bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective Assessment of the Efficacy of Modified Progressive Tinnitus Management Skills Education in a Military Medical Treatment Facility
Authors: Sherlock LaGuinn P , Ortiz Candice E , Blasco Georgina P , Brooks Daniel I
Published: February 2019

Introduction

The number-one service-connected disability is tinnitus. Tinnitus currently has no cure, but the functional impact of tinnitus has been shown to be mitigated by Progressive Tinnitus Management (PTM), a multi-level management approach. The duration of PTM Level 3 skills education (PTM-SE) and the inclusion of mental health providers have been identified as barriers to implementation of PTM-SE in Department of Defense (DOD) medical treatment facilities. The goal of this study was to determine if a version of PTM-SE modified for use in DOD medical treatment facilities resulted in positive changes in tinnitus-related outcomes.

Materials and Methods

A retrospective study was conducted by examining the medical records of patients who attended modified PTM-SE appointments. The study was approved by the Walter Reed National Military Medical Center Institutional Review Board. The study sample included 130 patients who completed modified PTM-SE between January 2015 and June 2016. Primary outcome measures were tinnitus awareness and tinnitus annoyance; secondary outcome measures were effect on life and self-perceived coping ability. Outcome measures were analyzed with nonparametric statistics and logistic regression.

Results

Modified PTM-SE resulted in clinically significant improvements in the primary outcome measures (awareness, p < 0.0001; annoyance, p < 0.0001). The proportion of patients who indicated an improvement in coping with tinnitus was similar to other published data with similar modifications to PTM-SE.

Conclusions

The evidence supports the assumption that PTM is a flexible program of tinnitus management that even when modified to be suitable for use in a DOD medical treatment facility provides meaningful reductions in tinnitus awareness and annoyance and improves tinnitus coping ability among military beneficiaries. These findings should encourage audiologists to modify PTM to work within their military medical treatment facility.
Reconstructing small-scale lenses from the cosmic microwave background temperature fluctuations
Authors: Horowitz Benjamin , Ferraro Simone , Sherwin Blake D
Published: February 2019

Cosmic microwave background (CMB) lensing is a powerful probe of the matter distribution in the Universe. The standard quadratic estimator, which is typically used to measure the lensing signal, is known to be suboptimal for low-noise polarization data from next-generation experiments. In this paper, we explain why the quadratic estimator will also be suboptimal for measuring lensing on very small scales, even for measurements in temperature where this estimator typically performs well. Though maximum likelihood methods could be implemented to improve performance, we explore a much simpler solution, revisiting a previously proposed method to measure lensing that involves a direct inversion of the background gradient. An important application of this simple formalism is the measurement of cluster masses with CMB lensing. We find that directly applying a gradient inversion matched filter to simulated lensed images of the CMB can tighten constraints on cluster masses compared to the quadratic estimator. While the difference is not relevant for existing surveys, for future surveys it can translate to significant improvements in mass calibration for distant clusters, where galaxy lensing calibration is ineffective due to the lack of enough resolved background galaxies. Improvements can be as large as ${\sim } 50{{\ \rm per\ cent}}$ for a cluster at z = 2 and a next-generation CMB experiment with 1 $\mu$K arcmin noise, and over an order of magnitude for lower noise levels. For future surveys, this simple matched filter or gradient inversion method approaches the performance of maximum likelihood methods, at a fraction of the computational cost.
Footprints of the Sagittarius dwarf galaxy in the Gaia data set
Authors: Laporte Chervin F P , Minchev Ivan , Johnston Kathryn V , Gómez Facundo A
Published: February 2019

We analyse an N-body simulation of the interaction of the Milky Way (MW) with a Sagittarius-like dSph (Sgr), looking for signatures which may be attributed to its orbital history in the phase space volume around the Sun in light of Gaia DR2 discoveries. The repeated impacts of Sgr excite coupled vertical and radial oscillations in the disc which qualitatively, and to a large degree quantitatively are able to reproduce many features in the 6D Gaia DR2 samples, from the median VR, Vϕ, V$z$ velocity maps to the local δρ($v$$z$, $z$) phase-space spiral which is a manifestation of the global disc response to coupled oscillations within a given volume. The patterns in the large-scale velocity field are well described by tightly wound spirals and vertical corrugations excited from Sgr’s impacts. We show that the last pericentric passage of Sgr resets the formation of the local present-day δρ($v$$z$, $z$) spiral and situate its formation around 500-800 Myr. As expected δρ(vz, $z$) grows in size and decreases in woundedness as a function of radius in both the Gaia DR2 data and simulations. This is the first N-body model able to explain so many of the features in the data on different scales. We demonstrate how to use the full extent of the Galactic disc to date perturbations dating from Myr to Gyr, probe the underlying potential and constrain the mass-loss history of Sgr. δρ(vz, $z$) looks the same in all stellar populations age bins down to the youngest ages which rules out a bar buckling origin.
Rotational modulation in TESS B stars
Authors: Balona L A , Handler G , Chowdhury S , Ozuyar D , Engelbrecht C A , Mirouh G M , Wade G A , David-Uraz A , Cantiello M
Published: February 2019

Light curves and periodograms of 160 B stars observed by the Transiting Exoplanet Survey Satellite (TESS) space mission and 29 main-sequence B stars from Kepler and K2 were used to classify the variability type. There are 114 main-sequence B stars in the TESS sample, of which 45 are classified as possible rotational variables. This confirms previous findings that a large fraction (about 40 per cent) of A and B stars may exhibit rotational modulation. Gaia DR2 parallaxes were used to estimate luminosities, from which the radii and equatorial rotational velocities can be deduced. It is shown that observed values of the projected rotational velocities are lower than the estimated equatorial velocities for nearly all the stars, as they should be if rotation is the cause of the light variation. We conclude that a large fraction of main-sequence B stars appear to contain surface features which cannot likely be attributed to abundance patches.
Light element discontinuities suggest an early termination of star formation in the globular cluster NGC 6402 (M14)
Authors: Johnson Christian I , Caldwell Nelson , Michael Rich R , Mateo Mario , Bailey John I
Published: February 2019

NGC 6402 is among the most massive globular clusters in the Galaxy, but little is known about its detailed chemical composition. Therefore, we obtained radial velocities and/or chemical abundances of 11 elements for 41 red giant branch stars using high resolution spectra obtained with the Magellan-M2FS instrument. We find NGC 6402 to be only moderately metal-poor with 〈[Fe/H]〉 = −1.13 dex (σ = 0.05 dex) and to have a mean heliocentric radial velocity of −61.1 km s−1 (σ = 8.5 km s−1). In general, NGC 6402 exhibits mean composition properties that are similar to other inner Galaxy clusters, such as [α/Fe] ∼+0.3 dex, [Cr,Ni/Fe] ∼ 0.0 dex, and 〈[La/Eu]〉 = −0.08 dex. Similarly, we find large star-to-star abundance variations for O, Na, Mg, Al, and Si that are indicative of gas that experienced high temperature proton-capture burning. Interestingly, we not only detect three distinct populations but also find large gaps in the [O/Fe], [Na/Fe], and [Al/Fe] distributions that may provide the first direct evidence of delayed formation for intermediate composition stars. A qualitative enrichment model is discussed where clusters form stars through an early ($\lesssim$5–10 Myr) phase, which results in first generation and ‘extreme’ composition stars, and a delayed phase ($\gtrsim$40 Myr), which results in the dilution of processed and pristine gas and the formation of intermediate composition stars. For NGC 6402, the missing intermediate composition stars suggest the delayed phase terminated prematurely, and as a result the cluster may uniquely preserve details of the chemical enrichment process.
Fibroblast-specific plasminogen activator inhibitor-1 depletion ameliorates renal interstitial fibrosis after unilateral ureteral obstruction
Authors: Yao Lan , Wright M Frances , Farmer Brandon C , Peterson Laura S , Khan Amir M , Zhong Jianyong , Gewin Leslie , Hao Chuan-Ming , Yang Hai-Chun , Fogo Agnes B
Published: February 2019

Background

Plasminogen activator inhibitor-1 (PAI-1) expression increases extracellular matrix deposition and contributes to interstitial fibrosis in the kidney after injury. While PAI-1 is ubiquitously expressed in the kidney, we hypothesized that interstitial fibrosis is strongly dependent on fibroblast-specific PAI-1 (fbPAI-1).

Methods

Tenascin C Cre (TNC Cre) and fbPAI-1 knockdown (KD) mice with green fluorescent protein (GFP) expressed within the TNC construct underwent unilateral ureteral obstruction and were sacrificed 10 days later.

Results

GFP+ cells in fbPAI-1 KD mice showed significantly reduced PAI-1 expression. Interstitial fibrosis, measured by Sirius red staining and collagen I western blot, was significantly decreased in fbPAI-1 KD compared with TNC Cre mice. There was no significant difference in transforming growth factor β (TGF-β) expression or its activation between the two groups. However, GFP+ cells from fbPAI-1 KD mice had lower TGF β and connective tissue growth factor (CTGF) expression. The number of fibroblasts was decreased in fbPAI-1 KD compared with TNC Cre mice, correlating with decreased alpha smooth muscle actin (α-SMA) expression and less fibroblast cell proliferation. TNC Cre mice had decreased E-cadherin, a marker of differentiated tubular epithelium, in contrast to preserved expression in fbPAI-1 KD. F4/80-expressing cells, mostly CD11c+/F4/80+ cells, were increased while M1 macrophage markers were decreased in fbPAI-1 KD compared with TNC Cre mice.

Conclusion

These findings indicate that fbPAI-1 depletion ameliorates interstitial fibrosis by decreasing fibroblast proliferation in the renal interstitium, with resulting decreased collagen I. This is linked to decreased M1 macrophages and preserved tubular epithelium.
Wearables for Pediatric Rehabilitation: How to Optimally Design and Use Products to Meet the Needs of Users
Authors: Lobo Michele A , Hall Martha L , Greenspan Ben , Rohloff Peter , Prosser Laura A , Smith Beth A
Published: February 2019

This article will define “wearables” as objects that interface and move with users, spanning clothing through smart devices. A novel design approach merging information from across disciplines and considering users’ broad needs will be presented as the optimal approach for designing wearables that maximize usage. Three categories of wearables applicable to rehabilitation and habilitation will be explored: (1) inclusive clothing (eg, altered fit, fasteners); (2) supportive wearables (eg, orthotics, exoskeletons); and (3) smart wearables (eg, with sensors for tracking activity or controlling external devices). For each category, we will provide examples of existing and emerging wearables and potential applications for assessment and intervention with a focus on pediatric populations. We will discuss how these wearables might change task requirements and assist users for immediate effects and how they might be used with intervention activities to change users’ abilities across time. It is important for rehabilitation clinicians and researchers to be engaged with the design and use of wearables so they can advocate and create better wearables for their clients and determine how to most effectively use wearables to enhance their assessment, intervention, and research practices.
The RXLR Effector PcAvh1 Is Required for Full Virulence of Phytophthora capsici
Authors: Chen Xiao-Ren , Zhang Ye , Li Hai-Yang , Zhang Zi-Hui , Sheng Gui-Lin , Li Yan-Peng , Xing Yu-Ping , Huang Shen-Xin , Tao Hang , Kuan Tung , Zhai Yi , Ma Wenbo
Published: February 2019

Plant pathogens employ diverse secreted effector proteins to manipulate host physiology and defense in order to foster diseases. The destructive Phytophthora pathogens encode hundreds of cytoplasmic effectors, which are believed to function inside the plant cells. Many of these cytoplasmic effectors contain the conserved N-terminal RXLR motif. Understanding the virulence function of RXLR effectors will provide important knowledge of Phytophthora pathogenesis. Here, we report the characterization of RXLR effector PcAvh1 from the broad–host range pathogen Phytophthora capsici. Only expressed during infection, PcAvh1 is quickly induced at the early infection stages. CRISPR/Cas9-knockout of PcAvh1 in P. capsici severely impairs virulence while overexpression enhances disease development in Nicotiana benthamiana and bell pepper, demonstrating that PcAvh1 is an essential virulence factor. Ectopic expression of PcAvh1 induces cell death in N. benthamiana, tomato, and bell pepper. Using yeast two-hybrid screening, we found that PcAvh1 interacts with the scaffolding subunit of the protein phosphatase 2A (PP2Aa) in plant cells. Virus-induced gene silencing of PP2Aa in N. benthamiana attenuates resistance to P. capsici and results in dwarfism, suggesting that PP2Aa regulates plant immunity and growth. Collectively, these results suggest that PcAvh1 contributes to P. capsici infection, probably through its interaction with host PP2Aa.
Propofol Anesthesia Increases Long-range Frontoparietal Corticocortical Interaction in the Oculomotor Circuit in Macaque Monkeys
Authors: Ma Li , Liu Wentai , Hudson Andrew E.
Published: February 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Frontoparietal functional connectivity decreases with multiple anesthetics using electrophysiology and functional imaging. This decrease has been proposed as a final common functional pathway to produce anesthesia. Two alternative measures of long-range cortical interaction are coherence and phase-amplitude coupling. Although phase-amplitude coupling within frontal cortex changes with propofol administration, the effects of propofol on phase-amplitude coupling between different cortical areas have not previously been reported. Based on phase-amplitude coupling observed within frontal lobe during the anesthetized period, it was hypothesized that between-lead phase-amplitude coupling analysis should decrease between frontal and parietal leads during propofol anesthesia.

Methods

A published monkey electrocorticography data set (N = 2 animals) was used to test for interactions in the cortical oculomotor circuit, which is robustly interconnected in primates, and in the visual system during propofol anesthesia using coherence and interarea phase-amplitude coupling.

Results

Propofol induces coherent slow oscillations in visual and oculomotor networks made up of cortical areas with strong anatomic projections. Frontal eye field within-area phase-amplitude coupling increases with a time course consistent with a bolus response to intravenous propofol (modulation index increase of 12.6-fold). Contrary to the hypothesis, interareal phase-amplitude coupling also increases with propofol, with the largest increase in phase-amplitude coupling in frontal eye field low-frequency phase modulating lateral intraparietal area β-power (27-fold increase) and visual area 2 low-frequency phase altering visual area 1 β-power (19-fold increase).

Conclusions

Propofol anesthesia induces coherent oscillations and increases certain frontoparietal interactions in oculomotor cortices. Frontal eye field and lateral intraparietal area show increased coherence and phase-amplitude coupling. Visual areas 2 and 1, which have similar anatomic projection patterns, show similar increases in phase-amplitude coupling, suggesting higher order feedback increases in influence during propofol anesthesia relative to wakefulness. This suggests that functional connectivity between frontal and parietal areas is not uniformly decreased by anesthetics.
Digital papillary adenocarcinoma: a case review
Authors: Ziino Chason , Rieger Kerri E. , Sen Subhro
Published: February 2019

Digital papillary adenocarcinoma (DPAca) is a rare eccrine sweat gland tumor that typically presents on the upper extremities and can evade correct diagnosis and treatment because of its benign appearance. Treatment for lesions of the distal digits requires amputation given the high risk of metastasis and recurrence. This paper reviews a digital papillary adenocarcinoma in a patient who was initially managed at an outside institution and required further surgery including amputation. Treatment recommendations are reviewed.
Effect of Preoperative Video Information on Anxiety and Satisfaction in Patients Undergoing Abdominal Surgery
Authors: Soydaş Yeşilyurt Duygu , Yildiz Findik Ümmü
Published: February 2019

Video images are used as materials to provide information. This quasi-experimental research was intended to determine the effect of preoperative video information on the anxiety and satisfaction levels of patients undergoing abdominal surgery. The research was conducted from January 2015 to April 2016; 70 patients participated (35 in the experimental and 35 in the control group) who underwent planned open abdominal surgery. Data were collected by having the patients complete a patient identification form and the Anxiety Specific to Surgery Questionnaire, as well as by means of the Satisfaction With Nursing Care Scale via face-to-face interviews. After the patients in the experimental group viewed the video information, the Anxiety Specific to Surgery Questionnaire mean scores of the experimental group were lower than before the information (P < .001) and scores for the control group (P < .001). Satisfaction With Nursing Care Scale mean scores were also higher than those of the control group (P < .001). In order to decrease the anxiety levels of surgical patients and increase their satisfaction levels, we suggest that they should be informed via video images.
Implementation of Structured Documentation and Standard Nursing Statements
Authors: Lee Seonah , Jeon Mi Yang , Kim Eun Ok
Published: February 2019

Nurses implement structured documentation using standardized nursing terminologies in computerized healthcare settings. Nurses' perceptions, shaped by their experiences of implementing such documentation, are an important indicator for the documentation system's optimal maintenance and improvement. The purpose of this study was to describe perceptions of nurses using SYSTEM featuring standard nursing statements and structured documentation. A quantitative cross-sectional study design was used. A total of 42 nurses from a tertiary teaching hospital participated in this study. A researcher-developed survey questionnaire included seven questions asking nurses' perceptions of nursing process phases and SYSTEM's usefulness, effectiveness, necessity, assistance in decision making, and suggestions for SYSTEM improvement. As results, the assessment phase was perceived to be the most necessary, while the planning phase was perceived to be the most unnecessary. Perceived disadvantages were decreased patient care time, increased charting time, and standard nursing statements not covering diverse patients' conditions. These disadvantages conflicted with perceived advantages. For successful implementation of electronic nursing records, stakeholders at clinical, information technology, and administrative levels should cooperate closely to address adverse consequences from implementation of structured documentation and standardized nursing terminologies.
From Biology to Therapy: The CLL Success Story
Authors: Yosifov Deyan Y. , Wolf Christine , Stilgenbauer Stephan , Mertens Daniel
Published: February 2019

Chemoimmunotherapy has been the standard of care for patients with chronic lymphocytic leukemia (CLL) over the last decade. Advances in monoclonal antibody technology have resulted in the development of newer generations of anti‐CD20 antibodies with improved therapeutic effectiveness. In parallel, our knowledge about the distinctive biological characteristics of CLL has progressively deepened and has revealed the importance of B‐cell receptor (BCR) signaling and upregulated antiapoptotic proteins for survival and expansion of malignant cell clones. This knowledge provided the basis for development of novel targeted agents that revolutionized treatment of CLL. Ibrutinib and idelalisib inhibit the Bruton tyrosine kinase (BTK) and phosphoinositide 3‐kinase (PI3K) delta, respectively, thus interfering with supportive signals coming from the microenvironment via the BCR. These drugs induce egress of CLL cells from secondary lymphoid organs and remarkably improve clinical outcomes, especially for patients with unmutated immunoglobulin heavy‐chain genes or with p53 abnormalities that do not benefit from classical treatment schemes. Latest clinical trial results have established ibrutinib with or without anti‐CD20 antibodies as the preferred first‐line treatment for most CLL patients, which will reduce the use of chemoimmunotherapy in the imminent future. Further advances are achieved with venetoclax, a BH3‐mimetic that specifically inhibits the antiapoptotic B‐cell lymphoma 2 protein and thus causes rapid apoptosis of CLL cells, which translates into deep and prolonged clinical responses including high rates of minimal residual disease negativity. This review summarizes recent advances in the development of targeted CLL therapies, including new combination schemes, novel BTK and PI3K inhibitors, spleen tyrosine kinase inhibitors, immunomodulatory drugs, and cellular immunotherapy.
Intracholecystic Papillary Neoplasms Are Distinct From Papillary Gallbladder Cancers
Authors: Akita Masayuki , Fujikura Kohei , Ajiki Tetsuo , Fukumoto Takumi , Otani Kyoko , Hirose Takanori , Tominaga Masahiro , Itoh Tomoo , Zen Yoh
Published: February 2019

Although intracholecystic papillary neoplasms (ICPNs) have been increasingly recognized, their features remain unclear because of the lack of standardized definition. This study aimed to elucidate clinicopathologic and genetic features of ICPNs using stringent diagnostic criteria. On the basis of the recently proposed criteria, gallbladder neoplasms showing delicate papillary growth were diagnosed as ICPNs, while polypoid papillary adenocarcinomas arranged in a complex architecture were categorized as papillary gallbladder cancers (GBCs). Clinicopathologic features were compared among ICPNs (n=7), papillary GBCs (n=24), and nonpapillary GBCs (n=44). Whole-exome and validation Sanger sequencing was also conducted. Gross mucin hypersecretion was detected in 3/7 ICPNs (43%), 1/24 papillary GBCs (4%), and 1/44 nonpapillary GBCs (2%) (P<0.001). All patients with ICPN lacked lymphovascular invasion and nodal metastasis, while these features were occasionally observed in patients with papillary or nonpapillary GBC (13% to 59%). ICPNs were less advanced than papillary and nonpapillary GBCs (P<0.001) with all cases of ICPNs being recurrence-free. Whole-exome and Sanger sequencing identified somatic mutations in STK11 (a causative gene of Peutz-Jegher syndrome; n=3), CTNNB1 (n=2), and APC (a gene of familial adenomatous polyposis; n=1) in ICPNs, while those alterations were exceptional in papillary and nonpapillary GBCs. ICPNs more commonly showed cytoplasmic and/or nuclear expressions of β-catenin than papillary and nonpapillary GBCs. In conclusion, the histology-based classification of gallbladder papillary neoplasms is useful for identifying ICPNs that share clinicopathologic features with the pancreatic counterpart. ICPNs meeting the criteria were genetically distinct from papillary and nonpapillary GBCs, with STK11, CTNNB1, and APC being identified as major driver genes for ICPNs.
State Health Official Career Advancement and Sustainability Evaluation—Description of the Methods Used in the SHO-CASE Study
Authors: Halverson Paul K. , Yeager Valerie A. , Menachemi Nir , Chapple-McGruder Theresa , Moffatt Sharon , Baker Edward L. , Boedigheimer Steven F. , Tilson Hugh , Castrucci Brian C. , Gould Elizabeth , Jacinto Corey M. , Mays Glen
Published: February 2019

State health officials (SHOs) lead state governmental public health agencies, playing an important role in their states. However, little comprehensive research has examined SHOs or characteristics of these leaders, limiting evidence about ways to improve SHO selection and subsequent performance. This brief describes the methods of the SHO-CASE study focused on current and former SHOs in state public health agencies. Methods used include qualitative components that informed the development of survey questions, survey administration, and survey response. A total of 147 SHOs responded to the SHO survey representing every state and Washington, District of Columbia. The SHO-CASE study survey database represents the most comprehensive database of its kind regarding a range of attributes of current and former SHOs. These data can be used to explore factors contributing to SHO success including valuable insights into effectively working with the states' elected officials.
Modified Selective Neurectomy for the Treatment of Post–Facial Paralysis Synkinesis
Authors: Azizzadeh Babak , Irvine Leslie E. , Diels Jaqueline , Slattery William H. , Massry Guy G. , Larian Babak , Riedler Kiersten L. , Peng Grace Lee
Published: February 2019

Background:

To address functional and smile dysfunction associated with post–facial paralysis synkinesis, the senior author (B.A.) has offered “modified selective neurectomy” of the lower division of the facial nerve as a long-term solution. This article examines technical considerations and outcomes of this procedure.

Methods:

A retrospective review was conducted of patients who underwent modified selective neurectomy of buccal and cervical branches of the facial nerve performed by a single surgeon over a 4½-year period. House-Brackmann facial grading scores, electronic clinician-graded facial function scale, and onabotulinumtoxinA (botulinum toxin type A) dosages were examined before and after the procedure.

Results:

Sixty-three patients underwent modified selective neurectomy between June 20, 2013, and August 12, 2017. There were no serious complications. The revision rate was 17 percent. Temporary oral incompetence was reported in seven patients (11 percent) postoperatively. A statistically significant improvement was achieved in electronic clinician-graded facial function scale analysis of nasolabial fold depth at rest, oral commissure movement with smile, nasolabial fold orientation with smile, nasolabial depth with smile, depressor labii inferioris lower lip movement, midfacial synkinesis, mentalis synkinesis, platysmal synkinesis, static score, dynamic score, synkinesis score, periocular score, lower face and neck score, and midface and smile score. There was a significant decrease in botulinum toxin type A dosage and House-Brackmann score after surgery.

Conclusion:

Modified selective neurectomy of the buccal and cervical divisions of the facial nerve is an effective long-term treatment for smile dysfunction in patients with post–facial paralysis synkinesis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Early Peritoneal Dialysis Ameliorates Blast Lung Injury by Alleviating Pulmonary Edema and Inflammation
Authors: Chen Kehong , Yang Jie , Xiao Fei , Chen Jia , Hu Wei , Wang Xiaoyue , Wang Liming , Du Juan , Jiang Jianxin , He Yani
Published: February 2019

Background:

Blast lung injury is a high-energy trauma with high mortality for explosion victims. A treatment for blast lung injury is still lacking. The aim of this study was to observe the efficacy and mechanism of peritoneal dialysis combined with glucocorticoids (GC) in the treatment of blast lung injury in rats.

Methods:

Rats were randomly divided into five groups: control, sham, GC, peritoneal dialysis (dialysis for short), and dialysis + GC groups. All rats were injured by a biological shock tube-I.

Results:

The lung water levels in the dialysis group and dialysis + GC group were significantly lower than that in the control group at 6 and 24 h after blast injury. The oxygenation index, forced vital capacity, maximum midexpiratory flow, and functional residual capacity of rats in the dialysis and dialysis + GC groups were significantly higher than those in the control group. The serum levels of interleukin (IL)-1β, IL-6, tumor necrosis factor- α, monocyte chemoattractant protein-1, C-reactive protein, and IL-10 in the dialysis and dialysis + GC groups were significantly lower than those in the control group. Genome-wide mRNA microarray results showed that the aquaporin 1 level in the lung tissue of the dialysis group was 6.67 times higher than that in the control group.

Conclusion:

Early peritoneal dialysis can attenuate pulmonary edema and inflammation, and protect acute lung injury after blast injury.
Left-Sided Ventricular–arterial Coupling and Volume Responsiveness in Septic Shock Patients
Authors: Li Suwei , Wan Xianyao , Laudanski Krzysztof , He Ping , Yang Lihui
Published: February 2019

Background:

Suboptimal ventricular arterial coupling (VAC) is one of the pivotal determinants of inefficient heart performance despite appropriate administration of fluids or vasopressors in shocks. Here, we investigate the performance of VAC in patients who are unresponsive to fluid administration in septic shock.

Methods:

This is a retrospective observational study of septic shock patients (n = 35). VAC was evaluated by effective arterial elastance (EaI), left ventricular end-systolic elastance (EesI), and EaI/EesI. Septic shock patients successfully fluid resuscitated after pulse indicator continuous cardiac output (PiCCO) monitoring, defined as an increase in general end-diastolic ventricular volume (GEDVI) more than 10%, were divided into volume responsive (VVr), and volume unresponsive (VVur) groups based on a cardiac index increase above 10%. We hypothesize that two groups of patients will exhibit dissimilarities of VAC variation, defined as EaI/EesI variation (ΔEaI/EesI).

Results:

Variations of EaI (ΔEaI), and EaI/EesI (ΔEaI/EesI), and systemic vascular resistance index (ΔSVRI) were significantly lower in the VVr group than those in the VVur group (P < 0.05). Variations of cardiac index (ΔCI), stroke volume index (ΔSVI), and EesI (ΔEesI) were significantly higher in patients with ΔEaI/EesI ≤ 0. Concomitantly, ΔEaI and ΔSVRI were significantly diminished as compared with patients with ΔEaI/EesI > 0 (P < 0.05). ΔCI has an inverse relationship with both ΔEaI (r = −0.46, P = 0.006), ΔEaI/EesI (r = −0.65, P < 0.001), and ΔSVRI (r = −0.59, P < 0.001). We observed more patients who were fluid responsive in the ΔEaI/EesI ≤ 0 group than in the group with ΔEaI/EesI > 0 (88.89% vs. 26.92%, P = 0.01).

Conclusions:

Variation of VAC is often related to suboptimal ventricular volume responsiveness among patients with septic shock.
Heparin-Binding Protein as a Prognostic Biomarker of Sepsis and Disease Severity at the Emergency Department
Authors: Kahn Fredrik , Tverring Jonas , Mellhammar Lisa , Wetterberg Nils , Bläckberg Anna , Studahl Erika , Hadorn Niklas , Kahn Robin , Nueesch Susanne , Jent Philipp , Ricklin Meret E. , Boyd John , Christensson Bertil , Sendi Parham , Åkesson Per , Linder Adam
Published: February 2019

Objective:

Rapid and early detection of patients at risk to develop sepsis remains demanding. Heparin-binding protein (HBP) has previously demonstrated good prognostic properties in detecting organ dysfunction among patients with suspected infections. This study aimed to evaluate the plasma levels of HBP as a prognostic biomarker for infection-induced organ dysfunction among patients seeking medical attention at the emergency department.

Design:

Prospective, international multicenter, convenience sample study.

Setting:

Four general emergency departments at academic centers in Sweden, Switzerland, and Canada.

Patients:

All emergency encounters among adults where one of the following criteria were fulfilled: respiratory rate >25 breaths per minute; heart rate >120 beats per minute; altered mental status; systolic blood pressure <100 mm Hg; oxygen saturation <90% without oxygen; oxygen saturation <93% with oxygen; reported oxygen saturation <90%.

Intervention:

None.

Measurements and Main Results:

A total of 524 emergency department patients were prospectively enrolled, of these 236 (45%) were eventually adjudicated to have a noninfectious disease. Three hundred forty-seven patients (66%) had or developed organ dysfunction within 72 h, 54 patients (10%) were admitted to an intensive care unit, and 23 patients (4%) died within 72 h. For the primary outcome, detection of infected-related organ dysfunction within 72 h, the area under the receiver operating curve (AUC) for HBP was 0.73 (95% CI 0.68–0.78) among all patients and 0.82 (95% CI 0.76–0.87) among patients confidently adjudicated to either infection or no infection. Against the secondary outcome, infection leading to admittance to the ICU, death or a persistent high SOFA-score due to an infection (SOFA-score ≥5 at 12–24 h) HBP had an AUC of 0.87 (95% CI 0.79–0.95) among all patients and 0.88 (95% CI 0.77–0.99) among patients confidently adjudicated to either infection or noninfection.

Conclusions:

Among patients at the emergency department, HBP demonstrated good prognostic and discriminatory properties in detecting the most severely ill patients with infection.
Perioperative Adverse Events in Women Undergoing Concurrent Hemorrhoidectomy at the Time of Urogynecologic Surgery
Authors: Casas-Puig Viviana , Bretschneider C. Emi , Ferrando Cecile A.
Published: February 2019

Objective

The aim of this study was to describe the incidence and trends of outcomes after concurrent surgeries for symptomatic hemorrhoids and pelvic floor disorders.

Methods

This was a retrospective matched cohort study. Women who underwent concurrent vaginal urogynecologic and hemorrhoid surgery between 2007 and 2017 were identified by their surgical codes and matched to a cohort of women who underwent vaginal urogynecologic surgery only. The medical record was queried for demographic and perioperative data.

Results

Thirty-three subjects met the inclusion criteria; 198 subjects were matched accordingly (N = 231). Mean age and body mass index were 57 ± 12 years and 28.9 ± 5.6 kg/m2, respectively. Subjects who underwent concurrent hemorrhoidectomy were more likely to have had previous prolapse surgery (27.3% vs 15.2%, P = 0.09) and preoperative fecal incontinence (27.3% vs 13.6%, P = 0.05). Concurrent cases were more likely to have unplanned office visits (27.2% vs 12.6%, P = 0.03) and phone calls (range, 1–7 vs 0–10; P = 0.001), mostly for pain complaints. Reoperation was higher in combined cases (3% vs 0%, P = 0.01); however, the overall rate of serious perioperative adverse events was low and not different between groups. Concurrent cases were more likely to be discharged home with a Foley (42.4% vs 18.2%, P = 0.002) and to have a postoperative urinary tract infection (33.3% vs 10.6%, P = 0.005). In the concurrent group, 33.3% of the patients experienced severe rectal pain.

Conclusions

Patients undergoing concurrent hemorrhoidectomy at the time of vaginal urogynecologic surgery are at higher risk of minor events such as postoperative urinary tract infection and need for discharge home with a Foley, as well as risk of pain that may be greater than urogynecologic surgery alone.
Utility of Preoperative Laboratory Testing in Women Undergoing Suburethral Sling
Authors: Pandya Lopa K. , McLaughlin Eric M. , Hudson Catherine O. , Nekkanti Silpa , Smith Pamela E. , Hade Erinn M. , Hundley Andrew F.
Published: February 2019

Objective

The aim of the study was to examine current patterns and factors associated with preoperative testing in patients undergoing midurethral sling and to compare 30-day outcomes in subjects.

Methods

This retrospective cohort study was performed using the National Surgery Quality Improvement Program database from 2005 to 2014. All women undergoing midurethral slings were identified by Current Procedural Terminology code. Clinical variables were abstracted and the incidence of preoperative serum labs was determined. Multivariable logistic regression was used to estimate associations between clinical factors and collection of preoperative serum labs and between 30-day outcomes and collection of labs.

Results

A total of 12,368 women underwent midurethral sling in the National Surgery Quality Improvement Program database during the study period. Preoperative serum testing within 30 days before surgery was observed in 9172 (74.2%) women. Age, American Society of Anesthesiologists class, diabetes, and hypertension were strongly associated with preoperative testing when modeling together in multivariable regression. Of the 543 women who had any complication, 410 (75.5%) received preoperative testing. Urinary tract infection was the most frequent complication (66.1%). Age, American Society of Anesthesiologists class, body mass index, and presence of any comorbidity were associated with the presence of any complication at 30 days. Adjusting for these factors, the odds of complications were not significantly different between those who did and did not have preoperative testing (adjusted odds ratio = 0.98, 95% confidence interval = 0.78–1.24).

Conclusions

Most women who underwent midurethral sling procedures had preoperative testing. Major postoperative complications were uncommon, and there was no substantial difference in outcomes between women who underwent preoperative testing and those who did not. In the future, surgeons may consider eliminating preoperative testing in low-risk patients.
All Levels of Providers Can Effectively and Efficiently Teach Pelvic Floor Strength Assessment at Time of Pelvic Examination
Authors: Armstrong Abigail A. , Nguyen My-Linh M. , Wieslander Cecilia K. , Tarnay Christopher M.
Published: February 2019

Objective

In women who undergo provider-guided vaginal biofeedback of pelvic floor muscle strength, we sought to determine whether the level of the provider correlates with the patient’s ability to achieve adequate pelvic floor muscle contractions (PFMCs).

Methods

From August 2017 to April 2018, patients from 2 urogynecology clinics were recruited to participate in an institutional review board–approved, prospective study examining PFMCs. Pelvic examination and teaching session were done by providers who had specific training on how to assess pelvic floor muscle strength using the validated, modified Oxford scale. Patients were asked to perform a baseline PFMC during a 2-digit pelvic examination. Thereafter, patients were counseled to relax their muscles, identify the levator ani muscles during provider teaching, and perform 3 consecutive provider-guided PFMCs. The strength of each PFMC was measured, and the time-to-teach (TTT) was recorded. The level of provider and TTT were correlated with PFMC1 to PFMC3 using Spearman correlation coefficient.

Results

One hundred women participated. Obstetrics/gynecology (OB/GYN) residents (post-graduate years 1–4) evaluated 20 patients; female pelvic medicine and reconstructive surgery fellowship trainees (post-graduate years 5–7), 38 patients; OB/GYN nurse practitioners, 18 patients; generalist OB/GYN faculty, 9 patients; and female pelvic medicine and reconstructive surgery faculty, 15 patients. There was no correlation between level of provider and TTT or between level of provider and strength of PFMC1, PFMC2, or PFMC3.

Conclusions

At the time of pelvic floor muscle assessment, the level of provider does not impact teaching time or PFMC1 to PFMC3. Teaching pelvic floor muscle exercise is a cost-effective, low-resource tool to improve patient care, and providers of any level should be encouraged to teach pelvic floor muscle exercise to patients at the time of office examination.
Understanding Your Online Ratings: A Methodological Analysis Using Urogynecologists in the United States
Authors: Huber Sarah A. , Priestley Jennifer , Kasabwala Khushabu , Gadidov Bogdan , Culligan Patrick
Published: February 2019

Objective

The influence of online physician ratings is growing, yet their interpretation remains difficult. Our aim was to analyze the online content of urogynecologists on 1 website to transform these ratings into practical tools for care improvement.

Methods

This cross-sectional analysis studied the ratings and reviews of every board-certified urogynecologist listed on Healthgrades.com. The ratio of 5:1 ratings was compared between various physician characteristics and practice qualities. Four investigators classified narrative reviews into one or more of the following themes: about the (1) physician, (2) clinical outcomes, (3) and/or staff. The content of the narrative reviews was analyzed, and word clouds were created to understand the primary motivators behind ratings.

Results

In February 2018, the Healthgrades pages for 689 urogynecologists were evaluated, and 523 physicians were included in the study. Higher 5:1 ratios were found among men versus women (4.0 vs 3.0; P < 0.01), and OB-GYN–trained versus urology-trained (4.0 vs 2.2; P < 0.01) physicians. A benchmarking rubric was developed to illustrate the 5:1 ratio distribution for all physicians stratified by number of ratings. A total of 3300 narrative reviews were assigned themes with strong inter- and intrarater reliability (Table 3). Physician qualities most influenced extreme scores (1 or 5 stars), whereas average reviews were more influenced by staff. Commonly discussed physician qualities included professionalism, time with patient, and counseling.

Conclusions

Using the 5:1 rating ratio and simplified review themes as tools, physicians can understand what their ratings signify both as an indicator of their online reputation compared with their peers and as a means for improving the patient experience.
Validation and Testing of an E-Learning Module Teaching Core Urinary Incontinence Objectives in a Randomized Controlled Trial
Authors: Parker-Autry Candace Y. , Shen E. , Nance Andrea , Butler Timberly , Covarrubias Julie B. , Varner Robert E. , Richter Holly E.
Published: February 2019

Objectives

To evaluate the efficacy of a urinary incontinence (UI) e-learning module (ELM) in undergraduate medical education.

Methods

An ELM was developed and validated to teach on UI learning objectives. A 21-item assessment was developed to test knowledge gained. A randomized-controlled trial and parallel nested-cohort study were performed to test the effectiveness of the validated UI-ELM compared with standard methods of UI learning. Students were recruited and enrolled at the onset of their obstetrics and gynecology clerkship. Assignments to either a week-long rotation of gynecologic (GYN) or urogynecologic (UroGyn) surgery were made independent of the study protocol. On the GYN rotation, students were randomly assigned to the UI-ELM intervention or no intervention (control group). The nested-cohort comprised students assigned to the UroGyn rotation. Parametric statistics were applied assessing score changes between the UI-ELM versus control/UroGyn groups.

Results

Eighty-three students rotated between June 2015 and February 2016. Fifty-five were assigned to GYN and randomized: 35 UI-ELM versus 20 no intervention; 28 were assigned to UroGyn. Students randomized to the UI-ELM had greater score improvement compared with controls (between group difference of +2.73; 95% confidence interval, 0.53–4.93; P = 0.02). Knowledge improvement was similar between students exposed to the UI-ELM compared with those with UroGyn exposure (between group difference, +0.91; 95% confidence interval, −1.05 to 2.88; P = 0.35).

Conclusions

The UI-ELM resulted in greater improvement in UI knowledge among third year medical students compared with traditional methods of learning and similar to those exposed to a UroGyn rotation.
Determining the Health State Utility Value of Urinary Tract Infection in Women
Authors: Kalyanaraman Rajeshwari , Demtchouk Veronica , Iyer Vidya , Patterson Danielle
Published: February 2019

Objectives

Health state utility values are a unique representation of an individual’s valuation for being in a particular health state. Depending on the method of evaluation, group of patients, and setting, these values vary significantly. To date, majority of the available estimates for the health-related state utility values for urinary tract infection (UTI) has been in men with comorbid conditions such as benign prostatic hyperplasia and bladder cancer or with spinal cord abnormalities. The utility values in these studies ranged between 0.3 and 0.9. The purpose of this study was to determine and compare the health state utility value for UTI in women derived from EuroQol 5 dimensions (EQ-5D) questionnaire and visual analog scale (VAS) with the Standard Gamble (SG) interview in a tertiary medical center.

Methods

Healthy volunteers at least 18 years of age with no history of UTI were approached for study participation. Twenty-five subjects were given a standard sheet describing UTI and its symptoms and were asked to complete the EQ-5D and VAS followed by SG conversation.

Results

The median utility (interquartile range) for UTI varied based on the methods: EQ-5D, 1.00 (0.124); VAS, 0.98 (0.10); and SG, 0.90 (0.15). Spearman correlation showed that these values were weakly correlated.

Conclusions

Our data suggest a value of 0.90 to represent the health state utility value of UTI in women older than 18 years. The EQ-5D is not sensitive to impact of UTI in women, and we would not recommend using it for that purpose based on our findings.
Adenovirus flow in host cell networks
Authors: Flatt Justin W. , Butcher Sarah J.
Published: February 2019

Viruses are obligatory parasites that take advantage of intracellular niches to replicate. During infection, their genomes are carried in capsids across the membranes of host cells to sites of virion production by exploiting cellular behaviour and resources to guide and achieve all aspects of delivery and the downstream virus manufacturing process. Successful entry hinges on execution of a precisely tuned viral uncoating program where incoming capsids disassemble in consecutive steps to ensure that genomes are released at the right time, and in the right place for replication to occur. Each step of disassembly is cell-assisted, involving individual pathways that transmit signals to regulate discrete functions, but at the same time, these signalling pathways are organized into larger networks, which communicate back and forth in complex ways in response to the presence of virus. In this review, we consider the elegant strategy by which adenoviruses (AdVs) target and navigate cellular networks to initiate the production of progeny virions. There are many remarkable aspects about the AdV entry program; for example, the virus gains targeted control of a large well-defined local network neighbourhood by coupling several interacting processes (including endocytosis, autophagy and microtubule trafficking) around a collective reference state centred on the interactional topology and multifunctional nature of protein VI. Understanding the network targeting activity of protein VI, as well as other built-in mechanisms that allow AdV particles to be efficient at navigating the subsystems of the cell, can be used to improve viral vectors, but also has potential to be incorporated for use in entirely novel delivery systems.