bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilizing Monte Carlo Computations to Estimate Radiation Doses From Some Cosmetics
Authors: Orabi Momen , Abdurahem Om-Azez , Sherif Mohamed
Published: July 2018

Monte Carlo simulations are exploited to assess the annual radiation doses from some cosmetics due to the radioactive decay series of 238U and 232Th and to the radionuclide 40K. The measured radioactivity concentrations are entered into simulation codes modeled and implemented by Monte Carlo n-particle software. The concentrations are found to be relatively high for a large number of the samples. The Monte Carlo-simulated gamma-radiation annual doses are compared with the results of another theoretical approach. Both methods are in good agreement with each other and predict low doses from use of cosmetics.
Establishment of Criteria for Skin Decontamination in a Radiation Emergency
Authors: Yoo Jaeryong , Jin Young Woo
Published: July 2018

In the event of a radiological or nuclear emergency, internal or external contamination (or both) by radionuclides can occur. In such cases, removal of the radionuclides from the injured skin is important because such surface contamination may induce skin damage such as deterministic effects at very high skin doses (2 to 3 Gy). In addition, internal contamination will occur due to radionuclide absorption through the injured skin. Previous studies have suggested various decontamination criteria. However, those criteria are impractical in the case of large-scale population monitoring. Here, to identify practical decontamination criteria, the VARSKIN 4.0 software code is used to assess skin doses originating from surface contamination by 60Co, 131I, and 137Cs. In addition, Integrated Modules for Bioassay Assessment dosimetry software is used to assess the effective doses following radionuclide intake through external contamination for the same three radionuclides. The effective dose dependence on the soluble material type is also assessed. In particular, the effective dose due to radionuclide absorption is found to be greater than the skin dose rate due to surface contamination for the same radioactivity levels. Based on the calculation results, decontamination criteria and actions that depend on the effective dose and surface contamination level (Bq cm−2) for alpha and beta or gamma radiation are suggested. Actions for contaminated injured persons are classified as no action, optional, recommended, or required.
Calibration of Radiation Portal Monitors for Characterization of Historic Low-level Radioactive Waste
Authors: Cole David , Martin-Burtart Nicolas
Published: July 2018

Radiation portal monitors are large-volume radiation detectors typically positioned along roadways, railways, and pedestrian portals. They are typically used for the detection of radioactive material where no such material is expected. Applications include monitoring vehicles and personnel exiting nuclear facilities, at the entrance to steel and scrap metal facilities, and at international borders. As part of the Port Hope Area Initiative, the Port Granby Project involves the relocation of approximately 450,000 m3 of historic low-level radioactive waste, located at an existing site on the shoreline of Lake Ontario in Southeast Clarington, to a new, engineered aboveground mound. Ongoing maintenance and monitoring will continue for hundreds of years after the facility is capped and closed. The waste is transported from its current location about 700 m to the new facility using trucks. Each truck passes through a radiation portal monitor when travelling between the waste location and waste storage facility (both directions; empty and full). The radiation portal monitors have been calibrated to provide an estimate of the total radioactivity being deposited into the new waste facility. This paper describes the methodology and results of the calibration.
Importance of a Risk Stratification Strategy to Identify High-risk Patients Presenting With Cocaine-associated Acute Coronary Syndrome
Authors: Sehatbakhsh Samineh , Kushnir Alexander , Furlan Stefanie , Donath Elie , Ghumman Waqas , Chait Robert
Published: July 2018

Objective:

Current guidelines recommend treating patients with cocaine-associated chest pain, unstable angina, or myocardial infarction similarly to patients with traditional acute coronary syndrome (ACS). Risk stratifying these patients could potentially reduce unnecessary procedures and improve resource utilization.

Methods:

This is a retrospective cross-sectional analysis of 258 patients presenting with cocaine-associated ACS who underwent cardiac catheterization in a community teaching hospital between 2006 and 2015. The primary outcome was the prevalence of acute obstructive coronary artery disease (CAD) requiring percutaneous coronary intervention and coronary artery bypass grafting compared with that of patients with normal coronary or nonobstructive disease.

Results:

Of the studied population, 36% had obstructive CAD requiring intervention and 64% were found to have normal coronaries or nonobstructive disease. Significant risk factors for obstructive CAD were older age, history of CAD, diabetes mellitus, dyslipidemia, ST-segment–elevation myocardial infarction, and troponin elevation. A logistic model was developed based on these variables, applied to the studied population, and was found to have 93% sensitivity in predicting the likelihood of obstructive CAD.

Conclusions:

Cardiac catheterization in patients presenting with cocaine-associated ACS may be overutilized. A predictive model based on clinical risk factors may help individualize patient care and reduce unnecessary invasive diagnostic interventions.
Cervical Spine Dysfunction Following Pediatric Sports-Related Head Trauma
Authors: Ellis Michael J. , McDonald Patrick J. , Olson Ashley , Koenig James , Russell Kelly
Published: July 2018

Objective:

To examine the prevalence of cervical spine injuries among children and adolescents referred with suspected and diagnosed sports-related concussion (SRC); and evaluate the effect of cervical spine dysfunction (CSD) on physician-documented clinical recovery following SRC.

Setting:

A multidisciplinary pediatric concussion program.

Participants:

A total of 266 patients (6-19 years) referred with suspected SRC.

Design:

A retrospective cohort study.

Main Measures:

CSD defined as neurological symptoms localized to the cervical spine or the presence of neck pain, headache, or dizziness and abnormal cervical spine examination findings; physician-documented clinical recovery.

Results:

One patient was diagnosed with a T1 compression fracture. Of the 246 patients diagnosed with SRC, 80 (32.5%) met the clinical criteria for CSD including 4 patients with central cord neuropraxia and 1 with a spinal cord injury without radiographic abnormality (SCIWORA). Excluding patients with central cord neuropraxia OR SCIWORA, patients with SRC with CSD took longer to achieve physician-documented clinical recovery (28.5 days vs 17 days, P < .0001) and were 3.95 times more likely to experience delayed physician-documented clinical recovery (>4 weeks postinjury) compared with those without CSD.

Conclusions:

Patients with suspected and diagnosed SRC can present with a wide spectrum of coincident cervical spine injuries. Cervical spine dysfunction may be a risk factor for delayed clinical recovery.
Early Elementary School Outcome in Children With a History of Traumatic Brain Injury Before Age 6 Years
Authors: Haarbauer-Krupa Juliet , King Tricia Z. , Wise Justin , Gillam Schauna , Trapani Julie , Weissman Barbara , DePompei Roberta
Published: July 2018

Objective:

To describe elementary school outcomes for children who experienced a traumatic brain injury (TBI) before age 6 years compared with a control group of children with orthopedic injuries.

Participants:

Children ages 6 to 9 years recruited from community and trauma registries in a large southeastern state.

Design:

Descriptive findings from the first year of a 3-year longitudinal study.

Main Measures:

Child assessment and parent report measures were administered to capture cognitive, language, reading, and behavior outcomes. Medical record review confirmed injuries and injury severity.

Results:

The TBI group (n = 39) had a mean age of 7.55 years (standard deviation = 1.29) and was 5.15 (standard deviation = 1.56) years postinjury. The TBI group had primarily classified as mild complicated TBI (63%). On average, children in both groups performed within normal limits on most cognitive, language, and reading measures. Group differences were identified in verbal IQ, receptive language, and reading comprehension, with robust performance differences in pragmatic language, story retell and word fluency, and parent report of executive functions.

Conclusions:

Findings indicate the importance of in-depth follow-up specialist assessments (eg, neuropsychologist and speech and language pathologists) to identify potential nuanced difficulties in children with mild complicated TBI that may be missed by general evaluations.
Inertial Sensors Reveal Subtle Motor Deficits When Walking With Horizontal Head Turns After Concussion
Authors: Fino Peter C. , Wilhelm Jennifer , Parrington Lucy , Stuart Samuel , Chesnutt James C. , King Laurie A.
Published: July 2018

Objective:

To examine whether horizontal head turns while seated or while walking, when instrumented with inertial sensors, were sensitive to the acute effects of concussion and whether horizontal head turns had utility for concussion management.

Setting:

Applied field setting, athletic training room.

Participants:

Twenty-four collegiate athletes with sports-related concussion and 25 healthy control athletes.

Design:

Case-control; longitudinal.

Main Measures:

Peak head angular velocity and peak head angle (range of motion) when performing head turns toward an auditory cue while seated or walking. Gait speed when walking with and without head turns.

Results:

Athletes with acute sports-related concussion turned their head slower than healthy control subjects initially (group β = −49.47; SE = 16.33; P = .003) and gradually recovered to healthy control levels within 10 days postconcussion (group × time β = 4.80; SE = 1.41; P < .001). Peak head velocity had fair diagnostic accuracy in differentiating subjects with acute concussion compared with controls (areas under the receiver operating characteristic curve [AUC] = 0.71-0.73). Peak head angle (P = .17) and gait speed (P = .64) were not different between groups and showed poor diagnostic utility (AUC = 0.57-0.62).

Conclusion:

Inertial sensors can improve traditional clinical assessments by quantifying subtle, nonobservable deficits in people following sports-related concussion.
ULTRA-WIDEFIELD MULTIMODAL IMAGING OF PRIMARY VITREORETINAL LYMPHOMA
Authors: Lavine Jeremy A. , Singh Arun D. , Sharma Sumit , Baynes Kimberly , Lowder Careen Y. , Srivastava Sunil K.
Published: July 2018

Purpose:

To determine the features of primary vitreoretinal lymphoma on multimodal ultra-widefield imaging and correlate these findings to clinical outcomes.

Methods:

We report a retrospective, observational case series of 43 eyes of 23 patients with biopsy-proven B-cell primary vitreoretinal lymphoma. Fundus photography, fluorescein angiography (FA), optical coherence tomography, fundus autofluorescence, and indocyanine green angiography images were reviewed. Medical records were assessed for the central nervous system involvement and visual acuity outcomes at 6 and 12 months after presentation.

Results:

Common fundus photography findings were sub–retinal pigment epithelium lesions and vitritis alone. Common ultra-widefield FA findings were vascular leakage and scleral staining. Retinal optical coherence tomography features overlying sub–retinal pigment epithelium lesions or within the macula predicted fluorescence patterns. The presence of retinal fluid or disorganization associated with hyperfluorescence and late leakage. Normal retinal structures associated with hypofluorescence of sub–retinal pigment epithelium lesions or macular leopard spotting on FA and fundus autofluorescence. Peripheral abnormalities noted on ultra-widefield fundus photography, FA, and indocyanine green angiography were more frequent than posterior pole abnormalities. No imaging characteristics predicted time to the central nervous system progression.

Conclusion:

Ultra-widefield imaging was more informative than posterior pole imaging in fundus photography, FA, and indocyanine green angiography. Common findings on multimodal ultra-widefield imaging may lead to early diagnostic vitrectomy and may reduce the delay in primary vitreoretinal lymphoma diagnosis.
UNDERDIAGNOSED OPTIC DISK PIT MACULOPATHY
Authors: Iglicki Matias , Busch Catharina , Loewenstein Anat , Fung Adrian T. , Invernizzi Alessandro , Mariussi Miriana , Arias Romina , Gabrielle Pierre-Henry , Cebeci Zafer , Okada Mali , Nawrocki Jerzy , Michalewska Zofia , Goldstein Michaella , Barak Adiel , Zur Dinah ,   On behalf of The International Retina Group
Published: July 2018

Purpose:

To report a cohort with optic disk pit maculopathy (ODPM) presenting with neurosensory macular detachment that were initially misdiagnosed and mistreated; and to describe structural features on spectral domain optical coherence tomography in misdiagnosed and all other consecutive cases of ODPM.

Methods:

Multicenter international retrospective cohort study. Participants: 59 eyes from 59 patients with ODPM. Main outcome measures: 1) Proportion of patients with ODPM initially misdiagnosed, inaccurate diagnosis and treatment. 2) Morphologic features on spectral domain optical coherence tomography: other causes of subretinal and/or intraretinal fluid, inner/outer retinoschisis, communication with optic disk pit, and retinal pigment epithelium alterations. 3) Visual and anatomical outcomes 6 months after proper treatment.

Results:

Fifteen patients (25.4%) with ODPM were correctly diagnosed initially and those were significantly younger than misdiagnosed cases (age 33.8 ± 15.2 vs. 58.7 ± 15.8 years, P < 0.0001). Forty of forty-four misdiagnosed eyes (90.9%) were treated for their presumed diagnosis before referral. Eyes with initial misdiagnosis had significantly more outer retinoschisis at baseline (88.4 vs. 40.0%, P = 0.0002) and more retinal pigment epithelium alterations (90.0 vs. 27.3%, P < 0.0001) 6 months after proper treatment.

Conclusion:

Optic disk pit maculopathy is an underdiagnosed entity and can mimic other causes for subretinal fluid. Awareness and identification of pertinent spectral domain optical coherence tomography features can help avoid inappropriate and delayed treatment.
BILATERAL CHOROIDAL DETACHMENTS SECONDARY TO IPILIMUMAB AND PEMBROLIZUMAB USE
Authors: O'Bryhim Bliss Elizabeth , Sychev Yevgeniy , Rao Prabakar Kumar
Published: July 2018

Purpose:

To report the occurrence of bilateral choroidal detachments due to the use of ipilimumab and pembrolizumab immunochemotherapeutics to treat widely metastatic cutaneous melanoma and to raise awareness about this potentially vision-threatening adverse drug event.

Methods:

A 77 year-old man presented with acute onset, painless, and bilateral blurry vision. He had started ipilimumab and pembrolizumab 2 weeks prior for Stage IV metastatic cutaneous melanoma.

Results:

Clinical examination revealed bilateral choroidal detachments. After discussion with the patient's medical oncologist, the patient discontinued both medications and began oral prednisone to expedite visual recovery. The choroidal detachments subsequently resolved, and visual acuity improved 2 weeks later.

Conclusion:

Ipilimumab and pembrolizumab have been reported both in monotherapy and in combination to cause a wide variety of ophthalmic adverse events. This is the first report of choroidal detachments as a complication.
The Instruction of Balance and Its Measurement in Professional Physical Therapy Education Programs
Authors: Oates Alison R. , Santoro Regan , Arnold Catherine , Sibley Kathryn M.
Published: July 2018

Introduction.

Physical therapists (PTs) have an important role in identifying and treating individuals with balance impairments to help modify fall risk; however, gaps in comprehensive assessment of balance among practicing PTs have been consistently identified. As academic preparation influences clinical practice, identifying the balance measurement tools included in entry-level training for PTs is important. In particular, exploring their underlying content in relationship to recognized components of balance described in the Systems Framework for Postural Control can highlight strengths and may identify opportunities to advance training and future practice. The objective of this study was to examine how balance and its measurement are included in entry-level physical therapy education programs.

Methods.

Faculty from 110 physical therapy programs in Canada and the United States were surveyed on the inclusion of balance components and validated balance measures using an online survey.

Results.

Descriptive analysis of 95 completed responses illustrated that instructors reported including detailed instruction and practical experience for most balance components. Almost all (26/27) measures included in the survey were included in course content with practical experience by at least one participant. Years of instructing had minimal effect on how the components and/or measures were included in course content. The measures reported to be included with practical experience most often do not assess all components of balance.

Discussion and Conclusions.

Overall, instructors in participating physical therapy education programs reported providing detailed and practical instruction of commonly used balance measures and multiple components of balance. There is opportunity to enhance instruction by incorporating currently available measures that assess most and/or all balance components to ensure newly educated PTs are equipped to comprehensively assess and treat balance to improve fall prevention efforts.
Use of the Dual-Processing Theory to Develop Expert Clinical Reasoning in Physical Therapy Students
Authors: Prokop Tricia R.
Published: July 2018

Background and Purpose.

Cognitive error as a result of poor judgment accounts for a significant percentage of diagnostic errors in medicine. Use of judgment in the clinical setting can be described as clinical reasoning. Therefore, if educators of PT students intend to cultivate safe and effective practitioners, it is imperative to assist students in the development of effective judgment in addition to requisite knowledge and skills. Despite the importance, there are currently many limitations in clinical reasoning research in the field of physical therapy education. The purposes of this article are to introduce dual-processing theory as a means of conceptualizing clinical reasoning in physical therapy education and to provide recommendations for development of clinical reasoning.

Position and Rationale.

Clinical reasoning in physical therapy education lacks a unified theoretical framework from which to base instructional methods. It is the opinion of this author that in conjunction with an understanding of the development of expertise and expert performance, the dual-processing theory of reasoning provides an optimal foundation for clinical reasoning instruction and assessment. The dual-processing theory is underused despite being the prevailing theory to describe reasoning in health care providers. The dual-processing theory describes clinical reasoning as a balance between type I, intuitive, and type II, analytical processing. The final decision made is the result of the interaction between the two types of processing rather than sole reliance on analytical or intuitive thinking alone. This balance is how health care providers make decisions during the evaluation, examination, and treatment of patients. A key component in the ability to accurately manage the use of both types of processing is the awareness of the accuracy of thought processes. This awareness is also referred to as metacognition and is the necessary component of accurate clinical reasoning.

Discussion and Conclusion.

This position paper addresses one of the current limitations in clinical reasoning research in physical therapy by providing a theoretical rationale for use of the dual-processing theory in conceptualizing the components of clinical reasoning. PT students must cultivate an awareness of the accuracy of their thought processes in addition to acquiring deep-structure disciplinary knowledge. In accordance with the dual-processing theory as the theoretical framework for clinical reasoning, explicit teaching of accurate metacognitive self-monitoring in physical therapy education is integral to effective clinical reasoning.
A Versatile Hybrid Mock Circulation for Hydraulic Investigations of Active and Passive Cardiovascular Implants
Authors: Petrou Anastasios , Granegger Marcus , Meboldt Mirko , Schmid Daners Marianne
Published: July 2018

During the development process of active or passive cardiovascular implants, such as ventricular assist devices or vascular grafts, extensive in-vitro testing is required. The aim of the study was to develop a versatile hybrid mock circulation (HMC) which can support the development of such implants that have a complex interaction with the circulation. The HMC operates based on the hardware-in-the-loop concept with a hydraulic interface of four pressure-controlled reservoirs allowing the interaction of the implant with a numerical model of the cardiovascular system. Three different conditions were investigated to highlight the versatility and the efficacy of the HMC during the development of such implants: 1) biventricular assist device (BiVAD) support with progressive aortic valve insufficiency, 2) total artificial heart (TAH) support with increasing pulmonary vascular resistance, and 3) flow distribution in a total cavopulmonary connection (TCPC) in a Fontan circulation during exercise. Realistic pathophysiologic waveforms were generated with the HMC and all hemodynamic conditions were simulated just by adapting the software. The results of the experiments indicated the potential of physiologic control during BiVAD or TAH support to prevent suction or congestion events, which may occur during constant-speed operation. The TCPC geometry influenced the flow distribution between the right and the left pulmonary artery, which was 10% higher in the latter and led to higher pressures. Together with rapid prototyping methods, the HMC may enhance the design of implants to achieve better hemodynamics. Validation of the models with clinical recordings is suggested for increasing the reliability of the HMC.
Critical care outcomes in resource-limited settings
Authors: Vukoja Marija , Riviello Elisabeth D. , Schultz Marcus J.
Published: July 2018

Purpose of review

The burden of critical illness in low-income and middle-income countries (LMICs) is substantial. A better understanding of critical care outcomes is essential for improving critical care delivery in resource-limited settings. In this review, we provide an overview of recent literature reporting on critical care outcomes in LMICs. We discuss several barriers and potential solutions for a better understanding of critical care outcomes in LMICs.

Recent findings

Epidemiologic studies show higher in-hospital mortality rates for critically ill patients in LMICs as compared with patients in high-income countries (HICs). Recent findings suggest that critical care interventions that are effective in HICs may not be effective and may even be harmful in LMICs. Little data on long-term and morbidity outcomes exist. Better outcomes measurement is beginning to emerge in LMICs through decision support tools that report process outcome measures, studies employing mobile health technologies with community health workers and the development of context-specific severity of illness scores.

Outcomes from HICs cannot be reliably extrapolated to LMICs, so it is important to study outcomes for critically ill patients in LMICs. Specific challenges to achieving meaningful outcomes studies in LMICs include defining the critically ill population when few ICU beds exist, the resource-intensiveness of long-term follow-up, and the need for reliable severity of illness scores to interpret outcomes. Although much work remains to be done, examples of studies overcoming these challenges are beginning to emerge.
Both WHR and FLI as Better Algorithms for Both Lean and Overweight/Obese NAFLD in a Chinese Population
Authors: Li Chunlong , Guo Panpan , Zhang Runan , Zhang Meng , Li Yanchuan , Huang Min , Ji Xiaoning , Jiang Yongshuai , Wang Cheng , Li Rui , Feng Rennan
Published: July 2018

Goals:

To compare current nonalcoholic fatty liver disease (NAFLD)-related algorithms to find suitable algorithms for NAFLD, especially lean NAFLD in middle-aged and elderly Chinese population.

Background:

NAFLD is the most common cause of chronic liver disease in the world today. Various algorithms based on obesity indicators, blood lipids, and liver enzymes, etc. have been developed to screen NAFLD.

Materials and Methods:

General, anthropometric and biochemical characteristics were collected. One-way analysis of variance and the χ2 test were applied to test the differences in continuous and categorical variables, respectively. Multivariable logistic regression analyses, adjusted by age, gender, body mass index, tobacco use, alcohol consumption, and physical activities, were used to investigate the associations between NAFLD-related algorithms and NAFLD. The accuracy and cut-off point of NAFLD-related algorithms to detect NAFLD were evaluated by area under the receiver operator characteristic curve and the maximum Youden index analysis, respectively.

Results:

In 8 NAFLD-related algorithms, the receiver operator characteristic of fatty liver index (FLI) and waist circumstance-to-height ratio (WHR) for NAFLD were in the whole (0.83 and 0.84), lean (0.74 and 0.74), and overweight/obese (0.71 and 0.72) population, respectively, which were higher than those of other algorithms. The cut-off points of WHR and FLI for NAFLD were different in the overall (0.50 and 20), lean (0.47 and 10), and overweight/obese (0.53 and 45) population.

Conclusions:

WHR and FLI could be the most accurate of 8 algorithms for the noninvasive diagnosis of NAFLD in both lean and overweight/obese population.
Cardiovascular disease in Williams syndrome
Authors: Collins R. Thomas
Published: July 2018

Purpose of review

Williams syndrome is a multisystem disorder seen with some regularity at most pediatric centers and usually fairly often at larger centers. Cardiovascular abnormalities, because of elastin deficiency, are the leading cause of morbidity and mortality in patients with Williams syndrome. The present article presents a review of the most recent developments regarding the cardiovascular issues in Williams syndrome.

Recent findings

Cardiovascular abnormalities occur in 80% of patients with Williams syndrome, the majority of which are arterial stenoses. The stenoses seen in Williams syndrome now appear to arise from deficient circumferential arterial growth. Pharmacological therapies aimed at improving the vascular stenoses have shown some promise in animal models. Surgical outcomes for supravalvar aortic stenosis are good at most centers. Transcatheter interventions are largely ineffective in Williams syndrome. Multilevel surgical pulmonary artery reconstruction has excellent results for peripheral pulmonary artery stenosis. Periprocedural risk stratification and management algorithms may decrease the risk of cardiovascular complications.

Cardiovascular abnormalities are a major determining factor in the clinical picture and trajectory of patients with Williams syndrome. Advances in surgical techniques, medical therapeutic options, and periprocedural management hold promise for significant improvements in the cardiovascular outcomes of these patients.
Patient and Procedural Factors Associated With Increased Islet Cell Yield in Total Pancreatectomy With Islet Autotransplantation
Authors: Trinh Katherine V. , Smith Kerrington D. , Gardner Timothy B.
Published: July 2018

Objectives

Total pancreatectomy with islet autotransplantation (TPIAT) offers symptom relief to highly selected patients with recurrent acute and/or chronic pancreatitis. However, with variable clinical response, it is important to refine islet manipulation technique and patient selection criteria. This study explores the variables associated with high islet cell yield, a driver of success in TPIAT.

Methods

This study evaluated patients who underwent TPIAT at Dartmouth-Hitchcock Medical Center from 2012 to 2016. Odds ratios were calculated for various patient and procedural characteristics. The primary clinical outcome was the number of isolated islet equivalents per kilogram body weight.

Results

Thirty-eight patients met inclusion criteria. Patients with no computed tomography or magnetic resonance imaging evidence of chronic pancreatitis, without pancreatic duct stones, and without parenchymal stones were associated with higher odds of success (P = 0.02, P = 0.02, and P = 0.002, respectively). Patients with preoperative glycated hemoglobin greater than 5.6, with islet cell suspensions positive for cultures, and with positive gram stains were associated with lower odds of success (P = 0.02, P = 0.01, and P = 0.02, respectively).

Conclusions

Factors that diminish a successful islet cell harvest during TPIAT include the presence of infected islets, an elevated preoperative glycated hemoglobin, and the presence of pancreatic duct stones.
Severe ABO Hemolytic Disease of the Newborn Requiring Exchange Transfusion
Authors: Metcalf Ryan A. , Khan Jenna , Andrews Jennifer , Mayock Dennis , Billimoria Zeenia , Pagano Monica B.
Published: July 2018

ABO incompatibility (ABOi), the most common cause of hemolytic disease of the newborn (HDN), is nearly always mild and treatable with phototherapy. Reports of ABOi HDN requiring neonatal exchange transfusion are extremely rare since the inception of modern guidelines. Here, a case of ABOi HDN clearly met criteria for exchange transfusion. An O-positive African American mother delivered a B-positive neonate that quickly developed hyperbilirubinemia. The neonatal DAT was positive from anti-B and anti-A,B, and maternal IgG titer was 1024. Double volume exchange transfusion resulted in a favorable outcome. Given early discharge of newborns, further understanding of factors predicting severe disease is needed.
Feasibility of a targeted strengthening program to improve gait in people with multiple sclerosis: a brief report
Authors: Mañago Mark M. , Hebert Jeffrey R. , Kittelson John , Schenkman Margaret
Published: July 2018

This study aims to determine feasibility of strengthening muscles that are important contributors to gait for people with multiple sclerosis, yet are not routinely targeted in the literature. An 8-week strengthening intervention targeted ankle plantarflexion, hip abduction, and trunk muscles using a repeated-measures design. Outcomes included satisfaction, adherence, muscle strength, gait speed (timed 25-foot walk), gait endurance (6-min walk test), and self-reported gait-related participation (Multiple Sclerosis Walking Scale-12). Ten participants (Expanded Disability Status Scale: 3.5–5.5) completed the intervention. All participants were at least ‘satisfied’; adherence was 87% (supervised sessions) and 75% (home sessions). All quantitative measures improved: muscle strength (23.1–47.6%, P<0.001–0.039), timed 25-foot walk (−13.4%, P<0.001), 6-min walk test (41.56 m, P=0.019), and Multiple Sclerosis Walking Scale-12 (−10.5, P=0.007). Strengthening of ankle plantarflexion, hip abduction, and trunk muscles was feasible and associated with improvements in gait performance.
Depressive Symptom Clusters and Their Relationships With Anxiety and Posttraumatic Stress Disorder Symptoms in Patients With Cancer
Authors: Li Jie , Zhang Huihui , Shao Di , Xue Jiaomei , Bai Huayu , Sun Jiwei , Lin Pingzhen , Cao Fenglin
Published: July 2018

Background

Depressive symptoms are prevalent in patients with cancer and are heterogeneous; however, existing methods of grouping patients with heterogeneous symptoms have limitations.

Objectives

The purpose of this study was to identify depressive symptom clusters in patients with cancer using a data-driven method and to explore their relationships with symptoms of anxiety and posttraumatic stress disorder.

Methods

Data from 247 patients were analyzed in this cross-sectional study. Latent class analysis was used to identify depressive symptom clusters, using 9 depressive symptoms from the Patient Health Questionnaire. Symptoms of anxiety and posttraumatic stress disorder were measured, and the relationships between them and the clusters were explored through linear regression analyses.

Results

Four clusters of depressive symptoms were identified: (1) minimal with sleep and appetite disturbances (23.9%), (2) somatic (22.3%), (3) moderate with sleep disturbance and fatigue (32.4%), and (4) severe (21.5%). The order of severity of anxiety and posttraumatic stress disorder symptoms was comparable across the 4 clusters of depressive symptoms. The anxiety and posttraumatic stress disorder symptoms of patients in clusters 3 and 4 were more severe than those in cluster 1 (B = 4.70-19.19, P < .001).

Conclusion

Using latent class analysis, 4 clusters of depressive symptoms were identified in patients with cancer, which were significantly correlated with symptoms of anxiety and posttraumatic stress disorder.

Implications for Practice

Latent class analysis can be used to identify clusters of depressive symptoms in patients with cancer. Such groupings may hasten the development of individualized intervention approaches tailored to patients' specific depressive clusters.
Combination Antimicrobial Prophylaxis for Hysterectomy: Harm Without the Benefit?
Authors: Branch-Elliman Westyn , Ripollone John , O’Brien William , Itani Kamal , Strymish Judith , Gupta Kalpana
Published: July 2018

(Abstracted from Am J Obstet Gynecol 2018;218(5):536–537)

Results from several studies suggest that prophylactic use of combination antimicrobial regimens reduce postoperative surgical site infections (SSIs) after cesarean delivery and other surgical procedures. A recent study, however, reported that combination regimens were associated with increases in postoperative acute kidney injury (AKI) after nongynecologic surgical procedures.
Does Implementing a Regime of Dexamethasone Before Planned Cesarean Section at Term Reduce Admission With Respiratory Morbidity to Neonatal Intensive Care Unit? A Randomized Controlled Trial
Authors: Nooh Ahmed Mohamed , Abdeldayem Hussein Mohammed , Arafa Eisa , Shazly Sherin Attia , Elsayed Hany , Mokhtar Wesam A.
Published: July 2018

(Abstracted from J Matern Fetal Neonatal Med 2018;31:614–620)

Planned cesarean section (CS) has been found to lead to significantly higher rates of overall neonatal respiratory morbidity than intended vaginal delivery. Various etiologies for these complications have been proposed such as iatrogenic prematurity with surfactant deficiency and an absence of hormonal and physiological changes necessary for proper lung functioning in infants delivered by planned CS.
Impact of Significant Decreases Over Time in the Proportion of Sexually Active Medicaid Women Who Had Papanicolaou Testing or Were Pregnant on Trends of Overall Chlamydia Testing Rates
Authors: Tao Guoyu , Kreisel Kristen , Gift Thomas L.
Published: July 2018

We examined Medicaid claims data during 2004 to 2013. The proportion of sexually active females aged 15 to 25 years who had Papanicolaou testing or were pregnant significantly decreased during 2004 to 2013 (67.0% to 43.9%, P < 0.05), resulting in a slowed increasing trend in overall chlamydia screening rates. Structural-level interventions for improving chlamydia screening are urgently needed.
Differences Between Pulmonary and Extrapulmonary Pediatric Acute Respiratory Distress Syndrome: A Multicenter Analysis
Authors: Gan Chin Seng , Wong Judith Ju-Ming , Samransamruajkit Rujipat , Chuah Soo Lin , Chor Yek Kee , Qian Suyun , Anantasit Nattachai , Feng Xu , Ong Jacqueline Soo May , Phuc Phan Huu , Phumeetham Suwannee , Sultana Rehena , Loh Tsee Foong , Lum Lucy Chai See , Lee Jan Hau
Published: July 2018

Objectives:

Extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome are poorly described in the literature. We aimed to describe and compare the epidemiology, risk factors for mortality, and outcomes in extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome.

Design:

This is a secondary analysis of a multicenter, retrospective, cohort study. Data on epidemiology, ventilation, therapies, and outcomes were collected and analyzed. Patients were classified into two mutually exclusive groups (extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome) based on etiologies. Primary outcome was PICU mortality. Cox proportional hazard regression was used to identify risk factors for mortality.

Setting:

Ten multidisciplinary PICUs in Asia.

Patients:

Mechanically ventilated children meeting the Pediatric Acute Lung Injury Consensus Conference criteria for pediatric acute respiratory distress syndrome between 2009 and 2015.

Interventions:

None.

Measurements and Main Results:

Forty-one of 307 patients (13.4%) and 266 of 307 patients (86.6%) were classified into extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome groups, respectively. The most common causes for extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome were sepsis (82.9%) and pneumonia (91.7%), respectively. Children with extrapulmonary pediatric acute respiratory distress syndrome were older, had higher admission severity scores, and had a greater proportion of organ dysfunction compared with pulmonary pediatric acute respiratory distress syndrome group. Patients in the extrapulmonary pediatric acute respiratory distress syndrome group had higher mortality (48.8% vs 24.8%; p = 0.002) and reduced ventilator-free days (median 2.0 d [interquartile range 0.0–18.0 d] vs 19.0 d [0.5–24.0 d]; p = 0.001) compared with the pulmonary pediatric acute respiratory distress syndrome group. After adjusting for site, severity of illness, comorbidities, multiple organ dysfunction, and severity of acute respiratory distress syndrome, extrapulmonary pediatric acute respiratory distress syndrome etiology was not associated with mortality (adjusted hazard ratio, 1.56 [95% CI, 0.90–2.71]).

Conclusions:

Patients with extrapulmonary pediatric acute respiratory distress syndrome were sicker and had poorer clinical outcomes. However, after adjusting for confounders, it was not an independent risk factor for mortality.
Acute Scrotal Pain and a Different Use of an Old Imaging Method
Authors: Tramma Despoina , Gogou Maria , Lambropoulos Vasilios
Published: July 2018

The differential diagnosis of scrotal pain in childhood is a challenge for every primary care physician. We report the case of a 5-year-old boy presenting to the emergency department owing to acute left scrotal pain. Ultrasound screening revealed a Morgagni hydatid in the left testis, which was surgically removed. X-rays revealed microcalcifications of the cyst wall and stroma, signs indicative of chronic inflammation. Results of histological examination confirmed radiographic evaluation. No similar use of x-rays has been described in literature before, to the best of our knowledge. A brief discussion also follows about Morgagni hydatid in childhood.
Latent Classes of Sexual Risk Behavior and Engagement in Outreach, Intervention and Prevention Services Among Women Who Inject Drugs Across 20 US Cities
Authors: Mackesy-Amiti Mary Ellen , Boodram Basmattee , Handanagic Senad , Paz-Bailey Gabriela , Prachand Nikhil G. , Broz Dita ,   for the NHBS Study Group
Published: July 2018

Background:

Monitoring the effects of HIV prevention efforts among persons who inject drugs is key to informing prevention programs and policy.

Methods:

Data for this study came from the 2012 National HIV Behavioral Surveillance interviews with persons who inject drugs across 20 US cities. The present analyses include those who identified as female, ever had sex with a man, and were at risk of HIV infection (did not report a previous positive HIV test result) (n = 2624). We conducted latent class analysis to identify sexual risk classes, and modeled associations with engagement in HIV prevention services and HIV test results.

Results:

We identified 6 classes of sexual risk behavior: (1) low risk, (2) monogamous, (3) casual partner, (4) multiple partners, (5) exchange sex, and (6) exchange plus main partner. The class distribution was similar across the mainland regions. Bisexual orientation and homelessness were significant predictors of higher-risk class. HIV prevalence and participation in behavioral interventions did not vary significantly by risk class, while obtaining and using free condoms did. Independent of risk class, women in cities in the South were significantly less likely to use free condoms, and HIV prevalence was higher among non-Hispanic black women and women aged 40–49 years.

Conclusions:

Bisexual orientation and homelessness were predictors of higher risk. Condom distribution programs reached fewer women in cities in the South. Race and age disparities in HIV-positive rates persisted after adjusting for sexual risk class.
Lymphocytic Thrombophilic Arteritis
Authors: Vakili Sharif , Zampella John G. , Kwatra Shawn G. , Blanck Jaime , Loss Manisha
Published: July 2018

Macular lymphocytic arteritis or lymphocytic thrombophilic arteritis (LTA) is a recently described cutaneous arteritis that is characterized by asymptomatic macules and patches of the extremities associated with lymphocytic arteritis at the deep dermal/subcuticular junction for which little information exists on demographics, evaluation, and management. There has been recent debate in the literature whether this disease is a new distinct entity, misdiagnosed cutaneous polyarteritis nodosa (cPAN), or a disease on a spectrum with cPAN. We systematically review the literature on demographic information, medical history, histopathology findings, and treatment management to analyze trends and clarify controversies in characterizations of LTA. Forty detailed cases of LTA have been published. We submit that, although literature is limited, a review of the data still suggests that LTA is distinct from cPAN and systemic PAN. In addition, to better reflect the pathophysiologic natural history of this condition and correct for the historical artifact of how the disease was identified, we encourage the disease to be referred to as LTA and discourage ongoing use of macular lymphocytic arteritis.
Xenoantigen Deletion and Chemical Immunosuppression Can Prolong Renal Xenograft Survival
Authors: Adams Andrew B. , Kim Steven C. , Martens Gregory R. , Ladowski Joseph M. , Estrada Jose L. , Reyes Luz M. , Breeden Cindy , Stephenson Allison , Eckhoff Devin E. , Tector Matt , Tector Alfred Joseph
Published: July 2018

Objective:

Xenotransplantation using pig organs could end the donor organ shortage for transplantation, but humans have xenoreactive antibodies that cause early graft rejection. Genome editing can eliminate xenoantigens in donor pigs to minimize the impact of these xenoantibodies. Here we determine whether an improved cross-match and chemical immunosuppression could result in prolonged kidney xenograft survival in a pig-to-rhesus preclinical model.

Methods:

Double xenoantigen (Gal and Sda) knockout (DKO) pigs were created using CRISPR/Cas. Serum from rhesus monkeys (n = 43) was cross-matched with cells from the DKO pigs. Kidneys from the DKO pigs were transplanted into rhesus monkeys (n = 6) that had the least reactive cross-matches. The rhesus recipients were immunosuppressed with anti-CD4 and anti-CD8 T-cell depletion, anti-CD154, mycophenolic acid, and steroids.

Results:

Rhesus antibody binding to DKO cells is reduced, but all still have positive CDC and flow cross-match. Three grafts were rejected early at 5, 6, and 6 days. Longer survival was achieved in recipients with survival to 35, 100, and 435 days. Each of the 3 early graft losses was secondary to IgM antibody-mediated rejection. The 435-day graft loss occurred secondary to IgG antibody-mediated rejection.

Conclusions:

Reducing xenoantigens in donor pigs and chemical immunosuppression can be used to achieve prolonged renal xenograft survival in a preclinical model, suggesting that if a negative cross-match can be obtained for humans then prolonged survival could be achieved.
Increased sea ice concentration worsens fledging condition and juvenile survival in a pagophilic seabird, the snow petrel
Authors: Sauser Christophe , Delord Karine , Barbraud Christophe
Published: July 2018

Polar sea ice is changing rapidly, threatening many taxa in the Arctic and the Antarctic. Little is known about the effects of sea ice on early life-history traits of sea ice specialist species, although juvenile stages are a critical component of population dynamics and recruitment. We examined how annual variation in sea ice concentration (SIC) affects juvenile survival and body condition at fledging in the snow petrelPagodroma niveausing long-term datasets encompassing 22 years for body condition and 37 years for juvenile survival. We show that SIC and southern annular mode (SAM), the principal mode of variability of the atmospheric circulation in the Southern Hemisphere, have strong nonlinear effects on juvenile survival and body condition. Belowca20–30% SIC, body condition remained stable, but decreased almost linearly for higher SIC. Juvenile survival was negatively related to SIC and to SAM during the chick rearing period. We suggest that the base of the sea ice food web would be directly affected by sea ice conditions, thus acting locally on the abundance and structure of prey communities.
Wnt controls the medial–lateral subdivision of theDrosophilahead
Authors: Magri M. S. , Domínguez-Cejudo M. A. , Casares F.
Published: July 2018

In insects, the subdivision of the head into a lateral region, harbouring the compound eyes (CEs), and a dorsal (medial) region, where the ocelli localize, is conserved. This organization might have been already present in the insects' euarthropodan ancestors. InDrosophila,the Wnt-1 homologuewingless (wg)plays a major role in the genetic subdivision of the head. To analyse specifically the role ofwgsignalling in the development of the dorsal head, we attenuated this pathway specifically in this region by genetic means. We find that loss ofwgsignalling transforms the dorsal/medial head into lateral head structures, including the development of ectopic CEs.Our genetic analysis further suggests thatwgsignalling organizes the dorsal head medial–lateral axis by controlling, at least in part, the expression domains of the transcription factors Otd and Ey/Pax6.
Sexual attractiveness and reproductive performance in ageing females of a coccoid insect
Authors: Tabata Jun , Teshiba Mayumi
Published: July 2018

Female age strongly influences reproductive success in various animals. Males are, therefore, expected to show preferential responses to sexual signals released from females of ages suitable for reproduction. Here, however, we report an unexpected and contradictory effect of ageing on sexual attractiveness and reproductive performance in a coccoid insect: the pheromone-based attractiveness of females increased with ageing, though their reproductive performance was in rapid decline. Surprisingly, senescent females continued releasing relatively high amounts of pheromone and maintained their sexual attractiveness, even at ages when they had almost completely lost fertility, with reduced densities of endosymbionts to support their physiology. Our dataset suggests a potential sexual conflict within a pheromone communication system, where females benefit at males' expense through deceptive signals of fertility.