bluuebunny/crossref_metadata_2025 huggingface dataset:
Cigarette Smoking and Secondhand Smoke Exposure Before and After a Tobacco-Free Olympic Policy Period: Qingdao, China
Authors: Zhao Jing , Li Xiaojing , Stewart Susan LeRoy , Gao Weiguo , Qi Fei , Zhang Lei , Pang Zengchang , Qiao Qing , Ning Feng , Tong Elisa
Published: October 2018

Introduction

We explored the impact of a temporary tobacco-free public policy for the 2008 Summer Olympics on the smoking prevalence and secondhand smoke exposure among the population of a co-hosting city, Qingdao, China.

Methods

The Qingdao Diabetes Survey was analyzed for 2006 (n = 4599) and 2009 (n = 4680), which are survey years before and after the tobacco-free Olympics public policy period (July 2007 to January 2009). We analyzed the differences in self-reported smoking prevalence and exposure to secondhand smoke at home and/or workplace, and compared odds of smoking by survey year and of exposure to secondhand smoke among nonsmokers.

Results

From 2006 to 2009, the male smoking prevalence declined from 51.4% (95% confidence interval [CI] = 49.0% to 53.9%) to 42.6% (95% CI = 40.2% to 45.1%), and the proportion of lighter smokers decreased more. Among nonsmokers, the secondhand smoke exposure rate declined from 62.2% (95% CI = 60.5% to 63.9%) to 56.8% (95% CI = 55.1% to 58.6%). Regression analyses show 34% lower odds of men smoking after Olympics (OR = 0.66, 95% CI = 0.57% to 0.77%). Rural residents and individuals who are not retired were more likely to smoke. Female nonsmokers report 17% less exposure to secondhand smoke after Olympics (OR = 0.83, 95% CI = 0.70% to 0.98%). Urban nonsmokers were more likely to be exposed than their rural counterparts.

Conclusions

Smoking prevalence among men and secondhand smoke exposure among women significantly decreased in Qingdao, China, after the tobacco-free Olympics public policy period. As only the proportion of lighter smokers decreased, this may help explain why urban nonsmokers reported increased exposure. Unintended increased secondhand smoke exposure and cessation support need to be addressed in large-scale policy campaigns.

Implications

Hosting the Olympic Games can help to initiate large-scale tobacco-free public policies for hosting cities. Although previous studies have demonstrated reduction in nonsmoker exposure to secondhand smoke, the impact on the hosting city’s smoking prevalence or exposure rates is unclear. After the Olympic Games in Qingdao, China, smoking prevalence among men significantly decreased, mostly due to light smokers. Secondhand smoke exposure at home and/or workplace significantly decreased among female nonsmokers. Urban nonsmokers had an unintended consequence of increased secondhand smoke exposure after the tobacco-free Olympic policy period. Concurrent promotion of cessation support for heavier smokers may be needed.
Characteristics of mid-infrared PAH emission from star-forming galaxies selected at 250 μm in the North Ecliptic Pole field
Authors: Kim Seong Jin , Jeong Woong-Seob , Goto Tomotsugu , Lee Hyung Mok , Shim Hyunjin , Pearson Chris , Im Myungshin , Matsuhara Hideo , Seo Hyunjong , Hashimoto Tetsuya , Kim Minjin , Chiang Chia-Ying , Barrufet Laia , Varillas Maria del Carmen Campos
Published: October 2018

Evolutionary properties of infrared (IR) luminous galaxies are important keys to understand dust-obscured star formation history and galaxy evolution. Based on near- to mid-IR imaging with nine continuous filters of the AKARI space telescope, we present the characteristics of dusty star-forming (SF) galaxies showing polycyclic aromatic hydrocarbon (PAH) features observed by the North Ecliptic Pole (NEP) wide field survey of AKARI and Herschel. All the sample galaxies from the AKARI/NEP-Wide data are selected based both on the Herschel/SPIRE 250 μm detection and optical spectroscopic redshift data. The physical modeling of spectral energy distribution (SED) using all available data points from u* to sub-mm 500 μm band, including WISE and PACS data where available, takes unique advantages of the continuous near- to mid-IR coverage, the reliable constraint on the far-IR peak, and spectroscopically determined accurate redshifts, as well as the energy balance principle by MAGPHYS. This enables us to derive physically meaningful and accurate total infrared luminosity and 8 μm (or PAH) luminosity consistently. Our sample galaxies are in the redshift range $z$ < 1, and the majority of them appear to be normal SF/spiral populations showing PAH features near 8 μm. These SF galaxies showing PAHs in the mid-IR include various types, from quiescent to starbursts. Some of our sample show shortage of 8 μm luminosity compared to the total IR luminosity and this PAH deficit gets severe in more-luminous IR galaxies, suggesting PAH molecules in these galaxies are destroyed by a strong radiation field from the SF region or a large amount of cold dust in the interstellar medium. The specific SFR of our sample shows mass-dependent time evolution which is consistent with a downsizing evolutionary pattern.
Nilpotency and strong nilpotency for finite semigroups
Authors: Almeida J , Shahzamanian M H , Kufleitner M
Published: October 2018

Nilpotent semigroups in the sense of Mal’cev are defined by semigroup identities. Finite nilpotent semigroups constitute a pseudovariety, MN, which has finite rank. The semigroup identities that define nilpotent semigroups lead us to define strongly Mal’cev nilpotent semigroups. Finite strongly Mal’cev nilpotent semigroups constitute a non-finite rank pseudovariety, SMN. The pseudovariety SMN is strictly contained in the pseudovariety MN, but all finite nilpotent groups are in SMN. We show that the pseudovariety MN is the intersection of the pseudovariety BGnil with a pseudovariety defined by a κ-identity. We further compare the pseudovarieties MN and SMN with the Mal’cev product 𝖩ⓜ𝖦nill.
Histologic evidence that mast cells contribute to local tissue inflammation in peripheral spondyloarthritis by regulating interleukin-17A content
Authors: Chen Sijia , Noordenbos Troy , Blijdorp Iris , van Mens Leonieke , Ambarus Carmen A , Vogels Esther , te Velde Anje , Alsina Mercé , Cañete Juan D , Yeremenko Nataliya , Baeten Dominique
Published: October 2018

Objectives

Synovial mast cells contain IL-17A, a key driver of tissue inflammation in SpA. A recent in vitro study showed that tissue-derived mast cells can capture and release exogenous IL-17A. The present study aimed to investigate if this mechanism could contribute to tissue inflammation in SpA.

Methods

Potential activation of mast cells by IL-17A was assessed by gene expression analysis of the Laboratory of Allergic Diseases 2 (LAD2) mast cell line. The presence of IL-17A-positive mast cells was assessed by immunohistochemistry in synovial tissue obtained before and after secukinumab treatment, as well as in skin and gut tissues from SpA-related conditions.

Results

IL-17A did not induce a pro-inflammatory response in human LAD2 mast cells according to the canonical IL-17A signalling pathway. In SpA synovial tissue, the percentage of IL-17A-positive mast cells increased upon treatment with secukinumab. IL-17A-positive mast cells were also readily detectable in non-inflamed barrier tissues such as skin and gut. In non-inflamed dermis and gut submucosa, IL-17A-positive mast cells are the most prevalent IL-17A-positive cells in situ. Compared with non-inflamed tissues, both total mast cells and IL-17A-positive mast cells were increased in psoriatic skin dermis and in submucosa from inflammatory bowel disease gut. In contrast, the proportion of IL-17A-positive mast cells was strikingly lower in the inflamed compared with non-inflamed gut lamina propria.

Conclusion

IL-17A-positive mast cells are present across SpA target tissues and correlate inversely with inflammation, indicating that their IL-17A content can be regulated. Tissue-resident mast cells may act as IL-17A-loaded sentinel cells, which release IL-17A to amplify tissue inflammation.
Outcomes of salvage hip surgery in children with cerebral palsy
Authors: Chan Priscella , Hsu Angela , Godfrey Jenna , Silva Selina S. , Goldstein Rachel Y. , Ryan Deirdre , Choi Paul D. , Kay Robert M.
Published: October 2018

This study compared the outcomes of four salvage procedures in treating painful dislocated hips in patients with cerebral palsy: Schanz osteotomy, Girdlestone, Castle, and McHale procedures. A retrospective review of cerebral palsy patients treated between 1990 and 2014 with minimum 6-month follow-up was carried out. Of 69 hips (62 patients), there were 36 McHales, 24 Castles, four Girdlestones, and five Schanz procedures at a mean age of 13.9 years. All four procedures provided pain relief. Proximal femoral migration was similar following the procedures, but heterotopic ossification was more common after the Castle procedure. Bone resorption and revision surgery were more frequent after the McHale procedure.
Design and Implementation of an Enhanced Recovery After Surgery (ERAS) Program for Minimally Invasive Lumbar Decompression Spine Surgery
Authors: Soffin Ellen M. , Vaishnav Avani S. , Wetmore Douglas S. , Barber Lauren , Hill Patrick , Gang Catherine Himo , Beckman James D. , Albert Todd J. , Qureshi Sheeraz A.
Published: October 2018

Study Design.

A retrospective cohort study of prospectively collected data.

Objective.

The aim of this study was to describe the development of and early experience with an evidence-based enhanced recovery after surgery (ERAS) pathway for lumbar decompression.

Summary of Background Data.

ERAS protocols have been consistently associated with improved patient experience and outcomes, and reduced cost and length of hospital stay (LoS). Despite successes in other orthopedic subspecialties, ERAS has yet to be established in spine surgery. Here, we report the development of and initial experience with the first comprehensive ERAS pathway for MIS lumbar spine surgery.

Methods.

An evidence-based review of the literature was performed to select components of the ERAS pathway. The pathway was applied to 61 consecutive patients presenting for microdiscectomy or lumbar laminotomy/laminectomy between dates. Data collection was performed by review of the electronic medical record. We evaluated compliance with individual ERAS process measures, and adherence to the overall pathway. The primary outcome was LoS. Demographics, comorbidities, perioperative course, prevalence of opioid tolerance, and factors affecting LoS were also documented.

Results.

The protocol included 15 standard ERAS elements. Overall pathway compliance was 85.03%. Median LoS was 279 minutes [interquartile range (IQR) 195–398 minutes] overall, 298 minutes (IQR 192–811) for lumbar decompression and 285 minutes (IQR 200–372) for microdiscectomy. There was no correlation between surgical subtype or duration and LoS. Overall, 37% of the cohort was opioid-tolerant at the time of surgery. There was no significant effect of baseline opioid use on LoS, or on the total amount of intraoperative or PACU opioid administration. There were four complications (6.5%) resulting in extended LoS (>23 hours).

Conclusion.

This report comprises the first description of a comprehensive, evidence-based ERAS for spine pathway, tailored for lumbar decompression/microdiscectomy resulting in short LoS, minimal complications, and no readmissions within 90 days of surgery.

Level of Evidence: 3
Halo Gravity Traction Can Mitigate Preoperative Risk Factors and Early Surgical Complications in Complex Spine Deformity
Authors: Iyer Sravisht , Boachie-Adjei Oheneba , Duah Henry Ofori , Yankey Kwadwo Poku , Mahmud Rufai , Wulff Irene , Tutu Henry Osei , Akoto Harry
Published: October 2018

Study Design.

Retrospective review of prospective cohort.

Objective.

We sought to examine the role of halo gravity traction (HGT) in reducing preoperative surgical risk.

Summary of Background Data.

The impact of HGT on procedure choice, preoperative risk factors, and surgical complications has not been previously described.

Methods.

Patients treated with HGT before primary surgery were included. The FOCOS Score (FS) was used to quantify operative risk. FS was calculated using patient-factors (ASIA, body mass index, etiology), procedure-factors (PcF; osteotomy planned, number of levels fused, etc.), and curve magnitude (CM). Scores ranged from 0 to 100 with higher scores indicating increased risk. FS was calculated before and after HGT to see how changes in FS affected complication rates.

Results.

A total of 96 patients were included. Halo-related complications occurred in 34% of patients but revision was required in only 8.3%. Average FS improved by 18 points after HGT. CM, PcF, and patient-factors all improved (P < 0.05). The greatest changes were in CM and PcF. The planned rate of three-column osteotomies dropped from 91% to 38% after HGT. FS (area under the curve [AUC]: 0.68, P = 0.023) and change in FS (AUC: 0.781, P < 0.001) was successfully able to predict the rate of surgical complications. A preoperative FS of 74 was identified as a cut-off for a higher rate of surgical complications (sensitivity 58.8%, specificity 74.7%). Patients with a reduction in FS <  = 10pts were five times more likely to have a complication (relative risk 5.2, 95% confidence interval: 1.9–14.6, P < 0.001). A multivariate regression showed that change in FS was an independent predictor of complication rates (P < 0.05).

Conclusion.

FS can successfully predict surgical risk in pediatric patients with complex spinal deformity. Preoperative HGT can reduce FS and surgical risk by improving CM, lowering three-column osteotomies use, and improving body mass index. A reduction in FS after HGT predicts a lower rate of surgical complications.

Level of Evidence: 3
Spinal Manipulative Therapy Effects in Autonomic Regulation and Exercise Performance in Recreational Healthy Athletes
Authors: Valenzuela Pedro L. , Pancorbo Sara , Lucia Alejandro , Germain Francisco
Published: October 2018

Study Design.

A randomized, double blind, parallel groups, sham-controlled trial.

Objective.

The aim of this study was to analyze the acute effects of spinal manipulative therapy (SMT) on performance and autonomic modulation.

Summary of Background Data.

The use of SMT is progressively spreading from the clinical to the sporting context owing to its purported ergogenic effects. However, its effects remain unclear.

Methods.

Thirty-seven male recreational athletes (aged 37 ± 9 years) who had never received SMT were assigned to a sham (n = 19) or actual SMT group (n = 18). Study endpoints included autonomic modulation (heart rate variability), handgrip strength, jumping ability, and cycling performance [8-minute time trial (TT)]. Differences in custom effects between interventions were determined using magnitude-based inferences.

Results.

A significant and very likely lower value of a marker of sympathetic modulation, the stress score, was observed in response to actual compared with sham SMT [P = 0.007; effect size (ES) = -0.97]. A trend toward a significant and likely lower sympathetic:parasympathetic ratio (P = 0.055; ES = -0.96) and a likely higher natural logarithm of the root-mean-square differences of successive heartbeat intervals [(LnRMSSD), P = 0.12; ES = 0.36] was also found with actual SMT. Moreover, a significantly lower mean power output was observed during the TT with actual compared with sham SMT (P = 0.035; ES = -0.28). Nonsignificant (P > 0.05) and unclear or likely trivial differences (ES < 0.2) were found for the rest of endpoints, including handgrip strength, heart rate during the TT, and jump loss thereafter.

Conclusion.

A single pre-exercise SMT session induced an acute shift toward parasympathetic dominance and slightly impaired performance in recreational healthy athletes.

Level of Evidence: 2
Reliability and Validity of the Turkish Version of the Fremantle Back Awareness Questionnaire
Authors: Erol Erkan , Yildiz Ayse , Yildiz Ramazan , Apaydin Umut , Gokmen Derya , Elbasan Bulent
Published: October 2018

Study Design.

Cross-cultural adaptation and psychometric analysis.

Objective.

To develop the Turkish version of the Fremantle Back Awareness Questionnaire (FreBAQ-T) and to evaluate its psychometric properties.

Summary of Background Data.

There is a growing interest in the role that the disturbance of body perception may lead to long-lasting pain problems such as chronic low back pain (CLBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is a simple and low-cost way of evaluating disturbed back awareness in people with CLBP.

Methods.

The FreBAQ was translated from English into Turkish using the forward-backward-forward method. One hundred four participants with low back pain completed the FreBAQ-T. The FreBAQ-T was repeated in 15 participants after 1 week to establish test-retest reliability. Although internal and external construct validity was investigated using Rasch analysis and Spearman correlation coefficient, respectively; reliability was evaluated in terms of internal consistency by Cronbach alpha and Person Separation Index.

Results.

All items of the FreBAQ-T were found to fit the Rasch Model (chi-square 6.17 [df = 9], P = 0.723). The internal construct validity was good, overall mean item fit residual was −0.305 (standard deviation: 0.369) and mean person fit residual was −0.290 (standard deviation: 1.349). The reliability was good with Cronbach alpha of 0.87 and Person Separation Index of 0.82. When the test-retest was examined via differential item functioning by time, none of the items showed differential item functioning.

Conclusion.

The FreBAQ-T is a valid, reliable, and unidimensional scale for patients with CLBP. This scale will allow assessing back-specific perception in the Turkish population with CLBP.

Level of Evidence: 3
Hip Arthroscopy Technique for Acetabular Osteochondral Loose Bodies After Combined Lower Extremity Trauma
Authors: Hoyt Benjamin W. , Dickens Jonathan F.
Published: October 2018

The postoperative rehabilitation of acetabular fractures after fixation may be complicated by osteochondral loose bodies in the hip joint and resultant mechanical or instability symptoms. There are multiple surgical options to address these lesions, however, arthroscopic removal exposes the patient to a smaller incision and lower risk of complication when performed appropriately. As these high-energy injuries commonly occur with ipsilateral lower extremity osseous and soft tissue injury, traction for arthroscopy may be limited. We describe a case of an acetabular fracture and ipsilateral open tibia/fibula fracture with osteochondral loose bodies in the hip joint inhibiting physical therapy potential, treated successfully with arthroscopic removal using an adjusted skeletal traction method.
Epidemiology of low-energy fracture in Chinese postmenopausal women: changing trend of incidence since menopause and associated risk factors, a national population-based survey
Authors: Zhu Yanbin , Liu Song , Chen Wei , Liu Bo , Lv Hongzhi , Zhang Xiaolin , Zhang Yingze
Published: October 2018

Objective:

The aim of the study was to report the incidence of low-energy fracture since menopause in postmenopausal women ≤70 years and to explore associated risk factors

Methods:

This was a part of the Chinese National Fracture Survey (CNFS), which was carried out in eight provinces of China mainland between January and May 2015. Data on 68,783 postmenopausal women ≤70 years were extracted from the CNFS database for calculations and analyses.

Results:

A total of 309 women were confirmed to have low-energy fractures in 2014, indicating the incidence of 449.2 (95% CI, 399.3-499.2) per 100,000 women. There were two obvious peaks of fracture incidence at the 4th year and the 9th year since menopause. From the 10th year on, the fracture incidence rate presented the relatively steady trends over years, only with slight interannual fluctuation. After adjustment for confounding variables, advanced age, higher latitude, milk intake ≥1/d, residence ≥2nd floor without elevator, alcohol consumption, sleep duration <7 h/d, history of past fracture, and more births were identified as significant risk factors. Supplementation of calcium or vitamin D or both was associated with 44% of fracture reduction (OR, 0.56; 95% CI, 0.37-0.84).

Conclusions:

These data on low-energy fractures in postmenopausal women provided an updated clinical evidence base for better national healthcare planning and preventive efforts in China.
Characterization of Corneoscleral Geometry Using Fourier Transform Profilometry in the Healthy Eye
Authors: Piñero David P. , Martínez-Abad Antonio , Soto-Negro Roberto , Ariza-Gracia Miguel Angel , Carracedo Gonzalo
Published: October 2018

Objective:

To characterize peculiarities of the corneoscleral geometry in healthy eyes.

Methods:

This is a prospective case series including 88 healthy eyes of 88 patients with an age ranging from 21 to 73 years. A complete ocular examination was performed with emphasis on the analysis of the corneoscleral topographic profile with the Fourier transform profilometer Eye Surface Profiler (Eaglet-Eye BV, Houten, the Netherlands). The distribution of different topographic parameters was evaluated, as well as the correlations between corneal and scleroconjunctival parameters.

Results:

Mean values of 8.64±0.37 (range, 7.81–9.50 mm), 6.06±0.52 (4.88–7.63 mm) and 11.93±1.32 mm (8.17–15.89 mm) were obtained for inner, limbal, and outer best-fit sphere, respectively. Mean values of 8.54±0.38 (7.86–9.66 mm) and 13.35±1.29 mm (11.05–17.31 mm) were obtained for mean corneal and scleral radius, respectively. Regarding tangent angles at limbus, mean values of 35.31±6.55°, 38.76±5.90°, 32.75±7.04°, and 25.91±8.99° were obtained for nasal, temporal, superior, and inferior angles, respectively. Mean difference between temporal and nasal sagittal heights increased from −1.48±120.70 μm for a chord of 11 mm to 73.53±236.55 μm for a chord of 14 mm. A weak but statistically significant correlation was found between corneal and scleral radii (r=0.325, P=0.004). The maximum sagittal height for a diameter of 12 mm was significantly correlated with flattest keratometry, astigmatism, corneal diameter, and corneal eccentricity (R2: 0.77, P<0.001).

Conclusions:

The scleroconjunctival surface in the healthy eye presents some level of nasotemporal asymmetry that is higher with increasing diameters of analysis.
Using Deep Learning in Automated Detection of Graft Detachment in Descemet Membrane Endothelial Keratoplasty: A Pilot Study
Authors: Treder Maximilian , Lauermann Jost Lennart , Alnawaiseh Maged , Eter Nicole
Published: October 2018

Purpose:

To evaluate a deep learning–based method to automatically detect graft detachment (GD) after Descemet membrane endothelial keratoplasty (DMEK) in anterior segment optical coherence tomography (AS-OCT).

Methods:

In this study, a total of 1172 AS-OCT images (609: attached graft; 563: detached graft) were used to train and test a deep convolutional neural network to automatically detect GD after DMEK surgery in AS-OCT images. GD was defined as a not completely attached graft. After training with 1072 of these images (559: attached graft; 513: detached graft), the created classifier was tested with the remaining 100 AS-OCT scans (50: attached graft; 50 detached: graft). Hereby, a probability score for GD (GD score) was determined for each of the tested OCT images.

Results:

The mean GD score was 0.88 ± 0.2 in the GD group and 0.08 ± 0.13 in the group with an attached graft. The differences between both groups were highly significant (P < 0.001). The sensitivity of the classifier was 98%, the specificity 94%, and the accuracy 96%. The coefficient of variation was 3.28 ± 6.90% for the GD group and 2.82 ± 3.81% for the graft attachment group.

Conclusions:

With the presented deep learning-based classifier, reliable automated detection of GD after DMEK is possible. Further work is needed to incorporate information about the size and position of GD and to develop a standardized approach regarding when rebubbling may be needed.
Precut DMEK Using Dextran-Containing Storage Medium Is Equivalent to Conventional DMEK: A Prospective Pilot Study
Authors: Rickmann Annekatrin , Wahl Silke , Hofmann Nicola , Haus Arno , Michaelis Regina , Petrich Tanja , Blomberg Lutz , Börgel Martin , Jung Sascha , Szurman Peter
Published: October 2018

Purpose:

To compare the clinical outcome after Descemet membrane endothelial keratoplasty (DMEK) either as precut or conventional Descemet membrane graft preparation under standard European eye bank organ culture conditions.

Methods:

This was a prospective pilot study of patients receiving either precut or conventional DMEK. Graft preparation was performed using the liquid bubble technique. Precut grafts (n = 22) were prepared 1 day before surgery in the eye bank and stored in dextran-containing organ culture medium within a transport viewing chamber. Conventional grafts (n = 29) were prepared directly before surgery. End point criteria included the endothelial cell count (ECC), central corneal thickness, graft rejection rate, rebubbling rate, and best-corrected visual acuity after 1, 3, and 6 months.

Results:

A post hoc matched analysis revealed no statistically significant differences between the 2 groups. The ECC in the precut and conventional groups was comparable with an EC loss of 34% and 35%, respectively, after 6 months. The early graft failure rate, best-corrected visual acuity, and central corneal thickness were comparable between the 2 groups.

Conclusions:

This pilot study shows a comparable clinical outcome after DMEK surgery for precut Descemet membrane grafts versus conventionally prepared grafts, using the liquid bubble preparation technique and storage conditions with dextran-containing medium.
Anamnestic Immune Response and Safety of an Inactivated Quadrivalent Influenza Vaccine in Primed Versus Vaccine-Naïve Children
Authors: Claeys Carine , Chandrasekaran Vijayalakshmi , García-Sicilia José , Prymula Roman , Díez-Domingo Javier , Brzostek Jerzy , Marès-Bermúdez Josep , Martinón-Torres Federico , Pollard Andrew J. , Růžková Renata , Carmona Martinez Alfonso , Ulied Angels , Miranda Valdivieso Mariano , Faust Saul N. , Snape Matthew D. , Friel Damien , Ollinger Thierry , Soni Jyoti , Schuind Anne , Li Ping , Innis Bruce L. , Jain Varsha K.
Published: October 2018

Background:

It has not yet been demonstrated whether 2 doses of inactivated quadrivalent influenza vaccine (IIV4) prime a booster response in infants. We evaluated the anamnestic immune response to an IIV4 in children 17−48 months of age.

Methods:

Children were randomized to 2 doses of IIV4 or control in the primary phase III study (NCT01439360). One year later, in an open-label revaccination extension study (NCT01702454), a subset of children who received IIV4 in the primary study (primed group) received 1 IIV4 dose and children who received control in the primary study (unprimed) received 2 IIV4 doses 28 days apart. The primary objective was to evaluate hemagglutination inhibition (HI) antibody titers 7 days after first IIV4 vaccination in the per-protocol cohort (N = 224 primed; N = 209 unprimed). Neutralizing and antineuraminidase antibodies were also measured. Safety was analyzed in the total vaccinated cohort (N = 241 primed; N = 229 unprimed).

Results:

An anamnestic response was observed in primed children relative to unprimed controls, measured by age-adjusted geometric mean HI titer ratios against strains homologous (A/H1N1: 9.0; B/Victoria: 3.9) and heterologous (A/H3N2: 2.7; B/Yamagata: 6.7) to those in the primary vaccination series. The anamnestic response in primed children included increases in neutralizing antibodies (mean geometric increase: 5.0–10.6) and antineuraminidase antibodies (4.9–8.8). No serious adverse events related to vaccination were reported.

Conclusions:

In this study, 2-dose priming with IIV4 induced immune memory that was recalled with 1-dose IIV4 the following year to boost HI, antineuraminidase and neutralizing antibodies, even though the IIV4 strain composition partially changed.
Incident opioid use and risk of hip fracture among persons with Alzheimer disease: a nationwide matched cohort study
Authors: Taipale Heidi , Hamina Aleksi , Karttunen Niina , Koponen Marjaana , Tanskanen Antti , Tiihonen Jari , Hartikainen Sirpa , Tolppanen Anna-Maija
Published: October 2018

The objective of this study was to investigate whether incident opioid use is associated with an increased risk of hip fractures among community-dwelling persons with Alzheimer disease (AD) and to assess the association in terms of duration of use and opioid strength. Among community-dwelling persons with AD diagnosed in 2010 to 2011 (N = 23,100), a matched cohort study comparing incident opioid users (N = 4750) with opioid nonusers (N = 4750) was constructed. Matching was based on age, sex, and time since AD diagnosis at opioid initiation. Data on drug use and hip fractures were retrieved from nationwide registers. Incident opioid users were identified with a 1-year washout. Cox proportional hazard models compared the risk of hip fracture between opioid use and nonuse, and were weighted with inverse probability of treatment (IPT), based on a propensity score. Age-adjusted incidence rate of hip fractures was 3.47 (95% confidence interval [CI] 2.62-4.33) during opioid use and 1.94 (95% CI 1.65-2.22) during nonuse. Opioid use was associated with an increased risk of hip fracture (IPT-weighted hazard ratio [HR] 1.96, 95% CI 1.27-3.02). The risk was observed during the first 2 months of use (IPT-weighted HR 2.37, 1.04-5.41) and attenuated after that. The results suggest an increase in the risk of hip fracture by increasing opioid strength; weak opioids IPT-weighted HR 1.75 (0.91-3.35), buprenorphine IPT-weighted HR 2.10 (1.41-3.13), and strong opioids IPT-weighted HR 2.89 (1.32-6.32). Further research is needed to find out whether the risk of injurious falls is avoidable by slow titration of opioid doses in the beginning of treatment.
Current approaches to instrumental assessment of swallowing in children
Authors: Dharmarathna Isuru , Miles Anna , Allen Jacqui E.
Published: October 2018

Purpose of the review

This article reviews recent developments in the instrumental assessment of swallowing in children with a specific focus on research published between January 2017 and June 2018.

Recent findings

Instrumental swallowing assessments reported in the time period included: videofluoroscopic study of swallowing, digital cervical auscultation, dynamic ultrasound, high-resolution impedance manometry, nasal airflow thermistry and respiratory inductance plethysmography. Several studies were found exploring tools to objectively quantify videofluoroscopic study of swallowing data; swallowing from the mouth through to stomach was addressed including approaches to analysing mastication as well as evaluating oesophageal motility disorders.

Even though a vast range of instrumentation were studied, lack of clarity on clinical feasibility and objective measures that facilitate medical decision-making in practice mean further research is required to provide guidance on implementation. Promising novel approaches to aid the quantification of swallowing physiology from the mouth, pharynx and through to the oesophagus are emerging.
Evaluation of a Mixed Meal Test for Diagnosis and Characterization of PancrEaTogEniC DiabeTes Secondary to Pancreatic Cancer and Chronic Pancreatitis
Authors: Hart Phil A. , Andersen Dana K. , Mather Kieren J. , Castonguay Alicia C. , Bajaj Mandeep , Bellin Melena D. , Bradley David , Contreras Noemy , Habtezion Aida , Korc Murray , Kudva Yogish , Petrov Maxim S. , Whitcomb David C. , Yadav Dhiraj , Yuan Ying , Rinaudo Jo Ann S. , Srivastava Sudhir , Serrano Jose , Goodarzi Mark O.
Published: October 2018

Pancreatogenic diabetes mellitus is most commonly the result of chronic pancreatitis but can also occur secondary to pancreatic cancer. The early identification of pancreatogenic diabetes and distinction from the more prevalent type 2 diabetes are clinically significant; however, currently, there is no validated method to differentiate these diabetes subtypes. We describe a study, “Evaluation of a Mixed Meal Test for Diagnosis and Characterization of PancrEaTogEniC DiabeTes Secondary to Pancreatic Cancer and Chronic Pancreatitis: the DETECT study,” that seeks to address this knowledge gap. The DETECT study is a multicenter study that will examine differences in hormone and glucose excursions after a mixed meal test. The study will also create a biorepository that will be used to evaluate novel diagnostic biomarkers for differentiating these diabetes subtypes.
A Prospective Study to Establish a New-Onset Diabetes Cohort
Authors: Maitra Anirban , Sharma Ayush , Brand Randall E. , Van Den Eeden Stephen K. , Fisher William E. , Hart Phil A. , Hughes Steven J. , Mather Kieren J. , Pandol Stephen J. , Park Walter G. , Feng Ziding , Serrano Jose , Rinaudo Jo Ann S. , Srivastava Sudhir , Chari Suresh T.
Published: October 2018

The National Cancer Institute and the National Institute for Diabetes and Digestive and Kidney Diseases initiated the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) in 2015 (the CPDPC's origin, structure, governance, and research objectives are described in another article in this journal). One of the key objectives of CPDPC is to assemble a cohort of 10,000 subjects 50 years or older with new-onset diabetes, called the NOD cohort. Using a define, enrich, and find early detection approach, the aims of the NOD study are to (a) estimate the 3-year probability of pancreatic ductal adenocarcinoma (PDAC) in NOD (define), (b) establish a biobank of clinically annotated biospecimens from presymptomatic PDAC and control new-onset type 2 diabetes mellitus subjects, (c) conduct phase 3 validation studies of promising biomarkers for identification of incident PDAC in NOD patients (enrich), and (d) provide a platform for development of a future interventional screening protocol for early detection of PDAC in patients with NOD that incorporates imaging studies and/or clinical algorithms (find). It is expected that 85 to 100 incidences of PDAC will be diagnosed during the study period in this cohort of 10,000 patients.
Standard Operating Procedures for Biospecimen Collection, Processing, and Storage
Authors: Fisher William E. , Cruz-Monserrate Zobeida , McElhany Amy L. , Lesinski Gregory B. , Hart Phil A. , Ghosh Ria , Van Buren George , Fishman Douglas S. , Rinaudo Jo Ann S. , Serrano Jose , Srivastava Sudhir , Mace Thomas , Topazian Mark , Feng Ziding , Yadav Dhiraj , Pandol Stephen J. , Hughes Steven J. , Liu Robert Y. , Lu Emily , Orr Robert , Whitcomb David C. , Abouhamze Amer S. , Steen Hanno , Sellers Zachary M. , Troendle David M. , Uc Aliye , Lowe Mark E. , Conwell Darwin L.
Published: October 2018

High-quality and well-annotated biorepositories are needed to better understand the pathophysiology and biologic mechanisms of chronic pancreatitis (CP) and its consequences. We report a methodology for the development of a robust standard operating procedure (SOP) for a biorepository based on the experience of the clinical centers within the consortium to study Chronic Pancreatitis, Diabetes and Pancreas Cancer Clinical Centers (CPDPC), supported by the National Cancer Institute and the National Institute for Diabetes and Digestive and Kidney Diseases as a unique multidisciplinary model to study CP, diabetes, and pancreatic cancer in both children and adults. Standard operating procedures from the CPDPC centers were evaluated and consolidated. The literature was reviewed for standard biorepository operating procedures that facilitated downstream molecular analysis. The existing literature on biobanking practices was harmonized with the SOPs from the clinical centers to produce a biorepository for pancreatic research. This article reports the methods and basic principles behind the creation of SOPs to develop a biorepository for the CPDPC. These will serve as a guide for investigators developing biorepositories in pancreas research. Rigorous and meticulous adherence to standardized biospecimen collection will facilitate investigations to better understand the pathophysiology and biologic mechanisms of CP, diabetes, and pancreatic cancer.
Ectopic Thymoma of the Right Atrium: A Case Report
Authors: Li Li , Duan Xuejing , Wang Haiping , Sun Yang , Lu Yang , Xu Hongyu , Wang Qingzhi , Wang Hongyue
Published: October 2018

Ectopic thymoma arising in organs other than the thymus is rare. To date, there is no report of intracardiac ectopic thymoma in the English language literature. We report a rare case of a right atrial ectopic thymoma. A 61-year-old woman presented with puffiness of face and shortness of breath. Cardiac computed tomography revealed a large right atrial mass with near-total occlusion of the chamber and extension into the superior vena cava and inflow tract of the right ventricle. She underwent resection of the right atrial mass. The final pathological diagnosis was intracardiac ectopic thymoma.
Follicular Dendritic Cell Sarcoma With NF2 Mutation
Authors: Karrs Jeremiah Xavier , Gohlke Amanda Lynn , Poklepovic Andrew , Oliveira Andre M. , Richard Hope , Pavlick Dean C. , Smith Steven Christopher
Published: October 2018

Follicular dendritic cell sarcoma (FDCS) is recognized as a diagnostically challenging neoplasm requiring rigorous exclusion of more common entities and high index of suspicion for diagnosis. Here, we report an aggressive case of FDCS arising in the mediastinum, which due to sampling limitations and the inherent difficulty of diagnosis required extensive workup with multiple samples prior to definitive classification. The patient was a 35-year-old woman who presented with progressive dyspnea and mediastinal mass on imaging studies. The initial sampling of the lesion had histologic features raising consideration of FDCS, but was too limited to allow definitive diagnosis, while progressing rapidly enough to require administration of chemotherapy even prior to classification. Repeat samples obtained via fine-needle aspiration and bronchoscopy enabled the diagnosis of FDCS, and high-throughput sequencing revealed apparently pathogenic NF2 mutations previously not reported in this disease. Unfortunately, the patient died of widely metastatic disease, which we comprehensively documented at autopsy. Together, these observations provide previously unreported insights into the end stage of this disease and experience relevant to its prospective recognition and workup.
A Case of Small Cell Carcinoma With Adenocarcinoma Found in a Rectal Fissure
Authors: Harinath Lakshmi , Mohanty Alok , Pai Reetesh K. , Islam Mohammed , Silverman Jan F.
Published: October 2018

Small cell carcinomas are aggressive high-grade malignancies most commonly diagnosed in the lung, but can also be found in extrapulmonary sites such as the breast, kidney, urinary bladder, uterus, ovary, pancreas, hepatobiliary tree, thymus, skin, and salivary glands. Although the gastrointestinal system has an abundance of neuroendocrine cells, small cell carcinomas in this region have a low incidence. We present the case of a 51-year-old man with a history of pain with bowel movements and recent weight loss. Colonoscopy was performed, which revealed a rectal fissure with a lesion involving the rectum and anal canal. Biopsy of the lesion revealed invasive carcinoma with 2 distinct morphologies, a poorly differentiated small cell component and a minor adenocarcinoma component. We discuss the differential diagnosis of small cell carcinoma that includes mixed adenoneuroendocrine carcinomas and other neuroendocrine neoplasms.
Gene therapy for neuropathic pain using dorsal root ganglion–targeted helper-dependent adenoviral vectors with GAD67 expression
Authors: Ogawa Nobuhiro , Terashima Tomoya , Oka Kazuhiro , Chan Lawrence , Kojima Hideto
Published: October 2018

Introduction:

Currently available medications for neuropathic pain are of limited efficacy. Moreover, they are administered systemically and are associated with significant side effects. Ideally, one can circumvent systemic side effects if such treatment can be administered by delivery of the therapeutic agent directly to the diseased neurons. Towards this end, we previously reported the production of a recombinant helper-dependent adenovirus (HDAd) armed with a tissue-specific homing peptide to deliver transgenes targeting sensory neurons with high efficacy.

Objectives:

To develop an effective gene therapy for neuropathic pain by producing a dorsal root ganglion (DRG)-targeted HDAd vector that specifically expresses glutamic acid decarboxylase (GAD) 67 (HDAd-DRG-GAD67).

Methods:

We produced spinal nerve transection (SNT) mice as a neuropathic pain model and delivered HDAd-DRG-GAD67 by injection into spinal nerve or intrathecally to these animals. We evaluated the therapeutic efficacy by measuring ion channel gene expression and quantifying mechanical allodynia, a representative symptom of neuropathic pain, in treated animals.

Results:

Glutamic acid decarboxylase expression by HDAd-DRG-GAD67 reduced allodynia significantly in SNT mice. In addition, HDAd-DRG-GAD67 had a much greater transduction efficacy and expressed the therapeutic gene for a much longer time and at a lower dose of viral particles than wild-type HDAd. We found that SNT induced the upregulation of Cav3.2 mRNA in the DRG and GAD67 overexpression suppressed the elevation. Furthermore, the HDAd-DRG-GAD67–induced allodynia amelioration occurred even when we delayed intrathecal delivery of the therapeutic vector to day 7 after SNT.

Conclusion:

HDAd-mediated DRG-targeted gene therapy delivering GAD67 is an efficacious treatment for neuropathic pain in SNT mice.
Flap Preconditioning with the Cyclic Mode (Triangular Waveform) of Pressure-Controlled Cupping in a Rat Model: An Alternative Mode to the Continuous System
Authors: Hong Yoon Gi , Kim Sung Chan , Koh Kyung S.
Published: October 2018

Background:

Improving flap survival is essential for successful soft-tissue reconstruction. Although many methods to increase the survival of the distal flap portion have been attempted, there has been no widely adopted procedure. The authors evaluated the effect of flap preconditioning with two different modes (continuous and cyclic) of external volume expansion (pressure-controlled cupping) in a rat dorsal flap model.

Methods:

Thirty rats were randomly assigned to the control group and two experimental groups (n = 10 per group). The continuous group underwent 30 minutes of preconditioning with −25 mmHg pressure once daily for 5 days. The cyclic group received 0 to −25 mmHg pressure for 30 minutes with the cyclic mode once daily for 5 days. On the day after the final preconditioning, caudally based 2 × 8-cm dorsal random-pattern flaps were raised and replaced in the native position. On postoperative day 9, the surviving flap area was evaluated.

Results:

The cyclic group showed the highest flap survival rate (76.02 percent), followed by the continuous and control groups (64.96 percent and 51.53 percent, respectively). All intergroup differences were statistically significant. Tissue perfusion of the entire flap showed similar results (cyclic, 87.13 percent; continuous, 66.64 percent; control, 49.32 percent). Histologic analysis showed the most increased and organized collagen production with hypertrophy of the attached muscle and vascular density in the cyclic group, followed by the continuous and control groups.

Conclusion:

Flap preconditioning with the cyclic mode of external volume expansion is more effective than the continuous mode in an experimental rat model.
Craniometric Analysis of Endoscopic Suturectomy for Bilateral Coronal Craniosynostosis
Authors: Rottgers S. Alex , Syed Hasan R. , Jodeh Diana S. , Jeelani Yasser , Yang Edward , Meara John G. , Proctor Mark R.
Published: October 2018

Background:

Endoscopic suturectomy and helmeting represents a successful first-line surgical treatment for bilateral coronal craniosynostosis. Its effect on cranial morphology has not been previously described.

Methods:

Patients were identified who had bilateral coronal craniosynostosis treated with endoscopic suturectomy and postoperative helmeting at Boston Children’s Hospital between 2005 and 2013 and who underwent preoperative and postoperative computed tomography. Two normative patient populations were identified from our trauma registry with computed tomographic scans completed at the same age as our pretreatment and posttreatment scans. Craniometric indices were used to quantify the effect of treatment.

Results:

Twenty-seven patients were identified who underwent bilateral coronal suturectomy. Twelve patients had preoperative and postoperative computed tomographic studies. Eight patients (66.7 percent) were syndromic. The average ages for preoperative and postoperative computed tomographic scan were 1.1 months (range, 0.03 to 2.6 months) and 19.6 months (range, 10.8 to 37.5 months). Thirteen patients with an average age of 1.1 months (range, 0.5 to 1.6 months) were identified as a preoperative control group. Fourteen patients with an average age of 18.5 months (range, 15.5 to 22.9 months) were identified as a postoperative control group. The anterior cranial height stabilized with treatment and the anterior cranial base length increased. The anterior cranial height–to–anterior cranial base length ratio significantly decreased with treatment (p = 0.128). Frontal bossing normalized with endoscopic suturectomy (craniosynostosis versus control: preoperatively, p = 0.001; postoperatively, p = 0.8). Cephalic indices also normalized with treatment (craniosynostosis versus control: preoperatively, p = 0.02; postoperatively, p = 0.13). No cases of hydrocephalus were observed.

Conclusion:

Endoscopic suturectomy and helmeting improves anterior turricephaly and corrects frontal bossing and brachycephaly in patients with bilateral coronal craniosynostosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Delayed Postconditioning with External Volume Expansion Improves Survival of Adipose Tissue Grafts in a Murine Model
Authors: Wei Shuyi , Liu Wenyue , Gundogan Buket , Moscoso Andrea V. , Orgill Dennis P. , Giatsidis Giorgio
Published: October 2018

Background:

External volume expansion improves the survival of adipose tissue grafts by preoperatively conditioning (“preconditioning”) tissues that will receive the graft. External volume expansion’s mechanisms of action (induction of angiogenesis and of adipogenesis) could improve graft survival also when applied postoperatively (“postconditioning”).

Methods:

Fifty-six 8-week-old athymic (nu/nu) mice received dorsal subcutaneous grafts of human lipoaspirate (0.3 ml each) bilaterally before undergoing external volume expansion (left dorsum) or no treatment (right dorsum, controls). External volume expansion was started either on the same day of (immediate group), 2 days after (early group), or 1 week after surgery (delayed group). At follow-up, grafts were analyzed for tissue survival, remodeling, adipogenesis, and angiogenesis using histology. The authors subsequently assessed the effects of the delayed application of external volume expansion adopting a foam-shaped interface to deliver the treatment.

Results:

At 28-day follow-up, delayed postconditioning with external volume expansion significantly improved the survival of grafts (18 percent) compared with controls (viable graft thickness ratio, 58 ± 15 percent versus 49 ± 13 percent) and increased the density of blood vessels within the graft (63 percent; blood vessels per 10× magnification field, 44 ± 12 versus 27 ± 11). Other groups did not experience significant changes. Adoption of external volume expansion with a foam-shaped interface similarly improved outcomes and further reduced fibrosis within the grafts.

Conclusions:

Postoperative delayed application of external volume expansion modestly improves the survival of adipose tissue grafts by inducing adipogenesis and angiogenesis. Use of a foam-shaped interface decreases the fibrosis induced in the grafts.