bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Elders in the Wellbeing of a Contemporary Australian Indigenous Community
Authors: Busija Lucy , Cinelli Renata , Toombs Maree R , Easton Caitlin , Hampton Ron , Holdsworth Kristen , Macleod, BPsySc(Hons) Ashley , Nicholson Geoffrey C , Nasir Bushra F , Sanders Kerrie M , McCabe Marita P
Published: October 2018

Background and Objectives

Traditional Elders are integral to the social structure of Australian Indigenous communities. Due to progressive loss of traditional way of life, however, the role of Elders has been eroding. This study aims to develop a conceptual model of the role of Elders in an Australian Indigenous community, with the goal of attaining strategies to strengthen the role of Elders.

Research Design and Methods

The study, conducted in a regional Indigenous community in Australia, adopted a community-based participatory approach. Design and focus of the project were informed by a community forum (Yarning Circle). One-on-one semistructured interviews and focus groups with community members were conducted by Indigenous researchers. Group concept mapping (GCM) was applied to elicit major themes in qualitative data, from the point of view of community members, and to derive a conceptual model of the role of Elders.

Results

Fifty members of the Indigenous community took part in interviews and focus groups. The participants’ median age was 45 years (range 18–76 years); 31 (62%) were female. An additional 24 Indigenous community members took part in the data sorting task of GCM. GCM identified seven major aspects of the role of Elders, including Community relations, Passing down the knowledge, Dealing with racism and oppression, Building a better resourced community, Intergenerational connectedness, Safeguarding our identity, and Caring for our youth.

Discussion and Implications

Elders fulfill many important roles in contemporary Indigenous communities. Our results can be used to assist the community to codesign a program to increase community wellbeing.
Directional bilateral asymmetry in otolith morphology may affect fish stock discrimination based on otolith shape analysis
Authors: Mahé Kélig , Ider Djamila , Massaro Andrea , Hamed Oussama , Jurado-Ruzafa Alba , Gonçalves Patrícia , Anastasopoulou Aikaterini , Jadaud Angelique , Mytilineou Chryssi , Elleboode Romain , Ramdane Zohir , Bacha Mahmoud , Amara Rachid , de Pontual Hélène , Ernande Bruno
Published: October 2018

Otolith shape analysis is an efficient fish stock identification tool. However, most applications used left and right otoliths or only one of them arbitrarily chosen without testing for biases resulting from potential directional bilateral asymmetry (DA) in otolith shape, i.e. a unimodal population-level deviation form bilateral symmetry between right and left otolith shapes. In this study, 560 bogues (Boops boops) were sampled from 11 geographical locations from the Canary Islands to the Aegean Sea and elliptical Fourier descriptors were used to describe their otoliths’ shape. First, a significant otolith DA was observed at the global scale with an average amplitude of 2.77%. However, at the scale of sampling locations, DA was not always significant and varied in amplitude and direction. Second, population structure was investigated using the shape of either right otoliths or left otoliths or both together. Analyses based on right otoliths or both otoliths together, suggested three stock units: a North-Western Mediterranean Sea stock, an Eastern Mediterranean Sea stock, and a Central-Eastern Atlantic Ocean and South-Western Mediterranean Sea stock. In contrast, no coherent geographical pattern was found based on left otoliths. Our results highlight the importance of accounting for potential otolith DA in otolith shape-based stock identification.
Improving inpatient mental health medication safety through the process of obtaining HIMSS Stage 7: a case report
Authors: Sulkers Heather , Tajirian Tania , Paterson Jane , Mucuceanu Daniela , MacArthur Tracey , Strauss John , Kalia Kamini , Strudwick Gillian , Jankowicz Damian
Published: October 2018

Although electronic health record systems have been implemented in many health settings globally, how organizations can best implement these systems to improve medication safety in mental health contexts is not well documented in the literature. The purpose of this case report is to describe how a mental health hospital in Toronto, Canada, leveraged the process of obtaining Healthcare Information Management Systems Society (HIMSS) Stage 7 on the Electronic Medical Record Adoption Model to improve clinical care specific to medication safety in its inpatient settings. Examples of how the organization met several of these HIMSS criteria are described as they relate to utilizing data from the system to support clinician practice and/or decision-making for medication safety.
Drugs linked to plasma homoarginine in chronic kidney disease patients—a cross-sectional analysis of the German Chronic Kidney Disease cohort
Authors: Maas Renke , Mieth Maren , Titze Stephanie I , Hübner Silvia , Fromm Martin F , Kielstein Jan T , Schmid Matthias , Köttgen Anna , Kronenberg Florian , Krane Vera , Hausknecht Birgit , Eckardt Kai-Uwe , Schneider Markus P
Published: October 2018

Background

Elevated plasma concentrations of symmetric and asymmetric dimethylarginine (SDMA and ADMA, respectively) and a lower plasma concentration of the structurally related homoarginine are commonly observed in patients with chronic kidney disease (CKD) and independently predict total mortality as well as progression of renal disease. We aimed to identify drugs that may alter this adverse metabolite pattern in a favourable fashion.

Methods

Plasma ADMA, SDMA, homoarginine and l-arginine were determined by liquid chromatography–tandem mass spectrometry in 4756 CKD patients ages 18–74 years with an estimated glomerular filtration rate (eGFR) of 30–60 mL/min/1.73 m2 or an eGFR >60 mL/min/1.73 m2 and overt proteinuria who were enrolled in the German Chronic Kidney Disease (GCKD) study. Associations between laboratory, clinical and medication data were assessed.

Results

Intake of several commonly used drugs was independently associated with plasma concentrations of homoarginine and/or related metabolites. Among these, the peroxisome proliferator-activated receptor alpha (PPAR-α) agonist fenofibrate was associated with the most profound differences in ADMA, SDMA and homoarginine plasma concentrations: 66 patients taking fenofibrate had a multivariable adjusted odds ratio (OR) of 5.83 [95% confidence interval (CI) 2.82–12.03, P < 0.001] to have a plasma homoarginine concentration above the median. The median homoarginine plasma concentration in patients taking fenofibrate was 2.30 µmol/L versus 1.55 in patients not taking the drug (P < 0.001). In addition, fibrates were significantly associated with lower plasma SDMA and higher l-arginine concentrations. In contrast, glucocorticoids were associated with lower plasma homoarginine, with adjusted ORs of 0.52 (95% CI 0.40–0.67, P < 0.001) and 0.53 (95% CI 0.31–0.90, P = 0.018) for prednisolone and methylprednisolone, respectively.

Conclusions

In a large cohort of CKD patients, intake of fenofibrate and glucocorticoids were independently associated with higher and lower plasma homoarginine concentrations, respectively. Effects on plasma homoarginine and methylarginines warrant further investigation as potential mechanisms mediating beneficial or adverse drug effects.
Variability of Zika Virus Incubation Period in Humans
Authors: Fourié Toscane , Grard Gilda , Leparc-Goffart Isabelle , Briolant Sébastien , Fontaine Albin
Published: October 2018

Zika virus (ZIKV) has recently emerged in numerous tropical countries worldwide. In this study, we estimated ZIKV incubation period distribution using time-to-event models adapted to interval-censored data based on declared date of travels from 123 symptomatic travelers returning from areas with active ZIKV transmission. The median time and 95th percentile of ZIKV incubation period was estimated to 6.8 days (95% confidence interval [CI], 5.8–7.7 days) and 15.4 days (95% CI, 12.7–19.7 days), respectively. Determining the incubation period for ZIKV is beneficial to improve protection guidelines.
When Do Professionals Envision and Trust Fathers as Caregivers over the Course of Giving Birth? A Comparison of Pre- and Postnatal Healthcare Professionals’ Assessments of Fathers in the Netherlands, Germany, and Poland
Authors: Veltkamp Gerlieke
Published: October 2018

When fathers are involved in caregiving from the beginning of their child’s life, they are more likely to stay involved, resulting in more gender equality between spouses and in positive cognitive and psychosocial health outcomes for children. It has been shown, however, that professional experts often focus predominantly on and build trust relationships with mothers rather than fathers. In this paper, drawing on interviews with and observations of pre- and postnatal healthcare professionals in the Netherlands, Germany, and Poland, I examine in which institutional contexts these professionals did activate and build trust relationships with fathers, while envisioning them as caregivers.
Increased lysine: metabolizable energy ratio improves grower pig performance during a porcine reproductive and respiratory syndrome virus challenge
Authors: Schweer Wesley P , Mendoza Omarh F , Shull Caleb M , Lehman James , Gaines Aaron M , Schwartz Kent J , Gabler Nicholas K
Published: October 2018

Porcine reproductive and respiratory syndrome virus (PRRSV) reduces grower pig performance. The amino acid (AA) requirements and lysine:metabolizable energy ratio (Lys:ME) of health-challenged pigs for optimum performance are poorly understood. Two experiments were conducted to evaluate the effect of increasing standardized ileal digestible (SID) Lys:ME (g SID Lys per Mcal ME) on growth performance during a PRRSV challenge. In Exp. 1, a total of 379 barrows (51.3 ± 0.3 kg body weight [BW]) were allotted to one of six diets (1.87 to 3.41 Lys:ME) for a 35-d growth study. In Exp. 2, a total of 389 barrows (29.2 ± 0.23 kg BW) were allotted to one of six diets (2.39 to 3.91 Lys:ME) for a 49-d growth study. These isocaloric diets represented 80% to 130% of National Research Council (NRC) SID Lys requirement. For each experiment, pigs were randomly allotted across two barns of 24 pens each with seven to nine pigs per pen (four pens per diet per health status). On day 0, one barn was inoculated with live PRRSV, one barn sham inoculated (control), and all pigs were started on experimental diets. Pen growth performance and feed intake were recorded weekly and gain-to-feed ratio (G:F) was calculated. Breakpoint analysis was used to determine the Lys:ME that maximized average daily gain (ADG) and G:F over the 35 or 49-d test periods for Exp. 1 and 2, respectively. In Exp. 1, increasing Lys:ME increased ADG (quadratic P = 0.01) and G:F (linear and quadratic P = 0.04) in control pigs over 35 d. In PRRSV-infected pigs, ADG and G:F increased linearly with increasing Lys:ME (P < 0.01). The Lys:ME for optimum ADG and G:F during PRRSV challenge was 2.83 and 3.17, respectively, compared to 2.24 and 2.83, respectively, in control pigs using a one-slope broken-line model. In Exp. 2, pigs in the control barn became naturally infected after 21 days post inoculation. Before infection, ADG and G:F increased with increasing Lys:ME in control and PRRSV-infected pigs (linear and quadratic P < 0.05), and optimum ADG and G:F were achieved at 3.02 and 2.92 Lys:ME, respectively, in PRRSV-infected pigs compared to 2.82 and 3.22 Lys:ME, respectively, in control pigs. Over the 49-d period, increasing Lys:ME improved ADG (P < 0.01, linear and quadratic) and G:F (linear P < 0.01) in naturally infected pigs. The response was similar in experimental infection for ADG (P < 0.01, linear and quadratic) and G:F (linear P = 0.01). The optimum ratio for ADG (2.86 vs. 3.12 Lys:ME) and G:F (3.18 vs. 3.08 Lys:ME) were similar between natural and experimental infection. In summary, increasing Lys:ME by 10% to 20% above NRC requirements improved performance and feed efficiency during an experimental and natural PRRSV challenge.
Coronal Imbalance in Adult Spinal Deformity Following Posterior Spinal Fusion With Instrument
Authors: Zhang Zifang , Song Kai , Wu Bing , Chi Pengfei , Wang Zhaohan , Wang Zheng
Published: October 2018

Study Design.

A retrospective radiographic study.

Objective.

To explore the radiological parameters which correlated to postoperative immediately coronal imbalance in adult spinal deformity (ASD) and to determine whether preoperative coronal imbalance affects postoperative coronal imbalance following posterior multi-level fusion with instruments and osteotomy operation.

Summary of Background Data.

There was paucity of literature paying attention to the postoperative immediately coronal imbalance after operation.

Methods.

The study included 67 consecutive patients with ASD who underwent posterior multi-level fusion with instruments and osteotomy operation. The radiological parameters, measured on the pre- and postoperative anteroposterior and lateral radiographs, were compared and analyzed. Patients were divided into three groups (group A, B, and C) according to preoperative coronal balance distance (pre-CBD) and the relation of cervical 7 plumb line (C7PL), and the convex of curvature. To analyze the radiological parameters of the three groups.

Result.

Differences of the radiological parameters between pre- and postoperation concerning Cobb angles, degree of apical vertebra rotation, thoracic kyphosis (TK), thoracic lumber kyphosis (TLK), lumber lordosis (LL), sacral slope (SS), pelvic tilt (PT), and sagittal vertical axis (SVA), were significant (P < 0.05). Pelvic incidence (PI), pre-CBD, and postoperative coronal balance distance (post-CBD) had no change (P > 0.05). The ratio of coronal imbalance in pre- and postoperation was 31.34% (21/67) and 40.30% (27/67), respectively, which had significant difference (P = 0.02). Significant correlations were observed among post-CBD, pre-CBD (P < 0.001), and d-Cobb (pre-Cobb – post-Cobb) (P = 0.002), post-CBD = –2.737 – 0.924∗d-Cobb + 0.356∗pre-CBD. The ratio of postoperative immediately coronal imbalance of the group C was much higher than other two groups (P = 0.01).

Conclusion.

The sagittal alignments in ASD patients would be improved effectively after posterior multi-level fusion with instruments and osteotomy operation. There were significant correlations among post-CBD, pre-CBD, and d-Cobb. Patients in group C may be at greater risk for immediate postoperative coronal imbalance after operation.

Level of Evidence: 3
Additional Sacroplasty Does Not Improve Clinical Outcome in Minimally Invasive Navigation-Assisted Screw Fixation Procedures for Nondisplaced Insufficiency Fractures of the Sacrum
Authors: Balling Horst
Published: October 2018

Study Design.

Prospective single-center cohort study (noninferiority study).

Objective.

To compare clinical results of navigation-assisted screw fixation (NSF) to those of NSF with additional sacroplasty (NSF + SP) for immobilizing nondisplaced insufficiency fractures of the sacrum.

Summary of Background Data.

NSF for sacral insufficiency fractures is a new, technically demanding procedure requiring surgical skills and experience. Up to date, controversies exist about the benefit of additional sacroplasty in surgically stabilized insufficiency fractures of the sacrum.

Methods.

From February 2011 to May 2017, all individuals with immobilizing nondisplaced sacral insufficiency fractures surgically treated using 3D-fluoroscopy for 3D-real-time navigation and postinstrumentation screw control in the form of NSF (I) or NSF + SP (II) were enrolled. SP was performed only in absence of transforaminal or central fractures. Outcome parameters were postsurgical pain relief determined by visual analog scale, postsurgical improvement of disability evaluated using the Oswestry Disability Index, and length of postsurgical hospital stay.

Results.

In 2 groups of 26 individuals, each, a total of 124 insufficiency fractures of sacral vertebrae were surgically treated. Postoperative pain-level decrease was comparable in both groups (5.3 vs. 5.4 visual analog scale points). Extent of postoperative disability score improvement (53.4 vs. 57.7 Oswestry Disability Index points) led to successful remobilization after similar durations of postsurgical hospital stay (9.3 vs. 9.6 days). Minimum clinically important differences of outcome parameters were not reached in the comparison of study group results. In procedures with SP, no major complications occurred, in those without SP, no specific complications were observed.

Conclusion.

This comparative study indicates noninferiority of NSF compared to NSF + SP for sacral insufficiency fractures, and could not confirm clinical advantages of additional SP concerning pain relief, improvement of fracture-related disability, or time from surgery to discharge. Therefore, additional sacroplasty is not recommended to enhance the clinical benefit for patients receiving image-guided sacral screw fixation.

Level of Evidence: 2
Alert Timing and Corresponding Intervention With Intraoperative Spinal Cord Monitoring for High-Risk Spinal Surgery
Authors: Yoshida Go , Ando Muneharu , Imagama Shiro , Kawabata Shigenori , Yamada Kei , Kanchiku Tsukasa , Fujiwara Yasushi , Tadokoro Nobuaki , Takahashi Masahito , Wada Kanichiro , Yamamoto Naoya , Kobayashi Sho , Ushirozako Hiroki , Kobayashi Kazuyoshi , Yasuda Akimasa , Tani Toshikazu , Matsuyama Yukihiro
Published: October 2018

Study Design.

Prospective multicenter study.

Objective.

To analyze the incidence of intraoperative spinal neuromonitoring (IONM) alerts and neurological complications, as well as to determine which interventions are most effective at preventing postoperative neurological complications following IONM alerts in high risk spinal surgeries.

Summary of Background Data.

IONM may play a role in identifying and preventing neural damage; however, few studies have clarified the outcomes of intervention after IONM alerts.

Methods.

We analyzed 2867 patients who underwent surgery for high risk spinal pathology using transcranial electrical motor-evoked potentials from 2010 to 2016. The high-risk spinal surgery cases consisted of 1009 spinal deformity cases, 622 cervical ossification of posterior longitudinal ligament (OPLL) cases, 249 thoracic-OPLL cases, 771 extramedullary spinal cord tumor cases, and 216 intramedullary spinal cord tumor (IMSCT) cases. We set a 70% amplitude reduction as the alarm threshold for transcranial electrical motor-evoked potentials and analyzed the outcomes of the interventions following monitoring alerts and postoperative neurological deficits.

Results.

The true positive, false positive, true negative, false negative, and rescue cases of IONM comprised 126, 234, 2362, 9, and 136 cases, respectively. Most alerts and interventions occurred during correction and release in deformity cases, posterior decompression and dekyphosis in OPLL cases, and tumor resection and surgery suspension with steroid injection in spinal cord tumor cases; however, individual interventions varied. The rescue rates (number of patients rescued with intervention after IONM alert/number of true positive cases plus rescue cases) for deformity, cervical-OPLL, thoracic--OPLL, extramedullary spinal cord tumor, and IMSCT cases were 61.4% (35/57), 82.1% (32/39), 40% (20/50), 52.5% (31/59), and 31.6% (18/57), respectively.

Conclusion.

Our prospective multicenter study identified potential neural damage in 9.5% of cases and 52% rescue cases using IONM. Although the rescue ratios for t-OPLL and IMSCT were relatively low, appropriate intervention immediately after an IONM alert may prevent neural damage even in high-risk spinal surgeries.

Level of Evidence: 3
INTERNAL LIMITING MEMBRANE PEELING AND AIR TAMPONADE FOR STAGE III AND STAGE IV IDIOPATHIC MACULAR HOLE
Authors: Yu Yanping , Liang Xida , Wang Zengyi , Wang Jing , Liu Xinxin , Chen Jinqiu , Liu Wu
Published: October 2018

Purpose:

To evaluate the effect of internal limiting membrane peeling and air tamponade for idiopathic macular hole, and explore reasons and interventions for persistent holes.

Methods:

One hundred and thirty-five eyes with Stage III and IV idiopathic macular hole that underwent 23-gauge vitrectomy, internal limiting membrane peeling, and air tamponade were reviewed. Eyes with persistent holes underwent a second surgery. Outcome-related factors and interventions treating persistent holes were discussed.

Results:

The initial closure (Type I) rate was 89.63% (121/135). Eyes that underwent the second surgery all obtained final closure (Type I). Diameter of macular hole was significantly smaller (P < 0.001) and duration of symptoms was significantly shorter (P = 0.017) in initially closed cases than in unclosed ones. Binary logistic regression indicated large diameter of macular hole as a risk factor for initial closure (P = 0.004). A cutoff value of 677 μm was provided by receiver operating characteristic curve to predict initial closure (P < 0.001). Best-corrected visual acuity of all individuals improved significantly (P < 0.001) from 20/154 to 20/40 (mean follow-up: 4.5 months).

Conclusion:

Internal limiting membrane peeling and air tamponade for idiopathic macular hole provide satisfactory morphologic and functional outcomes. Large diameter of macular hole and long duration of symptoms are risk factors for initial closure. Proper second surgery can obtain satisfactory outcomes for persistent holes.
BILATERAL ACUTE RETINAL NECROSIS
Authors: Lei Boya , Jiang Rui , Wang Zhujian , Xu Gezhi , Wu Xuyin , Zhou Min
Published: October 2018

Purpose:

To investigate the clinical characteristics and visual outcome of bilateral acute retinal necrosis.

Methods:

The study included 30 patients (60 eyes) who were diagnosed with bilateral acute retinal necrosis. The medical records were reviewed.

Results:

Twenty-five patients developed the disease in the contralateral eye within 5 months and 5 patients at >2 years after the initial onset. At presentation, 14 of 21 eyes suffered from retinal necrosis of more than 180° in the initially affected eye, whereas 3 of 22 eyes suffered it in the later-affected eye. Retinal detachment occurred in 23 of the 27 initially affected eyes and in 5 of the 27 later-affected eyes. The mean logarithm of the minimum angle of resolution best-corrected visual acuity decreased from 2.0 ± 1.1 (Snellen equivalent counting fingers) to 2.2 ± 1.0 (Snellen equivalent counting fingers) in the initially affected eyes after a follow-up of 34.1 ± 48.2 months (P = 0.529), and improved from 0.5 ± 0.4 (Snellen equivalent 20/66) to 0.3 ± 0.4 (Snellen equivalent 20/40) in the later-affected eyes after a follow-up of 21.2 ± 23.3 months (P = 0.005).

Conclusion:

Bilateral acute retinal necrosis usually occurs in the contralateral eye within a few months, but sometimes after several years. Inflammation and retinal necrosis are less severe in the later-affected eye, with less retinal detachment and a better visual outcome.
OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS TO DISTINGUISH DIABETIC MACULAR EDEMA FROM PSEUDOPHAKIC CYSTOID MACULAR EDEMA USING MACHINE LEARNING ALGORITHMS
Authors: Hecht Idan , Bar Asaf , Rokach Lior , Noy Achiron Romi , Munk Marion R. , Huf Wolfgang , Burgansky-Eliash Zvia , Achiron Asaf
Published: October 2018

Purpose:

In diabetic patients presenting with macular edema (ME) shortly after cataract surgery, identifying the underlying pathology can be challenging and influence management. Our aim was to develop a simple clinical classifier able to confirm a diabetic etiology using few spectral domain optical coherence tomography parameters.

Methods:

We analyzed spectral domain optical coherence tomography data of 153 patients with either pseudophakic cystoid ME (n = 57), diabetic ME (n = 86), or “mixed” (n = 10). We used advanced machine learning algorithms to develop a predictive classifier using the smallest number of parameters.

Results:

Most differentiating were the existence of hard exudates, hyperreflective foci, subretinal fluid, ME pattern, and the location of cysts within retinal layers. Using only 3 to 6 spectral domain optical coherence tomography parameters, we achieved a sensitivity of 94% to 98%, specificity of 94% to 95%, and an area under the curve of 0.937 to 0.987 (depending on the method) for confirming a diabetic etiology. A simple decision flowchart achieved a sensitivity of 96%, a specificity of 95%, and an area under the curve of 0.937.

Conclusion:

Confirming a diabetic etiology for edema in cases with uncertainty between diabetic cystoid ME and pseudophakic ME was possible using few spectral domain optical coherence tomography parameters with high accuracy. We propose a clinical decision flowchart for cases with uncertainty, which may support the decision for intravitreal injections rather than topical treatment.
COMPARATIVE RISK OF ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION WITH BEVACIZUMAB, AFLIBERCEPT, AND RANIBIZUMAB
Authors: Bavinger J. Clay , Yu Yinxi , VanderBeek Brian L.
Published: October 2018

Purpose:

To determine whether sterile preloading of anti–vascular endothelial growth factor agents reduces the risk of postintravitreal injection endophthalmitis.

Methods:

This is a retrospective cohort study using medical claims data from a large, national US insurer. Cohorts were created using intravitreal injections of anti–vascular endothelial growth factor injections from 2005 to 2016. For inclusion, patients had to have at least 6 months of data before the injection and were excluded for any previous diagnosis of endophthalmitis, multiple injected drugs on the day of injection, or intraocular surgery within 15 days of the injection or between an injection and a diagnosis of endophthalmitis. The primary outcome was the odds of endophthalmitis after an intravitreal injection.

Results:

A total of 706,725 bevacizumab, 210,849 ranibizumab, and 177,731 aflibercept injections were given to 130,327 patients. Multivariate analysis showed that ranibizumab and aflibercept together had an increased odds of endophthalmitis (odds ratio = 1.29, 95% confidence interval: 1.04–1.59, P = 0.02) compared with bevacizumab. Individually, ranibizumab (odds ratio = 1.25, 95% confidence interval: 0.97–1.61, P = 0.08) and aflibercept (odds ratio = 1.34, 95% confidence interval: 0.99–1.81, P = 0.06) each had higher odds of endophthalmitis, but neither result met significance. Also, when compared with male patients, female patients had a higher odds of getting endophthalmitis (odds ratio: 1.30, 95% confidence interval: 1.05–1.61, P = 0.02).

Conclusion:

The odds of endophthalmitis with aflibercept and ranibizumab combined were higher compared with the sterilely preloaded bevacizumab, arguing for a safety advantage of sterile preloading of anti–vascular endothelial growth factor injections.
Risk Factors for Post–Acute Coronary Syndrome Depression
Authors: Yuan Mei-zhen , Fang Qin , Liu Guang-wei , Zhou Min , Wu Jian-mei , Pu Chun-yun
Published: October 2018

Background:

The incidence of depression is very common among patients with post–acute coronary syndrome (ACS) and leads to adverse outcomes.

Aims:

The aim of this meta-analysis was to detect risk factors for depression among patients with ACS and to provide clinical evidence for its prevention.

Methods:

The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline to search the PubMed, Web of Science, EMBASE, and EBSCO databases from January 1996 to March 2018. Data that met the inclusion criteria were extracted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk factors of post-ACS depression.

Results:

A total of 30 articles met the inclusion criteria, and 25 risk factors were found to be associated with depression. The top 5 risk factors are as follows: antidepression treatment (OR, 4.25; 95% CI, 3.41–5.31), housewife status (OR, 4.17; 95% CI, 1.83–9.53), history of depressive disorders (OR, 3.52; 95% CI, 2.69–4.61), widow status (OR, 2.34; 95% CI, 1.05–5.21), and history of congestive heart failure (OR, 2.03; 95% CI, 1.04–3.97). The authors also found that a married status, high education level, and employment are protective factors.

Conclusion:

Clinical personnel should be alerted with regard to the high risk factors of depression, including female gender, low education level, unmarried status, living alone, unemployed status, unhealthy lifestyle, and complications such as cardiovascular, respiratory, and metabolic diseases. In particular, staff should pay attention to a history of previous depression, be concerned with the psychological condition of the patient, and monitor and perform early interventions to reduce the incidence of depression.
Ultrasound Evaluation of Anterior Acromioclavicular Relationship in the Horizontal Plane on 40 Healthy Subjects. A New Possibility for Differential Diagnosis of Acromioclavicular Disjunctions Rockwood Stage 3 and 4? A Pilot Study
Authors: Villatte Guillaume , Lecointe Thibault , Erivan Roger , Mulliez Aurélien , Métais Pierre , Descamps Stéphane , Boisgard Stéphane
Published: October 2018

Objective:

To evaluate the repeatability and reproducibility of an ultrasound examination of the acromioclavicular joint (ACJ) performed by an orthopaedic surgeon to analyze anterior ACJ relationship in the horizontal plane.

Design:

Prospective observational study on healthy subjects.

Setting:

The study was conducted in 2017 in a university department of orthopaedic surgery and traumatology.

Level of Evidence:

III.

Patients (or Participants):

Forty consecutive volunteers aged 18 to 40 years were involved.

Interventions (or Assessment of Risk Factors or Independent Variables):

The ultrasound examination was performed by 2 orthopaedic surgeons with a SonoSite M-Turbo portable ultrasound machine (Fujifilm, Japan). Distance measurement between the anterior edge of the clavicle (AECL) and the anterior edge of the acromion (AEAC) was done on the right side, then on the left one and repeated by the same examiner.

Main Outcome Measures:

The intra- and interexaminer reproducibility of measurements was analyzed as primary outcome. Concordance of distance measurements between the right and left sides on the same subject was evaluated, as well as the “typical morphology” of the ACJ in the horizontal plane.

Results:

The intra- and interexaminer reproducibility for AECL-AEAC distance measurements was, respectively, 0.95 (0.93-0.97) and 0.87 (0.84-0.90). The correlation between the right and left sides was significant (P < 0.001), with a reproducibility of 0.86 (0.83-0.89). Twenty-seven (67.5%) volunteers were considered to have a “perfect alignment” of the AECL and AEAC.

Conclusions:

This study confirms that it is possible to evaluate with good reproducibility the anterior AC relationship in the horizontal plane and that both sides are similar on the same subject.
Impact of Diabetes Mellitus on Survival in Patients Bridged to Transplantation with Left Ventricular Assist Devices in the United States
Authors: Al-Kindi Sadeer G. , Al-Suwaidi Jassim , Jayyousi Amin , Oliveira Guilherme H. , Abi Khalil Charbel
Published: October 2018

Diabetes mellitus (DM) is associated with increased mortality in advanced heart failure and in patients undergoing cardiac surgery. However, its impact on outcomes in patients supported with left ventricular assist devices (LVAD) is not well established. We queried the United Network for Organ Sharing (UNOS) for all adults listed for heart transplantation and bridged with continuous-flow LVAD in the United States from 2000 to 2015. We compared the pre- and post-transplant mortality of patients with and without DM. Unadjusted and adjusted time-event analyses were performed. A total of 4,978 patients were included in this analysis, of whom 33% had DM. Mean age was 53 ± 12 years, 79% were male, and 65% were Caucasian. Compared with those without, patients with DM were older (age 52 vs. 57 years; p < 0.001), more likely to be male (78% vs. 82%; p = 0.007), smokers (52% vs. 57%; p = 0.011), obese (mean body mass index [BMI] 28 vs. 30; p < 0.00), and have ischemic cardiomyopathy (37% vs. 53%; p < 0.001). Diabetes mellitus was not associated with increased wait-list mortality (adjusted hazard ratio [HR]: 1.16 [0.88–1.53]; p = 0.30), or wait-list mortality/delisting (HR: 1.17 [0.97–1.41]; p = 0.11). Among patients who underwent transplantation, DM was associated with increased adjusted overall mortality (HR: 1.23 [1.002–1.52]; p = 0.048). One-third of patients bridged-to-transplantation with LVAD in the United States have DM. While it does not increase wait-list mortality or delisting, DM is associated with decreased post-transplantation survival.
Cancer Patients' Long-term Experiences of Participating in a Comprehensive Lifestyle Intervention Study While Receiving Chemotherapy
Authors: Mikkelsen Hilde Elisabeth Timenes , Vassbakk-Brovold Karianne , Antonsen Anne Jørstad , Berntsen Sveinung , Kersten Christian , Fegran Liv
Published: October 2018

Background

Lifestyle interventions seem promising with regard to cancer patients' potential for physical and psychological health benefits and as an empowerment tool. Nevertheless, there is a lack of knowledge concerning cancer patients' longer-term experiences of participating in comprehensive lifestyle interventions.

Objective

The aim of this study was to explore cancer patients' long-term experiences of participating in a 12-month individualized comprehensive lifestyle intervention study focusing on physical activity, diet, smoking cessation, and stress management while receiving curative or palliative chemotherapy.

Methods

A qualitative design with semistructured interviews of 7 curative and 7 palliative cancer patients was conducted 12 months after inclusion in lifestyle intervention. Data were analyzed following a phenomenological-hermeneutic approach.

Results

Two main themes emerged: (1) awareness of the importance of a healthy lifestyle during cancer treatment and (2) individual follow-up; it's good to have someone to talk to.

Conclusions

Participation in a 12-month comprehensive lifestyle intervention is both feasible and desirable in curative and palliative patients. However, although the curative participants' motivation and perceived ability to adhere to lifestyle recommendations increased during the intervention period, the palliative participants' perceived ability to adhere decreased even though they were overall highly motivated.

Implications for Practice

Our findings encourage the future implementation of lifestyle interventions during cancer treatment, even in cancer patients with advanced disease. However, when implementing lifestyle interventions, healthcare professionals must keep the patients' motivation, perceived ability to adhere to lifestyle recommendations, and individual needs in mind.
Analyses of Mitochondrial DNA and Immune Phenotyping Suggest Accelerated T-Cell Turnover in Treated HIV
Authors: Massanella Marta , Karris Maile Y. , Pérez-Santiago Josué , Yek Christina , Vitomirov Andrej , Mehta Sanjay R.
Published: October 2018

Background:

HIV infection is associated with premature aging, and mitochondrial integrity is compromised during the aging process. Because mitochondrial toxicity is a consequence of antiretroviral therapies (ARTs), we hypothesized HIV and long-term ART would correlate with immunosenescence and mitochondrial DNA (mtDNA) pathology.

Setting:

Thirteen older HIV-infected individuals (aged >40 years) with virologic suppression (stratified by duration of ART) were compared with 10 uninfected controls well-matched for age.

Methods:

Peripheral blood T-cells were immunophenotyped to measure immune activation, proliferation, and immunosenescence in subsets. mtDNA copies per cell and the relative abundance of mtDNA carrying the “common deletion” (RACD) were quantified by droplet digital polymerase chain reaction.

Results:

Immune activation was higher in HIV-infected individuals than HIV-uninfected individuals in mature CD4+ T-cell subsets (CD4+TTM
P = 0.025, CD4+TEM
P = 0.0020) regardless of ART duration. Cell populations from uninfected individuals were more likely to be more senescent populations in mature CD4+ T-cell subsets (TTM
P = 0.017), and CD8+ (CD8+TEMRA+
P = 0.0026). No differences were observed in mtDNA or RACD levels in any CD4+ T-cell subsets, while CD8+TSCM of infected individuals trended to have more mtDNA (P = 0.057) and reduced RACD (P = 0.0025).

Conclusions:

HIV-infected individuals demonstrated increased immune activation, but reduced senescence in more mature T-cell subsets. Increased mtDNA content and lower RACD in CD8+TSCM suggest immune activation driven turnover of these cells in HIV-infected persons.
Diagnostic Accuracy of Different Surgical Procedures for Axillary Staging After Neoadjuvant Systemic Therapy in Node-positive Breast Cancer
Authors: Simons Janine M. , van Nijnatten Thiemo J. A. , van der Pol Carmen C. , Luiten Ernest J. T. , Koppert Linetta B. , Smidt Marjolein L.
Published: October 2018

Objective:

The aim of this study was to perform a systematic review and meta-analysis to assess the accuracy of different surgical axillary staging procedures compared with ALND.

Summary of Background Data:

Optimal axillary staging after neoadjuvant systemic therapy (NST) in node-positive breast cancer is an area of controversy. Several less invasive procedures, such as sentinel lymph node biopsy (SLNB), marking axillary lymph node with radioactive iodine seed (MARI), and targeted axillary dissection (a combination of SLNB and a MARI-like procedure), have been proposed to replace the conventional axillary lymph node dissection (ALND) with its concomitant morbidity.

Methods:

PubMed and Embase were searched for studies comparing less invasive surgical axillary staging procedures to ALND to identify axillary burden after NST in patients with pathologically confirmed node-positive breast cancer (cN+). A meta-analysis was performed to compare identification rate (IFR), false-negative rate (FNR), and negative predictive value (NPV).

Results:

Of 1132 records, 20 unique studies with 2217 patients were included in quantitative analysis: 17 studies on SLNB, 1 study on MARI, and 2 studies on a combination procedure. Overall axillary pathologic complete response rate was 37%. For SLNB, pooled rates of IFR and FNR were 89% and 17%. NPV ranged from 57% to 86%. For MARI, IFR was 97%, FNR 7%, and NPV 83%. For the combination procedure, IFR was 100%, FNR ranged from 2% to 4%, and NPV from 92% to 97%.

Conclusion:

Axillary staging by a combination procedure consisting of SLNB with excision of a pre-NST marked positive lymph node appears to be most accurate for axillary staging after NST. More evidence from prospective multicenter trials is needed to confirm this.
Spatial structuring of a Legionella pneumophila population within the water system of a large occupational building
Authors: David Sophia , Mentasti Massimo , Lai Sandra , Vaghji Lalita , Ready Derren , Chalker Victoria J. , Parkhill Julian
Published: October 2018

The diversity of Legionella pneumophila populations within single water systems is not well understood, particularly in those unassociated with cases of Legionnaires’ disease. Here, we performed genomic analysis of 235 L. pneumophila isolates obtained from 28 water samples in 13 locations within a large occupational building. Despite regular treatment, the water system of this building is thought to have been colonized by L. pneumophila for at least 30 years without evidence of association with Legionnaires’ disease cases. All isolates belonged to one of three sequence types (STs), ST27 (n=81), ST68 (n=122) and ST87 (n=32), all three of which have been recovered from Legionnaires’ disease patients previously. Pairwise single nucleotide polymorphism differences amongst isolates of the same ST were low, ranging from 0 to 19 in ST27, from 0 to 30 in ST68 and from 0 to 7 in ST87, and no homologous recombination was observed in any lineage. However, there was evidence of horizontal transfer of a plasmid, which was found in all ST87 isolates and only one ST68 isolate. A single ST was found in 10/13 sampled locations, and isolates of each ST were also more similar to those from the same location compared with those from different locations, demonstrating spatial structuring of the population within the water system. These findings provide the first insights into the diversity and genomic evolution of a L. pneumophila population within a complex water system not associated with disease.
Microbe Profile: Wolbachia: a sex selector, a viral protector and a target to treat filarial nematodes
Authors: Taylor Mark J. , Bordenstein Seth R. , Slatko Barton
Published: October 2018

Wolbachia is the most widespread genus of endosymbiotic bacteria in the animal world, infecting a diverse range of arthropods and nematodes. A broad spectrum of associations from parasitism to mutualism occur, with a tendency to drive reproductive manipulation or influence host fecundity to spread infection through host populations. These varied effects of Wolbachia are exploited for public health benefits. Notably, the protection of insect hosts from viruses is being tested as a potential control strategy for human arboviruses, and the mutualistic relationship with filarial nematodes makes Wolbachia a target for antibiotic therapy of human and veterinary nematode diseases.
Subclonal architecture, evolutionary trajectories and patterns of inheritance of germline variants in pediatric glioblastoma
Authors: Hoffman Mary , Gillmor Aaron H , Kunz Daniel J , Johnston Michael , Nikolic Ana , Narta Kiran , King Jennifer , Ellestad Katrina , Dang Ngoc Ha , Cavalli Florence MG , Kushida Michelle M , Coutinho Fiona J , Luu Betty , Ma Yussanne , Mungall Andrew J , Moore Richard , Marra Marco A , Taylor Michael D , Pugh Trevor J , Dirks Peter B , Senger Donna L , Simons Benjamin D , Chan Jennifer A , Morrissy A Sorana , Gallo Marco
Published: October 2018

Pediatric glioblastoma (pGBM) is a lethal cancer with no effective therapies. Intratumoral genetic heterogeneity and mode of tumor evolution have not been systematically addressed for this cancer. Whole-genome sequencing of germline-tumor pairs showed that pGBM is characterized by intratumoral genetic heterogeneity and consequent subclonal architecture. We found that pGBM undergoes extreme evolutionary trajectories, with primary and recurrent tumors having different subclonal compositions. Analysis of variant allele frequencies supported a model of tumor growth involving slow-cycling cancer stem cells that give rise to fast-proliferating progenitor-like cells and to non-dividing cells. pGBM patients’ germlines had subclonal structural variants, some of which underwent dynamic frequency fluctuations during tumor evolution. By sequencing germlines of mother-father-patient trios, we found that inheritance of deleterious germline variants from healthy parents cooperate withde novogermline and somatic events to the tumorigenic process. Our studies therefore challenge the current notion that pGBM is a relatively homogeneous molecular entity.
A spatio-temporal individual-based network framework for West Nile virus in the USA: spreading pattern of West Nile virus
Authors: Moon Sifat A. , Cohnstaedt Lee W. , McVey D. Scott , Scoglio Caterina M.
Published: October 2018

West Nile virus (WNV)—a mosquito-borne arbovirus— entered the USA through New York City in 1999 and spread to the contiguous USA within three years while transitioning from epidemic outbreaks to endemic transmission. The virus is transmitted by vector competent mosquitoes and maintained in the avian populations. WNV spatial distribution is mainly determined by the movement of residential and migratory avian populations. We developed an individual-level heterogeneous network framework across the USA with the goal of understanding the long-range spatial distribution of WNV. To this end, we proposed three distance dispersal kernels model: 1) exponential—short-range dispersal, 2) power-law—long-range dispersal in all directions, and 3) power-law biased by flyway direction—long-range dispersal only along established migratory routes. To select the appropriate dispersal kernel we used the human case data and adopted a model selection framework based on approximate Bayesian computation with sequential Monte Carlo sampling (ABC-SMC). From estimated parameters, we find that the power-law biased by flyway direction kernel is the best kernel to fit WNV human case data, supporting the hypothesis of long-range WNV transmission is mainly along the migratory bird flyways. Through extensive simulation from 2014 to 2016, we proposed and tested hypothetical mitigation strategies and found that mosquito population reduction in the infected states and neighboring states is potentially cost-effective.

Author summary

The underlying pattern of West Nile virus (WNV) geographic spread across the United States is not completely clear, which is a necessary step for continental or state level mitigation strategies to reduce WNV transmission. We report a network model that explains the geographic spread of WNV in the United States. West Nile virus is a mosquito-borne pathogen that infects many avian species with different movement ranges. From our research, we found that migration patterns and routes play an essential role in the WNV spatial distribution. The virus spreads in all directions at short distances because of local birds and short-distance migratory birds. However, the virus also disperses long distances along the avian migratory routes. Our model is designed to be flexible and therefore can be used to explore spreading patterns of other infectious diseases in other geographic locations.
Antibodies against egg- and cell-grown influenza A(H3N2) viruses in adults hospitalized during the 2017-2018 season
Authors: Levine Min Z. , Martin Emily T. , Petrie Joshua G. , Lauring Adam S. , Holiday Crystal , Jefferson Stacie , Fitzsimmons William J. , Johnson Emileigh , Ferdinands Jill M. , Monto Arnold S.
Published: October 2018

Background

The 2017-2018 US influenza season was severe with low vaccine effectiveness. Circulating A(H3N2) viruses from multiple genetic groups were antigenically similar to cell-grown vaccine strains. However, most influenza vaccines are egg-propagated.

Methods

Serum was collected shortly after illness onset from 15 PCR confirmed A(H3N2) infected cases and 15 uninfected (controls) hospitalized adults enrolled in an influenza vaccine effectiveness study.

Geometric mean titers against egg- and cell-grown A/Hong Kong/4801/2014 A(H3N2) vaccine strains and representative circulating viruses (including A/Washington/16/2017) were determined by microneutralization (MN) assays. Independent effects of strain-specific titers on susceptibility were estimated by logistic regression.

Results

MN titers against egg-A/Hong Kong were significantly higher among those who were vaccinated (MN GMT: 173 vs 41;P= 0.01). However, antibody titers to cell-grown viruses were much lower in all individuals (P>0.05) regardless of vaccination. In unadjusted models, a 2-fold increase in MN titers against egg-A/Hong Kong was not significantly protective against infection (29% reduction; p=0.09), but a similar increase in cell-A/Washington titer (3C.2a2) was protective (60% reduction; p=0.02). A similar increase in egg-A/Hong Kong titer was not significantly associated with odds of infection when adjusting for MN titers against A/Washington (15% reduction; P=0.61). A 54% reduction of odds of infection was observed with a 2-fold increase in A/Washington (not significant; P=0.07), adjusted for egg-A/Hong Kong titer.

Conclusion

Although individuals vaccinated in 2017-2018 had high antibody titers against the egg-adapted vaccine strain, antibody responses to cell-grown circulating viruses may not be sufficient to provide protection, likely due to egg-adaptation in the vaccine.