bluuebunny/crossref_metadata_2025 huggingface dataset:
Aneurismas associados à fenestração da artéria basilar: entidades raras submetidas a tratamento endovascular – Relato de casos e revisão da literatura
Authors: Parreira Johnathan de Sousa , Antonucci Adriano Torres , Santiago Natally Marques , Neto Roberto Parente , Oliveira Bruno de Azevedo , Garcia Lopes Luiz Henrique , Ferreira Adelmo , Lopes Pedro Garcia
Published: January 2018

Aneurismas da junção vertebrobasilar são raros e frequentemente associados com fenestração da artéria basilar. Estudos mostram que tal entidade representa entre 3% e 9% dos aneurismas infratentoriais e 7,4% dos aneurismas da circulação posterior, excluindo-se os aneurismas da bifurcação da basilar. A sua localização profunda, anterior ao tronco cerebral, e sua íntima relação com as artérias perfurantes tornam o tratamento cirúrgico um grande desafio. A fenestração foi mais comumente encontrada na metade inferior da basilar, situando-se na porção média quando as artérias vertebrais apresentam as mesmas dimensões ou encontradas do lado correspondente à artéria vertebral de maior calibre. Outras classificações para a fenestração da basilar foram propostas. De acordo com a mais utilizada, a fenestração pode ser considerada do tipo A quando apresentar dois pontos de bifurcação proximais, com uma artéria ponte associada e do tipo B quando apresentar bifurcação simples proximal ao sítio da fenestração. Tais aneurismas são de difícil caracterização pela angiografia digital convencional por apresentarem anatomia peculiar, sendo a angiografia em 3D o exame de escolha para a classificação da doença. As modernas técnicas endovasculares disponíveis na atualidade permitem o tratamento seguro mesmo de lesões altamente complexas.
Traumatismo cranioencefálico em um hospital de referência no estado do Pará, Brasil: prevalência das vítimas quanto a gênero, faixa etária, mecanismos de trauma, e óbito
Authors: Carvalho Viégas Maria Luana , Rodrigues Pereira Edmundo Luís , Targino Amanda Amaral , Furtado Viviane Gonçalves , Rodrigues Daniella Brito
Published: January 2018

Objetivo: O objetivo deste estudo foi analisar pacientes vítimas de traumatismo cranioencefálico (TCE) atendidos em hospital de referência em traumatologia do Pará, Brasil, com descrição da prevalência de aspectos clínico-epidemiológicos como gênero, idade, faixa etária, mecanismo de trauma e óbito. Método: Estudo epidemiológico, transversal, observacional, descritivo e individual, baseado na análise de 250 prontuários de vítimas de TCE internadas no Hospital Metropolitano de Urgência e Emergência (HMUE), Ananindeua, PA, no período de janeiro de 2007 a março de 2008. Resultados: Predominou o gênero masculino (88%), na faixa etária dos 20-30 anos de idade (32,4%); o principal mecanismo de trauma foram os acidentes de tráfego (36,4%), com os motociclísticos representando 44% deles; o óbito ocorreu em 22% dos casos. Conclusão: A maior parte das vítimas foi de adultos jovens, do gênero masculino, mais suscetível aos acidentes e à violência; as lesões ocorreram predominantemente por acidentes de tráfego, apontando para a maior necessidade de fiscalização e conscientização da população sobre a importância das medidas preventivas para se evitar a mortalidade por TCE, que neste estudo foi de 22%.
Craniotomia descompressiva: análise crítica baseada em relatos de caso
Authors: Rocha Júnior Marco Antônio , Alves Fernandes Camila Maria , Naves Érica Antunes , Rodrigues Costa Gustavo Alberto
Published: January 2018

Entende-se por infarto maligno aquele que acomete mais da metade do território da artéria cerebral média, atingindo níveis de mortalidade de até 80%. A craniotomia descompressiva tem se mostrado como técnica operatória capaz de reduzir significativamente essas taxas. No entanto, persistem na literatura muitas dúvidas quanto à indicação do procedimento relacionadas a idade, hemisfério cerebral acometido, time cirúrgico e status neurológico pré-operatório. Analisamos 10 pacientes vítimas de acidente vascular cerebral (AVC) isquêmicos extensos, tratados no hospital SEMPER-BH, levando-se esses fatores em consideração. Concluímos que a idade e o quadro neurológico prévio ao momento cirúrgico são os dois fatores mais importantes no prognóstico do paciente submetido à craniotomia descompressiva.
Cavernoma of the lateral ventricule presenting as speech arrests
Authors: Silva Lima Leonardo Conrado , Ferreira Marcelo Paglioli , Alba Davidson , Teles Alisson Roberto , Kliemann Frederico
Published: January 2018

Cavernous malformations (CM) are formed by dilated thin-walled vascular channels without intervening parenchyma and intraventricular lesions are rare. We report a case of an intraventricular cavernoma in a 54-year old female patient. She presented with speech arrests daily for 10 months. Neurological examination revealed no deficits. The brain MRI study revealed an intraventricular lesion at the level of the left atrium, heterogeneously hyperintense on both T1 and T2-weighted images. It was performed an interhemispheric transcallosal approach with gross-total resection of the lesion. The histological examination was compatible with the diagnosis of cavernous haemangioma. In the postoperative period the patient presented with transient right hemiparesis with recovery in two weeks. We briefly review the literature concerning intraventricular cavernomas.
Considerações sobre o modelo experimental de hipertensão intracraniana e avaliação do sistema de microchip para monitoração de pressão epidural
Authors: Paiva Wellingson Silva , de Andrade Almir Ferreira , Belon Alessandro Rodrigo , Bor-Seng-Shu Edson , Oliveira Marcelo de Lima , Amorim Robson Luis , Soares Matheus Schmidt , Otoch Jose Pinhata , Teixeira Manoel Jacobsen
Published: January 2018

Objetivo: Neste trabalho temos o objetivo de avaliar a acurácia do sistema de aferição da pressão intracraniana (PIC) epidural com microchip. Métodos: Foram estudados 27 suínos sob anestesia geraI, devidamente assistidos com monitoração ventilatória e hemodinâmica. Durante o experimento foi reproduzido um processo expansivo intracerebral programado no lobo frontal direito. O experimento constou de três grupos (A, B e C) com hipertensão intracraniana gerada com balão reproduzindo um hematoma intracerebral. Em todos os grupos foram calibrados os parâmetros normais: os dois sistemas de PIC foram comparados e estudados quanto à correlação dos valores aferidos. Resultados: O comportamento médio da PIC ao longo dos momentos de avaliação foi estatisticamente diferente entre os grupos (p < 0,001). A reprodução de ressangramento resultou em elevação significativa da PIC (p < 0,001). Avaliando-se a acurácia comparativa geral, verificou-se um coeficiente de correlação intraclasse de 0,8. Conclusão: O modelo de hipertensão intracraniana por balão em suínos é factível e confiável na geração de hipertensão intracraniana. O sistema de aferição de pressão intracraniana epidural apresenta elevado coeficiente de correlação com o sistema de aferição parenquimatoso na avaliação global.
Resultados econômicos e funcionais na cirurgia para hérnia do disco lombar
Authors: Daniel Jefferson Walter , Cesare Fabiane de Araújo , Haddad Luciano , Carreira Antônio Barros , Cannoni Luiz Fernando , Esteves Veiga José Carlos
Published: January 2018

O objetivo deste estudo é a comparação dos resultados cirúrgicos entre pacientes beneficiados por compensações financeiras previdenciárias decorrentes da inatividade ocupacional e aqueles que não as recebem, antes e após terem sido operados de hérnia do disco lombar.

Esta análise retrospectiva abrangeu o período de fevereiro de 1999 a janeiro de 2002. Foram estudados 47 pacientes consecutivos operados de hérnias discais lombares de etiologia degenerativa e sem artrodese, no Serviço de Neurocirurgia da Santa Casa de São Paulo. Foram analisados prontuários hospitalares e mantidos contatos telefônicos com os pacientes. Aplicamos questionário padronizado com informações a respeito de: estado clínico, ocupações, esforços físicos e recebimento de benefícios financeiros antes e após a cirurgia. Utilizamos a escala econõmico-funcional de Prolo para a avaliação dos resultados obtidos. Todos os doentes apresentavam sinais e sintomas semelhantes no período pré-operatório.

Os pacientes que recebem regularmente compensações financeiras previdenciárias, quando comparados àqueles sem benefícios, permaneceram inativos por período, em média, 69% maior; obtiveram apenas 21% de resultados excelentes e bons, apesar dos mesmos esforços físicos ocupacionais e 100% não retornaram ao trabalho. Houve diferença estatisticamente significativa entre o tempo de inatividade pré e pós-operatória dos pacientes que receberam benefício e o daqueles que não receberam benefício (p < 0,001, Mann-Whitney), e também nos valores da escala de Prolo entre os dois grupos (p < 0,001, teste t). Vários fatores influenciaram no resultado clínico final, em especial a seguridade social na forma de sua assistência beneficiária.
Fratura múltipla da coluna cervical em segmentos não-adjacentes: Relato de caso
Authors: de Campos Marcelo Ferraz , do Amaral Sérgio Henrique , Viterbo Marcelo Barletta , Gregorini Marcos , Haikel Júnior Luis Fernando , Rodrigues Júnior José Carlos , Listik Sérgio , de Brito Pereira Clemente Augusto , Sobrinho Jozias de Andrade
Published: January 2018

Relata-se um caso de fratura múltipla da coluna cervical em segmentos não-adjacentes. A radiografia da coluna cervical apresentava fratura dos corpos vertebrais de C4 e C6 e a ressonância magnética revelou edema medular do segmento de C4 a C6 com ruptura do ligamento longitudinal posterior entre C6 e C7, sem compressão medular.

Realizou-se artrodese com enxerto ósseo autólogo de crista ilíaca e fixação com placa e parafusos nos segmentos C3-C4 e C6-C7. O paciente evoluiu sem deformidade e com melhora do déficit neurológico.

A artrodese com enxerto ósseo autólogo, pela técnica de Smith-Robinson, e fixação com place e parafuso podem ser eficazes no tratamento das fraturas múltiplas da coluna cervical em segmentos não-adjacentes.
Meningioma intramedular cervical: relato de caso e revisão da literatura
Authors: Fonseca Ricardo Brandão , Marins Filho Josildo Pereira , Portela Gray , Castelo Branco Nilson Bandeira , Seixas Luciene
Published: January 2018

Os meningiomas estão entre os tumores benignos mais comuns do canal espinhal, em adultos, encontrados, predominantemente, nos segmentos torácicos. Segundo a literatura, a ocorrência de um meningioma intramedular cervical é muito rara, com apenas oito trabalhos científicos relatados até o momento. Apresentaremos o nono relato de caso – talvez o primeiro relato publicado na literatura médica brasileira – e revisaremos os estudos anteriores. Paciente, de 40 anos de idade, iniciou com sintomas de fraqueza na mão direita e dores cervicais que se agravavam durante a noite. A ressonância magnética revelou lesão intramedular extensa cervical. A paciente foi submetida somente à biópsia, por causa de dificuldades na ressecção, sendo depois proposta radioterapia. O tumor teve uma discreta redução, a paciente permaneceu sem piora dos sinais e sintomas durante os oito anos de evolução. Embora muito raros, meningiomas intramedulares cervicais existem e devem estar no diagnóstico diferencial de tumores nessa localização. O principal tratamento dessas lesões, de acordo com relatos anteriores, é a cirurgia, com bons resultados.
Neue Entwicklungen in der Dialysetechnik
Authors: Gohlisch Christopher , Zidek Walter
Published: January 2018

Die terminale Niereninsuffizienz geht mit einer Akkumulation von Urämietoxinen unterschiedlicher Größe, Hydrophilie und Proteinbindung
einher. Lange Zeit waren Dialyseverfahren v. a. auf die Elimination niedermolekularer Urämietoxine mittels Diffusion ausgerichtet, während
seit den 1980er-Jahren zunehmend die Konvektion mit einer verbesserten Elimination mittelmolekularer Moleküle in den Fokus rückte. Aktuelle
Entwicklungen haben zum Ziel, diese historischen Dialyseprinzipien um elektromagnetische und adsorptive Mechanismen zu ergänzen und dabei
Nebenwirkungen möglichst zu vermeiden. Neue nanotechnologische Verfahren bieten die Möglichkeit der Beschichtung von Dialysemembranen mit
verschiedenen Substanzen und weitere Dialyseverfahren versuchen mittels hochkonzentrierter Natriumkonzentrationen die Elimination von
proteingebundenen Substanzen zu verbessern. Neben diesen neuen Entwicklungen drängt sich aufgrund der unterschiedlichen, unspezifischen
Adsorptionseigenschaften der bisher verwendeten Dialysematerialen die Frage auf, ob und – wenn ja – welche Dialysematerialien die Mortalität
möglicherweise beeinflussen.
Dirac light bullets in nonlinear binary waveguide arrays
Authors: Tran Truong X. , Duong Dũng C.
Published: January 2018

We investigate the formation and dynamics of spatially broad Dirac light bullets in nonlinear binary waveguide arrays. We show that a Dirac light bullet can be formed during propagation when a pulse with an initial profile slightly different from the one of the Dirac light bullet is launched into the system. We also reveal that these Dirac light bullets are metastable and can propagate without significant distortion for hundreds of dispersion lengths even in the presence of the Raman effect, group velocity mismatch, and group velocity dispersion difference between adjacent waveguides.
Fast magnetohydrodynamic cnoidal waves and solitons in electron-positron plasma
Authors: Ur-Rehman Hafeez , Mahmood S. , Kaladze T. , Hussain S.
Published: January 2018

Linear and nonlinear propagation of fast magnetohydrodynamic waves (or magnetoacoustic waves) are studied in homogeneous, magnetized and warm collisionless electron-positron (e-p) plasma by using two fluid magnetohydrodynamic model. In the linear limit, the wave dispersion relation is obtained and wave dispersion effect which appears through inertial length in e-p plasma system is also discussed. Using reductive perturbation method, the Korteweg-de Vries (KdV) equation for small but finite wave amplitude of magnetoacoustic waves is derived with appropriate boundary conditions. The cnoidal wave and soliton solutions are obtained using well known Sagdeev potential approach for magnetoacoustic waves in e-p plasmas propagating in the direction perpendicular to the external magnetic field. The phase portrait analysis and numerical illustration of magnetoacoustic cnoidal waves and solitons is also presented by using the parameters such as magnetic field intensity, plasma density and temperature of electron and positron fluids for astrophysical plasma situations exist in the literature.
Review: Engineering of thermostable enzymes for industrial applications
Authors: Rigoldi Federica , Donini Stefano , Redaelli Alberto , Parisini Emilio , Gautieri Alfonso
Published: January 2018

The catalytic properties of some selected enzymes have long been exploited to carry out efficient and cost-effective bioconversions in a multitude of research and industrial sectors, such as food, health, cosmetics, agriculture, chemistry, energy, and others. Nonetheless, for several applications, naturally occurring enzymes are not considered to be viable options owing to their limited stability in the required working conditions. Over the years, the quest for novel enzymes with actual potential for biotechnological applications has involved various complementary approaches such as mining enzyme variants from organisms living in extreme conditions (extremophiles), mimicking evolution in the laboratory to develop more stable enzyme variants, and more recently, using rational, computer-assisted enzyme engineering strategies. In this review, we provide an overview of the most relevant enzymes that are used for industrial applications and we discuss the strategies that are adopted to enhance enzyme stability and/or activity, along with some of the most relevant achievements. In all living species, many different enzymes catalyze fundamental chemical reactions with high substrate specificity and rate enhancements. Besides specificity, enzymes also possess many other favorable properties, such as, for instance, cost-effectiveness, good stability under mild pH and temperature conditions, generally low toxicity levels, and ease of termination of activity. As efficient natural biocatalysts, enzymes provide great opportunities to carry out important chemical reactions in several research and industrial settings, ranging from food to pharmaceutical, cosmetic, agricultural, and other crucial economic sectors.
Magnetic and hyperthermia properties of CoxFe3-xO4 nanoparticles synthesized via cation exchange
Authors: Mohapatra Jeotikanta , Xing Meiying , Liu J. Ping
Published: January 2018

We demonstrate magnetic and hyperthermia properties of CoxFe3-xO4 (x = 0, 0.1, 0.3 and 0.5) nanoparticles synthesized via a simple cation exchange reaction of ∼12 nm Fe3O4 nanoparticles. The substitution of Fe cations with Co2+ ions leads to enhanced magnetocrystalline anisotropy and coercivity of the pristine superparamagnetic Fe3O4 nanoparticles. Hyperthermia measurement shows that by controlling the Co content (x = 0 to 0.5) in CoxFe3-xO4 nanoparticles, their specific absorption rate (SAR) can be greatly improved from 132 to 534 W/g. The strong enhancement in SAR value is attributed to the increased anisotropy and coercivity. Moreover, with the increase of ac magnetic field from 184 to 491 Oe, the SAR values of Fe3O4 and Co0.5Fe2.5O4 nanoparticles increase from 81 to 132 W/g and 220 to 534 W/g, respectively.
Magnetic and magnetocaloric properties of Co2-xFexVGa Heusler alloys
Authors: Schroeder K. , Waybright J. , Kharel P. , Zhang W. , Valloppilly S. , Herran J. , Lukashev P. , Huh Y. , Skomski R. , Sellmyer D. J.
Published: January 2018

The magnetic and magnetocaloric properties of iron-substituted Co2VGa alloys, Co2-xFexVGa (x = 0, 0.1, 0.15, 0.2, 0.3), were investigated. The Fe-substituted samples, prepared by arc melting, melt spinning, and annealing, crystallized in the L21 Heusler structure, without any secondary phases. The Curie temperature and high-field magnetization at 50 K decreased from 345 K and 44 emu/g (1.90 μB/f.u.) for Co2VGa to 275 K and 39 emu/g (1.66 μB/f.u.) for Co1.7Fe0.3VGa, respectively, but the maximum entropy change remained almost insensitive to Fe concentration for x ≤ 0.2, the highest value being 3.3 J/kgK at 7 T for Co1.85Fe0.15VGa. First-principle calculations show that Co2VGa retains its half-metallic band structure until at least 30% of the cobalt atoms are replaced by Fe atoms. The wide operating temperature window near room temperature and the lack of thermal and magnetic hysteresis are the interesting features of these materials for application in room-temperature magnetic refrigeration.
Size validity of plasma-metamaterial cloaking monitored by scattering wave in finite-difference time-domain method
Authors: Bambina Alexandre , Yamaguchi Shuhei , Iwai Akinori , Miyagi Shigeyuki , Sakai Osamu
Published: January 2018

Limitation of the cloak-size reduction is investigated numerically by a finite-difference time-domain (FDTD) method. A metallic pole that imitates an antenna is cloaked with an anisotropic and parameter-gradient medium against electromagnetic-wave propagation in microwave range. The cloaking structure is a metamaterial submerged in a plasma confined in a vacuum chamber made of glass. The smooth-permittivity plasma can be compressed in the radial direction, which enables us to decrease the size of the cloak. Theoretical analysis is performed numerically by comparing scattering waves in various cases; there exists a high reduction of the scattering wave when the radius of the cloak is larger than a quarter of one wavelength. This result indicates that the required size of the cloaking layer is more than an object scale in the Rayleigh scattering regime.
Magnetocaloric effects and electrical resistivity of Ni2Mn0.55CoxCr0.45-xGa – A Heusler alloy system exhibiting a partially-decoupled first-order phase transition
Authors: Brock Jeffrey , Khan Mahmud
Published: January 2018

The phase transitions and associated magnetocaloric properties of the Ni2Mn0.55CoxCr0.45-xGa (0 ≤ x ≤ 0.25) Heusler alloy system have been investigated. All samples exhibit a first-order martensitic phase transition, evidenced by a sharp drop in the resistivity versus temperature data and a thermomagnetic irreversibility in the dc magnetization data of the respective samples. Large magnetic entropy changes have also been observed near the phase transitions. The martensitic transformation temperature increases as Cr is partially replaced with Co. Additionally, this substitution leads to a partial decoupling of the magnetic and structural phase transitions, dramatically suppressing any magnetic hysteresis losses. Furthermore, the change in electrical resistivity during the phase transition remains relatively constant across the system, despite major changes in the degree of structural disorder and magnetostructural phase transition coupling. Detailed experimental results and conjectures as to the origin of these behaviors have been provided.
Simultaneous magnetic investigations of Cu precipitation and recovery in thermally aged Fe-Cu alloy by first-order-reversal-curves
Authors: Kobayashi Satoru , Kawagoe Riko , Murakami Hiroaki
Published: January 2018

We have measured first-order reversal curves (FORCs) for Fe-1wt%Cu alloy thermally aged at 753 K up to 20000 min. While hardness exhibits a maximum at around 1000 min, reflecting the formation and growth of Cu precipitates, major-loop coercivity monotonically decreases and becomes almost constant above 100 min.; an increase of coercivity associated with Cu precipitation is masked by a large decrease due to recovery. On the other hand, FORC diagrams exhibit two distribution peaks at low and high switching fields after aging. While the former shifts towards a lower switching field after aging, reflecting recovery, the latter shows up after aging up to ∼1000 min, possibly due to the formation of Cu precipitates. These observations demonstrate that FORCs are useful to separately evaluate competing microstructural changes in thermally aged Fe-Cu alloy where recovery and Cu precipitation take place simultaneously.
Diffusive-like effects and possible non trivial local topology on the half-Heusler YPdBi compound
Authors: Souza J. C. , Lesseux G. G. , Urbano R. R. , Rettori C. , Pagliuso P. G.
Published: January 2018

The non-ambiguous experimental identification of topological states of matter is one of the main interesting problems regarding this new quantum state of matter. In particular, the half-Heusler family RMT (R = rare-earth, T = Pd, Pt or Au and T = Bi, Sb, Pb or Sn) could be a useful platform to explore these states due to their cubic symmetry and the topological properties tunable via their unit cell volume and/or the nuclear charges of the M and T atoms. In this work, we report electron spin resonance (ESR) and complementary macroscopic measurements in the Nd3 + -doped putative topologically trivial semimetal YPdBi. Following the Nd3 + ESR lineshape as a function of microwave power, size of the particle and temperature, we have been able to observe an evolution from a Dysonian lineshape to a diffusive-like lineshape. Furthermore, the Nd3 + ESR intensity saturation is concentration dependent, which could be due to a phonon-bottleneck process. Comparing these results with the Nd3 + -doped YPtBi, we discuss a possible scenario in which the Nd3 + ions could locally tune the topological properties of the system.
Investigating phase transition temperatures of size separated gadolinium silicide magnetic nanoparticles
Authors: Hunagund Shivakumar G. , Harstad Shane M. , El-Gendy Ahmed A. , Gupta Shalabh , Pecharsky Vitalij K. , Hadimani Ravi L.
Published: January 2018

Gadolinium silicide (Gd5Si4) nanoparticles (NPs) exhibit different properties compared to their parent bulk materials due to finite size, shape, and surface effects. NPs were prepared by high energy ball-milling of the as-cast Gd5Si4 ingot and size separated into eight fractions using time sensitive sedimentation in an applied dc magnetic field with average particle sizes ranging from 700 nm to 82 nm. The largest Gd5Si4 NPs order ferromagnetically at 316 K. A second anomaly observed at 110 K can be ascribed to a Gd5Si3 impurity. As the particle sizes decrease, the volume fraction of Gd5Si3 phase increases at the expense of the Gd5Si4 phase, and the ferromagnetic transition temperature of Gd5Si4 is reduced from 316 K to 310 K, while the ordering of the minor phase is independent of the particle size, remaining at 110 K.
QuantumClone: clonal assessment of functional mutations in cancer based on a genotype-aware method for clonal reconstruction
Authors: Deveau Paul , Colmet Daage Leo , Oldridge Derek , Bernard Virginie , Bellini Angela , Chicard Mathieu , Clement Nathalie , Lapouble Eve , Combaret Valerie , Boland Anne , Meyer Vincent , Deleuze Jean-Francois , Janoueix-Lerosey Isabelle , Barillot Emmanuel , Delattre Olivier , Maris John M , Schleiermacher Gudrun , Boeva Valentina
Published: January 2018

Motivation

In cancer, clonal evolution is assessed based on information coming from single nucleotide variants and copy number alterations. Nonetheless, existing methods often fail to accurately combine information from both sources to truthfully reconstruct clonal populations in a given tumor sample or in a set of tumor samples coming from the same patient. Moreover, previously published methods detect clones from a single set of variants. As a result, compromises have to be done between stringent variant filtering [reducing dispersion in variant allele frequency estimates (VAFs)] and using all biologically relevant variants.

Results

We present a framework for defining cancer clones using most reliable variants of high depth of coverage and assigning functional mutations to the detected clones. The key element of our framework is QuantumClone, a method for variant clustering into clones based on VAFs, genotypes of corresponding regions and information about tumor purity. We validated QuantumClone and our framework on simulated data. We then applied our framework to whole genome sequencing data for 19 neuroblastoma trios each including constitutional, diagnosis and relapse samples. We confirmed an enrichment of damaging variants within such pathways as MAPK (mitogen-activated protein kinases), neuritogenesis, epithelial-mesenchymal transition, cell survival and DNA repair. Most pathways had more damaging variants in the expanding clones compared to shrinking ones, which can be explained by the increased total number of variants between these two populations. Functional mutational rate varied for ancestral clones and clones shrinking or expanding upon treatment, suggesting changes in clone selection mechanisms at different time points of tumor evolution.

Availability and implementation

Source code and binaries of the QuantumClone R package are freely available for download at https://CRAN.R-project.org/package=QuantumClone.

Supplementary information

Supplementary data are available at Bioinformatics online.
Changes in Socioeconomic Differences in Hospital Days With Age: Cumulative Disadvantage, Age-as-Leveler, or Both?
Authors: Hu Yaoyue , Leinonen Taina , Myrskylä Mikko , Martikainen Pekka
Published: January 2018

Objectives

Length of hospital stay is inversely associated with socioeconomic status (SES). It is less clear whether socioeconomic disparities in numbers of hospital days diverge or converge with age.

Method

Longitudinal linked Finnish registry data (1988–2007) from 137,653 men and women aged 50–79 years at the end of 1987 were used. Trajectories of annual total hospital days by education, household income, and occupational class were estimated using negative binomial models.

Results

Men and women with higher education, household income, and occupational class had fewer hospital days in 1988 than those with lower SES. Hospital days increased between 1988 and 2007. For some age groups, higher SES was associated with a faster annual rate of increase, resulting in narrowing rate ratios of hospital days between SES groups (relative differences); the rate ratios remained stable for other groups. Absolute SES differences in numbers of hospital days appeared to diverge with age among those aged 50–69 years at baseline, but converge among those aged 70–79 years at baseline.

Discussion

The hypotheses that socioeconomic disparities in health diverge or converge with age may not be mutually exclusive; we demonstrated convergence/maintenance in relative differences for all age groups, but divergence or convergence in absolute differences depending on age.
Equal Pay for Equal Work in Academic Obstetrics and Gynecology
Authors: Eichelberger Kacey Y.
Published: January 2018

The most compelling data suggest women in academic obstetrics and gynecology earn approximately $36,000 less than male colleagues per year in regression models correcting for commonly cited explanatory variables. Although residual confounding may exist, academic departments in the United States should consider rigorous examination of their own internal metrics around salary to ensure gender-neutral compensation, commonly referred to as equal pay for equal work.
Pregnancy-Associated Hypertension and Offspring Cardiometabolic Health
Authors: Rice Madeline Murguia , Landon Mark B. , Varner Michael W. , Casey Brian M. , Reddy Uma M. , Wapner Ronald J. , Rouse Dwight J. , Tita Alan T. N. , Thorp John M. , Chien Edward K. , Saade George , Peaceman Alan M. , Blackwell Sean C. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: January 2018

OBJECTIVE:

To evaluate whether pregnancy-associated hypertension (gestational hypertension and preeclampsia) was associated with the cardiometabolic health of young offspring.

METHODS:

This was a prospective observational follow-up study from 2012 to 2013 of children born to women previously enrolled in a mild gestational diabetes mellitus treatment trial or nongestational diabetes mellitus observational study. At 5–10 years after birth, children were examined and fasting blood samples obtained to determine the following cardiometabolic risk factors: blood pressure (BP), high-density lipoprotein cholesterol, triglycerides, glucose, homeostatic model assessment of insulin resistance, waist circumference, and body mass index (BMI).

RESULTS:

This analysis included 979 children evaluated at a median 7 years of age. Twenty-three (2%) were born preterm from a hypertensive pregnancy, 73 (7%) were born at term from a hypertensive pregnancy, 58 (6%) were born preterm from a normotensive pregnancy, and 825 (84%) were born at term from a normotensive pregnancy (reference group). After adjusting for confounding factors, mean adjusted systolic BP was significantly higher in the children who were born at term to mothers who experienced pregnancy-associated hypertension compared with those born at term to normotensive mothers (systolic BP of 104 mm Hg, 95% CI 101–106 vs systolic BP of 99 mm Hg, 95% CI 99–100, P=.001). No other significant differences were observed.

CONCLUSION:

Pregnancy-associated hypertension in women who deliver at term was associated with higher systolic BP in the offspring, but not with their measures of diastolic BP, BMI, waist circumference, homeostatic model assessment of insulin resistance, glucose, or lipids.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT00069576.
Risk Factors for the Development of Obstetric Anal Sphincter Injuries in Modern Obstetric Practice
Authors: Ramm Olga , Woo Victoria G. , Hung Yun-Yi , Chen Hsuan-Chih , Ritterman Weintraub Miranda L.
Published: January 2018

OBJECTIVE:

To characterize the rate of obstetric anal sphincter injuries and identify key risk factors of obstetric anal sphincter injuries, including duration of the second stage of labor.

METHODS:

This retrospective cohort study included all singleton, term, cephalic vaginal deliveries within Kaiser Permanente Northern California between January 2013 and December 2014 (N=22,741). Incidence of obstetric anal sphincter injuries, defined as third- or fourth-degree perineal lacerations, was the primary outcome. Multiple logistic regression models were conducted to identify obstetric anal sphincter injury risk factors and high-risk subpopulations.

RESULTS:

The overall incidence rate of obstetric anal sphincter injuries was 4.9% (3.6% of women who delivered spontaneously vs 24.0% of women who had a vacuum-assisted vaginal delivery, P<.001, CI 18.1–22.6%). In bivariate and multivariate analyses, obstetric anal sphincter injury incidence was higher among women with second stage of labor longer than 2 hours, Asian race, nulliparity, vaginal birth after cesarean delivery, episiotomy, and vacuum delivery. Women with a vacuum-assisted vaginal delivery had four times the odds of obstetric anal sphincter injury (adjusted odds ratio [OR] 4.23, 95% CI 3.59–4.98) and those whose second stage of labor lasted at least 180 minutes vs less than 60 minutes had three times the odds of incurring obstetric anal sphincter injury (adjusted OR 3.20, 95% CI 2.62–3.89).

CONCLUSION:

Vacuum-assisted vaginal delivery conferred the highest odds of obstetric anal sphincter injury followed by prolonged duration of the second stage of labor, particularly among certain subpopulations. Understanding these risk factors and their complex interactions can inform antepartum and intrapartum decision-making with the goal of reducing obstetric anal sphincter injury incidence.
An explanatory and predictive model of the variation in esophageal cancer incidence on the basis of changes in the exposure to risk factors
Authors: Castro Clara , Peleteiro Bárbara , Morais Samantha , Severo Milton , Bento Maria José , Lunet Nuno
Published: January 2018

Variations in the exposure to risk factors may be used to explain past cancer trends and to predict its future burden. This study aimed to develop a model to describe and predict the variation of esophageal cancer incidence in 1995–2005, taking into account changes in exposures to risk factors. We adapted an existing model to calculate the expected variation in the number of esophageal cancer cases, between 1995 and 2005, in Australia, Japan, Italy, Portugal, the UK, and the USA, because of changes in exposures to risk factors, taking into account the corresponding lag times. Analyses were based on country-specific data of cancer incidence and exposures to risk factors. We computed 95% credibility intervals through Monte Carlo simulation methods. Absolute deviations between the number of cases predicted and those observed in 2005 ranged between 1.8% in Japan and 23.6% in the UK among men and 0.0% in Japan and 18.0% in Australia among women. In Italy and Japan, deviations did not exceed 3%. The UK registered the worst model performance. The variation in esophageal cancer incidence was mainly influenced by changes in fruit and red meat intake, and BMI. For nearly half of the sex-specific and histological type-specific predictions performed, credibility intervals included the observed number of cases. This study proposes a framework for the analysis of the contribution of changes in exposure to different factors to esophageal cancer incidence trends and for long-term predictions at a population level.
INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS IN PHACOVITRECTOMY FOR EPIRETINAL MEMBRANE AND MACULAR HOLE
Authors: Fajgenbaum Mark A. P. , Neffendorf James E. , Wong Roger S. , Laidlaw David A. H. , Williamson Tom H.
Published: January 2018

Purpose:

The aim of this study was to report the intraoperative and postoperative complications of phacovitrectomy for epiretinal membrane (ERM) and macular hole (MH).

Methods:

This was a retrospective audit of 1,052 phacovitrectomy operations (410 for ERM and 642 for MH) by the same surgical team between 1998 and 2017. Outcome measures included rates of intraoperative anterior segment and posterior segment complications such as posterior capsule rupture and retinal breaks. A subgroup analysis of 189 procedures in which postoperative complications were rigorously recorded was also undertaken.

Results:

The rate of posterior capsule rupture was 2.2%, with no difference between ERM and MH (1.7 vs. 2.5%; P = 0.40). Iatrogenic retinal tears were more common in MH than in ERM surgery (15.6 vs. 6.8%; P < 0.001). The chance of one or more anterior segment or posterior segment intraoperative complications occurring (excluding iatrogenic retinal breaks) was not associated with: indication for surgery, grade of surgeon, gauge of surgery, surgical machine, diabetic status, patient sex, or patient age. Subgroup analysis showed postoperative events as follows: posterior capsular opacification 10.6% (20/189), posterior synechiae 4.2% (8/189), uveitis 2.1% (4/189), angle closure glaucoma 1.6% (3/189), and rhegmatogenous retinal detachment 1.1% (2/189).

Conclusion:

Phacovitrectomy seems to be safe in phakic patients with ERM or MH, performed either by fellows or consultants. It avoids the requirement for repeat surgery and is more cost and resource efficient.
Assuring Quality for Non‐hospital–based Biologic Infusions in Pediatric Inflammatory Bowel Disease
Authors: Barfield Elaine , Sockolow Robbyn , Hoffenberg Edward , Saeed Shehzad , Kim Sandra , Siebold Leah , Picoraro Joseph , Moses Jonathan , Dykes Dana , Grossman Andrew , Wahbeh Ghassan , Park K.T.
Published: January 2018

The primary aim of this Clinical Report by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition is to provide formal guidance to pediatric gastroenterologists and clinicians, health systems, and insurance payers regarding home‐ and office‐based infusions for biologic therapies in pediatric inflammatory bowel disease. Patients in North America are increasingly denied coverage by payers based on “place of service” codes at hospital‐based infusion units where the treating clinicians primarily provide care. A task force with topic expertise generated 8 best practice recommendations to ensure quality of care for pediatric patients with inflammatory bowel disease receiving non‐hospital–based biologic infusions. Pragmatic considerations discussed in this report include patient safety, pediatric‐trained nurse availability, care coordination, patient‐centeredness, shared liability, administrative support, clinical governance, and costs of care.
Pharmacy Students' Preparedness to Communicate With Mental Health Disorders Patients
Authors: Chow Claudia , Morrissey Hana , Ball Patrick
Published: January 2018

The aim of this project was to explore whether fourth-year pharmacy students in England are prepared to communicate with mental health patients. Mental health problems are rising in the United Kingdom, affecting around one in four people. A questionnaire-based study measured the knowledge about and attitude toward mental health problems. Participants were fourth-year pharmacy students from two west midlands universities. More males than females correctly answered the “attitude towards mental health” questions. However, overall, only 45.5% of students answered the “attitude towards mental health problems” questions correctly. Males demonstrated a better level of knowledge than females, with 33% overall answering 6 or more questions of the 13 knowledge questions correctly. Sixty-five percent of participants scored under 50%. The highest total score was 81%, and the lowest was 19%, three people did not answer any questions. In conclusion, a gap in knowledge was identified within the fourth-year pharmacy student cohort, and more intervention will be required to improve knowledge and attitudes such as the Mental Health First Aid courses.
Parafibromin-deficient (HPT-JT Type, CDC73 Mutated) Parathyroid Tumors Demonstrate Distinctive Morphologic Features
Authors: Gill Anthony J. , Lim Grace , Cheung Veronica K.Y. , Andrici Juliana , Perry-Keene Joanna L. , Paik Julie , Sioson Loretta , Clarkson Adele , Sheen Amy , Luxford Catherine , Elston Marianne S. , Meyer-Rochow Goswin Y. , Nano M. Teresa , Kruijff Schelto , Engelsman Anton F. , Sywak Mark , Sidhu Stanley B. , Delbridge Leigh W. , Robinson Bruce G. , Marsh Deborah J. , Toon Christopher W. , Chou Angela , Clifton-Bligh Roderick J.
Published: January 2018

The gene CDC73 (previously known as HRPT2) encodes the protein parafibromin. Biallelic mutation of CDC73 is strongly associated with malignancy in parathyroid tumors. Heterozygous germline mutations cause hyperparathyroidism jaw tumor syndrome,which is associated with a high life-time risk of parathyroid carcinoma. Therefore loss of parafibromin expression by immunohistochemistry may triage genetic testing for hyperparathyroidism jaw tumor syndrome and be associated with malignant behavior in atypical parathyroid tumors. We share our experience that parafibromin-negative parathyroid tumors show distinctive morphology. We searched our institutional database for parathyroid tumors demonstrating complete loss of nuclear expression of parafibromin with internal positive controls. Forty-three parafibromin-negative tumors from 40 (5.1%) of 789 patients undergoing immunohistochemistry were identified. Thirty-three (77%) were external consultation cases; the estimated incidence in unselected tumors was 0.19%. Sixteen (37.2%) fulfilled World Health Organization 2017 criteria for parathyroid carcinoma and 63% had serum calcium greater than 3mmol/L. One of 27 (3.7%) noninvasive but parafibromin-negative tumors subsequently metastasized. Parafibromin-negative patients were younger (mean, 36 vs. 63 y; P<0.001) and had larger tumors (mean, 3.04 vs. 0.62 g; P<0.001). Not all patients had full testing, but 26 patients had pathogenic CDC73 mutation/deletions confirmed in tumor (n=23) and/or germline (n=16). Parafibromin-negative tumors demonstrated distinctive morphology including extensive sheet-like rather than acinar growth, eosinophilic cytoplasm, nuclear enlargement with distinctive coarse chromatin, perinuclear cytoplasmic clearing, a prominent arborizing vasculature, and, frequently, a thick capsule. Microcystic change was found in 21 (48.8%). In conclusion, there are previously unrecognized morphologic clues to parafibromin loss/CDC73 mutation in parathyroid tumors which, given the association with malignancy and syndromic disease, are important to recognize.
Collagenous Enteritis is Unlikely a Form of Aggressive Celiac Disease Despite Sharing HLA-DQ2/DQ8 Genotypes
Authors: Kung Vanderlene Liu , Liu Ta-Chiang , Ma Changqing
Published: January 2018

Collagenous enteritis is an uncommon small intestinal injury pattern with unclear pathogenesis. While it has been speculated that collagenous enteritis represents a form of refractory celiac disease, recent clinical studies suggest a potential link to exposure to the antihypertensive medication olmesartan. Here we hypothesized that the pathogenesis of collagenous enteritis involves both genetic and environmental factors. All subjects with biopsy-proven collagenous enteritis diagnosed between 2002 and 2015 were identified from 2 tertiary care medical centers. Human leukocyte antigen (HLA)-DQ genotyping was performed by polymerase chain reaction on archived tissue. Celiac disease serology, past medical history, medications, smoking history, demographics, histology, clinical management, and follow-up were recorded. A total of 32 subjects were included. In contrast to celiac disease, subjects with collagenous enteritis were mostly elderly (median age at diagnosis, 69 y; range, 33 to 84 y). Seventy percent of collagenous enteritis subjects harbored celiac disease susceptibility alleles HLA-DQ2/DQ8; however, only 1 subject had elevated serum levels of celiac disease-associated autoantibodies while on a gluten-containing diet. Furthermore, 56% of subjects were taking nonsteroidal anti-inflammatory drugs, 36% proton-pump inhibitors, 28% statins, and 32% olmesartan at the time of diagnosis. Discontinuation of olmesartan and treatments with steroids and/or gluten-free diet resulted in symptomatic and histologic improvement. Neither lymphoma nor collagenous enteritis–related death was seen in this cohort. Therefore, while collagenous enteritis shares similar HLA genotypes with celiac disease, the difference in demographics, the lack of celiac disease-associated autoantibodies, and potential link to medications as environmental triggers suggest the 2 entities are likely distinct in pathogenesis.
Pediatric Electric Bicycle Injuries
Authors: Hermon Karin , Capua Tali , Glatstein Miguel , Scolnik Dennis , Tavor Oren , Rimon Ayelet
Published: January 2018

Background

Electric bicycles (E-bikes) are one of a wide range of light electric vehicles that provide convenient local transportation and attractive recreational opportunities. The aim of this study was to report E-bike–related injuries in children presenting to a trauma center.

Methods

Retrospective observational study, from December 2014 to November 2015, which included all pediatrics patients admitted to the emergency department with an injury related to E-bike use, was performed.

Results

A total of 97 E-bike injuries presented to the emergency department during this period. Mean age of E-bikers was 13.7 years (range, 7.5–16 years). Injuries to the head and the upper and the lower extremities were the most common. Thirteen patients (15%) were admitted, and 4 underwent surgery.

Conclusions

Children are mainly injured as riders when using E-bikes. There is a need for regulation regarding the use of E-bikes to enhance the safety of both bikers and other road and pavement users.
Chair Lift Falls and Injuries in Children
Authors: Glissmeyer Eric W. , Metzger Ryan R. , Bolte Robert
Published: January 2018

Objective

The objective of this study was to compare demographic injury and treatment characteristics of hospitalized pediatric cases of falls from chair lifts to cases of other ski and snowboarding injuries and identify potential interventions for preventing falls from chair lifts.

Methods

Retrospective query of the trauma registry of Utah's only pediatric trauma center for children younger than 18 years requiring hospitalization for a ski or snowboarding injury from November 2004 to February 2014.

Results

There were 443 cases of hospitalized ski and snowboarding injuries during the study period. Twenty-nine cases (7%) fell from height while riding a chair lift. Children falling from chair lifts were more likely to be younger (6.9 years vs 12.1, P < 0.0001), female (41% vs 20%, P < 0.01), and elicit trauma team activation (72% vs 34%, P = <0.0001) but were less frequently treated in the operating room (14 vs 24%, P = 0.02) than children with other ski and snowboarding injuries. There were no differences in mortality, injury severity score, length of hospital stay, or airway intubation outside the operating room. When stated (11/29 cases), mean estimated height of fall from lift was 26 feet. The most common body region in chair lift falls with a significant injury (abbreviated injury scale, ≥3) was lower extremity (4/29, all femur fractures). Patient age discriminated chair lift falls well (area under the receiver operating characteristic curve, 0.87) with age of 7 years and below predicting chair lift fall with a sensitivity of 76% and a specificity of 91%.

Conclusions

Injuries requiring hospitalization after falls from chair lifts occur at regulated facilities and are more common in younger female children when compared with other ski and snowboarding injuries. Interventions for reducing falls from chair lifts may be most effective applied to children 7 years and younger.