bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Anesthetic Management and Outcomes in Patients Having Either Transnasal or Transoral Endoscopic Odontoid Process Surgery
Authors: Sexton Matthew A. , Abcejo Arnoley S. , Pasternak Jeffrey J.
Published: February 2017

Background:

Endoscopic neurosurgical procedures involving the upper cervical vertebrae are challenging due to a narrow operating field and close proximity to vital anatomical structures. Historically, transoropharyngeal (transoral) endoscopy has been the preferred approach. More recently, however, an endoscopic transnasal approach was developed as an alternative method in hopes to reduce postoperative dysphagia, a common complication following transoral neurosurgery.

Methods:

Twenty-two endoscopic neurosurgical cases involving the odontoid or C1 vertebra were reviewed between January 1, 2005 and December 31, 2015 (17 and 5 through transoral and transnasal approaches, respectively). Patient demographics, anesthetic technique, intraoperative course, and postoperative outcomes such as were recorded.

Results:

Patients who underwent transnasal odontoidectomy had a shorter length of stay and lower rates of tracheostomy compared with those having similar surgery via the transoral route. In those having transoral surgery, no patient presented to the operating room with a preexisting tracheostomy. In 16 of 17 patients within the transoral group, a tracheostomy was performed. In those having transnasal surgery, 2 of 5 patients had a preexisting tracheostomy. In the remaining 3 of 5 patients, orotracheal intubation was performed and patients were extubated after the procedure.

Conclusions:

The transnasal odontoid resection technique may become a more popular surgical approach without increasing rates of complications compared with those having transoral surgery. Ultimately, a larger, study is needed to further clarify these relationships.
Similar Anatomical Reduction and Lower Complication Rates With the Sinus Tarsi Approach Compared With the Extended Lateral Approach in Displaced Intra-Articular Calcaneal Fractures
Authors: Schepers Tim , Backes Manouk , Dingemans Siem A. , de Jong Vincent M. , Luitse Jan S. K.
Published: February 2017

Objectives:

To investigate whether the sinus tarsi approach (STA) allows for a similar anatomical reduction of the posterior talocalcaneal facet as the extended lateral approach (ELA) and compare the rate of postoperative wound complications.

Design:

Retrospective.

Setting:

Level 1 trauma center.

Patients:

All consecutive patients from 2012 to 2015 with a closed displaced intra-articular calcaneal fracture Sanders type II and III surgically treated with the ELA (N = 60) and the STA (N = 65).

Main Outcome Measurements:

Wound complications, timing of surgery, operative time, length of postoperative hospitalization, and reduction of the posterior facet and calcaneal body.

Results:

Incidence of wound complications, time to surgery, postoperative duration of hospital admission, and number of hospital admissions because of wound complications were significantly different between the ELA group and STA group. There was no significant difference in restoration of calcaneal anatomy with either approach. Importantly, the STA was performed in a median duration of 105 minutes and the ELA in a median of 134 minutes, accounting for nearly half an hour difference in operating time (P < 0.001).

Conclusions:

The largest benefit of the STA was found in the significant reduction in wound complications and operative time, where time to closure may have accounted for the latter difference. This difference was without a compromise in reduction. Additional studies comparing functional outcome, especially rates of subtalar arthrosis, will be needed to determine the long-term benefits of STA.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Suppurative complications of acute hematogenous osteomyelitis in children
Authors: Johnston Jennifer J. , Murray-Krezan Cristina , Dehority Walter
Published: February 2017

We carried out a case–control study in children with acute hematogenous osteomyelitis (AHO) with and without suppurative complications discharged from our institution over an 11-year period to test the hypothesis that abscess formation was associated with a delayed presentation to care. Of 102 children with AHO, 54 abscesses were documented in 46 patients (25 bone, 29 muscle). A delay in presentation was not associated with abscess formation (6.5 vs. 5.0 days, P=0.26). Overall, 78% of all bone abscesses were visible on initial MRI. Consistent use of MRI at presentation may identify children with suppurative complications of AHO.
Information-seeking Behavior and Information Needs in Patients With Amyotrophic Lateral Sclerosis
Authors: Oh Juyeon , Kim Jung A
Published: February 2017

A few studies have examined the specific informational needs of the population with amyotrophic lateral sclerosis. The aims of this study were to describe the information-seeking behavior and information needs of patients with amyotrophic lateral sclerosis and their families in Korea by analyzing messages from an online patient community. A total of 1047 messages from the question and answer forum of the “Lou Gehrig’s Disease Network” (http://cafe.daum.net/alsfree) from January 2010 to September 2015 were collected. The word frequency, main questions, and asker of the messages were analyzed and coded. Terms such as “hospital,” “mother,” “father,” “gastrostomy,” and “ALS” were most frequently identified. The most commonly mentioned main topic was about disease-specific information, while the most frequent subcategory was symptoms or management of symptoms. Other prominent categories concerned information about treatment, rehabilitation, and the medical system. The people who wrote the questions were mostly the son/daughter of patients with amyotrophic lateral sclerosis. Patients with amyotrophic lateral sclerosis and their family members commonly obtained information by posting their inquiries online and have a variety of questions regarding amyotrophic lateral sclerosis in this study. The findings of this study can be used as a base of information for developing educational programs and resources for patients with amyotrophic lateral sclerosis and their families.
The role of 5-hydroxymethylcytosine in melanoma
Authors: Li Feng-juan , Li Li-ming , Zhang Rui-hua , Xu Cui , Zhou Pan , Long Jia , Hu Gang , Jiang Ming-jun
Published: February 2017

Malignant melanoma is a highly aggressive neoplasia of melanocytic origin. In part because of the lack of effective treatment methods, the incidence and mortality rates of this disease continue to increase. Rapidly accumulating evidence suggests that dysregulation of epigenetic mechanisms, including DNA methylation/demethylation, chromatin modification, and remodeling, and diverse activities of noncoding RNAs, play a central role in the pathogenesis of melanoma. The epigenetic mark 5-hydroxymethylcytosine (5-hmC) has attracted interest since 2009, when it was shown that ten-eleven translocation proteins can enzymatically convert 5-methylcytosine into 5-hmC, a key intermediate of DNA demethylation. Factors that regulate DNA hydroxymethylation are frequently altered in cancer, leading to deregulation of 5-hmC levels. In this review, we will discuss the relationship between melanoma and DNA hydroxymethylation, the regulation of DNA hydroxymethylation, and defects in this pathway in melanoma.
Adjuvant Radiotherapy Versus Wait-and-See Strategy for Pathologic T3 or Margin-Positive Prostate Cancer
Authors: Shaikh M. Parvez , Alite Fiori , Wu Meng-Jia , Solanki Abhishek A. , Harkenrider Matthew M.
Published: February 2017

Objective:

To conduct a meta-analysis of the randomized controlled trials (RCTs) comparing adjuvant radiotherapy (ART) to wait-and-see (WS) strategy in pathologic T3 or margin-positive prostate cancer.

Methods:

A comprehensive EMBASE, MEDLINE, http://www.clinicaltrails.gov, and Cochrane Library search for RCTs of ART versus WS was done. Results were synthesized for metastasis-free, biochemical progression-free, clinical progression-free, hormone-free, and overall survival as well as gastrointestinal (GI) and genitourinary (GU) toxicities. Either random-effects model or fixed-effects model were used based on the test of heterogeneity.

Results:

Three RCTs (EORTC22911, SWOG8794, ARO96-02/AUO-AP09/95) were identified with 1737 patients. ART resulted in greater biochemical progression-free survival (hazard ratio [HR]=0.48, P<0.00001) including benefit in all subsets, greater clinical progression-free survival (HR=0.73, P=0.0003) including benefit in subsets with margin-positive or seminal vesicle invasion and, greater hormone-free survival (HR=0.64, 95% confidence interval, 0.51-0.80, P=0.0001). Ten-year metastasis-free survival was significantly improved with ART (odds ratio=0.77, P=0.02). There was no survival benefit (HR=0.97; P=0.89). With ART compared with WS, there was significantly increased toxicity of any grade (50% vs. 38.6%), grade 2 or greater GU toxicity (17.1% vs. 10.3%), grade 2 or greater GI toxicity (2.5% vs. 1.1%), urinary stricture rates (11.1% vs. 5.7%) and, urinary incontinence (6.9% vs. 2.7%).

Conclusions:

Ten-year metastasis-free survival is significantly improved with ART compared with WS. Biochemical progression-free, clinical progression-free, and hormone-free survival were also improved with ART. Grade 2 or higher GI and GU toxicities were greater in ART. Therefore, ART should be offered to patients with these high-risk features.
Challenges in Management of Squamous Cell Carcinoma of the Anus in New England and Across the United States
Authors: Pricolo Victor E. , Viani Kyle L. , Bonvini Matteo , Abelli Carlo F. , McDuffie Tracey J.
Published: February 2017

Background:

Management of squamous cell carcinoma of the anus (SCCA) is becoming more relevant, as its incidence continues to increase. The purpose of this study was to evaluate regional and national data to assess trends in epidemiology, access to cancer center care, and overall management strategies in SCCA.

Study Design:

A review of available data from the American College of Surgeons Committee on Cancer National Cancer Data Base focused on incidence, sex, age, stage at diagnosis, distance traveled for care, and utilization of therapy as first course of treatment (FCT). The analysis included 40,817 patients treated for SCCA at 1513 cancer centers in the United States, of which 2347 patients were treated at 109 cancer centers in New England, between the years 2003 and 2013.

Results:

Over the 11-year period, incidence of SCCA increased by 76% in the United States and by 83.8% in New England. Stage was unknown in 11.7% of all US cases, significantly higher than more common cancers, for example, breast (4.3%), prostate (6%), or colon (7.8%) (P<0.001). Patients in southern New England, compared with northern New England, traveled <10 miles more often (53.4% vs. 38.1%) (P<0.001), and>25 miles less often (14.3% vs. 28.7%) (P<0.001). Cases of early stage SCCA (0, I) were more frequent in southern New England (29.2%) than northern New England (21.7%) (P=0.0025), whereas more advanced stage (II to IV) cases occurred less frequently in southern New England (60.1%) than northern New England (72%) (P<0.001). Overall, the most common FCT was chemoradiotherapy, utilized in 49.3% of cases, followed by chemoradiotherapy plus surgery in 19.4% of cases. Stage unknown patients were treated with chemoradiotherapy in 34.6% of cases, with surgery alone in 20.2%, and with chemoradiotherapy plus surgery in 15.4% of cases.

Conclusions:

The incidence of SCCA is steadily increasing. Its frequency of stage unknown is significantly higher than other common cancer sites. Travel distance and stage at diagnosis data may reflect regional differences in cancer center care access. Although chemoradiotherapy remains the most commonly utilized FCT, challenges in accurate staging and inconsistent use of additional prognostic variables may affect optimal treatment.
ACR Appropriateness Criteria® Resectable Pancreatic Cancer
Authors: Jones William E. , Suh W. Waren , Abdel-Wahab May , Abrams Ross A. , Azad Nilofer , Das Prajnan , Dragovic Jadranka , Goodman Karyn A. , Jabbour Salma K. , Konski Andre A. , Koong Albert C. , Kumar Rachit , Lee Percy , Pawlik Timothy M. , Small William , Herman Joseph M.
Published: February 2017

Management of resectable pancreatic adenocarcinoma continues to present a challenge due to a paucity of high-quality randomized studies. Administration of adjuvant chemotherapy is widely accepted due to the high risk of systemic spread associated with pancreatic adenocarcinoma, but the role of radiation therapy is less clear. This paper reviews literature associated with resectable pancreatic cancer to include prognostic factors to aid in the selection of patients appropriate for adjuvant therapies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Adjuvant External Radiation Impacts Outcome of Pelvis-limited Stage III Endometrial Carcinoma
Authors: Albuquerque Kevin , Folkert Michael , Mayadev Jyoti , Christie Alana , Liotta Margaret R. , Nagel Christa , Sevak Parag , Harkenrider Matthew M. , Lea Jayanthi S. , Hanna Rabbie K. , Small William C. , Miller David S. , Xie Xian-Jin , Potkul Ronald K. , Elshaikh Mohamed A.
Published: February 2017

Background:

Adjuvant therapy choice for women with FIGO stage III endometrial carcinoma (EC) is controversial. We investigate the comparative benefit of adjuvant chemotherapy (CT) alone, radiation therapy alone (RT) or in combination (chemotherapy and radiation therapy [CRT]) with respect to recurrence-free survival (RFS) and overall survival (OS) in women with pelvis-limited (PL) EC (stage IIIA, IIIB, and IIIC1).

Materials and Methods:

A multi-institutional database of 270 surgically staged women with PLEC was analyzed. Univariate log-rank analyses and Cox regression multivariate analyses (MVA) were performed to identify factors associated with RFS and OS.

Results:

Median RFS and OS were 112 and 130 months, respectively, for the full cohort. Adjuvant treatment was CT in 21%, RT in 27%, and CRT in 47%. Age, year of treatment, grade, histology, and adjuvant treatment were significantly associated with RFS and OS on univariate analysis. PLEC patients receiving CT alone fared worse in terms of RFS (P=0.07 relative to RT and <0.01 relative to CRT). On MVA, CRT retained significantly improved RFS relative to CT (hazard ratio for recurrence 0.38, P<0.01). PLEC patients receiving RT or CRT had improved OS compared with CT, P<0.01 and 0.03, respectively. On MVA, both RT only and CRT retained association with improved OS relative to CT alone (hazard ratio for death, 0.43, P=0.02 and 0.40, P<0.01, respectively).

Conclusions:

For surgically staged PL stage III EC, treatment regimens incorporating RT were associated with improved survival endpoints relative to CT alone. As such, RT should be considered an important component in the adjuvant management of stage III PLEC.
Third-line Salvage Chemotherapy for Recurrent Carcinoma of the Cervix is Associated With Minimal Response Rate and High Toxicity
Authors: Manders Dustin B. , Kehoe Siobhan M. , Miller David S. , Lea Jayanthi S. , Richardson Debra L.
Published: February 2017

Background:

Metastatic and recurrent cervical cancer is rarely a curable disease. Systemic chemotherapy is typically recommended for treatment based on clinical trials in the first-line or second-line setting. Rare patients who progress through 2 salvage regimens will have the performance status, medical ability, and desire to continue cytotoxic therapy. For these patients, there are no data to provide effective counseling regarding expected response rates (RRs) and toxicities. We sought to review our experience with this patient population.

Methods:

A single institution review was performed of all patients treated for cervical cancer between January 1, 2000 and June 30, 2013. Eligible patients were those who received at least 3 unique salvage chemotherapy regimens following primary surgery or radiation. RRs, survival statistics and toxicities were evaluated.

Results:

Twenty-three of 710 (3.2%) patients treated for cervical cancer met eligibility criteria. Nineteen received 2 or more cycles of a third-line regimen and were assessed for response and progression-free survival. The remainder were included in analysis of overall survival and toxicity. The RR to third-line chemotherapy was 10% (1 complete, 1 partial). An additional 27% achieved stable disease. In total, 57% suffered a grade 3 or 4 toxicity. The progression-free survival from the beginning of third-line therapy was 3.8 months, and the overall survival was 7.4 months.

Conclusions:

Patients eligible to receive third-line chemotherapy for metastatic and recurrent cervical cancer can expect minimal benefit at the cost of significant toxicity. Quality of life considerations should be of paramount importance when counseling regarding the risks and benefits of further cytotoxic therapy.
Association between osteoporosis treatment and severe periodontitis in postmenopausal women
Authors: Passos-Soares Johelle de S. , Vianna Maria Isabel P. , Gomes-Filho Isaac S. , Cruz Simone S. , Barreto Maurício L. , Adan Luis F. , Rösing Cassiano K. , Trindade Soraya C. , Cerqueira Eneida M.M. , Scannapieco Frank A.
Published: February 2017

Objective:

To estimate the association between osteoporosis treatment and severe periodontitis in postmenopausal women.

Methods:

This cross-sectional study comprised of 492 postmenopausal women, 113 women in osteoporosis treatment, and 379 not treated. Osteoporosis treatment consisted of systemic estrogen alone, or estrogen plus progestin, and calcium and vitamin D supplements, for at least 6 months. Severe periodontitis was defined as at least two interproximal tooth sites with clinical attachment loss of at least 6 mm, and at least one interproximal site with probing depth of at least 5 mm; and dental caries experience was measured using the decayed, missing, and filled teeth (DMFT) index. Analysis included descriptive statistics and Poisson multivariate analysis with robust variance.

Results:

Women receiving osteoporosis treatment had less periodontal probing depth, less clinical attachment loss, and less gingival bleeding than women not receiving treatment for osteoporosis (P ≤ 0.05). In the osteoporosis treatment group, the estimated mean DMFT index score was approximately 20, the most frequent component being the number of missing teeth, and in the nontreated group, the DMFT index was approximately 19. The prevalence of severe periodontitis was 44% lower in the osteoporosis treatment group than in the nontreatment group. The prevalence ratioadjusted was 0.56, 95% confidence interval was 0.31 to 0.99 (P = 0.05), after adjustments for smoking, age, family income, and visit to the dentist.

Conclusions:

The results suggest that women treated with estrogen for postmenopausal osteoporosis have a lower prevalence of severe periodontitis than women not receiving treatment.
The 4-flap Jester’s Hat Technique for Nipple Reduction
Authors: Economides James M. , Pittman Troy A.
Published: February 2017

Macrothelia, or nipple hypertrophy, is a condition that may cause severe psychological distress to those who suffer from it. Although effective in their primary goal of reducing nipple diameter and projection, previously reported techniques in nipple reduction suffer from imperfect aesthetic outcomes with noticeable scarring patterns, anatomically anomalous shape, and a smoothing of the natural ruffles of the nipple. We propose a simple technique to nipple reduction that improves upon previous techniques and creates a more naturally appearing nipple. A 4-flap technique resembling a jester’s hat is described whereby suture lines are concealed within the central nipple to recreate the naturally ruffled appearance of a native nipple. Four patients have undergone this technique at a single institution with 100% patient satisfaction and no postoperative complications. Nipple sensation was maintained in all patients postoperatively. A 4-flap nipple reduction technique is a viable alternative to previously described techniques, which may offer more anatomically congruent results.
Mechanical Efficiency in Chronic Obstructive Pulmonary Disease
Authors: Gosens Willem , van't Hul Alex J. , Oomen Joost M. , Hesselink Matthijs K. C. , Borghouts Lars B.
Published: February 2017

PURPOSE:

The primary aims of this study were (1) to evaluate whole-body mechanical efficiency (ME) in a large group of chronic obstructive pulmonary disease (COPD) patients with a wide range of degrees of illness and (2) to examine how ME in COPD is related to absolute work rate and indices of disease severity during exercise testing.

METHODS:

A total of 569 patients (301 male patients; GOLD stage I: 28, GOLD stage II: 166, GOLD stage III: 265, and GOLD stage IV: 110) with chronic obstructive pulmonary disease (COPD) were included in the data analysis. Individual maximal workload (watt), peak minute ventilation (

JOURNAL/jcprh/04.03/01273116-201703000-00009/9FSM1/v/2023-09-11T074124Z/r/image-gif

E, L/min body temperature and pressure, saturated), and peak oxygen uptake (

JOURNAL/jcprh/04.03/01273116-201703000-00009/9FSM1/v/2023-09-11T074124Z/r/image-gif

o
2, mL/min standard temperature and pressure, dry) were determined from a maximal incremental cycle ergometer test. Ventilatory and metabolic response parameters were collected during a constant work rate test at 75% of the individual maximal workload. From the exercise responses of the constant work rate test, the gross ME was calculated.

RESULTS:

The mean whole-body gross ME was 11.0 ± 3.5% at 75% peak power. The ME declined significantly (P < .001) with increasing severity of the disease when measured at the same relative power. Log-transformed absolute work rate (r = .87, P < .001) was the strongest independent predictor of gross ME. Body mass was the single other variable that contributed significantly to the linear regression model.

CONCLUSIONS:

Gross ME in COPD was largely predicted by the absolute work rate (r = .87; P < .001) while indices of the severity of the disease did not predict ME in COPD.
Designing a physician leadership development program based on effective models of physician education
Authors: Hopkins Joseph , Fassiotto Magali , Ku Manwai Candy , Mammo Dagem , Valantine Hannah
Published: February 2017

Background:

Because of modern challenges in quality, safety, patient centeredness, and cost, health care is evolving to adopt leadership practices of highly effective organizations. Traditional physician training includes little focus on developing leadership skills, which necessitates further training to achieve the potential of collaborative management.

Purpose:

The aim of this study was to design a leadership program using established models for continuing medical education and to assess its impact on participants’ knowledge, skills, attitudes, and performance.

Methodology/Approach:

The program, delivered over 9 months, addressed leadership topics and was designed around a framework based on how physicians learn new clinical skills, using multiple experiential learning methods, including a leadership active learning project. The program was evaluated using Kirkpatrick’s assessment levels: reaction to the program, learning, changes in behavior, and results. Four cohorts are evaluated (2008–2011).

Results:

Reaction: The program was rated highly by participants (mean = 4.5 of 5). Learning: Significant improvements were reported in knowledge, skills, and attitudes surrounding leadership competencies. Behavior: The majority (80%–100%) of participants reported plans to use learned leadership skills in their work. Improved team leadership behaviors were shown by increased engagement of project team members. Results: All participants completed a team project during the program, adding value to the institution.

Conclusion:

Results support the hypothesis that learning approaches known to be effective for other types of physician education are successful when applied to leadership development training. Across all four assessment levels, the program was effective in improving leadership competencies essential to meeting the complex needs of the changing health care system.

Practice implications:

Developing in-house programs that fit the framework established for continuing medical education can increase physician leadership competencies and add value to health care institutions. Active learning projects provide opportunities to practice leadership skills addressing real word problems.
THE FUNDUS PHENOTYPE ASSOCIATED WITH THE p.Ala243Val BEST1 MUTATION
Authors: Khan Kamron N. , Islam Farrah , Moore Anthony T. , Michaelides Michel
Published: February 2017

Purpose:

To describe a highly recognizable and reproducible retinal phenotype associated with a specific BEST1 mutation—p.Ala243Val.

Methods:

Retrospective review of consecutive cases where genetic testing has identified p.Ala243Val BEST1 as the cause of disease. Electronic patient records were used to extract demographic, as well as functional and anatomical data. These data were compared with those observed with the most common BEST1 genotype, p.Arg218Cys.

Results:

Eight individuals (six families) were identified with the p.Ala243Val BEST1 mutation and seven patients with the pathologic variant p.Arg218Cys. No patients with mutation of codon 243 knowingly had a family history of retinal disease, whereas all patients with the p.Arg218Cys variant did. The maculopathy was bilateral in all cases. The p.Ala243Val mutation was associated with a pattern dystrophy–type appearance, most visible with near-infrared reflectance and fundus autofluorescence imaging. This phenotype was never observed with any other genotype. This mutation was associated with an older median age of symptom onset (median = 42, interquartile range = 22) compared with those harboring the p.Arg218Cys mutation (median = 18, interquartile range = 12; Mann–Whitney U test; P < 0.05). Despite their older age, the final recorded acuity seemed to be better in the p.Ala243Val group (median = 0.55, interquartile range = 0.6475; median = 0.33, interquartile range = 0.358), although this did not reach statistical significance (Mann–Whitney U test; P > 0.05).

Conclusion:

The mutation p.Ala243Val is associated with highly recognizable and reproducible pattern dystrophy–like phenotype. Patients develop symptoms at a later age and tend to have better preservation of electrooculogram amplitudes.
Late-onset Sepsis in Extremely Premature Infants
Authors: Greenberg Rachel G. , Kandefer Sarah , Do Barbara T. , Smith P. Brian , Stoll Barbara J. , Bell Edward F. , Carlo Waldemar A. , Laptook Abbot R. , Sánchez Pablo J. , Shankaran Seetha , Van Meurs Krisa P. , Ball M. Bethany , Hale Ellen C. , Newman Nancy S. , Das Abhik , Higgins Rosemary D. , Cotten C. Michael
Published: February 2017

Background:

Late-onset sepsis (LOS) is an important cause of death and neurodevelopmental impairment in premature infants. The purpose of this study was to assess overall incidence of LOS, distribution of LOS-causative organisms and center variation in incidence of LOS for extremely premature infants over time.

Methods:

In a retrospective analysis of infants 401–1000 g birth weight and 22–28 6/7 weeks of gestational age born at 12 National Institute of Child Health and Human Development Neonatal Research Network centers in the years 2000–2005 (era 1) or 2006–2011 (era 2) who survived >72 hours, we compared the incidence of LOS and pathogen distribution in the 2 eras using the χ2 test. We also examined the effect of birth year on the incidence of LOS using multivariable regression to adjust for nonmodifiable risk factors and for center. To assess whether the incidence of LOS was different among centers in era 2, we used a multivariable regression model to adjust for nonmodifiable risk factors.

Results:

Ten-thousand one-hundred thirty-one infants were studied. LOS occurred in 2083 of 5031 (41%) infants in era 1 and 1728 of 5100 (34%) infants in era 2 (P < 0.001). Birth year was a significant predictor of LOS on adjusted analysis, with birth years 2000–2009 having a significantly higher odds of LOS than the reference year 2011. Pathogens did not differ, with the exception of decreased fungal infection (P < 0.001). In era 2, 9 centers had significantly higher odds of LOS compared with the center with the lowest incidence.

Conclusions:

The incidence of LOS decreased over time. Further investigation is warranted to determine which interventions have the greatest impact on infection rates.
Effects of Vacuum-Assisted Socket Suspension on Energetic Costs of Walking, Functional Mobility, and Prosthesis-Related Quality of Life
Authors: Rosenblatt Noah J. , Ehrhardt Tess , Fergus Rachel , Bauer Angela , Caldwell Ryan
Published: February 2017

Introduction

Proper suspension is critical to maintaining socket comfort and fit. Vacuum-assisted socket suspension (VASS) improves fit and comfort by reducing peak socket pressure and pistoning of the residual limb. The purpose of this study was to quantify the effects of VASS on metabolic costs of gait and performance-based outcomes by evaluating changes in these measures immediately after altering suspension and to compare self-reported outcome measures between groups of VASS and non-VASS users.

Materials and Methods

Eighteen current VASS users and 18 non-VASS users, all of whom were active community ambulators, participated in two related studies. For study 1, VASS users completed three tasks in the following order: 1) a quantitative gait analysis, 2) function and mobility tests (10-m walk test [10MWT] and timed up and go [TUG]); and 3) 6 minutes of walking at self-selected speed (SSS) to determine energetic costs of walking and socket comfort. Participants performed each task under three suspension conditions, in random order, before proceeding to the next task. The conditions were altering VASS by inactivating the vacuum and blocking the one-way valve. Participants completed tasks immediately after alterations in suspension; that is, we provided no specific accommodation period. All tasks in study 1 were completed during a single testing session. For study 2, both VASS and non-VASS subjects completed electronic versions of surveys to assess prosthetic use and locomotor function including sections of the Prosthetic Evaluation Questionnaire.

Results

Study 1: There was no effect of suspension on cost of transport (p = 0.47 for main effect of suspension). However, participants performed TUG in shorter time using VASS and suction (p = 0.02 VASS vs. sleeve; p = 0.049 suction vs. sleeve; p = 0.54 VASS vs. suction) and performed the 10MWT with greater speed while using VASS compared with both suction (p = 0.027) and sleeve (p = 0.011). The use of VASS resulted in a significant within-subject increase of 1.5 and 3 points in socket comfort compared to suction (p = 0.001) and sleeve (p = 0.001), respectively. Study 2: There were no significant differences in any self-reported outcomes measures between VASS and non-VASS users.

Conclusions

In absence of active vacuum, current users of VASS experience an immediate reduction in comfort, presumably reflecting worse fit, which may limit their ability to attain faster walking speeds but which does not have an immediate negative affect on the cost of transport. The self-reported measures used to quantify the effects of suspension on prosthetic use, locomotor capabilities, and domains reflecting prosthesis-related quality of life may have been ill-suited for identifying difference in the high-functioning heterogeneous population considered.
Adolescent transition clinic in inflammatory bowel disease: quantitative assessment of self-efficacy skills
Authors: Yerushalmy-Feler Anat , Ron Yulia , Barnea Efrat , Nachum Ayala , Matalon Shay , Dali-levy Margalit , Dotan Iris , Cohen Shlomi
Published: February 2017

Objectives

There is no model for the process of transition of adolescents with inflammatory bowel diseases (IBD) to the adult care protocol. We recently established a transition clinic where 17-year-old to 18-year-old IBD patients are seen by a multidisciplinary team including pediatric and adult gastroenterologists with expertise in IBD treatments, an IBD nurse, and a psychologist. We quantitatively describe this model and its benefits, and correlate demographic and transition parameters to self-efficacy in IBD adolescent patients before and after transition.

Patients and methods

All adolescent IBD patients enrolled in our transition clinic between January 2013 and December 2015 were included. They completed a self-efficacy questionnaire (‘IBD-yourself’) before and after the transition. The scores were correlated to demographic, disease, and transition parameters.

Results

Thirty of the 36 enrolled patients (mean age: 19±1.8 years, range: 17–27) had Crohn’s disease. Twenty-seven patients completed the transition protocol, which included an average of 3–4 meetings (range: 2–8) over 6.9±3.5 months. Self-efficacy scores in all domains of the questionnaire were significantly higher after completion of the transition. The weighted average score of the questionnaire’s domains was 1.85±0.3 before and 1.41±0.21 after transition (P<0.0001). Age, sex, disease duration, duration of transition, and the number of meetings in the clinic correlated with the questionnaire’s scores in the domains of coping with IBD, knowledge of the transition process, and medication use.

Conclusion

A well-planned adolescent IBD transition clinic contributes significantly toward improved self-efficacy in IBD. We recommend its implementation in IBD centers to enable a personalized transition program tailored to the needs of adolescents with IBD in specific domains.
Refractory Pure Red Cell Aplasia Manifesting as Deficiency of Adenosine Deaminase 2
Authors: Hashem Hasan , Egler Rachel , Dalal Jignesh
Published: February 2017

Primary progress has been made in the last 2 years, particularly in finding novel disease-causing genes for a number of autoinflammatory diseases and primary immunodeficiencies. Whole-exome sequencing has dramatically increased the pace at which causative genes are being discovered. CECR1 (Cat eye syndrome chromosome region, candidate 1) gene encodes adenosine deaminase 2 (ADA2) protein. Patients who carry CECR1 mutation(s) suffer from deficiency of ADA2 (DADA2). Here, we describe a patient with pure red cell aplasia discovered to have DADA2. We also review the literature on DADA2. This report will help raise awareness of physicians for this complex disease.
Spherical Soft Contact Lens Designs and Peripheral Defocus in Myopic Eyes
Authors: Moore Kelly E. , Benoit Julia S. , Berntsen David A.
Published: February 2017

Purpose

Peripheral retinal defocus has been implicated in myopia progression. The effect of commercially available spherical soft contact lenses (SCLs) on peripheral defocus of adult myopic eyes was investigated.

Methods

Twenty-five young adults with spherical equivalent (SE) refractions between −0.50D and −6.00D were enrolled. Cycloplegic autorefraction (right eye) was measured centrally and ±20°, ±30°, and ±40° from the line of sight along the horizontal meridian using an autorefractor. Four commercially available spherical SCLs (Biofinity, Acuvue2, PureVision2, and Air Optix Night & Day Aqua) were evaluated. SE defocus (M) was used to calculate relative peripheral defocus (RPD) while wearing each SCL and relative peripheral refraction of the uncorrected eye. Spherical aberration (SA) changes caused by each SCL were measured along the line of sight by aberrometry. Peripheral defocus was analyzed using repeated-measures analyses of variance (RM-ANOVA). The association between changes in axial SA and the change in peripheral defocus was evaluated using linear mixed models.

Results

The mean age (±SD) and central SE refractive error were 24.0 ± 1.3 years and −3.45 ± 1.42D, respectively. PureVision2 did not change RPD (P = .33). Significant myopic shifts on the temporal retina were found with three lenses: Acuvue 2 (−0.29D at 30°; −0.80D at 40°; both P ≤ .01), Biofinity (−1.21 D at 40°; P = .02), and Air Optix Night & Day Aqua (−0.23D at 20°, −0.48D at 30°, and −1.50D at 40°; all P < .004). All SCLs caused a negative change in SA. SCLs inducing less negative (more positive) SA changes were associated with a less hyperopic change in RPD.

Conclusions

Spherical SCL design can influence the peripheral defocus profile experienced by a myopic eye. Several, but not all, SCLs reduced peripheral hyperopia. Differences in how SCL types influence peripheral defocus may have implications for myopia progression.
The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions
Authors: Schafer Katherine R. , Albrecht Helmut , Dillingham Rebecca , Hogg Robert S. , Jaworsky Denise , Kasper Ken , Loutfy Mona , MacKenzie Lauren J. , McManus Kathleen A. , Oursler Kris Ann K. , Rhodes Scott D. , Samji Hasina , Skinner Stuart , Sun Christina J. , Weissman Sharon , Ohl Michael E. ,   on behalf of the North American Rural HIV Working Group
Published: February 2017

The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Socioeconomic factors, geography, cultural context, and evolving epidemics of injection drug use are coalescing to move the epidemic into locations where populations are dispersed and health care resources are limited. Rural–urban differences along the care continuum demonstrate the implications of this sociogeographic shift. Greater attention is needed to build a more comprehensive understanding of the rural HIV epidemic in the United States and Canada, including research efforts, innovative approaches to care delivery, and greater community engagement in prevention and care.
Two Cases of Oral Somatic Delusions Ameliorated With Brain Perfusion Asymmetry: A Case Report
Authors: Umezaki Yojiro , Uezato Akihito , Toriihara Akira , Nishikawa Toru , Toyofuku Akira
Published: February 2017

Background

Oral cenesthopathy is the complaint of abnormal oral sensation where no underlying organic cause can be identified. It is also called oral dysesthesia or oral somatic delusion and classified as delusional disorder, somatic type. The patients with oral cenesthopathy show right > left asymmetric regional cerebral blood flow (rCBF) in the broad brain region. However, the studies scrutinizing the rCBF change before and after the successful treatment are still a few so far.

Case

We present 2 cases of oral cenesthopathy, who responded well to aripiprazole. The asymmetric rCBF patterns were attenuated after successful treatment in both cases.

Conclusions

We found a marked improvement of oral cenesthopathy with aripiprazole. It is suggested that right > left rCBF asymmetry in the frontal and temporal lobes and thalamus, and the dopaminergic and serotonergic dysfunctions are involved in the pathology of oral cenesthopathy.
François Jacob. 17 June 1920 — 19 April 2013
Authors: Morange Michel
Published: February 2017

Biological research was a late vocation for François Jacob, who entered the laboratory of André Lwoff at the Institut Pasteur in Paris at the age of 30. Ten years before, in 1940, he had abruptly left France, after the German troops entered Paris, and joined the Free French Forces organized by de Gaulle in London. He served as a medic in battles against the German troops in Africa, and was severely wounded in Normandy in August 1944. He could no longer be a surgeon as he had expected, and his return to a civilian life was difficult.

Fifteen years after he entered the Institut Pasteur, in 1965, he received the Nobel Prize in Physiology or Medicine, together with André Lwoff and Jacques Monod, for the discovery of the mechanisms controlling gene expression in bacteria, the operon model. The impact of this discovery was immense and triggered the conversion of molecular biologists to the study of higher organisms and their development. Jacob decided to work on mice, and his characterization of embryonal carcinoma cells and of their differentiation foreshadowed recent studies on embryonic stem cells. His comparison between evolution and the work of a tinkerer was also highly influential.

Jacob wrote many books on the history and philosophy of the biological sciences. He was convinced that reflection on these issues was necessary for researchers to defend the value of scientific knowledge. He also continuously fought for an ethical use of scientific knowledge.
Morphoelasticity in the development of brown alga
Ectocarpus siliculosus
: from cell rounding to branching
Authors: Jia Fei , Ben Amar Martine , Billoud Bernard , Charrier Bénédicte
Published: February 2017

A biomechanical model is proposed for the growth of the brown alga
Ectocarpus siliculosus
. Featuring ramified uniseriate filaments, this alga has two modes of growth: apical growth and intercalary growth with branching. Apical growth occurs upon the mitosis of a young cell at one extremity and leads to a new tip cell followed by a cylindrical cell, whereas branching mainly occurs when a cylindrical cell becomes rounded and swells, forming a spherical cell. Given the continuous interplay between cell growth and swelling, a poroelastic model combining osmotic pressure and volumetric growth is considered for the whole cell, cytoplasm and cell wall. The model recovers the morphogenetic transformations of mature cells: transformation of a cylindrical shape into spherical shape with a volumetric increase, and then lateral branching. Our simulations show that the poro-elastic model, including the Mooney–Rivlin approach for hyper-elastic materials, can correctly reproduce the observations. In particular, branching appears to be a plasticity effect due to the high level of tension created after the increase in volume of mature cells.
A conditional mutant of the fatty acid synthase unveils unexpected cross talks in mycobacterial lipid metabolism
Authors: Cabruja Matías , Mondino Sonia , Tsai Yi Ting , Lara Julia , Gramajo Hugo , Gago Gabriela
Published: February 2017

Unlike most bacteria, mycobacteria rely on the multi-domain enzyme eukaryote-like fatty acid synthase I (FAS I) to make fatty acids de novo. These metabolites are precursors of the biosynthesis of most of the lipids present both in the complex mycobacteria cell wall and in the storage lipids inside the cell. In order to study the role of the type I FAS system inMycobacteriumlipid metabolismin vivo, we constructed a conditional mutant in thefas-acpSoperon ofMycobacterium smegmatisand analysed in detail the impact of reduced de novo fatty acid biosynthesis on the global architecture of the cell envelope. As expected, the mutant exhibited growth defect in the non-permissive condition that correlated well with the lower expression offas-acpSand the concomitant reduction of FAS I, confirming that FAS I is essential for survival. The reduction observed in FAS I provoked an accumulation of its substrates, acetyl-CoA and malonyl-CoA, and a strong reduction of C12to C18acyl-CoAs, but not of long-chain acyl-CoAs (C19to C24). The most intriguing result was the ability of the mutant to keep synthesizing mycolic acids when fatty acid biosynthesis was impaired. A detailed comparative lipidomic analysis showed that although reduced FAS I levels had a strong impact on fatty acid and phospholipid biosynthesis, mycolic acids were still being synthesized in the mutant, although with a different relative species distribution. However, when triacylglycerol degradation was inhibited, mycolic acid biosynthesis was significantly reduced, suggesting that storage lipids could be an intracellular reservoir of fatty acids for the biosynthesis of complex lipids in mycobacteria. Understanding the interaction between FAS I and the metabolic pathways that rely on FAS I products is a key step to better understand how lipid homeostasis is regulated in this microorganism and how this regulation could play a role during infection in pathogenic mycobacteria.
From the elastica compass to the elastica catapult: an essay on the mechanics of soft robot arm
Authors: Armanini C. , Dal Corso F. , Misseroni D. , Bigoni D.
Published: February 2017

An elastic rod is clamped at one end and has a dead load attached to the other (free) end. The rod is then slowly rotated using the clamp. When the load is smaller than the buckling value, the rod describes a continuous set of quasi-static forms and its end traces a (smooth, convex and simple) closed curve, which would be a circle if the rod were rigid. The closed curve is analytically determined through the integration of the Euler’s elastica, so that for sufficiently small loads the mechanical system behaves as an ‘elastica compass’. For loads higher than that of buckling, the elastica reaches a configuration from which a snap-back instability occurs, realizing a sort of ‘elastica catapult’. The whole quasi-static evolution leading to the critical configuration for snapping is calculated through the elastica and the subsequent dynamic motion simulated using two numerical procedures, one
ad hoc
developed and another based on a finite-element scheme. The theoretical results are then validated on a specially designed and built apparatus. An obvious application of the present model would be in the development of soft robotic limbs, but the results are also of interest for the optimization analysis in pole vaulting.
Single-cell epigenomics maps the continuous regulatory landscape of human hematopoietic differentiation
Authors: Buenrostro Jason D , Corces M Ryan , Wu Beijing , Schep Alicia N , Lareau Caleb A , Majeti Ravindra , Chang Howard Y. , Greenleaf William J.
Published: February 2017

Normal human hematopoiesis involves cellular differentiation of multipotent cells into progressively more lineage-restricted states. While epigenomic landscapes of this process have been explored in immunophenotypically-defined populations, the single-cell regulatory variation that defines hematopoietic differentiation has been hidden by ensemble averaging. We generated single-cell chromatin accessibility landscapes across 8 populations of immunophenotypically-defined human hematopoietic cell types. Using bulk chromatin accessibility profiles to scaffold our single-cell data analysis, we constructed an epigenomic landscape of human hematopoiesis and characterized epigenomic heterogeneity within phenotypically sorted populations to find epigenomic lineage-bias toward different developmental branches in multipotent stem cell states. We identify and isolate sub-populations within classically-defined granulocyte-macrophage progenitors (GMPs) and use ATAC-seq and RNA-seq to confirm that GMPs are epigenomically and transcriptomically heterogeneous. Furthermore, we identified transcription factors andcis-regulatory elements linked to changes in chromatin accessibility within cellular populations and across a continuous myeloid developmental trajectory, and observe relatively simple TF motif dynamics give rise to a broad diversity of accessibility dynamics at cis-regulatory elements. Overall, this work provides a template for exploration of complex regulatory dynamics in primary human tissues at the ultimate level of granular specificity – the single cell.

One Sentence Summary

Single cell chromatin accessibility reveals a high-resolution, continuous landscape of regulatory variation in human hematopoiesis.