bluuebunny/crossref_metadata_2025 huggingface dataset:
A Gaussian process model and Bayesian variable selection for mapping function-valued quantitative traits with incomplete phenotypic data
Authors: Vanhatalo Jarno , Li Zitong , Sillanpää Mikko J
Published: March 2019

Motivation

Recent advances in high dimensional phenotyping bring time as an extra dimension into the phenotypes. This promotes the quantitative trait locus (QTL) studies of function-valued traits such as those related to growth and development. Existing approaches for analyzing functional traits utilize either parametric methods or semi-parametric approaches based on splines and wavelets. However, very limited choices of software tools are currently available for practical implementation of functional QTL mapping and variable selection.

Results

We propose a Bayesian Gaussian process (GP) approach for functional QTL mapping. We use GPs to model the continuously varying coefficients which describe how the effects of molecular markers on the quantitative trait are changing over time. We use an efficient gradient based algorithm to estimate the tuning parameters of GPs. Notably, the GP approach is directly applicable to the incomplete datasets having even larger than 50% missing data rate (among phenotypes). We further develop a stepwise algorithm to search through the model space in terms of genetic variants, and use a minimal increase of Bayesian posterior probability as a stopping rule to focus on only a small set of putative QTL. We also discuss the connection between GP and penalized B-splines and wavelets. On two simulated and three real datasets, our GP approach demonstrates great flexibility for modeling different types of phenotypic trajectories with low computational cost. The proposed model selection approach finds the most likely QTL reliably in tested datasets.

Availability and implementation

Software and simulated data are available as a MATLAB package ‘GPQTLmapping’, and they can be downloaded from GitHub (https://github.com/jpvanhat/GPQTLmapping). Real datasets used in case studies are publicly available at QTL Archive.

Supplementary information

Supplementary data are available at Bioinformatics online.
Safety of Inactivated Influenza Vaccine in Cancer Patients Receiving Immune Checkpoint Inhibitors
Authors: Chong Curtis R , Park Vivian J , Cohen Bevin , Postow Michael A , Wolchok Jedd D , Kamboj Mini
Published: March 2019

Background

Cancer patients are at a higher risk for developing influenza (flu)– related complications. It is unclear if the flu vaccine exacerbates immune events in patients treated with immune checkpoint inhibitors (ICIs).

Methods

We conducted an institutional review board–IRB-approved retrospective review of advanced cancer patients on ICIs who received the flu vaccine during three 3 consecutive seasons: 2014–2015, 2015–2016, and 2016–2017. The primary outcome assessed was any “new onset” immune-related adverse event (IRAE). A subset analysis of vaccinated patients newly treated with anti–programmed cell death protein 1 (PD-1) agents (nivolumab or pembrolizumab) was conducted to assess overall IRAE rates for comparison with published clinical trials.

Results

During the three 3 seasons, 370 patients met criteria for ICI and vaccination within ~ twoapproximately 2 months (65 days). The most common underlying cancers were lung (46%) and melanoma (19%); 61% of patients received an anti–PD-1 agent only. In the entire cohort, 20% experienced an IRAE (any grade); incidence of grade 3 or 4 toxicity was 8%. No grade 5 events occurred. In the subset of 170 patients newly treated with anti–PD-1 agents, the overall IRAE rate was 18% and, grade 3/4 events occurred in 7.6%. Influenza was diagnosed in 2 patients.

Conclusions

No increase in incidence or severity of IRAEs was detected in patients on ICIs who received the inactivated influenza vaccine within ~ approximately 2 months of ICI. For newly treated patients on anti–PDI-1 agents, IRAE rates were comparable to those from published clinical trials and did not vary with order of administration. Routine seasonal flu vaccination is encouraged in patients on ICIs.
Mortality and morbidity reduction after frequent premature ventricular complexes ablation in patients with left ventricular systolic dysfunction
Authors: Berruezo Antonio , Penela Diego , Jáuregui Beatriz , Soto-Iglesias David , Aguinaga Luis , Ordóñez Augusto , Fernández-Armenta Juan , Martínez Mikel , Tercedor Luis , Bisbal Felipe , Acosta Juan , Martí-Almor Julio , Aceña Marta , Anguera Ignasi , Rossi Luca , Linhart Markus , Borràs Roger , Doltra Adelina , Sánchez Paula , Ortiz-Pérez José T , Perea Rosario J , Prat-González Susana , Teres Cheryl , Bosch Xavier
Published: March 2019

Aims

Ablation of frequent premature ventricular complexes (PVCs) improves left ventricular ejection fraction in patients with left ventricular (LV) systolic dysfunction. This study aims to evaluate the long-term hard outcomes and potential prognostic variables in this population.

Methods and results

Prospective multicentre study including 101 consecutive patients [56 ± 12 years old, 62 (61%) men] with LV systolic dysfunction and frequent PVCs who underwent PVC ablation before November 2015. The last evaluation performed was considered the long-term follow-up (LTFUP) evaluation. Mean follow-up was 34 ± 16 months (range 24–84 months). Ablation was successful in 95 (94%) patients. There was a significant reduction in the PVC burden from 21 ± 12% at baseline to 3.8 ± 6% at LTFUP, P < 0.001. Left ventricular ejection fraction improved from 32 ± 8% at baseline to 39 ± 12% at LTFUP (P < 0.001) and New York Heart Association class from 2.2 ± 0.6% to 1.3 ± 0.6% (P < 0.001). Brain natriuretic peptide levels decreased from 136 (78–321) to 68 (32–144) pg/mL (P = 0.007). Most of this improvement occurs during the first 6 months after ablation. Persistent abolition of at least 18 points of the baseline PVC burden was independently and inversely associated with the composite endpoint of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up [hazard ratio 0.18 (0.05–0.66), P = 0.01].

Conclusion

In patients with LV systolic dysfunction, ablation of frequent PVCs induces a significant improvement in functional, structural, and neurohormonal status, which persists at LTFUP. A sustained reduction in the baseline PVC burden is associated with a lower risk of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up.
Does the Flemish colorectal cancer screening programme reach equity in FIT uptake?
Authors: Hoeck S , van de Veerdonk W , De Brabander I , Kellen E
Published: March 2019

Background

To investigate colorectal cancer (CRC) screening rates by the faecal immunochemical test (FIT) according to sociodemographic characteristics and nationality.

Methods

Men and women, aged 56–74, invited to participate in the Flemish CRC screening programme in 2013 and 2014 were included in this study. We analysed the association between CRC screening uptake and sex, age, (first and current) nationality and several proxies for socio-economic status (SES). The statistical analysis was based on descriptive analyses and logistic regression models.

Results

A total of 1 184 426 persons were included in our analysis. The overall screening uptake was 52.3%, uptake varied by sex, age, nationality and SES. Lower participation rates were associated with the youngest and oldest age categories (56–60 and 70–74) and being male. All nationalities other than Belgian or Dutch were significantly less screened. Lower uptake of screening was also associated with several proxy’s for low SES, such as having an allowance for being disabled, not being able to work, being an extended minor and having a social allowance/minimum wage. The descriptive analysis showed a 27% difference in CRC screening uptake between the (early) retired and the people entitled to a minimum wage.

Conclusions

There is a significant difference between screening uptake and demographic and socio-economic variables in the first 2 years of the population-based screening programme in Flanders. Based on the study results, implementing strategies to improve participation in those subgroups is needed.
Increasing Rates of Opioid Misuse Among Older Adults Visiting Emergency Departments
Authors: Carter Mary W , Yang Bo Kyum , Davenport Marsha , Kabel Allison
Published: March 2019

Objective

This study sought to investigate factors associated with opioid misuse-related emergency department (ED) visits among older adults and changes in outcomes associated with these visits, using multiple years of nationally representative data.

Methods

A retrospective analysis of the Nationwide Emergency Department Sample was conducted. Study inclusion was limited to adults aged 65 years and older. Diagnostic codes were used to identify opioid misuse disorder; sampling weights were used to adjust standard estimates of the errors. Descriptive and multivariate procedures were used to describe risk and visit outcomes.

Results

ED visits by older adults with opioid misuse identified in the ED increased sharply from 2006 to 2014, representing a nearly 220% increase over the study period. Opioid misuse was associated with an increased number of chronic conditions, greater injury risk, and higher rates of alcohol dependence and mental health diagnoses.

Conclusion

The steep increase in opioid misuse observed among older adult ED visits underscores the critical need for additional research to better understand the national scope and impact of opioid misuse on older adults, as well as to better inform policy responses to meet the needs of this particular age group.
Joint inversion of gravity with cosmic ray muon data at a well-characterized site for shallow subsurface density prediction
Authors: Cosburn Katherine , Roy Mousumi , Guardincerri Elena , Rowe Charlotte
Published: March 2019

Estimating subsurface density is important for imaging various geologic structures such as volcanic edifices, reservoirs and aquifers. Muon tomography has recently been used to complement traditional gravity measurements as a powerful method for probing shallow subsurface density structure beneath volcanoes. Gravity and muon data have markedly different spatial sensitivities and, as a result, the combination is useful for imaging structures on spatial scales that are larger than the area encompassed by crossing muon trajectories. Here we explore and test a joint inversion of gravity and muon data in a study area where there is an independently characterized target anomaly: a regionally extensive, high-density layer beneath Los Alamos, New Mexico, USA. We resolve the nearly flat-lying structure using a unique experimental set-up wherein surface and subsurface gravity and muon measurements are obtained above and below the target volume. Our results show that with minimal geologic (prior) constraints, the joint inversion correctly recovers salient features of the expected density structure. The results of our study illustrate the potential of combining surface and subsurface (e.g. borehole) gravity and muon measurements to invert for shallow geologic structures.
Mendelian randomization of inorganic arsenic metabolism as a risk factor for hypertension- and diabetes-related traits among adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) cohort
Authors: Scannell Bryan Molly , Sofer Tamar , Mossavar-Rahmani Yasmin , Thyagarajan Bharat , Zeng Donglin , Daviglus Martha L , Argos Maria
Published: March 2019

Background

Hypertension and diabetes have been associated with inefficient arsenic metabolism, primarily through studies undertaken in populations exposed through drinking water. Recently, rice has been recognized as a source of arsenic exposure, but it remains unclear whether populations with high rice consumption but no known water exposure are at risk for the health problems associated with inefficient arsenic metabolism.

Methods

The relationships between arsenic metabolism efficiency (% inorganic arsenic, % monomethylarsenate and % dimethylarsinate in urine) and three hypertension- and seven diabetes-related traits were estimated among 12 609 participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). A two-sample Mendelian randomization approach incorporated genotype-arsenic metabolism relationships from literature, and genotype-trait relationships from HCHS/SOL, with a mixed-effect linear model. Analyses were stratified by rice consumption and smoking.

Results

Among never smokers with high rice consumption, each percentage point increase in was associated with increases of 1.96 mmHg systolic blood pressure (P = 0.034) and 1.85 mmHg inorganic arsenic diastolic blood pressure (P = 0.003). Monomethylarsenate was associated with increased systolic (1.64 mmHg/percentage point increase; P = 0.021) and diastolic (1.33 mmHg/percentage point increase; P = 0.005) blood pressure. Dimethylarsinate, a marker of efficient metabolism, was associated with lower systolic (−0.92 mmHg/percentage point increase; P = 0.025) and diastolic (-0.79 mmHg/percentage point increase; P = 0.004) blood pressure. Among low rice consumers and ever smokers, the results were consistent with no association. Evidence for a relationship with diabetes was equivocal.

Conclusions

Less efficient arsenic metabolism was associated with increased blood pressure among never smokers with high rice consumption, suggesting that arsenic exposure through rice may contribute to high blood pressure in the Hispanic/Latino community.
Postreconstitution Stability of Amoxicillin–Clavulanic Acid Suspensions at Tropical Room Temperature
Authors: Maiwada Jamilu , Said Mazlina Mohd
Published: March 2019

The storage conditions of reconstituted β-lactam suspensions are of concern, especially in tropical countries. Improper storage conditions after reconstitution lead to administration of a subtherapeutic dose of medication, which in turn leads to treatment failure and antibiotic resistance.
Solar cycle variation in radar meteor rates
Authors: Campbell-Brown M D
Published: March 2019

16 yr of meteor radar data from the Canadian Meteor Orbit Radar (CMOR) were used to investigate the link between observed meteor rates and both solar and geomagnetic activity. Meteor rates were corrected for transmitter power and receiver noise, and seasonal effects were removed. A strong negative correlation is seen between solar activity, as measured with the 10.7 cm flux, and observed meteor rates. This lends support to the idea that heating in the atmosphere at times of elevated solar activity changes the scale height and therefore the length and maximum brightness of meteors; a larger scale height near solar maximum leads to longer, fainter meteors and therefore lower rates. A weaker negative correlation was observed with geomagnetic activity as measured with the K index; this correlation was still present when solar activity effects were removed. Meteor activity at solar maximum is as much as 30 per cent lower than at solar minimum, strictly due to observing biases; geomagnetic activity usually affects meteor rates by less than 10 per cent.
The role of charitable funding in university research
Authors: Kundu Oishee , Matthews Nicholas E
Published: March 2019

There has been a diversification in the sources of university research funding in recent decades. While substantial research efforts have explored and discussed the implications of this diversification, with the exception of biomedical research the role of charities has typically been neglected, despite their importance in funding university research. This article explores the significance of charitable funding in academic research through the sponsorship of doctoral students. We demonstrate a sponsor classification strategy which classifies PhD theses by sponsor type with high accuracy and coverage. We find that: 1. charities play a significant role in funding doctoral students particularly within medical research, 2. charities are prominent in the wider network of research sponsors, and 3. they exhibit distinct preferences in terms of the subjects they fund. The dataset generated through this study provides an instrumental resource to initiate greater discussion on the role of this important source of research funding.
Linguistic Fractionalization and Health Information in Sub-Saharan Africa
Authors: Gomes Joseph Flavian
Published: March 2019

This paper explores the relationship between linguistic diversity and the stock of health information in society. Information is measured using individual-level knowledge about the oral rehydration product for treating children with diarrhea. Exploiting an individual woman-level dataset from the Demographic and Health Surveys for 14 sub-Saharan African countries combined with a novel high-resolution dataset on the spatial distribution of linguistic groups at a 1 km × 1 km level, this study shows that linguistic diversity has an inverted U-shaped relationship with the stock of information in society.
XVIII Bibliography, Textual Criticism, and Reference Works
Authors: Baker William
Published: March 2019

This chapter has five sections: 1: Periodicals; 2. Editions; 3. Bibliography and Associated Books and Articles; 4. Histories and Companions; 5. Shakespeare, History of Libraries, Collections, and Miscellaneous including Reference Materials. These sections are not inviolable. With some exceptions this review of the year’s work published in 2017 in the areas of bibliography, textual criticism, and reference materials is alphabetically arranged. Within the alphabetical arrangement by author there are some exceptions where publications are grouped under the respective authors rather than under editors of, for instance, the correspondence. There is also included in this chapter work that has been missed in some of the other chapters in this volume. Readers should be aware that coverage is largely limited to those items that have been received by the contributor, who would like to thank James E. May, James Fergusson, Patrick Scott, and Jan Webster for their assistance.
Improving Management Strategies of Plant Diseases Using Sequential Sensitivity Analyses
Authors: Rimbaud Loup , Dallot Sylvie , Bruchou Claude , Thoyer Sophie , Jacquot Emmanuel , Soubeyrand Samuel , Thébaud Gaël
Published: March 2019

Improvement of management strategies of epidemics is often hampered by constraints on experiments at large spatiotemporal scales. A promising approach consists of modeling the biological epidemic process and human interventions, which both impact disease spread. However, few methods enable the simultaneous optimization of the numerous parameters of sophisticated control strategies. To do so, we propose a heuristic approach (i.e., a practical improvement method approximating an optimal solution) based on sequential sensitivity analyses. In addition, we use an economic improvement criterion based on the net present value, accounting for both the cost of the different control measures and the benefit generated by disease suppression. This work is motivated by sharka (caused by Plum pox virus), a vector-borne disease of prunus trees (especially apricot, peach, and plum), the management of which in orchards is mainly based on surveillance and tree removal. We identified the key parameters of a spatiotemporal model simulating sharka spread and control and approximated optimal values for these parameters. The results indicate that the current French management of sharka efficiently controls the disease, but it can be economically improved using alternative strategies that are identified and discussed. The general approach should help policy makers to design sustainable and cost-effective strategies for disease management.
Epidemiology of Cervical Injuries in NCAA Football Players
Authors: Chung Andrew S. , Makovicka Justin L. , Hassebrock Jeffrey D. , Patel Karan A. , Tummala Sailesh V. , Deckey David G. , Hydrick Thomas C. , Rubel Nicolas C. , Chhabra Anikar
Published: March 2019

Study Design.

Descriptive epidemiology study.

Objective.

The purpose of this study was to describe the epidemiology of cervical spine injuries in collegiate football players.

Summary of Background Data.

The incidence and etiology of cervical spine injuries in National Collegiate Athletic Association (NCAA) football players has not been well defined in recent years.

Methods.

The incidence and characteristics of cervical spine injuries were identified utilizing the NCAA-ISP database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition.

Results.

An estimated 7496 cervical spine injuries were identified. Of these, 85.6% were categorized as new injuries. These occurred at a rate of 2.91 per 10000 AEs. Stingers were most common (1.87 per 10000 AEs) followed by cervical strains (0.80 per 10000 AEs). Injuries were nine times more likely to occur during competition when compared with practice settings. When compared with the regular season, the relative risks of sustaining a cervical spine injury during the preseason and postseason were 0.69 (95% CI 0.52–0.90) and 0.39 (95% CI 0.16–0.94), respectively. The rate of cervical spine injuries was highest in Division I athletes. Direct contact-related injuries were most common, representing 90.8% of all injuries sustained. Injuries were most common in linebackers (20.3%) followed secondarily by defensive linemen (18.2%). Most players returned to play within 24 hours of the initial injury (64.4%), while only 2.8% remained out of play for > 21 days.

Conclusion.

Fortunately, the rate of significant and disabling cervical spine injuries appears to be low in the NCAA football athlete. The promotion of safer tackling techniques, appropriate modification of protective gear, and preventive rehabilitation in these aforementioned settings is of continued value.

Level of Evidence: 4
Dropped Head Syndrome
Authors: Drain Joseph P. , Virk Sohrab S. , Jain Nikhil , Yu Elizabeth
Published: March 2019

Study design:

This study was a systematic review.

Objectives:

To reveal demographic factors, etiologies, response to treatment, and to propose a novel treatment algorithm for dropped head syndrome (DHS).

Summary of background data:

DHS is a rare condition defined by weakness of the cervical paraspinal muscles resulting in passively correctable flexion of the cervical spine. Patients present with neck pain, difficulty eating, and impaired horizontal gaze. Because of the rarity of DHS, a paucity of information exists with regard to demographics, etiology, and relative superiority of medical and surgical treatment.

Materials and Methods:

We conducted a systematic literature review by searching PubMed for “dropped head syndrome,” “chin on chest,” “isolated neck extensor myopathy” (INEM), and “camptocephalia.” Inclusion criteria were English-language articles that applied a specific treatment regimen with outcome data. A binomial logistic regression analysis was then performed to determine which covariates (age, sex, and treatments) were predictive of a positive response to treatment.

Results:

A total of 129 patients were described in 74 studies. Mean age was 63.6 and 63% were female. More than two-thirds of all patients fell into just 4 diagnostic categories (isolated neck extensor myopathy, 31.8%; Parkinson’s, 20.2%; myasthenia gravis, 12.4%; amyotrophic lateral sclerosis, 7.0%). Overall positive response to treatment was 64.3%; primary medical treatment (73.5%), immune suppression (78.9%), and a combination of both (87.5%). Surgery was 93.8% successful. A treatment algorithm focused on appropriate diagnosis, initial medical management, with surgical evaluation only after failure of medical treatment was proposed.

Conclusions:

Treatment for DHS starts with accurate diagnosis of the underlying etiology and is often associated with neuromuscular disease. A treatment algorithm for appropriate management of these patients was proposed. A trial of medical management and/or immunomodulators is warranted. Failing nonoperative management, surgery is predictive of a positive outcome.

Level of Evidence:

Level V.
The Implications of Pouch Physiology
Authors: Church James
Published: March 2019

INTRODUCTION:

Patients undergoing an IPAA experience a completely different physiology of defecation than when they had a rectum. The new “normal” is poorly appreciated and incompletely understood, and the lack of understanding has implications for pouch function. This technical note lays out the physiology of defecation with an ileal pouch and its implications for patients and surgeons.

TECHNIQUE:

An intestinal pouch acts as a reservoir because the united antegrade and retrograde peristaltic loops produce no evacuatory pressure. Defecation occurs by gravity. Efficient defecation results in fewer stools, but inefficient defecation may cause stool frequency, incontinence, obstruction, constipation, and pouch inflammation. The technical aspects of pouch construction that impact emptying include a long efferent limb of an S-pouch, any degree of twist in the pouch body, afferent limb syndrome, and anal stenosis.

RESULTS:

Constructing a pouch with no twists and with an open anus, maintaining liquid stool, and encouraging unhurried defecation can improve pouch function.

CONCLUSIONS:

Understanding pouch physiology is important in optimizing pouch function and maintaining patient expectations.
Randomized Clinical Trial: A Normocaloric Low-Fiber Diet the Day Before Colonoscopy Is the Most Effective Approach to Bowel Preparation in Colorectal Cancer Screening Colonoscopy
Authors: Alvarez-Gonzalez Marco A. , Pantaleon Miguel A. , Flores-Le Roux Juana A. , Zaffalon Diana , Amorós Jaume , Bessa Xavier , Seoane Agustin , Pedro-Botet Juan
Published: March 2019

BACKGROUND:

Clinical guidelines recommend either a clear-liquid diet or a low-fiber diet for colonoscopy preparation. Participants in a screening program are usually motivated healthy individuals in which a good tolerability is important to improve adherence to potential surveillance colonoscopies.

OBJECTIVE:

Our aim was to assess whether or not a normocaloric low-fiber diet followed the day before a screening colonoscopy compromises the efficacy of bowel cleansing and may improve the tolerability of bowel preparation.

DESIGN:

This is a randomized, endoscopist-blinded, noninferiority clinical trial.

SETTINGS:

The study was conducted at a tertiary care center.

PATIENTS:

A total of 276 consecutive participants of the Barcelona colorectal cancer screening program were included.

INTERVENTION:

Participants were randomly assigned to a clear-liquid diet or a normocaloric low-fiber diet the day before the colonoscopy. Both groups received 4 L of polyethylene glycol in a split-dose regimen.

MAIN OUTCOME MEASURES:

Primary outcome was the adequate bowel preparation rate measured with the Boston bowel preparation scale. Secondary outcomes included tolerability, fluid-intake perception, hunger, side effects, and acceptability.

RESULTS:

Participants in both groups were similar in baseline characteristics. Adequate bowel preparation was achieved in 89.1% vs 95.7% in clear-liquid diet and low-fiber diet groups, showing not only noninferiority, but also superiority (p = 0.04). Low-fiber diet participants reported less fluid-intake perception (p = 0.04) and less hunger (p = 0.006), with no differences in bloating or nausea.

LIMITATIONS:

The single-center design of the study could limit the external validity of the results. The present findings may not be comparable to other clinical settings.

CONCLUSION:

A normocaloric low-fiber diet the day before a screening colonoscopy achieved better results than a clear-liquid diet in terms of adequate colon preparation. Moreover, it also improved the perception of hunger and excessive fluid intake. Registered at clinicaltrials.gov: NCT02401802. See Video Abstract at http://links.lww.com/DCR/A829.
Academic Hospitals Discharge Fewer Patients to Postacute Care Facilities After Colorectal Resection
Authors: Kanters Arielle E. , Nikolian Vahagn C. , Kamdar Neil S. , Regenbogen Scott E. , Hendren Samantha K. , Suwanabol Pasithorn A.
Published: March 2019

BACKGROUND:

Discharge to a nonhome destination (ie, skilled nursing facility, subacute rehabilitation, or long-term care facility) after surgery is associated with increased mortality and higher costs and is less desirable to patients than discharge to home.

OBJECTIVE:

We sought to identify modifiable hospital-level factors that may reduce rates of nonhome discharge after colorectal resection.

DESIGN:

This was a retrospective cohort study of patients undergoing colorectal resection in the Michigan Surgical Quality Collaborative (July 2012 to June 2015). Patient- and hospital-level characteristics were tested for association with nonhome discharge patterns.

SETTINGS:

Patients were identified using prospectively collected data from the Michigan Surgical Quality Collaborative, a statewide collaborative encompassing 63 community, academic, and tertiary hospitals.

PATIENTS:

Patients undergoing colon and rectal resections were included.

MAIN OUTCOME MEASURE:

The main outcome measure was hospital use patterns of nonhome discharge.

RESULTS:

Of the 9603 patients identified, 1104 (11.5%) were discharged to a nonhome destination. After adjustments for patient factors associated with nonhome discharge, we identified variability in hospital use patterns for nonhome discharge. Designation as a low utilizer hospital was associated with affiliation with a medical school (p = 0.020) and high outpatient volume (p = 0.028). After adjustments for all hospital factors, only academic affiliation maintained a statistically significant relationship (OR = 4.94; p = 0.045).

LIMITATIONS:

This study had a retrospective cohort design with short-term follow-up of sampled cases. Additionally, by performing our analysis on the hospital level, there is a decreased sample size.

CONCLUSIONS:

This population-based study shows that there is significant variation in hospital practices for nonhome discharge. Specifically, hospitals affiliated with a medical school are less likely to discharge patients to a facility, even after adjustment for patient and procedural risk factors. This study raises the concern that there may be overuse of subacute facility discharge in certain hospitals, and additional study is warranted. See Video Abstract at http://links.lww.com/DCR/A837.
Prognostic Impact of Tumor-Infiltrating Lymphocytes in Primary and Metastatic Colorectal Cancer: A Systematic Review and Meta-analysis
Authors: Kong Joseph C. , Guerra Glen R. , Pham Toan , Mitchell Catherine , Lynch A. Craig , Warrier Satish K. , Ramsay Robert G. , Heriot Alexander G.
Published: March 2019

BACKGROUND:

There is increasing literature emerging on the significance of tumor-infiltrating lymphocytes in colorectal cancer. However, there have been inconsistent findings, secondary to small patient numbers and varied methods for identifying these lymphocytes.

OBJECTIVE:

The aim of this study was to determine the prognostic and predictive power of tumor-infiltrating lymphocytes in colon, rectal (in neoadjuvant setting), and metastatic colorectal cancer.

DATA SOURCES:

A comprehensive search of PubMed and Embase was undertaken from January 2006 to December 2016.

STUDY SELECTION:

The inclusion criteria included a description of the tumor-infiltrating lymphocyte subset(s) assessed with reporting of associated short- and long-term outcomes.

MAIN OUTCOME MEASURES:

The main outcome measures, were disease-free and overall survival.

RESULTS:

A total of 25 studies were included, 15 for primary colorectal cancer (4719 patients), 7 for locally advanced rectal cancer (727 patients), and 3 studies for metastatic colorectal cancer (418 patients). High CD3+, CD8+, FoxP3+, and CD45RO+densities were associated with improved overall survival for primary colorectal cancer, with pooled estimated HRs of 0.88, 0.81, 0.70, and 0.63 (allp< 0.001) respectively. Furthermore, in locally advanced rectal cancer, the levels of CD8+cells were a significant predictor of good tumor regression grade after chemoradiotherapy.

LIMITATIONS:

The retrospective nature of included studies and the significant interstudy heterogeneity were limitations.

CONCLUSIONS:

There is increasing evidence that tumor-infiltrating lymphocytes play an important role in predicting prognosis in colorectal cancer and tumor regression after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Clinical researchers are now in a unique position to build on this work to identify robust predictive markers to stratify patients not only to currently available therapies but also to immunotherapy, which has demonstrated success in improving patient outcomes.
Effectiveness of Vascularized Lymph Node Transfer for Extremity Lymphedema Using Volumetric and Circumferential Differences
Authors: Ho Olivia A. , Chu Sung-Yu , Huang Yen-Ling , Chen Wen-Hui , Lin Chia-Yu , Cheng Ming-Huei
Published: March 2019

Background:

Circumferential difference of lymphedematous limbs at designated anatomic distances has been the primary mode for measuring lymphedematous extremities. Computed tomography (CT) imaging produces accurate, consistent, hygienic volume measurements and a direct limb representation. This study compares these 2 main modalities and assesses their correlation.

Methods:

CT and circumferential difference measurements, costs, and correlation of patient limbs that received vascularized lymph node transfer were compared.

Results:

Mean circumferential difference by tape measurement pre- and postoperatively was 31.4% ± 19.1% and 17.4% ± 8.8% for upper limbs and 43.2% ± 16.1% and 22.4% ± 12% for the lower limbs, respectively. Mean CT volumetric difference pre- and postoperatively were 36.1 ± 4.1% and 27.2 ± 2.8% for the upper limb and 46.2 ± 3.2% and 33.2 ± 2.1% for the lower limbs, respectively. CT volume measurements significantly correlated with their respective circumferential difference with Pearson correlation coefficient of r = +0.7, which was statistically significant (P = 0.03), indicating a strong positive correlation between circumferential difference and actual limb volume changes as determined by CT imaging. Circumferential differences are more cost effective than CT volume assessments in the domains of measurement frequency (P = 0.03), fee (P < 0.01), time (P = 0.03), total cost per year (P < 0.01), and cost/minute (P = 0.03).

Conclusions:

Standardized circumferential differences that are currently used are comparable to unbiased CT volumetric measurements and can be used as a reliable, reproducible, minimally invasive, low cost, and accurate method of measuring the lymphedematous limbs.
Evaluating Postoperative Narcotic Use in Prepectoral Versus Dual-plane Breast Reconstruction Following Mastectomy
Authors: Copeland-Halperin Libby R. , Yemc Louisa , Emery Erica , Collins Devon , Liu Chang , Mesbahi Ali N. , Venturi Mark L.
Published: March 2019

Background:

The majority of postmastectomy breast reconstruction performed in the United States is device-based. Typically, a tissue expander or implant is placed in the dual-plane (ie, subpectoral). Prepectoral breast reconstruction with acellular dermal matrices following mastectomy is a relatively new technique that has favorable outcomes with minimal complications and satisfactory aesthetic results. Few studies have compared opioid use between the 2 approaches. This study compares duration of postoperative opioid use among patients undergoing prepectoral device-based breast reconstruction with those in whom dual-plane devices were placed.

Methods:

We reviewed the records of adult female patients aged 18 years or older who underwent prepectoral or dual-plane device-based breast reconstructions following mastectomy by one of the 2 plastic surgeons (A.M. or M.V.) from 2015 to 2017 at a large tertiary care hospital. Patients with a history of substance abuse, chronic pain, or who were already receiving opioid medication were excluded. Electronic medical records were reviewed and patient surveys were conducted during postoperative visits to determine postoperative opioid requirements.

Results:

During the study period, 58 patients underwent dual-plane breast reconstruction and 94 underwent prepectoral reconstruction. Demographics and comorbidities of the groups were similar. By multivariate regression analysis, the prepectoral reconstruction group required 33% fewer days on opioid analgesic medication (P = 0.016) and were 66% less likely to require opioid prescription refills (P = 0.027). There were no statistically significant differences in other outcomes or complications.

Conclusion:

Patients undergoing prepectoral tissue expander or implant-based reconstruction required fewer days of opioid pain medication than those managed with the dual-plane technique.
ASSOCIATION OF RETINAL VEIN OCCLUSION WITH CARDIOVASCULAR EVENTS AND MORTALITY
Authors: Wu Chris Y. , Riangwiwat Tanawan , Limpruttidham Nath , Rattanawong Pattara , Rosen Richard B. , Deobhakta Avnish
Published: March 2019

Purpose:

Previous studies examining the association of retinal vein occlusion (RVO) and cardiovascular events have been inconsistent and have mostly focused on stroke and myocardial infarction. The goal of this study is to use meta-analysis to examine the available evidence examining the association of RVO with incident cardiovascular events and mortality.

Methods:

Systematic review and meta-analysis of all longitudinal cohort studies published in PubMed, Embase, and the Cochrane Library from inception to April 7, 2018, that evaluated the association of baseline RVO and incident cardiovascular events and/or mortality, that provided multivariate-adjusted risk estimates with 95% confidence intervals (95% CIs), and that had average follow-up ≥1 year. The Newcastle–Ottawa scale was used to assess study quality. Multivariate-adjusted risk estimates with 95% CI along with study characteristics were extracted from each study, and pooled risk ratios (RRs) with 95% CI were generated using a random-effects model with inverse-variance weighting to account for heterogeneity. Main outcomes were incident stroke (fatal or nonfatal), myocardial infarction, heart failure, peripheral arterial disease, all-cause mortality, and cardiovascular mortality.

Results:

Fifteen cohort studies with a total of 474,466 patients (60,069 with RVO and 414,397 without RVO) were included. Each study had Newcastle–Ottawa scale score ≥6, indicating moderate-to-high quality. Retinal vein occlusion was associated with increased risk of stroke (RR = 1.45; 95% CI, 1.31–1.60), myocardial infarction (RR = 1.26; 95% CI, 1.17–1.37), heart failure (RR = 1.53; 95% CI, 1.22–1.92), peripheral arterial disease (RR = 1.26; 95% CI, 1.09–1.46), and all-cause mortality (RR = 1.36; 95% CI, 1.02–1.81), but was not associated with increased risk of cardiovascular mortality (RR = 1.78; 95% CI, 0.70–4.48).

Conclusion:

This review suggests patients with RVO have an increased risk of cardiovascular events and all-cause mortality. More studies are needed to determine the highest risk periods for cardiovascular events and mortality after RVO and whether immediate cardiovascular evaluation and intervention will improve outcomes.
INI1/SMARCB1-Deficient Carcinoma (Rhabdoid Tumor) of the Lacrimal Gland
Authors: Srinivasan Archana , Tuluc Madalina , Jordan Arthur J. , Curry Joseph M. , Bilyk Jurij R.
Published: March 2019

Integrase interactor 1 (INI1) is a tumor suppressor gene that is ubiquitously expressed in all nucleated cells. The loss of INI1 protein activity was first demonstrated in aggressive pediatric tumors, including atypical teratoid/rhabdoid (AT/RT) tumor of the central nervous system and malignant rhabdoid tumor of the kidney. Subsequently, INI1 deficiency was discovered in other pediatric and some adult neoplasms. The spectrum of INI1-negative tumors includes a wide variety of neoplasms that occur over a wide age range, are variably aggressive, and have a variable rhabdoid component on histopathologic evaluation. In this report, the authors describe a 27-year-old gravid woman with INI1-deficient carcinoma of the lacrimal gland, previously not described in this location.
Reporting Guidelines for Use in Preparing Manuscripts for Nursing Journals
Authors: Oermann Marilyn H. , Eskew Michael S. , Conklin Jamie L. , Williams Dennis C.
Published: March 2019

For research to be used to build evidence and guide practice decisions, studies need to be reported accurately, completely, and without bias. Standardized reporting guidelines have been developed to improve the quality of manuscripts on different types of studies. Reporting guidelines are often in the form of a checklist, ensuring that authors include important elements in their manuscripts. Research has shown that authors who use standardized reporting guidelines submit higher quality manuscripts that include essential information. This article describes common reporting guidelines that can be used by nurse authors when preparing their manuscripts.
Decreased Pediatric Trauma Length of Stay and Improved Disposition With Implementation of Lewin's Change Model
Authors: Abd el-shafy Ibrahim , Zapke Jennifer , Sargeant Danielle , Prince Jose M. , Christopherson Nathan A. M.
Published: March 2019

Although often cared for nonoperatively, trauma is a surgical disease managed by surgical services in a multidisciplinary manner. The American College of Surgeons Committee on Trauma (ACS COT) emphasizes this as part of the ACS COT verification process and expects nonsurgical service admission rate of less than 10%. In this project, we developed a collaborative care model captained by surgical services with medical service consultation to achieve this goal for optimal care of injured patients. The project was conducted at a freestanding pediatric trauma center undergoing verification as a Level 1 ACS COT pediatric trauma center. The trauma registry was utilized to obtain nonsurgical service admission rate from January 2011 to June 2015. Lewin's 3-Step Model was utilized to guide change. Adherence to the new ACS standards was continually tracked and fallouts were addressed on an individual basis. Overall compliance was reported routinely through trauma and hospital quality programs. Individual successes and accomplishments were recognized and reinforced. At the inception of the project, nonsurgical admission rate was 30%. Implementation of Lewin's 3-Step Model nonsurgical admission rate decreased to 3%, representing a reduction of 27%. In addition, a 21% reduction in hospital length of stay, 3.78–3 days, was demonstrated with no change in 30-day readmission rate. Lewin's change model facilitated culture change to achieve ACS COT standards and reduced nonsurgical admissions to less than 10%. Reduction in hospital length of stay supports an improvement in the efficiency of care when directed by the pediatric trauma surgery team.
Surgical margins in oral squamous cell cancer: intraoperative evaluation and prognostic impact
Authors: Mannelli Giuditta , Comini Lara Valentina , Piazza Cesare
Published: March 2019

Purpose of review

To summarize recent findings regarding surgical management of oral squamous cell cancer (OSCC) through analysis of different intraoperative techniques for assessment of margins, evaluate the pros and cons of each, and ensuing prognostic impact.

Recent findings

‘En bloc’ OSCC resection and histopathologic evaluation of margins on the formalin-fixed specimen remain the ‘gold standard’ for oral oncologic surgery, whereas assessment of intraoperative surgical margins and its overall clinical value are still questioned and debated in the literature. The commonly applied evaluation of frozen sections still raises concerns regarding its efficacy and reproducibility; therefore, several ancillary diagnostic methods have entered the field of head and neck oncology in the last decades, aiming to support the surgeon in achieving tumor-free margins during ablative procedures.

Poor prognosis of OSCC is strongly associated with residual tumor after surgery. Negative surgical margins are one of the strongest prognosticators for disease-free survival and locoregional control, but their intraoperative determination seems still to be suboptimal and needs better refinement. The most studied techniques to assess intraoperative margins include fluorescence, Raman spectroscopy, narrow band imaging, optical coherence tomography, and cytological bone margins analysis; each has its unique characteristics that are described in detail herein.
Rare Manifestation of Gout
Authors: IIliev Georgi , Ivanova Polina Petrova , Nedev Plamen , Popov Hristo
Published: March 2019

Gout is a disease characterized by abnormal metabolism of the uric acid, leading to undesired buildup of monosodium urate crystals affecting mainly the first metatarsal-phalangeal joint of the foot and less commonly other joints or the soft tissues of the body. The prevalence of the disease increases with age, and it is statistically more observed in men than in women.

We present the case of a 62-year-old male patient diagnosed as having gout 20 years ago. He came to the clinic with a nasal hump and a mass growing in his nose for the last 3 years, presenting as a nasal obstruction and facial deformity. Although the patient was treated with allopurinol and nonsteroidal anti-inflammatory drugs, surgical treatment was deemed necessary, and the patient was taken to receive a surgical resection of the nasal mass. The follow-up histopathology observation revealed deposits of urate crystals surrounded by a granulomatous inflammation. This confirmed the diagnosis—gouty tophi in the nose. In the follow-up period after the surgery, the patient reported overall improved breathing and aesthetic results.

Tophi can be found in atypical locations, which increases morbidities and deformities caused by the disease. We report on this peculiar case of tophaceus gout as it is—a rare manifestation of the disease with tophi located in the nasal region.
A low-passage insect-cell isolate of bluetongue virus uses a macropinocytosis-like entry pathway to infect natural target cells derived from the bovine host
Authors: Stevens Lisa M. , Moffat Katy , Cooke Lyndsay , Nomikou Kyriaki , Mertens Peter P. C. , Jackson Terry , Darpel Karin E.
Published: March 2019

Bluetongue virus (BTV) causes an economically important disease in domestic and wildlife ruminants and is transmitted by Culicoides biting midges. In ruminants, BTV has a wide cell tropism that includes endothelial cells of vascular and lymphatic vessels as important cell targets for virus replication, and several cell types of the immune system including monocytes, macrophages and dendritic cells. Thus, cell-entry represents a particular challenge for BTV as it infects many different cell types in widely diverse vertebrate and invertebrate hosts. Improved understanding of BTV cell-entry could lead to novel antiviral approaches that can block virus transmission from cell to cell between its invertebrate and vertebrate hosts. Here, we have investigated BTV cell-entry using endothelial cells derived from the natural bovine host (BFA cells) and purified whole virus particles of a low-passage, insect-cell isolate of a virulent strain of BTV-1. Our results show that the main entry pathway for infection of BFA cells is dependent on actin and dynamin, and shares certain characteristics with macropinocytosis. The ability to use a macropinocytosis-like entry route could explain the diverse cell tropism of BTV and contribute to the efficiency of transmission between vertebrate and invertebrate hosts.