bluuebunny/crossref_metadata_2025 huggingface dataset:
Adductor Canal Block Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty
Authors: Gao Fuqiang , Ma Jinhui , Sun Wei , Guo Wanshou , Li Zirong , Wang Weiguo
Published: June 2016

Objectives:

The efficacy and safety of adductor canal block (ACB) as compared with femoral nerve block (FNB) for postoperative pain management in total knee arthroplasty (TKA) remains controversial. We therefore performed a meta-analysis of randomized-controlled trials (RCTs) to compare ACB with FNB in TKA.

Materials and Methods:

Databases, including Pubmed, Medline, Embase, Web of Science, and Cochrane library were searched to identify RCTs comparing ACB with FNB for pain management in patients undergoing TKA. The primary outcomes included pain score with rest or activity and opioid consumption. Secondary outcomes were mobilization ability, quadriceps strength and grade, length of hospital stay, and complications (nausea or vomiting).

Results:

A total of 573 TKAs in 514 patients from 7 RCTs were included in the meta-analysis. Two studies with 155 TKAs reported the mobilization ability assessed by Timed Up and Go Test. The ACB patients performed significantly faster than the FNB patients in the early postoperative period (mean difference=−5.08; 95% confidence interval, −6.03 to −4.13;P<0.00001). The subgroup analysis showed that the outcomes of pain, morphine consumption, quadriceps strength, and length of hospital stay in single shot and continuous subgroups were not statistically different between the 2 groups (P>0.05).

Discussion:

ACB may achieve faster mobilization ability recovery for patients after TKA without a reduction in analgesia when compared with FNB in the early postoperative period. However, due to the variations in the included studies, additional studies are needed to validate these conclusions.
Kupffer Cell p38 Mitogen-Activated Protein Kinase Signaling Drives Postburn Hepatic Damage and Pulmonary Inflammation When Alcohol Intoxication Precedes Burn Injury
Authors: Chen Michael M. , O’Halloran Eileen B. , Shults Jill A. , Kovacs Elizabeth J.
Published: June 2016

Objectives:

Clinical and animal studies demonstrate that alcohol intoxication at the time of injury worsens postburn outcome. The purpose of this study was to determine the role and mechanism of Kupffer cell derangement in exacerbating postburn end organ damage in alcohol-exposed mice.

Design:

Interventional study.

Setting:

Research Institute.

Subjects:

Male C57BL/6 mice.

Interventions:

Alcohol administered 30 minutes before a 15% scald burn injury. Antecedent Kupffer cell depletion with clodronate liposomes (0.5 mg/kg). p38 mitogen-activated protein kinase inhibition via SB203580 (10 mg/kg).

Measurements and Main Results:

Kupffer cells were isolated 24 hours after injury and analyzed for p38 activity and interleukin-6 production. Intoxicated burned mice demonstrated a two-fold (p < 0.05) elevation of Kupffer cell p38 activation relative to either insult alone, and this corresponded to a 43% (p < 0.05) increase in interleukin-6 production. Depletion of Kupffer cells attenuated hepatic damage as seen by decreases of 53% (p < 0.05) in serum alanine aminotransferase and 74% (p < 0.05) in hepatic triglycerides, as well as a 77% reduction (p < 0.05) in serum interleukin-6 levels compared to matched controls. This mitigation of hepatic damage was associated with a 54% decrease (p < 0.05) in pulmonary neutrophil infiltration and reduced alveolar wall thickening by 45% (p < 0.05). In vivo p38 inhibition conferred nearly identical hepatic and pulmonary protection after the combined injury as mice depleted of Kupffer cells.

Conclusions:

Intoxication exacerbates postburn hepatic damage through p38-dependent interleukin-6 production in Kupffer cells.
The Effect of Intraaortic Balloon Pumping Under Venoarterial Extracorporeal Membrane Oxygenation on Mortality of Cardiogenic Patients: An Analysis Using a Nationwide Inpatient Database
Authors: Aso Shotaro , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo
Published: June 2016

Objectives:

The role of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients remains unknown. This study investigated the effect of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation on reducing mortality of cardiogenic shock patients.

Design:

Retrospective cohort study.

Setting:

The Japanese Diagnosis Procedure Combination national inpatient database.

Patients:

Cardiogenic shock adult patients receiving peripheral venoarterial extracorporeal membrane oxygenation at admission were identified in the Japanese Diagnosis Procedure Combination database from July 1, 2010, to March 31, 2013.

Interventions:

None.

Measurements and Main Results:

The primary outcomes were all-cause 28-day mortality and in-hospital mortality, and the secondary outcome was the proportion of patients weaned from venoarterial extracorporeal membrane oxygenation, using propensity score matching. Eligible patients (n= 1,650) were divided into the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group (n= 604) and the venoarterial extracorporeal membrane oxygenation–alone group (n= 1,064). Propensity score matching created matched cohort of 533 pairs. In the propensity score–matched analysis, all-cause 28-day mortality and in-hospital mortality were significantly lower in the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group than the venoarterial extracorporeal membrane oxygenation–alone group (48.4% vs 58.2%;p= 0.001 and 55.9% vs 64.5%;p= 0.004, respectively). In Cox regression, there was a significant difference in survival between the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group and the venoarterial extracorporeal membrane oxygenation–alone group (hazard ratio, 0.74; 95% CI, 0.63–0.86;p< 0.001). The proportion of patients weaned from venoarterial extracorporeal membrane oxygenation was significantly higher in the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group than in the venoarterial extracorporeal membrane oxygenation–alone group (82.6% vs 73.4%;p< 0.001).

Conclusions:

In a national inpatient database, intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation was associated with improved mortality and successful weaning from venoarterial extracorporeal membrane oxygenation. Randomized controlled studies are required to confirm the mortality-reducing effect of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation.
Prognostic Impact of Missed Chemotherapy Doses During Chemoradiation Therapy for Non–Small Cell Lung Cancer
Authors: Deek Matthew P. , Kim Sinae , Ahmed Inaya , Fang Bruno S. , Zou Wei , Malhotra Jyoti , Aisner Joseph , Jabbour Salma K.
Published: June 2016

Objective:

The aim of this study is to investigate the impact of missed chemotherapy administrations (MCA) on the prognosis of non–small cell lung cancer (NSCLC) patients treated with definitive chemoradiation therapy (CRT).

Materials and Methods:

In total, 97 patients with NSCLC treated with definitive CRT were assessed for MCA due to toxicities. Logistic regression was used to determine factors associated with MCA. Kaplan-Meier curves, log-rank tests, and Cox Proportional Hazards models were conducted.

Results:

MCA occurred in 39% (n=38) of the patients. Median overall survival was 9.6 months for patients with MCA compared with 24.3 months for those receiving all doses (P=0.004). MCA due to decline in performance status was associated with the worst survival (4.6 mo) followed by allergic reaction (10.0 mo), hematologic toxicity (11 mo), and esophagitis (17.2 mo, P=0.027). In multivariate models, MCA was associated with higher mortality (hazard ratio, 1.97; P=0.01) and worse progression-free survival (hazard ratio, 1.96; P=0. 009).

Conclusions:

MCA correlated with worse prognosis and increased mortality. Methods to reduce toxicity may improve administration of all chemotherapy doses and increase overall survival in NSCLC treated with CRT.
Cost-effectiveness of Management Options for Small Renal Mass
Authors: Wang Ye , Chen Yu-Wei , Leow Jeffrey J. , Levy Alison C. , Chang Steven L. , Gelpi Francisco-Hammerschmidt
Published: June 2016

Costs of surgery for small renal masses (SRMs) are high. This study aimed to systematically review and evaluate the cost-effectiveness analyses of management options for SRMs. Six databases were searched from inception to August 2015. Inclusion criteria were full original research, full economic evaluation of management options for SRM, and written in English. Among 776 studies screened, 6 met the inclusion criteria. Ablation was cost-effective versus nephron-sparing surgery. Laparoscopic partial nephrectomy was cost-effective versus the open approach. Renal mass biopsy dominated immediate treatment in the United States, but not in Canada. According to the Consolidated Health Economic Evaluation Reporting Standards, all the studies had relatively good quality. Despite the observed evidence, future research is needed to fill in the knowledge gap. A few suggestions should be kept in mind such as conducting the cost-effectiveness analysis in a variety of countries.
The Missing Pieces in Reporting of Randomized Controlled Trials of External Beam Radiation Therapy Dose Escalation for Prostate Cancer
Authors: Zaorsky Nicholas G. , Egleston Brian L. , Horwitz Eric M. , Dicker Adam P. , Nguyen Paul L. , Showalter Timothy N. , Den Robert B.
Published: June 2016

Randomized controlled trials (RCTs) are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost-effectiveness of a treatment. For many patients, cancer is a chronic illness; RCTs evaluating treatments for indolent cancers must evolve to facilitate medical decision-making, as “concrete” patient outcomes (eg, survival) will likely be excellent independent of the intervention, and detecting a difference between trial arms may be impossible. In this commentary, we articulate 9 recommendations that we hope future clinical trialists and funding agencies (including those under the National Cancer Institute) will take into consideration when planning RCTs to help guide subsequent interpretation of results and clinical decision making, based on RCTs of external beam radiation therapy dose escalation for the most common indolent cancer in men, that is, prostate cancer. We recommend routinely reporting: (1) race; (2) medical comorbidities; (3) psychiatric comorbidities; (4) insurance status; (5) education; (6) marital status; (7) income; (8) sexual orientation; and (9) facility-related characteristics (eg, number of centers involved, type of facilities, yearly hospital volumes). We discuss how these factors independently affect patient outcomes and toxicities; future clinicians and governing organizations should consider this information to plan RCTs accordingly (to maximize patient accrual and total n), select appropriate endpoints (eg, toxicity, quality of life, sexual function), actively monitor RCTs, and report results so as to identify the optimal treatment among subpopulations.
Phase II Study of Preoperative Capecitabine and Oxaliplatin-based Intensified Chemoradiotherapy With or Without Induction Chemotherapy in Patients With Locally Advanced Rectal Cancer and Synchronous Liver-limited Resectable Metastases
Authors: Cho Hyungwoo , Kim Jeong Eun , Kim Kyu-pyo , Yu Chang Sik , Kim Jin Cheon , Kim Jong Hoon , Lee Myung Ah , Jang Hong Seok , Oh Seong Taek , Kim Sun Young , Oh Jae Hwan , Kim Dae Yong , Hong Yong Sang , Kim Tae Won
Published: June 2016

Objectives:

Controversy surrounds the management of patients with locally advanced rectal cancer with synchronous resectable liver metastases (LMs). This study was designed to improve both systemic and local control in these patients.

Methods:

Patients with locally advanced rectal cancer (cT3-4N0 or cTanyN1-2) and synchronous resectable liver-limited metastases (cM1a) were randomly assigned to receive either preoperative treatments of induction CapeOx, followed by chemoradiotherapy with CapeOx (CapeOx-RT) (arm A) or CapeOx-RT alone (arm B). Induction CapeOx consisted of oxaliplatin 130 mg/m2 on day 1 and capecitabine 1000 mg/m2 twice daily on days 1 to 14, every 3 weeks for 2 cycles; CapeOx-RT consisted of radiotherapy with 45 Gy/25 daily fractions±5.4 Gy/3 fractions, oxaliplatin 50 mg/m2 weekly for 5 weeks, and capecitabine 825 mg/m2 twice daily on days 1 to 38. Total mesorectal excision and simultaneous liver metastasectomy were planned within 6 weeks after completion of preoperative treatments. The primary endpoint was R0 resection rate of both the primary tumor and LMs.

Results:

Thirty-eight patients were randomly assigned to the present study, 18 to arm A and 20 to arm B. The overall R0 resection rate for both the primary tumor and LMs was 77.8% in arm A and 70.0% in arm B (P=0.72). The median progression-free survival was 14.2 versus 15.1 months (P=0.422) and the 3-year overall survival rate was 75.0% versus 88.8% (P=0.29), respectively.

Conclusions:

Both treatment strategies showed considerable R0 resection rates; however, further study will be warranted to apply these intensified strategies in clinical practice.
Bone Marrow–Derived Mesenchymal Stem Cells Enhance Bacterial Clearance and Preserve Bioprosthetic Integrity in a Model of Mesh Infection
Authors: Criman Erik T. , Kurata Wendy E. , Matsumoto Karen W. , Aubin Harry T. , Campbell Carmen E. , Pierce Lisa M.
Published: June 2016

Background:

The reported incidence of mesh infection in contaminated operative fields is as high as 30% regardless of the material used. Recently, mesenchymal stem cells (MSCs) have been shown to possess favorable immunomodulatory properties and improve tissue incorporation when seeded onto bioprosthetics. The aim of this study was to evaluate whether seeding noncrosslinked bovine pericardium (Veritas Collagen Matrix) with allogeneic bone marrow–derived MSCs improves infection resistance in vivo after inoculation with Escherichia coli (E. coli).

Methods:

Rat bone marrow–derived MSCs at passage 3 were seeded onto bovine pericardium and cultured for 7 days before implantation. Additional rats (n = 24) were implanted subcutaneously with MSC-seeded or unseeded mesh and inoculated with 7 × 105 colony-forming units of E. coli or saline before wound closure (group 1, unseeded mesh/saline; group 2, unseeded mesh/E. coli; group 3, MSC-seeded mesh/E. coli; 8 rats per group). Meshes were explanted at 4 weeks and underwent microbiologic and histologic analyses.

Results:

MSC-seeded meshes inoculated with E. coli demonstrated superior bacterial clearance and preservation of mesh integrity compared with E. coli–inoculated unseeded meshes (87.5% versus 0% clearance; p = 0.001). Complete mesh degradation concurrent with abscess formation was observed in 100% of rats in the unseeded/E. coli group, which is in contrast to 12.5% of rats in the MSC-seeded/E. coli group. Histologic evaluation determined that remodeling characteristics of E. coli–inoculated MSC-seeded meshes were similar to those of uninfected meshes 4 weeks after implantation.

Conclusions:

Augmenting a bioprosthetic material with stem cells seems to markedly enhance resistance to bacterial infection in vivo and preserve mesh integrity.
A standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy
Authors: Scholz Joachim , Rathmell James P. , David William S. , Chad David A. , Broderick Alithia C. , Perros Stephen G. , Shin Naomi S. , Wells Jenna L. , Davis John B. , DiMaggio Charles J. , Wang Shuang , Tate Simon N.
Published: June 2016

Diabetic polyneuropathy (DPN) is a major cause of neuropathic pain and a frequent target condition in analgesic treatment trials. Differences in the clinical symptoms and signs associated with DPN suggest distinct pathophysiological mechanisms underlying nerve damage and dysfunction that are likely to have therapeutic relevance. The aim of this study was to develop a tool for the bedside assessment of painful neuropathies such as DPN that captures the diversity of phenotypes. Sixty-one patients with type 2 diabetes and painful neuropathy, 19 patients with painless DPN, 25 patients with type 2 diabetes but no clinical evidence of neuropathy, and 20 healthy control subjects completed a structured interview (47 items) and a standardized physical examination (39 items). After analyzing critical features of pain and painless symptoms and examining the outcome of physical tests of sensory function, we determined principal components of the phenotypic variance among patients. Increased sensitivity to mechanical or thermal stimuli and, to a lesser extent, the sensory quality of pain or paresthesia were the most discriminating elements of DPN phenotypes. Correlation patterns of symptoms and signs indicated the involvement of functionally distinct nerve fiber populations. We combined interview questions and physical tests identifying these differences in a shortened assessment protocol that we named Standardized Evaluation of Pain and Somatosensory Function (StEPS). The protocol StEPS generates a phenotypic profile of patients with neuropathy. Separate intensity ratings for spontaneous painful symptoms and pain evoked by standard stimuli support a detailed documentation of neuropathic pain and its response to analgesic treatment.
Paliperidone Palmitate Once-Monthly Injectable Treatment for Acute Exacerbations of Schizoaffective Disorder
Authors: Fu Dong-Jing , Turkoz Ibrahim , Simonson R. Bruce , Walling David , Schooler Nina , Lindenmayer Jean-Pierre , Canuso Carla , Alphs Larry
Published: June 2016

The optimal treatment for schizoaffective disorder (SCA) is not well established. In this initial 6-month open-label treatment period of a large, multiphase, relapse-prevention study, the efficacy and safety of paliperidone palmitate once-monthly (PP1M) injectable were evaluated in subjects with symptomatic SCA. Subjects with acute exacerbation of SCA (ie, with psychotic and either depressive and/or manic symptoms) were enrolled and treated with PP1M either as monotherapy or in combination with antidepressants or mood stabilizers (combination therapy group). After flexible-dose treatment with PP1M for 13 weeks, stabilized subjects continued into a 12-week fixed-dose PP1M treatment period. A total of 667 subjects were enrolled; 320 received monotherapy and 347 received PP1M as combination therapy; 334 subjects completed the entire 25-week treatment. Statistically significant and clinically meaningful improvements from baseline were observed for all efficacy measures in psychosis (per Positive and Negative Syndrome Scale), mood symptoms (per Young Mania Rating Scale and Hamilton Depression Rating Scale—21 items), and functioning (per Personal and Social Performance Scale) from week 1 to all time points during the 25-week treatment period (P < 0.001). Similar improvements in efficacy measures were observed between subjects receiving monotherapy or combination therapy. Efficacy benefits persisted throughout the 25-week period. The most common adverse events were akathisia (11.1%), injection-site pain (10.6%), and insomnia (10.0%). Paliperidone palmitate once-monthly administered as monotherapy or in combination with mood stabilizers or antidepressants in patients with an acute exacerbation of SCA provided rapid, broad, and persistent reduction in psychotic, depressive, and manic symptoms, as well as improved functioning.
Communication Access for Deaf People in Healthcare Settings: Understanding the Work of American Sign Language Interpreters
Authors: Olson Andrea M. , Swabey Laurie
Published: June 2016

Despite federal laws that mandate equal access and communication in all healthcare settings for deaf people, consistent provision of quality interpreting in healthcare settings is still not a reality, as recognized by deaf people and American Sign Language (ASL)-English interpreters. The purpose of this study was to better understand the work of ASL interpreters employed in healthcare settings, which can then inform on training and credentialing of interpreters, with the ultimate aim of improving the quality of healthcare and communication access for deaf people. Based on job analysis, researchers designed an online survey with 167 task statements representing 44 categories. American Sign Language interpreters (N = 339) rated the importance of, and frequency with which they performed, each of the 167 tasks. Categories with the highest average importance ratings included language and interpreting, situation assessment, ethical and professional decision making, manage the discourse, monitor, manage and/or coordinate appointments. Categories with the highest average frequency ratings included the following: dress appropriately, adapt to a variety of physical settings and locations, adapt to working with variety of providers in variety of roles, deal with uncertain and unpredictable work situations, and demonstrate cultural adaptability. To achieve health equity for the deaf community, the training and credentialing of interpreters needs to be systematically addressed.
Noninvasive Tests for Fibrosis Predict 5-Year Mortality and Hepatocellular Carcinoma in Patients With Chronic Hepatitis B
Authors: Kim Jeong Han , Kim Ji Wan , Seo Jung Woong , Choe Won Hyeok , Kwon So Young
Published: June 2016

Goals:

To evaluate the degree of liver fibrosis as a predictor of mortality and hepatocellular carcinoma (HCC) development among patients with chronic hepatitis B.

Background:

The level of fibrosis predicts mortality and liver-related complications.

Study:

A total of 542 patients over 18 years old with chronic hepatitis B who visited the Konkuk University Hospital between the years 2005 and 2006 were enrolled. We performed noninvasive tests of fibrosis (APRI, FIB-4) and hepatitis B virus (HBV) DNA levels. The data on mortality and newly developed HCC collected during a 5-year follow-up were analyzed.

Results:

In 5 years, 40 patients died and 68 patients developed HCC. The area under the receiver operator characteristic (AUROC) curve of APRI, FIB-4, and HBV DNA levels for mortality was 0.760, 0.789, and 0.463, with cut-off points at 0.766, 2.671, and 3.150, respectively. The AUROC curve of APRI, FIB-4, and HBV DNA levels for HCC was 0.731, 0.803, and 0.523, with cut-off points at 0.766, 2.225, and 4.245, respectively. APRI and FIB-4 were predictors of mortality and HCC development, where patients with APRI over 0.766 had a greater risk of death [odds ratio (OR)=3.214, 95% confidence interval (CI), 1.009-10.238] and HCC development (OR=4.245, 95% CI, 1.723-10.456). Patients with FIB-4>2.671 had a higher risk of death (OR=4.431, 95% CI, 1.512-12.986) and those over 2.225 had a greater risk of developing HCC (OR=3.607, 95% CI, 1.622-8.021).

Conclusions:

APRI and FIB-4 may be more useful than HBV DNA level in predicting 5-year mortality and development of HCC.
A New Scoring System to Predict the Risk for High-risk Adenoma and Comparison of Existing Risk Calculators
Authors: Murchie Brent , Tandon Kanwarpreet , Hakim Seifeldin , Shah Kinchit , O’Rourke Colin , Castro Fernando J.
Published: June 2016

Background:

Colorectal cancer (CRC) screening guidelines likely over-generalizes CRC risk, 35% of Americans are not up to date with screening, and there is growing incidence of CRC in younger patients.

Goals:

We developed a practical prediction model for high-risk colon adenomas in an average-risk population, including an expanded definition of high-risk polyps (≥3 nonadvanced adenomas), exposing higher than average-risk patients. We also compared results with previously created calculators.

Study:

Patients aged 40 to 59 years, undergoing first-time average-risk screening or diagnostic colonoscopies were evaluated. Risk calculators for advanced adenomas and high-risk adenomas were created based on age, body mass index, sex, race, and smoking history. Previously established calculators with similar risk factors were selected for comparison of concordance statistic (c-statistic) and external validation.

Results:

A total of 5063 patients were included. Advanced adenomas, and high-risk adenomas were seen in 5.7% and 7.4% of the patient population, respectively. The c-statistic for our calculator was 0.639 for the prediction of advanced adenomas, and 0.650 for high-risk adenomas. When applied to our population, all previous models had lower c-statistic results although one performed similarly.

Conclusions:

Our model compares favorably to previously established prediction models. Age and body mass index were used as continuous variables, likely improving the c-statistic. It also reports absolute predictive probabilities of advanced and high-risk polyps, allowing for more individualized risk assessment of CRC.
Clinical Profile and Natural Course in a Large Cohort of Patients With Hypertriglyceridemia and Pancreatitis
Authors: Vipperla Kishore , Somerville Chris , Furlan Alessandro , Koutroumpakis Efstratios , Saul Melissa , Chennat Jennifer , Rabinovitz Mordechai , Whitcomb David C. , Slivka Adam , Papachristou Georgios I. , Yadav Dhiraj
Published: June 2016

Goals:

To report the clinical profile and natural course in a large series of patients with hypertriglyceridemia (HTG) and acute pancreatitis (AP).

Background:

The natural history of HTG-related pancreatitis is poorly defined.

Study:

Medical records of 121 patients with serum triglycerides (TG) levels of ≥500 mg/dL suffering 225 attacks of AP between January 2001 to August 2013 treated at the University of Pittsburgh Medical Center were retrospectively studied. Structured data were collected on initial presentation and long-term outcomes (mean follow-up 64.7±42.8 mo). AP severity was classified using Revised Atlanta Classification.

Results:

Most patients were young-middle aged (mean 44±12.7 y), male (70%), white (78%), and had sentinel AP (63%). Peak serum TG recorded was ≥1000 mg/dL in 48%. At least 1 secondary risk factor (diabetes, high-risk drinking, obesity, offending medications) was present in the majority (78%). Sentinel AP attack varied in severity between mild (41%), moderate (26%), and severe (33%). Recurrent AP attacks occurred in 32%, often in patients with poorly controlled diabetes, alcoholism, and TG levels. A cumulative increase in prevalence of pancreatic and/or peripancreatic necrosis was observed, with 45% patients having it at some time during observation. Local complications were higher in patients with serum TG ≥1000 mg/dL. Chronic pancreatitis was noted in 16.5% patients (new-onset in 9%).

Conclusions:

Patients with HTG-related pancreatitis have a high prevalence of secondary risk factors. Frequent recurrences in them are usually due to poor control of secondary factors or TG. Serum TG ≥1000 mg/dL increases the risk of local complications. A subset can have or develop chronic pancreatitis.
Update on reconstructive options for nasal Mohs defects 1.5 cm or less
Authors: Moses Helen A. , Woodard Charles R.
Published: June 2016

Purpose of review

The article reviews the current literature to provide an overview on contemporary reconstructive options for closure of Mohs defects of the nose that are 1.5 cm or less.

Recent findings

Although some of the techniques described in the literature are of historical importance only, others have undergone modification and metamorphosis to be broadly used in their contemporary form. Others are implemented in their original design, irrespective of relative age or multiple attempted adaptations. The increase in variable closure options available provides the surgeon with the ability to tailor reconstruction in such a way as to maximize form and function for the patient.

Here we will provide an update on the core techniques in terms of subtle modifications, expanded applications, and examination of outcomes as well as newly described closure techniques that may fill a certain niche in nasal reconstruction.
A 10-Year Follow-up Survey of Treatment Abandonment of Children With Acute Myeloid Leukemia in Suzhou, China
Authors: Hong Dan , Zhou Chenyan , He Hailong , Wang Yi , Lu Jun , Hu Shaoyan
Published: June 2016

A survey of the clinical data on acute myeloid leukemia (AML) over the past 10 years in the treatment center of Children’s Hospital was presented. The aim of the study was to identify the factors influencing the treatment abandonment rate (AR) of AML. Of the 474 AML cases examined, 264 were abandoned (55.7%). The most important factor affecting AR appeared to be the AML subtype—that is, the M3 versus non-M3 (42% vs. 60%). Patient age was observed to be closely related to AR—the older the patients, the lower the AR—and infants had the highest prevalence of abandonment (84.2%). The patient’s residential location was markedly correlated to AR, which was almost inversely proportional to the size of the township where the patient came from. From large cities, intermediate and small towns to countryside villages, the AR increased linearly. So was the correlation with health insurance coverage, which decreased in the same way. Sex and karyotypes did not affect AR. In conclusion, the patients’ financial burden and the perceived incurability of AML were the 2 leading factors dominating the decision for abandonment in parents and caregivers.
Neoadjuvant Treatment With Cyclooxygenase-2 Inhibitor and Prednisolone Allows Conservative Surgery for Inflammatory Myofibroblastic Tumor of the Bladder
Authors: Tsuma Yusuke , Miyachi Mitsuru , Ouchi Kazutaka , Tsuchiya Kunihiko , Iehara Tomoko , Naitoh Yasuyuki , Konishi Eiichi , Yanagisawa Akio , Hosoi Hajime
Published: June 2016

Inflammatory myofibroblastic tumor (IMT), which expresses cyclooxygenase-2 (COX-2), can be effectively treated with COX-2 inhibitor. Here, we report a case of urinary bladder IMT in a 13-year-old boy. Although total cystectomy was initially planned for complete resection of the tumor, neoadjuvant treatment with COX-2 inhibitor and prednisolone reduced the size of the tumor and enabled complete resection of the tumor by partial cystectomy. Neoadjuvant treatment with COX-2 inhibitor and prednisolone for IMT of the bladder allowed a more conservative surgical procedure that preserved bladder function.
Heparin-resistant Thrombosis Due to Homozygous Antithrombin Deficiency Treated With Rivaroxaban: A Case Report
Authors: Van Bruwaene Lore , Huisman Albert , Urbanus Rolf T. , Versluys Birgitta
Published: June 2016

Background:

Heparin fulfills its anticoagulant action through activation of antithrombin (AT), and thus thrombosis secondary to AT deficiency can be associated with heparin resistance.

Observation:

A 12-year-old girl with severe venous thrombosis was referred to us because of undetectable anti-Xa levels despite low-molecular-weight heparin therapy. Laboratory investigations revealed a homozygous AT mutation in the heparin binding site (AT Budapest III). She was subsequently treated with rivaroxaban successfully.

Conclusions:

Heparin resistance warrants evaluation for AT deficiency. Rivaroxaban may be considered a valid anticoagulant alternative to low-molecular-weight heparin in these patients.
A Case of Urachal Yolk Sac Tumor With Spontaneous Rupture in a Child
Authors: Suma T.L. , Ramanathan Subramaniam , Padma M. , Appaji L. , Suma M.N.
Published: June 2016

Tumors arising from urachus in children are exceedingly rare and sporadically reported in literature. Being a midline structure, the urachus may harbor neoplastic germ cell elements and can occasionally present as a case of acute abdomen. A 20-month-old toddler presented with spontaneous rupture of an urachal yolk sac tumor causing hemoperitoneum. He underwent resection, received platinum-based chemotherapy and presently remains well on follow-up. Despite its rarity, urachal germ cell tumors must be considered in a child with acute abdomen and tumor markers must be measured preemptively in such cases.
Results of the Women's Self-Performed Anal Pap Trial in Human Immunodeficiency Virus–Infected Women
Authors: McNeil Candice J. , Kong Christina S. , Anglemyer Andrew , Levy Vivian , Maldonado Yvonne
Published: June 2016

High-risk human papillomavirus anal infections are common in human immunodeficiency virus–infected women. We conducted a cross-over study in 30 women seen in a California human immunodeficiency virus clinic, to test the feasibility of self-performed anal Pap smears. Women found the tests acceptable and feasible. Compared with physician-collected specimens, results were highly concordant for anal cytology (κ = 0.53) and high-risk human papillomavirus typing (κ = 0.59 inclusive of equivocal results, or κ = 0.81 excluding equivocal results).
Prevalence of Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infections Among Transgender Persons Referred to an Italian Center for Total Sex Reassignment Surgery
Authors: Luzzati Roberto , Zatta Marta , Pavan Nicola , Serafin Maurizia , Maurel Cristina , Trombetta Carlo , Barbone Fabio
Published: June 2016

Introduction

The burden of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections in transgender population is an underestimated issue. We performed a study to evaluate the prevalence of such infections in transgender persons addressed our center for total sex reassignment surgery (SRS).

Materials and Methods

All transgender persons undergoing SRS from 2000 to 2014 were evaluated retrospectively. Participant characteristics and results of HIV, HBV, and HCV testing were collected. Exact Fisher test, Cochran-Armitage tests for trend and correct prevalence ratios were estimated.

Results

Among 498 transgender persons, 243 had confirmed serological data. Of them, 25 were female-to-male and 218 male-to-female (MtF) subjects. The prevalence of HIV, HBV and HCV infections was 0%, 4.0%, and 8.0% in female-to-male, and 12.1%, 4.6%, and 3.7% in MtF. Among MtF, younger age and earlier year of SRS were associated with lower HIV prevalence. From the multivariate model, the mutually adjustment prevalence ratios were 1.9 (95% confidence interval [95% CI], 1.2–3.1) for SRS in 2005–2010 and 3.6 (95% CI, 1.3–9.4) in 2010–2014, as compared with SRS in 2000–2004; and 4.7 (95% CI, 2.4–9.4) for South Americans as compared with others. Among the HCV-positive MtF, 57.1% were also HIV-positive. Regarding HBV, the immunity was 38.5% and, after mutual adjustment, the prevalence ratios were 2.1 (95% CI, 1.3–3.4) for South Americans versus others and 2.2 (95% CI, 1.6–3.1) for year of birth ≥ 1980.

Discussion

The prevalence of HBV and HCV infections among our transgender persons overlaps that reported in the general population, but HCV prevalence was much higher in HIV-infected MtF. The high burden of HIV infection among MtF and its recent incremented prevalence points out that social and medical support should be strongly promoted in such population.
Prevalence of Curable Sexually Transmitted Infections in Pregnant Women in Low- and Middle-Income Countries From 2010 to 2015
Authors: Joseph Davey DL , Shull HI , Billings JD , Wang D , Adachi K , Klausner JD
Published: June 2016

Background

Current literature comparing the prevalence rates of curable sexually transmitted infections (STIs) in pregnant women in various global regions is limited. As a result, antenatal screening practices for curable STIs in pregnant women, specifically Treponema pallidum (syphilis), Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) vary around the world, differing by country and particular STI.

Methods

We conducted a systematic review of publications on STI prevalence among pregnant women in 30 different low- and middle-income countries. We searched PubMed for studies reporting prevalence of syphilis, CT, NG, and TV in pregnant women. English language studies published between January 1, 2010, and March 1, 2015, were included. The adjusted mean STI prevalence by region was calculated via multivariable linear regression adjusting for health care setting, women's mean age, study sample size, and sensitivity of diagnostic test.

Results

We identified 75 studies that met inclusion criteria, providing 116 point prevalence estimates for curable STIs among 3,489,621 pregnant women. Adjusted mean prevalence for NG ranged from 1.2% (95% confidence interval [CI], 1.0–1.3) in Latin America to 4.6% (95% CI, 4.0–5.2) in Southern Africa; syphilis prevalence ranged from 1.1% (95% CI, 0.5–1.6) in Asia to 6.5% (95% CI, 4.7–6.3) in Southern Africa; CT ranged from 0.8% (95% CI, 0.4–1.1) in Asia to 11.2% (95% CI, 6.0–16.4) in Latin America; and TV ranged from 3.9% (95% CI, 2.2–5.6) in Latin America to 24.6% (95% CI, 17.9–31.4) in Southern Africa.

Conclusions

Although we observed a wide variation in STI burden in pregnancy after adjusting for age, test, and health care setting, further valid comparison may depend on adjustment for access to care and screening practices.
Understanding Clinic Practices for Human Papilloma Virus Vaccination Series Completion in Clinics That Provide Primary Care: Survey of Clinic Managers in Iowa
Authors: Askelson Natoshia M. , Edmonds Stephanie W. , Momany Elizabeth T. , Tegegne Mesay A.
Published: June 2016

Background

Rates for human papilloma virus (HPV) vaccination are low across the United States. Evidence-based-practices to increase immunization coverage have been recommended by public health organizations, yet many primary care clinics do not follow these practices. The purpose of this study was to examine if primary care clinics use these best practices to promote completion of the HPV vaccine series for their adolescent patients. Understanding the prevalence of evidence-based immunization strategies is key to increasing vaccination coverage.

Methods

We mailed 914 surveys to clinic managers of clinics that provide primary care in Iowa. The survey content was based on immunization strategies related to clinic practice and policies that have been proven effective to promote the completion of the HPV vaccination series.

Results

Survey responses from 127 clinics were used in the final analysis. Most clinics always used the state's immunization information system to record HPV vaccinations (89.4%). Over a quarter of clinics (27.6%) did not use any type of reminder or recall system to alert parents or providers that an HPV vaccine was due, and 35.0% did not give the vaccine at sick visits.

Conclusions

Clinics need to focus more on the recommended logistics and processes to ensure that patients receive the entire HPV vaccination series. Survey results indicate that clinics are not consistently implementing the recommended best practices to ensure that vaccination series are completed.
Lubricant Use and Rectal Chlamydial and Gonococcal Infections Among Men Who Engage in Receptive Anal Intercourse
Authors: Maierhofer Courtney , Rice Cara E. , Wang Shu-Hua , Fields Karen S. , Ervin Melissa , Turner Abigail Norris
Published: June 2016

Background

Use of lubricants during anal intercourse is very common among men who have sex with men. However, few studies have evaluated associations between specific lubricants and rectal sexually transmitted infections (STIs).

Methods

Between July 2012 and October 2013, we conducted a cross-sectional study of men who have sex with men recruited from an urban, public sexual health clinic. In a self-administered survey, participants identified the lubricants used and frequency of lubricant use in the previous three months. Among men reporting any receptive anal intercourse (RAI) in the previous 3 months, we used multivariable binomial regression models to analyze associations between recent use of 9 specific lubricants and prevalent rectal chlamydia, rectal gonorrhea, and either rectal infection.

Results

Twenty-five percent of the 146 participants had rectal chlamydial infection and 21% had rectal gonococcal infection; 37% had either (chlamydial or gonococcal) infection. Three-quarters reported always or almost always using lubricant during recent receptive anal intercourse. After adjustment for age, race, human immunodeficiency virus status, and condom use, Gun Oil (adjusted prevalence ratio [aPR], 1.99; 95% confidence interval [CI], 1.04–3.80) and Slick (aPR, 3.55; 95% CI, 1.38–9.12) were significantly associated with prevalent gonococcal infection. No lubricants were significantly associated with prevalent rectal chlamydia, but in analyses of either rectal infection, precum (aPR, 1.68; 95% CI, 1.06–2.66), Vaseline (aPR, 1.70; 95% CI, 1.10–2.64), and baby oil (aPR, 2.26; 95% CI, 1.43–3.57) were all significantly associated with prevalent rectal infection.

Conclusions

Several lubricants were significantly associated with increased prevalence of rectal STI. Longitudinal studies are needed to examine any causal relationship between specific lubricants and STI acquisition.
Contraction Bands Are Induced by Cardiac Massage Itself
Authors: Morita Satomu , Furukawa Satoshi , Nishi Katsuji , Hitosugi Masahito
Published: June 2016

Pathological contraction bands (CB) are recognized as a type of necrosis pattern found in the myocardium. It is well known that CB are induced by cardiopulmonary resuscitation (CPR) with cardiac massage. However, it is not known whether the reperfusion or massage itself causes the formation of CB. We studied 10 cardiac tissues taken from forensic autopsy cases that had not received CPR. We excluded the cases where the cause of death was a cardiac event. After making sections for forensic research, we massaged the left ventricles for 10 minutes. We found CB in all cases with massage performed within 12 hours after death, which is the time frame for supravital reactions. We did not find CB in any cases where more than 24 hours had elapsed since the time of death. Contraction bands were not observed in any sections that were taken before massage. We suggested here that CB induced by CPR were caused by the cardiac massage itself, and that most CPR-induced CB are not contraction band necrosis but rather artifactual CB.
Can Severe Kyphoscoliosis Lead to Aorta Rupture?
Authors: Kotopoulos Constantinos , Karakasi Maria Valeria , Kapetanakis Stylianos , Pavlidis Pavlos
Published: June 2016

Neurofibromatosis type 1 is a polysystemic disease presenting with a multifaceted clinical picture. Clinical manifestations may present in the skin, as well as in the skeletal and cardiovascular system. The present study aims to describe and examine the case of a 46-year-old woman, who suffered from neurofibromatosis type 1 and died abruptly in the emergency room. The forensic examination attributed her death to traumatic rupture of the thoracic aorta resulting from an acute angulation that her vertebral column formed in the thoracic region (severe kyphosis). Outspread cutaneous neurofibromas, severe scoliosis, and osteoporosis (brittle bones) were observed during the autopsy. No atherosclerotic lesions were detected in the aortic lumen. To the authors’ knowledge, no similar case has been reported throughout relevant literature.
A direct multi-generational estimate of the human mutation rate from autozygous segments seen in thousands of parentally related individuals
Authors: Narasimhan Vagheesh M , Rahbari Raheleh , Scally Aylwyn , Wuster Arthur , Mason Dan , Xue Yali , Wright John , Trembath Richard C , Maher Eamonn R , van Heel David A , Auton Adam , Hurles Matthew E , Tyler-Smith Chris , Durbin Richard
Published: June 2016

Heterozygous mutations within homozygous sequences descended from a recent common ancestor offer a way to ascertain de novo mutations (DNMs) across multiple generations. Using exome sequences from 3,222 British-Pakistani individuals with high parental relatedness, we estimate a mutation rate of 1. 45 ± 0.05 × 10−8per base pair per generation in autosomal coding sequence, with a corresponding noncrossover gene conversion rate of 8.75 ± 0.05 × 10−6per base pair per generation. This is at the lower end of exome mutation rates previously estimated in parent-offspring trios, suggesting that post-zygotic mutations contribute little to the human germline mutation rate. We found frequent recurrence of mutations at polymorphic CpG sites, and an increase in C to T mutations in a 5’ CCG 3’ → 5’ CTG 3’ context in the Pakistani population compared to Europeans, suggesting that mutational processes have evolved rapidly between human populations.
Botrytis cinerea loss and restoration of virulence during in vitro culture follows flux in global DNA methylation
Authors: Breen Jimmy , Mur Luis , Sivakumaran Anushen , Akinyemi Aderemi , Wilkinson Mike , Rodriguez Lopez Carlos Marcelino
Published: June 2016

Pathogenic fungi can lose virulence after protracted periods of culture but little is known of the underlying mechanisms. Here we present the first single-base resolution methylome for the plant pathogen B. cinerea and identify differentially methylated genes/genomic regions associated with virulence erosion. Cultures were maintained for eight months with subcultures and virulence testing every month. Methylation-sensitive amplified polymorphisms were performed at monthly intervals to characterise global changes to the pathogen's genome during culture and also on DNA from mycelium inoculated onto Arabidopsis thaliana after eight months in culture. Characterisation of culture-induced epialleles was assessed by whole-genome re-sequencing and whole-genome bisulfite sequencing. Virulence declined with time in culture and recovered after inoculation on A. thaliana. Variation detected by methylation-sensitive amplified polymorphisms followed virulence changes during culture. Whole-genome (bisulfite) sequencing showed marked changes on global and local methylation during culture but no significant genetic changes. We imply that virulence is a non-essential plastic character that is at least partly modified by changing levels of DNA methylation during culture. We hypothesise that changing DNA methylation during culture may be responsible for the high virulence/low virulence transition in B. cinerea and speculate that this may offer fresh opportunities to control pathogen virulence.
Fractured tonotopy of functional neural clusters in mouse auditory cortex
Authors: Ruz Isabel Delgado , Schultz Simon R.
Published: June 2016

The degree of order versus randomness in mammalian cortical circuits has been the subject of much discussion. Previous reports showed that at a large scale there is smooth tonotopy in mouse auditory cortex, while at the single neuron level the representation is the traditional “salt and pepper” configuration attributed to rodent cortex. Here we show that at the micro columnar scale we find a large variety of response profiles, but neurons tend to share similar preference in terms of frequency, bandwidth and latency. However, this smooth representation was fractured and large differences were possible between neighbouring neurons. Despite the tendency of most groups of neurons to operate redundantly, high information gains were achieved between cells that had a high signal correlation. Connectivity between neurons was highly non-random, in agreement with a previous in-vitro report from layer five. Our results suggest the existence of functional clusters, connecting neighbouring mini-columns. This supports the idea of a “salt and pepper” configuration at the level of functional clusters of neurons rather than single units.