink Dennis A. , Clahsen-van Groningen Marian C. , Baan Carla C.
Published: December 2018

Background:

There is an unmet need for reliable minimally invasive diagnostic biomarkers for immunological allograft monitoring and for the detection of acute kidney transplant rejection. Here, targeted proteomic analysis was applied to compare 92 proteins in sera of belatacept-treated patients who had biopsy-proven, acute T-cell–mediated rejection (aTCMR) with patients without aTCMR.

Methods:

Proximity extension immunoassay was used to measure 92 inflammation-related protein concentrations in the prerejection and rejection sera of 11 patients with aTCMR and 9 patients without aTCMR. This assay uses 2 matched oligonucleotide-labeled antibody probes for each protein and polymerase chain reaction to measure normalized protein expression values.

Results:

Five proteins (CD5, CD8A, NCR1, TNFRSF4, and TNFRSF9) were expressed significantly higher in samples with aTCMR compared with samples without aTCMR (adjusted P-value < 0.014) and had a good predictive capacity for aTCMR [area under the curve in a receiver–operator curve ranged from 0.83 to 0.91 (P < 0.014)]. These proteins are associated with CD8+ cytotoxic T-cell and NK cell functions. Nonhierarchical clustering analysis showed distinct clustering of samples with aTCMR and samples without aTCMR. This clustering was not found in prerejection samples (1 month after transplantation). In prerejection samples, IFN-γ was expressed at a significantly lower level (normalized protein expression value median −0.15, interquartile range: −0.27 to 0.04) than in samples of patients without rejection (median 0.13, interquartile range: −0.07 to 0.15, adjusted P-value = 0.00367).

Conclusions:

Targeted proteomic analysis with proximity extension immunoassay is a promising minimally invasive technique to diagnose aTCMR in kidney transplant recipients.
Bedside respiratory physiology to detect risk of lung injury in acute respiratory distress syndrome
Authors: Beitler Jeremy R.
Published: December 2018

Purpose of review

The most effective strategies for treating the patient with acute respiratory distress syndrome center on minimizing ventilation-induced lung injury (VILI). Yet, current standard-of-care does little to modify mechanical ventilation to patient-specific risk. This review focuses on evaluation of bedside respiratory mechanics, which when interpreted in patient-specific context, affords opportunity to individualize lung-protective ventilation in patients with acute respiratory distress syndrome.

Recent findings

Four biophysical mechanisms of VILI are widely accepted: volutrauma, barotrauma, atelectrauma, and stress concentration. Resulting biotrauma, that is, local and systemic inflammation and endothelial activation, may be thought of as the final common pathway that propagates VILI-mediated multiorgan failure. Conventional, widely utilized techniques to assess VILI risk rely on airway pressure, flow, and volume changes, and remain essential tools for determining overdistension of aerated lung regions, particularly when interpreted cognizant of their limitations. Emerging bedside tools identify regional differences in mechanics, but further study is required to identify how they might best be incorporated into clinical practice.

Quantifying patient-specific risk of VILI requires understanding each patient's pulmonary mechanics in context of biological predisposition. Tailoring support at bedside according to these factors affords the greatest opportunity to date for mitigating VILI and alleviating associated morbidity.
Is endoscopic sphincterotomy beneficial for the treatment of acute gallstone pancreatitis with small bile duct stone?
Authors: Kim Sung Bum , Nam Yoon Jeong , Kim Kook Hyun , Kim Tae Nyeun
Published: December 2018

Background

Acute gallstone pancreatitis occurs when a gallstone is impacted at the ampulla of Vater. The role of endoscopic retrograde cholangiopancreatography in the treatment of small choledocholithiasis in these patients is uncertain. The aim of this study was to compare outcomes of expectant management with endoscopic sphincterotomy for the treatment of small choledocholithiasis (≤5 mm) in patients with acute gallstone pancreatitis.

Patients and methods

Of the 258 patients admitted for acute gallstone pancreatitis from January 2010 to December 2014, 174 patients with small choledocholithiasis were reviewed retrospectively. Patients with coexisting acute cholangitis and/or pancreatobiliary malignancy were excluded. They were divided into an endoscopic sphincterotomy group (n=64) and an expectant management group (n=110). Severity index and outcomes of pancreatitis, complications, and overall mortality were compared.

Results

Age and sex were not significantly different between the two groups. The mean Ranson, acute physiology and chronic health evaluation-II, and bedside index of severity in acute pancreatitis scores were not significantly different between the two groups. The computed tomography severity index score was significantly higher in the expectant management group than in the endoscopic sphincterotomy group (1.6±1.1 vs. 1.0±0.9, P<0.001). Duration of hospitalization, time for normalization of the white blood cell count, and time for oral feeding were similar in both groups. There was no significant difference between two groups in the incidence of development of pseudocyst or walled-off necrosis. In addition, no difference was observed in the rate of recurrence of acute pancreatitis and readmission because of recurrent choledocholithiasis.

Conclusion

Expectant management seems to be effective for the treatment of patients with acute gallstone pancreatitis and size of bile duct stones equal to or less than 5 mm.
Inpatients Sign On
Authors: Kelly Michelle M. , Hoonakker Peter L.T. , Coller Ryan J.
Published: December 2018

Background:

Inpatient portals are online patient portals linked to electronic health records that provide hospitalized patients and caregivers secure access to real-time clinical information and tools to enhance their communication with providers and hospital experience.

Objective:

The main objective of this commentary was to provide a perspective that inpatient portals are innovative tools poised to engage patients and caregivers during hospitalization and, thus, enhance patient-centered care.

Results:

Inpatient portals are desired by patients and caregivers and may contribute to improved recognition of their inpatient care team, knowledge of their treatment plan and overall inpatient experience. A sociotechnical systems approach is recommended to mitigate potential unintended consequences of inpatient portal use and support effective portal design, implementation and evaluation.

Conclusions:

This article highlights the potential of using inpatient portals to engage hospitalized patients and caregivers and proposes next steps to evaluate this emerging technology.
Ergonomics in endoscopic sinus surgery
Authors: Ramakrishnan Vijay R.
Published: December 2018

Purpose of review

Awareness of ergonomics is growing into surgical specialties including otolaryngology. Most otolaryngologists experience occupational physical discomfort, and daily incorporation of standard ergonomic principles may alleviate some of this pain.

Recent findings

Further demonstration of surgery-related physical discomfort has been documented based on surveys of general otolaryngologists and subspecialty rhinologists. One study utilized surface electromyography to document physical findings directly associated with the endoscopic sinus surgery procedure. However, relatively little work has been published on interventions to relieve task-related pain and body discomfort in rhinology.

Surgeon fatigue and bodily injury is a surprisingly frequent occurrence and is more likely to occur in procedures that are mentally challenging, prolonged, and require the surgeon to operate in a fixed position. Endoscopic sinus and skull base surgeons appear particularly susceptible to task-related physical discomfort, and incorporation of ergonomic principles should be a priority.
The Collaborative Improvement and Innovation Network project to drive quality improvement
Authors: Tosoc-Haskell Henrisa , Sisaithong Kristen , Carrico Robert
Published: December 2018

Purpose of review

The purpose is to describe an approach for improvement using an organized collaborative improvement framework where participants learn, apply, and share improvement ideas supported through a 3-year Organ Procurement Transplant Network (OPTN) project called Collaborative Improvement and Innovation Network (COIIN). The COIIN project, proposed as an alternative approach to monitoring transplant performance, supported collaboration, and improvement in 58 transplant hospitals and partner organ procurement organizations. The aim was to increase transplantation with a focus on increasing the utilization of moderate-to-high (50–100%) Kidney Donor Profile Index (KDPI) kidneys.

Recent findings

Preliminary findings show increases in transplant rate and utilization of moderate-to-high KDPI kidneys was achieved in many participating organizations. Preliminary COIIN project results suggest that an improvement approach that supports collaborative improvement can be effective in driving improvement.

The COIIN project involved the development of a change package of key interventions for three key areas: waitlist management, organ-offer acceptance, and care coordination. Additionally, a balanced scorecard approach using outcome, process, and relationship measures, was used and effective in driving improvement. The preliminary COIIN outcome and process results suggest that collaborative improvement does drive improvement and was well received in the transplant community.

Video abstract

In the video, two of the authors describe the content of the review and present the main topics discussed in the article (http://links.lww.com/MOT/A22).
Thrombospondin-1 and Vitamin D in Children With Sickle Cell Anemia
Authors: Adegoke Samuel A. , Smith Olufemi S. , Adeniyi Adewuyi T. , Adekile Adekunle D.
Published: December 2018

Background:

Thrombospondin-1 (TSP-1) and 25-hydroxyvitamin D (25-OHD) play significant roles in the pathogenesis of sickle cell anemia (SCA). TSP-1 enhances cellular adhesion/inflammation, hence contributing to vaso-occlusive crisis (VOC); vitamin D, in contrast, retards inflammation and may lower rate of pain episodes. We determined serum levels of TSP-1 and 25-OHD in Nigerian children with SCA and their matched hemoglobin AA controls; and assess the relationship between the 2 biomarkers.

Methods:

In total 90 children (32 SCA in steady state, 30 SCA in VOC, and 28 HbAA controls) were studied. Serum TSP-1 and 25-OHD levels were measured with ELISA and HPLC, respectively.

Results:

The mean TSP-1 of children with VOC was significantly higher than those in steady state (P=0.022) and HbAA controls (P<0.001). Similarly, the mean TSP-1 of those in steady state was higher than the controls (P=0.007). However, mean serum 25-OHD of the children with VOC was significantly lower than those in steady state (28.9±8.2 ng/mL vs. 37.1±12.3 ng/mL,P=0.004). There was a significant inverse correlation between TSP-1 and 25-OHD among the VOC subgroup,r=−0.57,P=0.001. The mean TSP-1 of the 28 children with SCA who had suboptimal vitamin D (213.5±118.6 ng/mL) was higher than 144.2±58.7 ng/mL of the 34 SCA who had normal serum vitamin D,P=0.008.

Conclusions:

Children with SCA, especially those with VOC, had high serum TSP-1 and low 25-OHD. Also, an inverse relationship exist between serum 25-OHD and TSP-1 in children with VOC. These findings provide basis for further studies into the regulation of TSP-1 by vitamin D.
Anticariogenic and antibiofilm of purified bacteriocin of Lactobacillus curvatus and immunomodulatory effect of L. curvatus in streptococcal bacteremia
Authors: Mahdi Likaa H. , Mahdi Nada Z. , Sajet Rasha M. , Auda Ibtesam G. , Mater Haifa N. , Zwain Luma A.H. , Kadhem Bushra M. , Alsaadi Luma G.
Published: December 2018

Streptococcus mutans and Streptococcus sanguinis have been associated with the development of caries, oral infections and bacteremia. In fact, there are only a few case reports in the literature describing bacteremia in relation to S. mutans and S. sanguine. The objective of this study was purification and characterization of curvatcin LHM from Lactobacillus curvatus, evaluation of its antibacterial activity against S. mutans and S. sanguinis and evaluation the effect of minimum inhibitory concentration of curvatcin LHM and chlorohexidine on biofilm formation as well as, study the effect of L. curvatus as immunomodulator. Curvatcin LHM was isolated and purified from L. curvatus culture. Purified and crude curvatcin LHM exhibited bactericidal action against S. mutans and S. sanguinis isolates in vitro. Significant differences (P < 0.05) were found in viable count between pre and posttreatment of S. mutans and S. sanguinis biofilms with curvatcin LHM and chlorohexidine. Unlike chlorohexidine, curvatcin LHM left no viable bacterial cells in biofilm of S. mutans and S. sanguinis. Bagg Albino laboratory breed (BALB/c) mice were orally administered with L. curvatus for 2 weeks and then intravenously injected with S. mutans and S. sanguinis. Four days before inoculation, microbiological and immune response were determined, serum proinflammatory cytokine, TNF-α, IL-10 and IL-6 were evaluated by ELISA. The L. curvatus treatment significantly decreased S. mutans and S. sanguinis in the organs and blood of mice with bacteremia as compared with the non-L. curvatus-treated mice (P < 0.05). Furthermore, proinflammatory cytokine, TNF-α, IL-10 and IL-6, were significantly higher in groups pretreated with L. curvatus (P < 0.05) prior streptococcal infection. These data suggest that curvatcin LHM may be a good alternative to chlorhexidine as an additive for teeth-protective materials. Curvatcin LHM cotreatment with chlorohexidine might help to increase the anticariogenic efficacy of chlorohexidine. On the other hand, L. curvatus can be serving as direct modulator of proinflammatory responses.
Akkermansia muciniphila bacteria: a new perspective on the management of obesity: an updated review
Authors: Payahoo Laleh , Khajebishak Yaser , Ostadrahimi Alireza
Published: December 2018

Background:

Obesity as a multifactorial disorder has shown a growing trend, in recent times. Considering the importance of obesity as a potent public health problem, finding a novel preventive approach for the management of obesity seems crucial. In addition to genetic and environmental factors, alteration in gut microbiota composition and inflammation are involved in the pathogenesis of obesity. The aim of the current study was to discuss the role of Akkermansia muciniphila in the management of obesity.

Method:

In this review article, all articles indexed in the scientific database using the keywords A. muciniphila, inflammation, gut microbiota, peroxisome proliferator-activated receptor-alpha (PPAR-α), overweight, and obesity were searched and discussed between 2000 and 2018.

Results:

Specific strains of gut microbiota such as A. muciniphila modify energy homeostasis in the body. In addition to degrading mucin and providing a desirable environment for the growth of other bacteria in the intestine, A. muciniphila participates in the management of obesity. Indeed, A. muciniphila increases the levels of Short chain fatty acids (SCFAs) and N-acylethanolamines as ligands of GPR41/GPR43 and G protein-coupled receptor119 (GPR119) receptors in L-cells, respectively, such that these receptors are involved in the various aspects of energy balance and appetite sensation. A. muciniphila also improves the low chronic inflammation observed in obese people through various mechanisms.

Conclusion:

A. muciniphila supplementation and the use of other approaches such as prebiotics or food components that increase the abundance of this bacterium in the gut microbiota population could be a novel valuable approach in the management of obesity.
The Role of Nurses in Advancing the Objectives of the Global Compacts for Migration and on Refugees
Authors: Shaffer Franklin , Bakhshi Mukul , Farrell Niamh , Álvarez Thomas
Published: December 2018

Nurses and other health care professionals are in a unique position to shift the paradigm around migration debates. As caregivers and advocates for patients and other providers, nurses are crucial to the health and well-being of individuals, families, and communities. This is especially true for migrants, including increasingly vulnerable refugee populations around the world. As negotiations surrounding the Global Compact for Migration and Global Compact on Refugees come to a close, nurses' roles are becoming more apparent. Nurses are facilitators of migration and can help ensure that the benefits of migration are maximized and the challenges are mitigated. Often, nurses are migrants themselves. Leveraging nurses' knowledge, experience, talents, and compassion is crucial for attaining the objectives of both the Global Compact for Migration and the Global Compact on Refugees. Nurses are large contributors to the United Nations' 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals. The global nursing workforce has enormous potential to advance the achievement of these goals and objectives. In a world that appears to be increasingly xenophobic and hostile to migrants, nurses stand out as professionals who can change the narrative while providing compassionate care for the most vulnerable.
Characteristics Associated With Human Immunodeficiency Virus Transmission Networks Involving Adolescent Girls and Young Women in Human Immunodeficiency Virus Prevention Trials Network 068 Study
Authors: Stoner Marie C.D. , Dennis Ann M. , Hughes James P. , Eshleman Susan H. , Sivay Mariya V. , Hudelson Sarah E. , Grabowski M. Kate , Gómez-Olivé F. Xavier , MacPhail Catherine , Piwowar-Manning Estelle , Kahn Kathleen , Pettifor Audrey
Published: December 2018

We combined behavioral survey data from the human immunodeficiency virus (HIV) Prevention Trials Network 068 study with phylogenetic information to determine if cluster membership was associated with characteristics of young women and their partners. Clusters were more likely to involve young women from specific villages and schools, indicating some localized transmission.

Supplemental digital content is available in the text.
Outcomes Analysis of Children Diagnosed With Hemophagocytic Lymphohistiocytosis in the PICU
Authors: Gregory Jillian , Greenberg Jay , Basu Sonali
Published: December 2018

Objectives:

Describe a single center experience of hemophagocytic lymphohistiocytosis in a PICU over a 10-year period, to identify clinical features that may be associated with worse outcomes, including mortality, hospital and ICU length of stay, and functional and cognitive impairments on discharge.

Design:

Retrospective electronic medical record review, 2007–2017.

Setting:

PICU located in a large urban academic quaternary care children’s hospital.

Patients:

All children admitted with hemophagocytic lymphohistiocytosis to our PICU from 2007 to 2017.

Interventions:

None.

Measurements and Main Results:

All patients were identified utilizing International Classification of Diseases, 9th Revision and International Classification of Diseases, 10th Revision codes. Each chart was reviewed for demographic information, hemophagocytic lymphohistiocytosis diagnostic criteria, laboratory data, Pediatric Risk of Mortality Score III, clinical features and events of ICU stay, and PICU and hospital (length of stay). Mortality at 1 year and change in Functional Status Scale from admission to discharge were recorded. There were 42 admissions with 33 unique patients. Median Pediatric Risk of Mortality score at admission was 9 (interquartile range, 7–16). Median PICU length of stay was 7 days (interquartile range, 2–21 d) and hospital length of stay was 24 days (interquartile range, 14–37 d). During their ICU stay, 56% of patients received mechanical ventilation, 43% required vasoactives, 18% required continuous renal replacement therapy, and 5% received extracorporeal life support. Clinical factors related to increased PICU length of stay included Pediatric Risk of Mortality III score (p = 0.019), maximum lactate dehydrogenase (p = 0.017), maximum total bilirubin (p = 0.042), need for mechanical ventilation (p = 0.002), vasoactive use (p = 0.02), and secondary infection (p = 0.007). The most common therapies for hemophagocytic lymphohistiocytosis included steroids (93%), etoposide (55%), and anakinra (48%). Of the 26 patients who survived to hospital discharge, 19% had newly acquired morbidities. Overall 1-year mortality was 42%.

Conclusions:

Hemophagocytic lymphohistiocytosis diagnosed in the PICU is a disease with high mortality. Patients who survive to discharge had relatively little morbidity, however, the mortality risk in the year following discharge continued to remain high.
Wilms Tumor of the Ovary: Review of the Literature and Report of 2 Cases
Authors: Turashvili Gulisa , Fix Daniel J. , Soslow Robert A. , Park Kay J.
Published: December 2018

Primary extrarenal Wilms tumor of the gynecologic tract is extremely rare with scattered case reports occurring in the ovary, uterine corpus and cervix. Only 9 cases of primary ovarian Wilms tumor have been reported to date. Here, we provide an extensive literature review and describe 2 patients with ovarian Wilms tumor: a 36-yr-old female (patient 1) and a 16-yr-old female (patient 2), both presenting with abdominal pain and suspected ovarian torsion. They were each found to have unilateral ovarian masses measuring >15 cm in size which were removed by unilateral salpingo-oophorectomy. Microscopically, the tumors exhibited the typical triphasic histology of Wilms tumor. In addition, the tumor from patient 1 contained elements of mature cystic teratoma, while an extensive rhabdomyosarcomatous component was identified in patient 2. Both tumors were diffusely and strongly positive for WT1 with variable staining for other biomarkers. The cases were diagnostically challenging and referred to our center for an expert opinion. Teratoid Wilms tumor in patient 1 is the second reported case of ovarian Wilms tumor arising in association with teratoma. Recognition of primary ovarian Wilms tumor requires a high index of suspicion and exclusion of other entities based on tumor morphology and immunohistochemical studies.
FDG-PET/CT for Detecting an Infection Focus in Patients With Bloodstream Infection
Authors: Pijl Jordy P. , Glaudemans Andor W. J. M. , Slart Riemer H. J. A. , Yakar Derya , Wouthuyzen-Bakker Marjan , Kwee Thomas C.
Published: December 2018

Purpose

To investigate the diagnostic performance of 18F-fluoro-2-deoxy-D-glucose (FDG) PET/ CT for the detection of an infection focus in patients with a bloodstream infection (BSI) and to identify factors influencing the diagnostic yield of FDG-PET/CT.

Methods

This retrospective single-center study included 185 consecutive patients with a BSI who underwent an FDG-PET/CT scan for the detection of an infection focus between 2010 and 2017. The final diagnosis at hospital discharge was used as reference standard. Diagnostic performance of FDG-PET/CT for the detection of an infection focus was assessed, and logistic regression analyses were performed to identify factors associated with FDG-PET/CT yield.

Results

An infection focus was identified on FDG-PET/CT in 120 (64.8%) of 185 patients. FDG-PET/CT achieved a sensitivity of 80.2%, specificity of 79.6%, positive predictive value of 90.8%, and a negative predictive value of 61.4% for detecting an infection focus in patients with a BSI. Blood cultures positive for enterococci (odds ratio, 0.14; P = 0.019) and days of antibiotic treatment before FDG-PET/CT (odds ratio, 0.94 per day increase; P = 0.014) were statistically significant independent predictors of a lower odds of detecting an infection focus on FDG-PET/CT. In patients who received antibiotics for less than 7 days before FDG-PET/CT, an infection focus was found in 71% (56/79). In patients who received antibiotics for 8 to 14 days before FDG-PET/CT, an infection focus was found in 52% (22/42). After 15 to 21 days of antibiotic treatment, an infection focus was found in 61% (8/13), and for 22 days or more, this declined to 38% (5/13).

Conclusions

FDG-PET/CT is a useful method for detecting an infection focus in patients with BSI. However, longer duration of antibiotic treatment before FDG-PET/CT and bacteremia with enterococci reduce the diagnostic yield of FDG-PET/CT. These factors should be taken into account when considering an FDG-PET/CT scan for this indication.
Voriconazole-Induced Periostitis After Allogeneic Stem Cell Transplantation
Authors: Haemels Maarten , Pans Steven , Schoemans Hélène , Goffin Karolien , Gheysens Olivier , Jentjens Sander
Published: December 2018

A 34-year-old man with history of Hodgkin lymphoma presented 7 months after allogeneic stem cell transplantation with an unexplained severe musculoskeletal pain syndrome. A 99mTc-MDP bone SPECTCT showed multiple foci with moderate to intense bone uptake across the axial and appendicular skeleton consistent with periostitis. The patient had been on voriconazole daily for 4 months to treat an Aspergillus pneumonia, and in the absence of other causes, a drug-induced periostitis was suspected. Voriconazole was changed to posaconazole with complete resolution of the musculoskeletal symptoms within 3 weeks.
Ischemic Complications After High-Grade Glioma Resection Could Interfere With Residual Tumor Detection With 18F-Fluorocholine PET/CT
Authors: García Vicente Ana María , Rodriguez Muñoz María José , Pena Pardo Francisco José , Martinez Madrigal Milton Miguel , Soriano Castrejón Angel
Published: December 2018

Ischemic complications after resection of high-grade glioma are frequent and may constitute potential cause of false-positive results in postsurgical evaluation using 18F-fluorocholine PET/CT. On the other hand, hypoxia caused by ischemia promotes invasive glioma growth. We present 3 cases of patients with different grades of ischemic injury after resection of high-grade glioma. The combined interpretation of diffusion-weighted imaging and apparent diffusion coefficient map on MRI, in this clinical setting, is mandatory to avoid PET/CT misinterpretations.
Systemic Changes Affecting the Morphology of Calvarial Bone
Authors: Yao Amy , Taub Justin S. , Gault Allison T. , Naidich Thomas P. , Taub Peter J.
Published: December 2018

Plastic surgeons are frequently consulted to evaluate concerns about a patient's skull. Imaging studies often reveal abnormalities in bone morphology, from increased porosity to sclerotic changes. While focal findings imply a benign or malignant neoplasm, the etiology of more diffuse findings can be more varied, making the correct diagnosis challenging. The present review summarizes the differential diagnosis of osseous lesions of the calvarium that affect the bone and contribute to changes seen on imaging studies.
Index Admission Emergency Laparoscopic Cholecystectomy and Common Bile Duct Exploration: Results From a Specialist Center in the United Kingdom
Authors: Deytrikh Andrew , Stewart Sabrina , Malone Nicholas , McTaggart Eleanor , Leeder Paul , Bhatti Imran , Awan Altaf
Published: December 2018

Background:

The incidence of common bile duct (CBD) stones is between 10% to 18% in people undergoing cholecystectomy for gallstones. Laparoscopic exploration of the CBD is now becoming routine practice in the elective setting, however its safety and efficacy in emergencies is poorly understood.

Methods:

We analyzed our results for index emergency admission laparoscopic cholecystectomy within a specialist center in the United Kingdom. Data from all emergency cholecystectomies in our unit, between 2011 to 2016 were collected and analyzed retrospectively.

Results:

In total, 494 patients underwent emergency laparoscopic cholecystectomy; 53 (10.7%) patients underwent common bile duct exploration (CBDE), with 1 conversion and 1 bile leak. Indications for CBDE were based on preoperative imaging (41 cases, 81%) or intra-operative cholangiogram (44 cases, 83%) findings.

Conclusions:

Index admission laparoscopic cholecystectomy and concomitant CBDE is safe and should be the gold standard treatment for patients presenting with acute biliary complications, reducing readmissions and the need for a 2-stage procedure.
Fluoroscopy Dose and Time Characteristics During Endoscopic Retrograde Cholangiopancreatography (ERCP)
Authors: Syed Aslam R. , Garg Mrinal S. , Patel Pikul , Singh Shailendra , Blackwood Margaret , Munigala Satish , Thakkar Payal , Farah Katie , Aoun Elie , Kulkarni Abhijit , Dhawan Manish , Agarwal Satty , Wallace Dustin , Thakkar Shyam
Published: December 2018

Radiation exposure during endoscopic retrograde cholangiopancreatography is known, however, data in relation to radiation usage is unclear. We evaluate radiation exposure using fluoroscopy dose (FD) and time (FT). A prospective analysis of 197 patients undergoing endoscopic retrograde cholangiopancreatography was completed. Univariate and multivariate analyses were performed to determine characteristics associated with higher FD and FT. The mean FT was 307 seconds; the mean FD was 16.5 centigray. On univariate and multivariate analysis, indication of common bile duct stricture and pancreatic stricture, interventions including dilation and the use of plastic stents placement, procedures that were moderately or very difficult, and procedures that used magnification and high-resolution images were associated with higher FD± and longer FT. Indications of common bile duct stricture and pancreatic stricture as well as interventions of dilation, plastic stents placement, and procedures that are moderately or very difficult, involve high-resolution image leading to a higher radiation exposure. Special care should be considered in these settings.
Examining the ocular fundus in neurology
Authors: Rodenbeck Stefanie J. , Mackay Devin D.
Published: December 2018

Purpose of review

The funduscopic examination can be a technically difficult, and often omitted, portion of the neurologic examination, despite its great potential to influence patient care.

Recent findings

Medical practitioners are often first taught to examine the ocular fundus using a direct ophthalmoscope, however, this skill requires frequent practice. Nonmydriatic tabletop and portable fundus photography and even smartphone-based photography offer alternative and practical means for approaching examination of the ocular fundus. These alternative tools have been shown to be practical in a variety of settings including ambulatory clinics and emergency departments. Decreased retinal microvascular density detected with fundus photography has been linked to accelerated rates of cognitive decline. Research has also found optic disc pallor and retinopathy detected via fundus photography to be more prevalent in patients with recent stroke or transient ischemic attack.

Alternative methods of funduscopic examination based on fundus photography have the potential to improve the ease of use, portability, and availability of funduscopy. Recognition of changes in retinal microvasculature has the potential to noninvasively identify patients at the highest risk for cognitive impairment and cerebrovascular disease. However, further research is needed to determine the specific utility of measurements of retinal microvascular changes in clinical care. Innovative funduscopy techniques offer neurologists new approaches to this essential facet of the neurological examination.
Milestones in the development of a vestibular implant
Authors: Guyot Jean-Philippe , Perez Fornos Angelica
Published: December 2018

Purpose of review

Bilateral vestibular deficits exist and their prevalence is more important than believed by the medical community. Their severe impact has inspired several teams to develop technical solutions in an attempt to rehabilitate patients. A particularly promising pathway is the vestibular implant. This article describes the main milestones in this field, mainly focusing on work conducted in human patients.

Recent findings

There have been substantial research efforts, first in animals and more recently in humans, toward the development of vestibular implants. Humans have demonstrated surprising adaptation capabilities to the artificial vestibular signal. Today, the possibility of restoring vestibular reflexes, particularly the vestibulo-ocular reflex, and even achieving useful function in close-to-reality tasks (i.e. improving visual abilities while walking) have been demonstrated in humans.

The vestibular implant opens new perspectives, not only as an effective therapeutic tool, but also pushes us to go beyond current knowledge and well-established clinical concepts.
Single-Dose Pharmacokinetics and Pharmacodynamics of IPX203 in Patients With Advanced Parkinson Disease: A Comparison With Immediate-Release Carbidopa-Levodopa and With Extended-Release Carbidopa-Levodopa Capsules
Authors: Modi Nishit B. , Mittur Aravind , Rubens Robert , Khanna Sarita , Gupta Suneel
Published: December 2018

Objective

IPX203 is an investigational oral extended-release capsule formulation of carbidopa-levodopa (CD-LD). The aim of this study was to characterize the single-dose pharmacodynamics, pharmacokinetics, and safety of IPX203 in subjects with advanced Parkinson disease compared with immediate-release (IR) CD-LD and extended-release CD-LD (Rytary).

Methods

This was a randomized, open-label, rater-blinded, multicenter, single-dose crossover study. Blinded clinicians assessed subject's motor state and Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III scores for up to 10 hours postdose. Duration of effect was determined using improvement thresholds in the MDS-UPDRS part III.

Results

Levodopa concentrations increased rapidly and similarly across all 3 treatments and were sustained for a longer duration after IPX203 dosing. All treatments exhibited a rapid onset of pharmacodynamic effect, whereas IPX203 had a significantly longer duration of effect based on MDS-UPDRS part III scores compared with IR CD-LD (P < 0.0001) and Rytary (P ≤ 0.0290). IPX203 had a 2.7-hour advantage over IR CD-LD (P < 0.0001) and a 0.9-hour advantage over Rytary in “off” time (P = 0.023) and in “good on” time (2.6 hours more than IR CD-LD, P < 0.0001; 0.9 hours more than Rytary, P = 0.0259) as measured by the Investigator Assessment of Subject's Motor State. Subjects were 77% more likely to require rescue following IR CD-LD treatment compared with IPX203 (hazard ratio, 0.23; P < 0.0001). More subjects reported treatment-emergent adverse effects during IR CD-LD (28.0%) and IPX203 (19.2%) than during Rytary (8.0%) treatment.

Conclusions

Compared with Rytary and IR CD-LD, IPX203 had a longer pharmacodynamic effect consistent with LD pharmacokinetics for the 3 treatments. The safety and tolerability of IPX203 were similar to those of IR CD-LD and Rytary.
Integrated biomarker responses of the submerged macrophyte
Vallisneria spiralis
via hydrological processes from Lake Poyang, China
Authors: Ji Yong , Yao Zhidong , Zhang Jie , Wang Xueru , Luo Jixiang , Xiao Liying , Zhang Shifeng
Published: December 2018

Vallisneria spiralis
, a widely distributed wetland plant, was used to reveal how the light intensity at the top of the plant, plant morphology and antioxidant enzyme activity respond to different hydrologic conditions from Lake Poyang, China. By designing a laboratory experiment simulating historical water levels of low, normal and high wetland plant submersion, this study aimed to elucidate the effects of different levels of flooding on growth and antioxidant enzyme activity for
V. spiralis
. The results showed that the plant crown light intensity of the treated group and control group (CG) first decreased and then increased along with the seasonal variation of the water level. The maximum and minimum values of the plant crown light intensity were observed in April and July, respectively. Similar to the CG,
V. spiralis
from the normal and low water level (LWL) groups was measured and had higher plant height growth in the flooding period from May to June, and the entire plant biomass also showed a steady growth trend in the same period. However, the plant growth of the high water level (HWL) group was lower during the whole simulation period, with negative growth in July. Antioxidant enzyme activities changed with the seasonal temperature, and the activity of the CG showed a rising trend. Compared with those of the CG, the antioxidant enzyme activities of the HWL group showed a ‘bell shaped’ trend, which was first significantly induced and then significantly inhibited. In addition, the peroxidase (POD) and catalase (CAT) activities from the LWL group in April were also significantly induced. The integrated biomarker response (IBR) index showed that a comprehensive biological index could well reflect the effects of seasonal water levels in Poyang Lake on the growth of the wetland plant
V. spiralis
. This study indicated that high flooding levels had the strongest negative effect on the growth and enzyme activity of the submerged plant
V. spiralis
.
Crystal growth of La

2/3-
x

Li

3
x

TiO
3
by the TSFZ method
Authors: Maruyama Yuki , Minamimure Shiho , Kobayashi Chinatsu , Nagao Masanori , Watauchi Satoshi , Tanaka Isao
Published: December 2018

Double-perovskite-type La

2/3-
x

Li

3
x

TiO
3
(LLT) crystals were grown by the travelling solvent floating zone (TSFZ) method. When the floating zone (FZ) crystal growth method was applied, the La
2
Ti
2
O
7
phase was deposited as an inclusion in the initial growth region. Using the TSFZ crystal growth method, however, inclusion-free LLT crystals were obtained for a 10 mol% La
2
Ti
2
O
7
-poor composition solvent relative to the stoichiometric LLT crystals. The molten zone was initially unstable as a result of habit plane formation during the crystal growth; however, the molten zone was stably maintained for a long period of time by decreasing the feed rate compared with the growth rate. Hence, LLT crystals of approximately 5 mm
φ
and 37 mm in length were obtained. The anisotropic ionic conductivity of the crystals annealed in air was
σ
[110]/
σ
[001] ≈ 3, with
σ
[110] = 1.64 × 10
−3
S cm
−1
and
σ
[001] = 5.26 × 10
−4
S cm
−1
. LLT single crystals are candidates for high-performance solid-state electrolytes in all-solid-state Li ion batteries.
Actuarial senescence in a dimorphic bird: different rates of ageing in morphs with discrete reproductive strategies
Authors: Grunst Melissa L. , Grunst Andrea S. , Formica Vincent A. , Korody Marisa L. , Betuel Adam M. , Barcelo-Serra Margarida , Gonser Rusty A. , Tuttle Elaina M.
Published: December 2018

It is often hypothesized that intra-sexual competition accelerates actuarial senescence, or the increase in mortality rates with age. However, an alternative hypothesis is that parental investment is more important to determining senescence rates. We used a unique model system, the white-throated sparrow (
Zonotrichia albicollis
), to study variation in actuarial senescence. In this species, genetically determined morphs display discrete mating strategies and disassortative pairing, providing an excellent opportunity to test the predictions of the above hypotheses. Compared to tan-striped males, white-striped males are more polygynous and aggressive, and less parental. Tan-striped females receive less parental support, and invest more into parental care than white-striped females, which are also more aggressive. Thus, higher senescence rates in males and white-striped birds would support the intra-sexual competition hypothesis, whereas higher senescence rates in females and tan-striped birds would support the parental investment hypothesis. White-striped males showed the lowest rate of actuarial senescence. Tan-striped females had the highest senescence rate, and tan-striped males and white-striped females showed intermediate, relatively equal rates. Thus, results were inconsistent with sexual selection and competitive strategies increasing senescence rates, and instead indicate that senescence may be accelerated by female-biased parental care, and lessened by sharing of parental duties.