bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of a Best Practice Alerts at Improving Hypertension Control
Authors: Swedlund Matthew , Norton Derek , Birstler Jennifer , Chen Guanhua , Cruz Laura , Hanrahan Larry
Published: October 2018

BACKGROUND

Inadequately treated hypertension (HTN) leads to considerable morbidity and mortality. Despite many treatment options, blood pressure (BP) control is suboptimal. Missed opportunities due to the growing complexity of primary care office visits contribute. Electronic health records (EHRs) offer best practice alerts (BPA) tools to support clinicians in identifying poor BP control. BPAs have demonstrated effectiveness for other health outcomes.

METHODS

EHR data were collected for patients ≥18 years old seen for primary care office visits prior to, during, and after the BPA active period and used to identify patients for whom the BPA fired or would have fired during control periods. Logistic regression examined the association of BPA activation with follow-up BP check within 14–90 days and with BP control at follow-up, controlling for demographics and health conditions.

RESULTS

The BPA active period was associated with reduced patient follow-up; however, a number of covariates were predictive of increased follow-up: Black non-Hispanics, Hispanics, patients on the chronic kidney disease, HTN, or diabetes registries, as well as the morbidly obese, insurance status, and seasonal factors. For those who did follow-up, BPA activation was associated with improved BP control.

CONCLUSIONS

BPA activation was associated with worse patient follow-up but improved BP control. Some subgroups had significantly different rates of follow-up and BP control. This study did not have an experimental design as the BPA was a quality improvement initiative. These results highlight the critical importance of planning experimentally designed organizational initiatives to fully understand their impact.
GeneLab: Omics database for spaceflight experiments
Authors: Ray Shayoni , Gebre Samrawit , Fogle Homer , Berrios Daniel C , Tran Peter B , Galazka Jonathan M , Costes Sylvain V
Published: October 2018

Motivation

To curate and organize expensive spaceflight experiments conducted aboard space stations and maximize the scientific return of investment, while democratizing access to vast amounts of spaceflight related omics data generated from several model organisms.

Results

The GeneLab Data System (GLDS) is an open access database containing fully coordinated and curated ‘omics’ (genomics, transcriptomics, proteomics, metabolomics) data, detailed metadata and radiation dosimetry for a variety of model organisms. GLDS is supported by an integrated data system allowing federated search across several public bioinformatics repositories. Archived datasets can be queried using full-text search (e.g. keywords, Boolean and wildcards) and results can be sorted in multifactorial manner using assistive filters. GLDS also provides a collaborative platform built on GenomeSpace for sharing files and analyses with collaborators. It currently houses 172 datasets and supports standard guidelines for submission of datasets, MIAME (for microarray), ENCODE Consortium Guidelines (for RNA-seq) and MIAPE Guidelines (for proteomics).

Availability and implementation

https://genelab.nasa.gov/
Atlantic salmon (Salmo salar) smolt and early post-smolt migration and survival inferred from multi-year and multi-stock acoustic telemetry studies in the Gulf of St. Lawrence, northwest Atlantic
Authors: Chaput Gérald , Carr Jonathan , Daniels Jason , Tinker Steve , Jonsen Ian , Whoriskey Frederick
Published: October 2018

The migration dynamics and inter-annual variation in early at-sea survival of Atlantic salmon (Salmo salar) smolts over 14 years of study are reported for four river populations located in the Gulf of St. Lawrence (Canada). Acoustically tagged smolts were monitored at three points along their migration from freshwater to the Labrador Sea, a migration extending more than 800 km at sea and a period of 2 months. A hierarchical state-space version of the Cormack–Jolly–Seber model was used to estimate apparent survival rates from incomplete acoustic detections at key points. There was a positive size-dependent probability of survival through the freshwater and estuary areas; the odds of survival of a 16 cm smolt were 1.5–1.7 times higher than for a 13.5 cm smolt, length at tagging. Length adjusted (centred to the mean fork length of smolts during the study of 14.6 cm) survivals through the estuary and nearshore waters were estimated to range between 67 and 90% for the two river populations migrating through Chaleur Bay in contrast to lower survival estimates of 28–82% for the two populations from the neighbouring Miramichi Bay. Across the 14 years of study, survival estimates varied without trend for the populations of Chaleur Bay, but declined for the populations migrating through Miramichi Bay. Survival through the Gulf of St. Lawrence was variable but generally high among years and rivers, ranging from 96% day−1 to 99% day−1. Long term, replicated studies at multiple sites using acoustically tagged smolts can provide empirical data to examine hypotheses of the location and timing of factors contributing to smolt and post-smolt mortality of salmon at sea.
Hyperelliptic d-Tangential Covers and d× d-Matrix KdV Elliptic Solitons
Authors: Treibich Armando
Published: October 2018

More than $40$ years ago I. Krichever developed the Theory of (vector) Baker–Akhiezer functions and devised a criterion for a $d$-marked compact Riemann surface to provide $d\times d$-matrix solutions to the KdV equation. Later on he also found a criterion for a $d$-marked curve to provide $d\times d$-matrix solutions to the Kadomtsev-Petviashvili (KP) equation, doubly periodic with respect to $x$, the 1st KP flow. In particular, when both criteria apply, one should obtain $d\times d$-matrix KdV elliptic solitons. It seems, however, that the latter issue has been completely neglected until very recently (cf. [10] where the $d=2$ case is treated). In this article we fix a complex elliptic curve $X=\mathbb{C}/\Lambda$, corresponding to a lattice $\Lambda \subset \mathbb{C}$, and define so-called hyperelliptic $d$-tangential covers as $d$-marked covers of $X$ satisfying a geometric condition inside their Jacobians. They satisfy Krichever’s criteria and give rise, therefore, to families of $d\times d$-matrix KdV elliptic solitons. We also construct an anticanonical rational surface ${\mathcal S}$ naturally attached to $X$, with a Picard group of rank $10$. It turns out that the former covers of $X$ correspond to rational irreducible curves in suitable divisor classes of ${\mathcal S}$. We thus reduce their construction to proving that the associated Severi Varieties (of rational irreducible nodal curves) are not empty. The final key to the problem consists in finding rational reducible nodal curves in the latter divisor classes that can be deformed to irreducible ones, according to A. Tannenbaum’s criterion (see [5]). At last we deduce, for any $d\geq 2$, infinite families (of arbitrary high genus and degree) of hyperelliptic $d$-tangential covers, giving rise to $d\times d$-matrix KdV elliptic solitons.
CHALLENGES IN CLINICAL PRACTICE OF CR MAMMOGRAPHY IN TANZANIA
Authors: Jackson Jofrey , Muhogora Wilbroad E , Makundi Ismael N
Published: October 2018

The aim of this study was to evaluate the clinical practice of CR mammography in Tanzania. The equipment performance and operational conditions were studied; and mean glandular dose (DG) estimated to 75 women undergoing diagnosis at three mammography facilities. All mammograms during this study were reported to be useful for the intended diagnosis. The median DG for craniocaudal and mediolateral oblique projections ranged from 1.27 ± 0.18 mGy to 1.9 ± 0.27 mGy and from 1.3 ± 0.18 mGy to 1.9 ± 0.27 mGy, respectively, and were below the national regulatory guidance of 2.5 mGy. Despite this positive result, unavoidable inappropriate use of beam quality and tube loading settings which could have been through appropriate staff training and performing routine quality control were not uncommon. This work provides an insight of current operational conditions of CR in Tanzania and what strategy should be employed to this service to improve patient care in the country.
Financialization and the Decline of Organized Labor: A Study of 18 Advanced Capitalist Countries, 1970–2012
Authors: Kollmeyer Christopher , Peters John
Published: October 2018

Is financialization contributing to the slow decline of union density that is occurring across most advanced capitalist countries? Combining insights from literatures on financialization, corporate governance, and comparative political economy, we argue that the growing dominance of finance within advanced capitalism weakens unions through several channels, and plays an important but underappreciated role in the deunionization of national workforces. Using data from 18 advanced capitalist countries over several decades, this assertion is tested against the literature’s existing explanations for declining union density. Results from panel regression models suggest that financialization is an important cause of union decline, but that its particular effects vary between different types of advanced capitalism. The study concludes by arguing that financialization creates new interconnections between firms and finance capital, resulting in business practices that ultimately put downward pressure on union densities across advanced capitalist countries.
In patients with heart failure the burden of central sleep apnea increases in the late sleep hours
Authors: Javaheri Shahrokh , McKane Scott W , Cameron Nathan , Germany Robin E , Malhotra Atul
Published: October 2018

Study Objectives

Periodic breathing with central sleep apnea (CSA) is common in patients with left ventricular systolic dysfunction. Based on the pathophysiological mechanisms underlying CSA, we hypothesized that the frequency of CSA episodes would increase in the late hours of non-rapid eye movement (NREM) of sleep.

Methods

Forty-one patients with left ventricular ejection fraction <40% underwent full-night-attended polysomnography scored by a central core lab. Because central apneas occur primarily in NREM sleep, total NREM sleep time for each patient was divided into 8 equal duration segments. Segment event counts were normalized to an events/hour index based on sleep segment duration.

Results

Central apnea index (CAI) varied among sleep segments (p = 0.001). As expected CAI was higher in segment 1 compared to segments 2 and 3, increasing during later segments. The minimum CAI occurred in segment 2 with mean ± SD of 21 ± 3 events/hour and maximum CAI was in segment 8 with 37 ± 4 events/hour. We also determined central apnea duration which varied among segments (p = 0.005), with longer durations later in the night (segment 1: 22 ± 1 seconds; segment 8: 26 ± 1 seconds, p < 0.001). Data were also analyzed including rapid eye movement (REM) sleep, with similar results. Further, comparison of CAI between the first and second half of the night showed a significant increase in the index. Circulation time did not change across the segments (p = 0.073).

Conclusions

In patients with left ventricular dysfunction and CSA, central apnea burden (number and duration) increases during later hours of sleep. These findings have pathophysiological and therapeutic implications.

Clinical Trial Registration

NCT01124370.
Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery—2018
Authors: Evered L. , Silbert B. , Knopman D. S. , Scott D. A. , DeKosky S. T. , Rasmussen L. S. , Oh E. S. , Crosby G. , Berger M. , Eckenhoff R. G. ,   The Nomenclature Consensus Working Group
Published: October 2018

Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions.

Two major classification guidelines (Diagnostic and Statistical Manual for Mental Disorders, fifth edition [DSM-5] and National Institute for Aging and the Alzheimer Association [NIA-AA]) are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that ‘perioperative neurocognitive disorders’ be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).
10-YEAR FOLLOW-UP OF A SUBCLINICAL CHOROIDAL NEOVASCULAR MEMBRANE IN A PATIENT WITH AGE-RELATED MACULAR DEGENERATION
Authors: Chen Katherine G. , Christakis Panos G. , Chew Emily Y.
Published: October 2018

Purpose:

To provide long-term, natural history data of a case of a subclinical choroidal neovascular membrane (CNVM) in the setting of age-related macular degeneration.

Methods:

Retrospective review of the 10-year clinical course of a patient including multimodal imaging.

Results:

A 75-year-old white female with macular degeneration presented with visual acuity of 20/25 in the right eye and 20/40 in the left eye. In the left eye, a retinal pigment epithelial detachment with associated subretinal and intraretinal fluid was found on spectral domain optical coherence tomography. Fluorescein angiography was consistent with a predominately classic CNVM, which was well-visualized on indocyanine green angiography. Treatment was initiated with bevacizumab for 10 months that reduced the amount of subretinal and intraretinal fluid, but progressive geographic atrophy developed over the subsequent 9 years reducing vision to 20/100. Interestingly, at initial presentation, a nonexudative fibrovascular pigment epithelial detachment was detected in the right (contralateral) eye. This was monitored with multimodal imaging twice yearly for 10 years without any signs of exudation, and vision remained 20/25. Optical coherence tomography angiography revealed a remarkably similar appearance of the subclinical CNVM compared with indocyanine green angiography 10 years prior, suggesting anatomical stability.

Conclusion:

The advent of optical coherence tomography angiography has increased the detection of subclinical CNVMs. Recent evidence suggests that subclinical CNVMs have a high rate of progression to exudation over 1 year, which raises the question of whether early treatment is beneficial. This case provides 10-year follow-up with multimodal imaging (fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography) of a subclinical CNVM, which remained stable and without exudation, suggesting that they may be closely observed.
Dopamine receptor D2, but not D1, mediates descending dopaminergic pathway–produced analgesic effect in a trigeminal neuropathic pain mouse model
Authors: Liu Sufang , Tang Yuanyuan , Shu Hui , Tatum Delton , Bai Qian , Crawford Joshua , Xing Ying , Lobo Mary Kay , Bellinger Larry , Kramer Phillip , Tao Feng
Published: October 2018

Neuropathic pain represents a challenge to clinicians because it is resistant to commonly prescribed analgesics due to its largely unknown mechanisms. Here, we investigated a descending dopaminergic pathway–mediated modulation of trigeminal neuropathic pain. We performed chronic constriction injury of the infraorbital nerve from the maxillary branch of trigeminal nerve to induce trigeminal neuropathic pain in mice. Our retrograde tracing showed that the descending dopaminergic projection from hypothalamic A11 nucleus to spinal trigeminal nucleus caudalis is bilateral. Optogenetic/chemogenetic manipulation of dopamine receptors D1 and D2 in the spinal trigeminal nucleus caudalis produced opposite effects on the nerve injury–induced trigeminal neuropathic pain. Specific excitation of dopaminergic neurons in the A11 nucleus attenuated the trigeminal neuropathic pain through the activation of D2 receptors in the spinal trigeminal nucleus caudalis. Conversely, specific ablation of the A11 dopaminergic neurons exacerbated such pain. Our results suggest that the descending A11−spinal trigeminal nucleus caudalis dopaminergic projection is critical for the modulation of trigeminal neuropathic pain and could be manipulated to treat such pain.
Accelerating the Drug Delivery Pipeline for Acute and Chronic Pancreatitis
Authors: Lowe Mark E. , Goodman Marc T. , Coté Gregory A. , Glesby Marshall J. , Haupt Mark , Schork Nicholas J. , Singh Vikesh K. , Andersen Dana K. , Pandol Stephen J. , Uc Aliye , Whitcomb David C.
Published: October 2018

Recurrent acute pancreatitis (RAP) is a complex clinical syndrome with significant morbidity, unpredictable outcomes, and limited treatment options. The National Institute of Diabetes and Digestive and Kidney Disease sponsored a workshop on July 25, 2018, in Pittsburgh, Pennsylvania, to address research gaps impeding development of effective therapies for pancreatitis. The RAP working group identified challenges to clinical progress using existing definitions, risk assessment, diagnostic and severity criteria, disease trajectories, outcomes, and research methods. Recurrent acute pancreatitis includes all the risk of acute pancreatitis and often progresses to chronic pancreatitis with variable complications of chronic pain, exocrine insufficiency, diabetes, and pancreatic cancer. However, the great variability among individuals with RAP requires better precision in defining the risks, individual episodes, as well as their frequency, pathogenic pathways, and specific outcome measures for each of the systems affected by pancreatic inflammation. Because of disease complexity, few patients are similar enough for traditional studies and methods to conduct clinical trials with small sample sizes are required. The need for genetic testing, biomarker development, and better imaging methods was highlighted. Adaptive and N-of-one study designs, better endpoints, and outcome measures including patient-reported outcomes should considered early in developing future therapeutic trial design and include all stakeholders.
INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE Cohort Study
Authors: Uc Aliye , Perito Emily R. , Pohl John F. , Shah Uzma , Abu-El-Haija Maisam , Barth Bradley , Bellin Melena D. , Ellery Kate M. , Fishman Douglas S. , Gariepy Cheryl E. , Giefer Matthew J. , Gonska Tanja , Heyman Melvin B. , Himes Ryan W. , Husain Sohail Z. , Maqbool Asim , Mascarenhas Maria R. , McFerron Brian A. , Morinville Veronique D. , Lin Tom K. , Liu Quin Y. , Nathan Jaimie D. , Rhee Sue J. , Ooi Chee Y. , Sellers Zachary M. , Schwarzenberg Sarah Jane , Serrano Jose , Troendle David M. , Werlin Steven L. , Wilschanski Michael , Zheng Yuhua , Yuan Ying , Lowe Mark E.
Published: October 2018

We created the INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE (INSPPIRE 2) cohort to study the risk factors, natural history, and outcomes of pediatric acute recurrent pancreatitis and chronic pancreatitis (CP). Patient and physician questionnaires collect information on demographics, clinical history, family and social history, and disease outcomes. Health-related quality of life, depression, and anxiety are measured using validated questionnaires. Information entered on paper questionnaires is transferred into a database managed by Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer's Coordinating and Data Management Center. Biosamples are collected for DNA isolation and analysis of most common pancreatitis-associated genes.

Twenty-two sites (18 in the United States, 2 in Canada, and 1 each in Israel and Australia) are participating in the INSPPIRE 2 study. These sites have enrolled 211 subjects into the INSPPIRE 2 database toward our goal to recruit more than 800 patients in 2 years. The INSPPIRE 2 cohort study is an extension of the INSPPIRE cohort study with a larger and more diverse patient population. Our goals have expanded to include evaluating risk factors for CP, its sequelae, and psychosocial factors associated with pediatric acute recurrent pancreatitis and CP.
Accelerating the Drug Delivery Pipeline for Acute and Chronic Pancreatitis
Authors: Abu-El-Haija Maisam , Gukovskaya Anna S. , Andersen Dana K. , Gardner Timothy B. , Hegyi Peter , Pandol Stephen J. , Papachristou Georgios I. , Saluja Ashok K. , Singh Vikesh K. , Uc Aliye , Wu Bechien U.
Published: October 2018

A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to focus on research gaps and opportunities on drug development for pancreatitis. This conference was held on July 25, 2018, and structured into 3 working groups (WG): acute pancreatitis (AP) WG, recurrent AP WG, and chronic pancreatitis WG. This article reports the outcome of the work accomplished by the AP WG to provide the natural history, epidemiology, and current management of AP; inform about the role of preclinical models in therapy selection; and discuss clinical trial designs with clinical and patient-reported outcomes to test new therapies.
Combining Russian stimulation with isometric exercise improves strength, balance, and mobility in older people with falls syndrome
Authors: Sanjuán Vásquez Myrope , Montes-Castillo María de la Luz , Zapata-Altamirano Leonor Elia , Martínez-Torres Sara , Vázquez-Mellado Janitzia , López López Carlos Omar
Published: October 2018

One of the main causes of falls in older people is muscle strength loss associated with aging. Russian stimulation can improve muscle strength in healthy individuals, but the effect has never been tested in older individuals with falls syndrome. The aim of this study was to evaluate the usefulness of Russian stimulation plus isometric exercise to improve muscular strength, balance, and mobility in older people with falls syndrome. The recruited participants (older than 60 years, at least one fall in the past year) were evaluated by a physiatrist, who collected clinical data and performed baseline and final evaluations (muscle strength, Berg balance scale, Tinetti mobility test, get up and go test, and 6-min walk test). A physical therapist applied the 10/50/10 protocol for Russian stimulation, stimulating the quadriceps and tibialis anterior muscles separately; simultaneously, the participants performed isometric exercise at a frequency of three sessions per week for 12 weeks. Descriptive statistics, the paired-sample t-test, and the χ
2-test were performed. The study included 25 participants (96% women, mean age 65.2±5.5 years). After the intervention, there was a significant improvement in the strength of the quadriceps (~30%) and tibialis anterior (~40%) muscles as well as the results of the balance (Tinetti 22%, Berg 10%) and mobility (get up and go 25%, 6-min distance 20%) tests. On the basis of the improvements in the Tinetti and Berg scores, significantly fewer participants were classified as being at increased risk for falls. The muscle strength correlated with several clinical evaluation results, but not with the Tinetti test score. Russian stimulation plus isometric exercise improves strength, balance, and mobility, which may decrease the fall risk.
Renal Cell Carcinoma With (Angio)Leiomyomatous Stroma in a Patient With TSC2 Mutation: A Case Report
Authors: Hibbert Joseph Milo , Janssen Karmon , Simper Novae B.
Published: October 2018

We present the case of a 34-year-old woman with a TSC2 gene mutation diagnosed with 4 distinct renal cell carcinomas with (angio)leiomyomatous stroma and 2 concomitant angiomyolipomas of the left kidney. Histologically, the nodules, located in the renal cortex, were mostly encapsulated with an abundant smooth muscle stromal component, which delved into the central epithelial component of the tumor forming septations. The epithelial component was made up of elongated tubules, papillae, and acinar structures with clear to eosinophilic cytoplasm and apical snouts. Focal acinar structures were filled with hypereosinophilic material. The nuclei were basally located and supported by a delicate vascular network. Immunohistochemical studies revealed the tumor cells to express cytokeratin 7, CD10 variably, and carbonic anhydrase IX in an incomplete “cup-like” membranous pattern. The tumor cells did not express AMACR, TFE3, MART-1, or cathepsin K. This report describes a unique presentation of a rare entity and brings attention to an evolving diagnostic field. We discuss problems and controversy surrounding the diagnosis of renal cell carcinoma with (angio)leiomyomatous stroma, its relationship to clear cell papillary renal cell carcinoma and other tumors, and how it correlates with newly discovered genetic mutations.
Pancreatic-Type Mixed Acinar Neuroendocrine Carcinoma Arising in the Common Bile Duct: A Case Report
Authors: Shafique Khurram , Lee Lik Hang , Samad Arbaz , Wang Lu , Klimstra David S.
Published: October 2018

Mixed acinar neuroendocrine carcinoma (MAcNEC) of pancreatic type arising in an extrapancreatic location is extremely rare. We present a case of a 70-year-old woman with constipation, abdominal discomfort, and jaundice. Imaging studies revealed a 1.8-cm solid mass in the common bile duct causing dilatation of intrahepatic and extrahepatic bile ducts, which was resected. Microscopically, the tumor was limited to the wall of the bile duct, without involvement of the pancreas, and was composed of solid sheets and nests of relatively monomorphic cells with minimal to moderate amounts of cytoplasm, granular chromatin, focally prominent nucleoli, and up to 160 mitoses per 10 high-power fields. Immunohistochemistry showed equal to or greater than 30% positivity for synaptophysin, chromogranin, chymotrypsin, and trypsin. A diagnosis of MAcNEC was rendered. Immunohistochemistry plays a pivotal role in the identification of these tumors and discrimination from other related entities, neuroendocrine neoplasms in particular. Because pancreatic heterotopia has been described in the common bile duct, we postulate that this case of MAcNEC in the common bile duct, the first to be reported in the literature, may have arisen via malignant transformation of pancreatic heterotopia.
Outcomes of Elbow Flexion Reconstruction in Patients Older than 50 with Traumatic Brachial Plexus Injury
Authors: Gillis Joshua A. , Khouri Joseph S. , Kircher Michelle F. , Spinner Robert J. , Bishop Allen T. , Shin Alexander Y.
Published: October 2018

Background:

There is controversy regarding the effectiveness of brachial plexus reconstruction for elbow function in older patients, as reported outcomes are generally poor. The purpose of this study was to evaluate elbow function outcomes in patients older than 50.

Methods:

Fifty-eight patients older than 50 years underwent nerve grafting, transfers, or free functioning muscle transfer to improve elbow function after traumatic brachial plexus injury. Patients were evaluated preoperatively and postoperatively for elbow flexion strength and range of motion; Disabilities of the Arm, Shoulder and Hand scores; pain; concomitant trauma; severity of trauma; and type of reconstruction.

Results:

The average age of the patients was 57.8 years, and the average follow-up was 24.0 months. The average modified British Medical Research Council elbow flexion grade improved significantly from 0.26 to 2.63. Thirty-three patients (60 percent) achieved functional flexion greater than or equal to M3 postoperatively, compared to zero patients preoperatively. There was no correlation between age and modified British Medical Research Council grade. Active elbow range of motion improved significantly postoperatively, with no effect of age on flexion motion. More patients achieved greater than or equal to M3 flexion with nerve transfers (69 percent) compared to free functioning muscle transfer (43 percent). Patients had worse outcomes with high-energy injuries. The mean Disabilities of the Arm, Shoulder and Hand score decreased from 51.5 to 49.6 postoperatively, and the average pain score decreased from 5.0 to 4.3.

Conclusion:

Brachial plexus reconstruction for elbow function in patients older than 50 can yield useful flexion.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Unexpected Corpus Callosum Involvement of Diffuse Large B-Cell Lymphoma on FDG PET/CT
Authors: Kan Ying , Wang Yu , Wang Wei , Liu Jie , Yang Jigang
Published: October 2018

Diffuse large B-cell lymphoma (DLBCL) was the most frequent subtype of lymphoid malignancy. Corpus callosum involvement of DLBCL was rarely reported. We present a case of DLBCL involving not only lymph nodes and bowels but also corpus callosum, detected by FDG PET/CT in a patient without neurological symptoms. After 4 cycles of systemic and intrathecal chemotherapy, all previously visualized abnormal activity disappeared on the follow-up FDG PET/CT.
Mediastinal Remnant Thymic Tissue Misdiagnosed as Ectopic Parathyroid Hyperplasia in Secondary Hyperparathyroidism
Authors: Zhang Jun
Published: October 2018

A 56-year-old woman with secondary hyperparathyroidism was referred for preoperative localization of hyperfunctioning parathyroid lesions. 99mTc-MIBI dual-phase and SPECT/CT parathyroid scan showed multiple focal activities behind the thyroid and in the anterior mediastinum, diagnosed as parathyroid hyperplasia. However, the histopathological findings proved them to be hyperplastic parathyroid glands and remnant thymic tissue after parathyroidectomy and unnecessary thoracotomy, respectively.
Selection of Reference Regions to Model Neurodegeneration in Huntington Disease by 18F-FDG PET/CT Using Imaging and Clinical Parameters
Authors: López Mora Diego Alfonso , Sampedro Frederic , Camacho Valle , Fernández Alejandro , Fuentes Francisco , Duch Joan , Pérez-Perez Jesús , Martínez-Horta Saül , Marín-Lahoz Juan , Domènech Anna , Flotats Albert , Estorch Montserrat , Kulisevsky Jaime , Carrió Ignasi
Published: October 2018

Objective

Normalization to an appropriate reference region in 18F-FDG PET imaging may enhance diagnostic performance in Huntington disease (HD). We aimed to identify stable brain areas that could be used to model neurometabolic degeneration in HD correlating imaging (SUVrvalues at the basal ganglia [BBGG]) and clinical parameters (disease burden score [DBS]).

Materials and Methods

We performed brain 18F-FDG PET/CT in 38 manifest HD patients (meanage ± SD, 54 ± 14.3 years; CAGrepeats ± SD, 44.2 ± 3.1), 20 premanifest HD patients (meanage ± SD, 42.7 ± 11.7 years; CAGrepeats ± SD, 40 ± 3.8), and 18 healthy controls (NC; meanage ± SD, 45 ± 13.2 years). For quantitative analysis, we selected (a) defined reference regions from the Montreal Neurological Institute space atlas (pons, whole cerebellum, cerebral white matter, thalamus, and a pons–cerebellar vermis region of interest), and (b) reference clusters obtained by voxelwise statistical comparison across groups (P < 0.05 FWE; extent voxel threshold k = 200). Each candidate reference region and reference cluster was quantitatively assessed using imaging and clinical parameters.

Results

Comparing HD and NC groups, we obtained a reference cluster in the cerebellum, and in temporal and frontal lobes. Comparing manifest HD and premanifest HD patients, we observed reference clusters in the cerebellum, pons, thalamus, parietal lobe, and cuneus. The set of reference regions showed a significant correlation between SUVrvalues at the BBGG and DBS in all HD patients. In premanifest HD patients, the correlation between SUVrvalues at the BBGG and DBS was significant using the pons–cerebellar vermis region of interest, the thalamus as defined reference regions, and the pons and thalamus as reference clusters. In manifest HD patients, the correlation was significant using the temporal and white matter frontal lobe clusters. Variance between SUVrvalues in the set of reference regions and reference clusters was minimal within NC.

Conclusions

The pons may be a stable and reliable region to calculate SUVrvalues to model the neurometabolic degeneration in quantitative 18F-FDG PET imaging in HD.
Single-Surgeon Experience for Maximizing Outcomes in Implant-Based Breast Reconstruction in Chinese Patients
Authors: He Shanshan , Yin Jian , Sun Jingyan , Huang Qingfeng , Liu Jing , Han Chunyong , Yin Zhuming
Published: October 2018

Introduction

Breast reconstruction for Chinese patients is vastly different given cultural differences, patient preferences, access to resources, and insurance coverage in China. Given these unique factors, a different approach for optimizing outcomes should be considered.

Methods

Retrospective review of all patients undergoing implant-based breast reconstruction from January 2013 to May 2016 was performed. Esthetic evaluations were made both by the patients and 1 nonoperative surgeon at least 6 months postoperative, and patient satisfaction was assessed using the Breast-Q.

Results

Overall, 135 patients undergoing 141 implant-based breast reconstructions were reviewed. The majority of implants (n = 134) were placed in a subpectoral position, whereas 7 were placed prepectorally, and no acellular dermal matrix was used. Given the limitations in acellular dermal matrix usage, soft-tissue coverage was augmented with local regional flaps. Ninety-four reconstructions (66.7%) used latissimus dorsi, 39 (27.7%) used serratus anterior, and 7 (5.0%) used mastectomy skin flaps only for implant coverage. Four patients (2.8%) underwent revision surgery to the reconstructed breasts. Grade III and grade IV capsular contracture was observed in 10 (7.1%) and 2 (1.4%) reconstructions, respectively. Both the patient's and the surgeon's satisfaction were higher than 80% in breast symmetry.

Conclusions

Our implant selection method fit the Chinese population characteristics and could be extended to different types of implant-based breast reconstruction. It produced good esthetic outcomes and was reproducible, predictable, and simple to master in the clinical setting.
Distal Radius Fractures in the Elderly
Authors: Miller Jonathan E. , Naram Aparajit , Qin BaiJing , Rothkopf Douglas M.
Published: October 2018

Background

Distal radius fractures represent some of the most common injuries to the upper extremity, yet current evidence demonstrates great variability in the management of this injury. Elderly patients, in particular, stand to benefit from the early mobilization provided by operative fixation with a volar bearing plate.

Methods

We conducted a retrospective chart review on all patients 65 years or older who underwent unilateral open reduction internal fixation of distal radius fractures using a volar bearing plate at a single institution between January 2014 and January 2016. We excluded patients with bilateral injuries, multiple fractures, and major injuries to the same extremity.

Results

Fifty-five patients met criteria for this study. By AO classification, we repaired 17 type A, 24 type B, and 14 type C fractures. At final radiographic measurements, average radial height compared with ulna measured −0.31 mm, average radial inclination measured 20.45 degrees, and average volar tilt measured 7.11 degrees. On discharge, 36 patients had wrist range-of-motion data consistent with a functional wrist. Four patients had limitations in the flexion/extension plane, 8 with radial-ulnar deviation, and 7 had limitations in both planes.

Conclusions

Distal radius fractures in the elderly may successfully be treated with a volar bearing plate. Useful strategies include supraperiosteal dissection of the radius from the pronator quadratus, use of a longer plate for stronger proximal fixation in osteoporotic bone, and regional block. This methodology allows for a safe procedure facilitating the early return of hand and wrist function.
Preoperative Hypoglycemia Increases Infection Risk After Trigger Finger Injection and Release
Authors: Buchanan Patrick J. , Law Tsun , Rosas Sam , Hubbard Zachary , Mast Bruce A. , Chim Harvey
Published: October 2018

Background

Diabetes mellitus is a well-known risk factor for infection after trigger finger (TF) injection and/or release. However, the effect of preoperative hypoglycemia before TF injection or release is currently unknown. The purpose of this study is to determine the effects of preoperative hypoglycemia on infection incidence after TF injection or release.

Methodology

A retrospective cohort review between 2007 and 2015 was conducted using a national private payer database within the PearlDiver Supercomputer. Preoperative, fasting, glucose levels were collected for each patient, and these ranged from 20 to 219 mg/dL. Surgical site infection (SSI) rates were determined using International Classification of Diseases, Ninth Revision codes.

Results

The query of the PearlDiver database returned 153,479 TF injections, of which 3479 (2.27%) and 6276 (4.09%) had infections within 90 days and 1 year after procedure, respectively. There were 70,290 TF releases identified, with 1887 (2.68%) SSIs captured within 3 months after surgery and 3144 (4.47%) within 1 year after surgery. There was a statistically significant increase in SSI rates in patients with hypoglycemia within 90-day (P = 0.006) and 1-year (P < 0.001) time intervals post-TF injection. Likewise, a statistically significant increase in SSI rate in patients with hypoglycemia undergoing TF release within 1 year after release was seen (P = 0.003).

Conclusions

Hypoglycemia before TF injection or release increases the risk for SSI. Tight glycemic control may be warranted to mitigate this risk. Further studies are needed to investigate the effect of hypoglycemia as an independent risk factor for SSI.
Transvaginal Retropubic Urethropexy Versus Pubovaginal Sling for Treatment of Postrepair Urinary Incontinence
Authors: Okunola Temitope Omoladun , Yakubu Emmanuel , Daniyan Babafemi , Ekwedigwe Kenneth , Eliboh Monday , Sunday-Adeoye Ileogben
Published: October 2018

Objectives

The aim of this study was to compare the success rates of transvaginal retropubic urethropexy with fascia lata pubovaginal sling (PV sling) for treatment of postrepair urinary incontinence at a fistula center in Nigeria.

Methods

This was a retrospective review of 60 patients who had transvaginal retropubic urethropexy and 46 patients who had PV sling on account of postrepair incontinence at National Obstetric Fistula Centre, Abakaliki, Nigeria, between January 2014 and December 2016. Data were retrieved from the hospital records. Success was defined as negative urinary stress test at 3 months after repair. Data were analyzed with SPSS version 20, and P value <0.05 was taken as statistically significant. χ2 was used to determine the association between the procedures and success rate.

Results

The success rate of transvaginal retropubic urethropexy versus PV sling was 53.3% versus 82.6% (χ2 = 9.95, P = 0.02). Complications occurred in 13.2%.

Conclusions

In conclusion, the efficacy of the fascia lata PV sling was more than that of transvaginal retropubic urethropexy for postrepair urinary incontinence. Urodynamic assessments need to be incorporated into management of these women for better patient's selection for each procedure.
Indwelling Versus Immediate Removal of Transurethral Catheter After Robotic Sacrocolpopexy: A Randomized Clinical Trial
Authors: Vallabh-Patel Vaneesha , Popiel Patrick , Salamon Charbel
Published: October 2018

Introduction and Hypothesis

This study evaluates the necessity and effect of an indwelling transurethral catheter in the early postoperative period following a robotic-assisted laparoscopic sacrocolpopexy.

Methods

This was a randomized clinical trial of patients who underwent a robotic sacrocolpopexy for pelvic organ prolapse. Patients were randomized to have their transurethral catheter removed 6 hours postoperative (intervention group) or the morning following surgery (control group). Our primary outcome was to compare the number of patients diagnosed with postoperative incomplete bladder empyting in each group. A sample size of 36 patients per group was needed to detect a 25% difference between the 2 groups. Anticipating a 20% patient withdrawal rate, we estimated that we would need a total of 88 participants. Outcome variable was analyzed using χ2 test, Fisher exact test, Mann-Whitney U test, 2-proportions test, and 2-sample t test.

Results

From December 2015 through May 2017, 88 women were randomized and analyzed: 44 in the intervention group and 44 in the control group. Women in the intervention group were more likely to be diagnosed with incomplete bladder emptying, 14 (31%) of 44, compared with the control group, 2 (4.5%) of 44, P <0.001. Rate of urinary tract infections within the 30-day postoperative period was also increased in the intervention group, 4 (9%) of 44, compared with 0 in the control group. Postoperative complications were similar between groups.

Conclusions

In women undergoing a robotic sacrocolpopexy, early transurethral catheter removal (6 hours postoperative) is associated with an increased rate of incomplete bladder emptying, recatheterization, and urinary tract infections.
Cullin3-RING ubiquitin ligases are intimately linked to the unfolded protein response of the endoplasmic reticulum
Authors: Kim Kyungho , Moretti Tamara , Park Sujin , Kim Jinoh
Published: October 2018

CUL3-RING ubiquitin ligases (CRL3s) are involved in various cellular processes through different Bric a brac, Tramtrack and Broad-Complex (BTB)-domain proteins. KLHL12, a BTB-domain protein, appears to play an essential role in export of large cargo molecules like procollagen from the endoplasmic reticulum (ER). It has been suggested that CRL3KLHL12 mono-ubiquitinates SEC31 and mono-ubiquitinated SEC31 increases the dimension of a COPII coat to accommodate the large cargo molecules. As we examined this model, we found that functional CRL3KLHL12 was indeed critical for the assembly of large COPII structures. Interestingly, we noticed that CRL3KLHL12 influences collagen synthesis in human skin fibroblasts (HSFs). Our results also suggest that there is a CRL3KLHL12–independent collagen secretion route in HSFs. In addition, we found that CRL3KLHL12 strongly influences levels of sensors of the unfolded protein response (UPR). Different cell lines reacted differently to CUL3 depletion with respect to UPR regulation. This cell line-dependency appears to rely on a cell line-specific BTB-domain protein(s). Consistent with this idea, depletion of a muscle-specific BTB-domain protein KLHL41 recapitulated the effects of CUL3 depletion in C2C12 myotubes in UPR regulation. Based on these results we propose that CRL3KLHL12 and CRL3KLHL41 are regulators of the UPR.
Automatic whale counting in satellite images with deep learning
Authors: Guirado Emilio , Tabik Siham , Rivas Marga L. , Alcaraz-Segura Domingo , Herrera Francisco
Published: October 2018

Despite their interest and threat status, the number of whales in world’s oceans remains highly uncertain. Whales detection is normally carried out from costly sighting surveys, acoustic surveys or through high-resolution orthoimages. Since deep convolutional neural networks (CNNs) achieve great performance in object-recognition in images, here we propose a robust and generalizable CNN-based system for automatically detecting and counting whales from space based on open data and tools. A test of the system on Google Earth images in ten global whale-watching hotspots achieved a performance (F1-measure) of 84% in detecting and 97% in counting 80 whales. Applying this cost-effective method worldwide could facilitate the assessment of whale populations to guide conservation actions. Free and global access to high-resolution imagery for conservation purposes would boost this process.
Dietary lysozyme supplement alters serum biochemical makers and milk metabolite profile of sows via gut microbiota
Authors: Zhou Jian , Xiong Xia , Zou Lijun , Yin Jia , Wang Kexing , Shao Yirui , Yin Yulong
Published: October 2018

Lysozyme is an important antimicrobial agent with promising future in replacing antibiotics in livestok production. The aim of current study was to determine variations in sow’s gut microbiota, serum immunity and breast milk metabolite profile mediated by lysozyme supplementation.Thirty-six pregnant sows were assigned to a control group without supplementation and two treatments with 0.5 g/kg and 1.0 g/kg lysozyme provided in formula feed for 21days. Microbiota analysis based on 16s RNA high-throughput sequencing and untargeted liquid chromatography tandem mass spectrometry were applied and combined in analysis. Serum biochemical indicators and immunoglobulins were also determined. Sows received 1.0kg/t lyszoyme treatment shown significant redution in microbial diversity. Spirochaetes, Euryarchaeota and Actinobacteria significantly increased while Firmicutes showed a remarkable reduction in 1.0kg/t treated group compared with control. Pyrimidine metabolism,Purine metabolism and Amino acid related enzymes were significantly upregulated in 1.0kg/t lysozyme treated group. The richness of gram-positive bacteria were significantly down-regulated by lysozyme treatments. Serum aspartate transaminase (AST) activity was significantly un-regulated. Serum IgM levels were significantly higher in the 1.0 kg/t group compared with control, while IgA levels was significantly lower in 1.0kg/t group. Over thirty metabolites from sow’s breast milk including L-Glutamine,creatine and L-Arginine were sigficantly altered by lysozyme treatment. There existed crucial correlations among gut microbiota, serum immunity and breast milk metabolites where lactobacillus and prevotella may play a key role in lysozyme mediated host-microbial interactions. Overall, lysozyme supplementation could effectively improve the composition, metabolic functions and phenotypes of sow’s gut microbiota and it also benefit sows with better immune status and breast milk composition.

Importance

Enteric infections caused by pathogens have a significant negative effect on neonatal survival and animal health in swine production. The application of antibiotics in feeds at subtherapeutic levels could improve performance and overall health and is used extensively throughout the industry. However, abuse of antibiotics is contributing to the high level of drug resistance in microbial communities and rising concerns regarding human health. Here, we revealed that lysozyme supplementation could effectively improve the composition, metabolic functions and phenotypes of sow’s gut microbiota and it also benefit sows with better immune status and breast milk composition. These findings confirmed that lysozyme could be a suitable alternative to antibiotics in swine production.