bluuebunny/crossref_metadata_2025 huggingface dataset:
Solubility of soy lipophilic proteins: comparison with other soy protein fractions
Authors: Sirison Jiraporn , Matsumiya Kentaro , Samoto Masahiko , Hidaka Hiroshi , Kouno Mitsutaka , Matsumura Yasuki
Published: February 2017

Solubility of soy lipophilic proteins (LP) was studied as compared with that of other soy protein fractions. LP, β-conglycinin, glycinin, and soy protein isolate (N-SPI) were prepared under the condition to avoid heat denaturation. Solubility of LP was lower than that of other soy protein fractions under all the tested conditions varying in pH values and ionic strength. The solubility of LP was increased constantly by elevating temperature until 90 °C, whereas that of β-conglycinin and glycinin dropped at high temperature. Temperature-dependent change in solubility of N-SPI might reflect the balance among that of glycinin, β-conglycinin and LP. Based on the results of SDS-PAGE, determination of phospholipid content and Fourier Transform Infrared spectroscopy, we discussed the solubilization behavior of LP relating to its origin and composition.
Low frequency bi-syllabic wordlists in a South-Indian language, Kannada
Authors: Barman Animesh , Narne Vijaya Kumar , Prabhu Prashanth , Singh Niraj Kumar , Thammaiah Spoorthi
Published: February 2017

Objective:

The present study aimed to develop, standardize and validate low frequency bi-syllabic wordlists in Kannada, a South-Indian language.

Study design:

The study was conducted in three different phases. The Kannada low frequency wordlists were developed in Phase I. The procedure involved collecting bi-syllabic familiar words, recording them, selecting the words dominant in low frequency energy by acoustical (Fast Fourier) transform and statistical means (k-means clustering) then generating equivalent wordlists using psychometric function. In Phase II, all the wordlists developed were standardized through estimation of speech identification scores in 100 individuals with normal hearing and through re-verification of equivalence of wordlists’ difficulty level by obtaining psychometric function. Finally, during Phase III, lists developed were evaluated for usefulness by administering them along with conventional phonemically-balanced Kannada wordlist on 10 individuals with cochlear hearing loss having rising audiometric configurations (i.e. more loss at lower frequencies).

Results:

Phase I resulted in development of seven psychometrically equivalent wordlists. Speech identification scores on 100 individuals with normal hearing showed mean scores greater than 95% for all the lists at 40 dB SL. No statistical difference was noted across wordlists. Further, individuals with rising cochlear hearing loss (RCHL) performed significantly poorer when compared to normal hearing counterparts across wordlists except low frequency wordlist 4 and phonemically balanced wordlist.

Conclusions:

The study utilized a unique procedure for the development of wordlists which can serve as guidelines for further research. The study has resulted in standardization (along with generation of normative data) and successful validation of the lists (except list 4) developed on a clinical population, i.e. individuals with RCHL. Given the lack of availability and the current clinical/research need of such test materials, the wordlists generated from this study can be useful.
PhosphoPICK-SNP: quantifying the effect of amino acid variants on protein phosphorylation
Authors: Patrick Ralph , Kobe Bostjan , Lê Cao Kim-Anh , Bodén Mikael
Published: February 2017

Motivation

Genome-wide association studies are identifying single nucleotide variants (SNVs) linked to various diseases, however the functional effect caused by these variants is often unknown. One potential functional effect, the loss or gain of protein phosphorylation sites, can be induced through variations in key amino acids that disrupt or introduce valid kinase binding patterns. Current methods for predicting the effect of SNVs on phosphorylation operate on the sequence content of reference and variant proteins. However, consideration of the amino acid sequence alone is insufficient for predicting phosphorylation change, as context factors determine kinase-substrate selection.

Results

We present here a method for quantifying the effect of SNVs on protein phosphorylation through an integrated system of motif analysis and context-based assessment of kinase targets. By predicting the effect that known variants across the proteome have on phosphorylation, we are able to use this background of proteome-wide variant effects to quantify the significance of novel variants for modifying phosphorylation. We validate our method on a manually curated set of phosphorylation change-causing variants from the primary literature, showing that the method predicts known examples of phosphorylation change at high levels of specificity. We apply our approach to data-sets of variants in phosphorylation site regions, showing that variants causing predicted phosphorylation loss are over-represented among disease-associated variants.

Availability and Implementation

The method is freely available as a web-service at the website http://bioinf.scmb.uq.edu.au/phosphopick/snp

Supplementary information

Supplementary data are available at Bioinformatics online.
OncoSimulR: genetic simulation with arbitrary epistasis and mutator genes in asexual populations
Authors: Diaz-Uriarte Ramon
Published: February 2017

OncoSimulR implements forward-time genetic simulations of biallelic loci in asexual populations with special focus on cancer progression. Fitness can be defined as an arbitrary function of genetic interactions between multiple genes or modules of genes, including epistasis, restrictions in the order of accumulation of mutations, and order effects. Mutation rates can differ among genes, and can be affected by (anti)mutator genes. Also available are sampling from simulations (including single-cell sampling), plotting the genealogical relationships of clones and generating and plotting fitness landscapes.

Availability and Implementation

Implemented in R and C ++, freely available from BioConductor for Linux, Mac and Windows under the GNU GPL license. Version 2.5.9 or higher available from: http://www.bioconductor.org/packages/devel/bioc/html/OncoSimulR.html. GitHub repository at: https://github.com/rdiaz02/OncoSimul

Supplementary information

Supplementary data are available at Bioinformatics online.
The Association Between Geographic Density of Infectious Disease Physicians and Limb Preservation in Patients With Diabetic Foot Ulcers
Authors: Brennan Meghan B. , Allen Glenn O. , Ferguson Patrick D. , McBride Joseph A. , Crnich Christopher J. , Smith Maureen A.
Published: February 2017

Background

Avoiding major (above-ankle) amputation in patients with diabetic foot ulcers is best accomplished by multidisciplinary care teams with access to infectious disease specialists. However, access to infectious disease physicians is partially influenced by geography. We assessed the effect of living in a hospital referral region with a high geographic density of infectious disease physicians on major amputation for patients with diabetic foot ulcers. We studied geographic density, rather than infectious disease consultation, to capture both the direct and indirect (eg, informal consultation) effects of access to these providers on major amputation.

Methods

We used a national retrospective cohort of 56440 Medicare enrollees with incident diabetic foot ulcers. Cox proportional hazard models were used to assess the relationship between infectious disease physician density and major amputation, while controlling for patient demographics, comorbidities, and ulcer severity.

Results

Living in hospital referral regions with high geographic density of infectious disease physicians was associated with a reduced risk of major amputation after controlling for demographics, comorbidities, and ulcer severity (hazard ratio, .83; 95% confidence interval, .75–.91; P < .001). The relationship between the geographic density of infectious disease physicians and major amputation was not different based on ulcer severity and was maintained when adjusting for socioeconomic factors and modeling amputation-free survival.

Conclusions

Infectious disease physicians may play an important role in limb salvage. Future studies should explore whether improved access to infectious disease physicians results in fewer major amputations.
Community Environmental Contamination of Toxigenic Clostridium difficile
Authors: Alam M Jahangir , Walk Seth T. , Endres Bradley T. , Basseres Eugenie , Khaleduzzaman Mohammed , Amadio Jonathan , Musick William L. , Christensen Jennifer L. , Kuo Julie , Atmar Robert L. , Garey Kevin W.
Published: February 2017

Background

Clostridium difficile infection is often considered to result from recent acquisition of a C difficile isolate in a healthcare setting. However, C difficile spores can persist for long periods of time, suggesting a potentially large community environmental reservoir. The objectives of this study were to assess community environmental contamination of toxigenic C difficile and to assess strain distribution in environmental versus clinical isolates.

Methods

From 2013 to 2015, we collected community environmental swabs from homes and public areas in Houston, Texas to assess C difficile contamination. All positive isolates were tested for C difficile toxins A and B, ribotyped, and compared with clinical C difficile isolates obtained from hospitalized patients in Houston healthcare settings.

Results

A total of 2538 environmental samples were collected over the study period. These included samples obtained from homes (n = 1079), parks (n = 491), chain stores (n = 225), fast food restaurants (n = 123), other commercial stores (n = 172), and hospitals (n = 448). Overall, 418 environmental isolates grew toxigenic C difficile (16.5%; P < .001) most commonly from parks (24.6%), followed by homes (17.1%), hospitals (16.5%), commercial stores (8.1%), chain stores (7.6%), and fast food restaurants (6.5%). A similar distribution of ribotypes was observed between clinical and environmental isolates with the exception that ribotype 027 was more common in clinical isolates compared with environmental isolates (P < .001).

Conclusions

We identified a high prevalence of toxigenic C difficile from community environs that were similar ribotypes to clinical isolates. These findings suggest that interventions beyond isolation of symptomatic patients should be targeted for prevention of C difficile infection.
Influence of Ethanol on Oxycodone-induced Respiratory Depression
Authors: van der Schrier Rutger , Roozekrans Margot , Olofsen Erik , Aarts Leon , van Velzen Monique , de Jong Merijn , Dahan Albert , Niesters Marieke
Published: February 2017

Background

Respiratory depression is a potentially fatal complication of opioid use, which may be exacerbated by simultaneous ethanol intake. In this three-way sequential crossover dose-escalating study, the influence of coadministration of oral oxycodone and intravenous ethanol was assessed on resting ventilation, apneic events and the hypercapnic ventilatory response in healthy young and older volunteers.

Methods

Twelve young (21 to 28 yr) and 12 elderly (66 to 77 yr) opioid-naive participants ingested one 20 mg oxycodone tablet combined with an intravenous infusion of 0, 0.5, or 1 g/l ethanol. Resting respiratory variables and the primary outcome, minute ventilation at isohypercapnia (end-tidal partial pressure of carbon dioxide of 55 mmHg or VE55), were obtained at regular intervals during treatment.

Results

Oxycodone reduced baseline minute ventilation by 28% (P < 0.001 vs. control). Ethanol caused a further decrease of oxycodone-induced respiratory depression by another 19% at 1 g/l ethanol plus oxycodone (P < 0.01 vs. oxycodone). Ethanol combined with oxycodone caused a significant increase in the number of apneic events measured in a 6-min window with a median (range) increase from 1 (0 to 3) at 0 g/l ethanol to 1 (0 to 11) at 1 g/l ethanol (P < 0.01). Mean (95% CI) VE55 decreased from 33.4 (27.9 to 39.0) l/min (control) to 18.6 (15.6 to 21.6) l/min (oxycodone, P < 0.01 vs. control) and to 15.7 (12.7 to 18.6) l/min (oxycodone combined with ethanol, 1 g/l; P < 0.01 vs. oxycodone).

Conclusions

Ethanol together with oxycodone causes greater ventilatory depression than either alone, the magnitude of which is clinically relevant. Elderly participants were more affected than younger volunteers.
Association of the Hospital Volume of Frail Surgical Patients Cared for with Outcomes after Elective, Major Noncardiac Surgery
Authors: McIsaac Daniel I. , Wijeysundera Duminda N. , Huang Allen , Bryson Gregory L. , van Walraven Carl
Published: February 2017

Background

Frailty is a risk factor for adverse postoperative outcomes. Hospitals that perform higher volumes of surgery have better outcomes than low-volume providers. We hypothesized that frail patients undergoing elective surgery at hospitals that cared for a higher volume of similarly frail patients would have improved outcomes.

Methods

We conducted a retrospective, population-based cohort study using linked administrative data in Ontario, Canada. We identified all adult major, elective noncardiac surgery patients who were frail according to the validated Johns Hopkins Adjusted Clinical Groups (ACG®) frailty-defining diagnoses indicator. Hospitals were categorized into frailty volume quintiles based on volumes of frail surgical patients cared for. Multilevel, multivariable modeling measured the association of frailty volume with 30-day survival (primary outcome), complications, failure to rescue (secondary outcomes), and costs (tertiary outcome).

Results

Of 63,381 frail patients, 708 (1.1%) died after surgery. The thirty-day mortality rate in the lowest volume quintile was 1.1% compared to 0.9% in the highest. After adjustment for surgical risk, demographic characteristics, comorbidities, and clustering within hospitals, we found a significant association between frailty volume and improved survival (highest volume vs. lowest volume quintile: hazard ratio 0.51; 95% CI, 0.35 to 0.74; P < 0.0001). Although complication rates did not vary significantly between hospitals, failure-to-rescue rates were inversely related to volume.

Conclusions

Frail patients have reduced survival and increased failure to rescue when they undergo operations at hospitals having a lower volume of frail surgical patients. Concentration of perioperative care in centers that frequently treat high-risk frail patients could improve population outcomes.
Predictors of Hospital Readmission and Surgical Site Infection in the United States, Denmark, and Japan
Authors: Glassman Steven , Carreon Leah Y. , Andersen Mikkel , Asher Anthony , Eiskjær Soren , Gehrchen Martin , Imagama Shiro , Ishii Ken , Kaito Takahashi , Matsuyama Yukihiro , Moridaira Hiroshi , Mummaneni Praveen , Shaffrey Christopher , Matsumoto Morio
Published: February 2017

Study Design.

Retrospective review of three spine surgery databases.

Objectives.

The purpose of the present study is to determine whether predictors of hospital readmission and surgical site infection (SSI) after lumbar fusion will be the same in United States, Denmark, and Japan.

Summary of Background Data.

Because clinical decision making becomes more data driven, risk stratification will be crucial to minimize complications. Spine surgeons worldwide face this issue, leading to parallel efforts to address risk stratification. This raises the question as to whether pooled data would be valuable and whether models generated in one country would be applicable to other populations.

Methods.

Predictors of SSI and 30-day readmission from three prospective databases (National Neurosurgery Quality and Outcomes Database [N2QOD] N = 2653, DaneSpine N = 1993, Japan Multicenter Spine Database [JAMSD] N = 3798) were determined and compared to identify common or divergent predictive risks.

Results.

Predictive variables differed in the three databases, for both readmission and SSI. Factors predictive for hospital readmission were American Society of Anesthesiologists (ASA) grade in N2QOD (P = 0.013, odds ratio [OR] 2.08), fusion levels in DaneSpine (P = 0.005, OR 1.67), and sex in JAMSD (P = 0.001, OR = 2.81). Associated differences in demographics and procedural factors included mean ASA grade (N2QOD = 2.45, JAMSD = 1.72) and fusion levels (N2QOD = 1.39, DaneSpine = 1.52, JAMSD = 1.34). For SSI, sex (P = 0.000, OR = 3.30), diabetes (P = 0.000, OR = 2.90), and length of stay (P = 0.000, OR = 1.02) were predictive in JAMSD. No predictors were identified in N2QOD or DaneSpine.

Conclusion.

Predictors of SSI and hospital readmission differ in the United States, Denmark, and Japan, suggesting that risk stratification models may need to be population specific or adjusted. Some differences in measured parameters exist in the three databases analyzed; however, patient and procedure selection also appear to differ and may limit the ability to directly pool data from different regions. Therefore, risk stratification models developed in one country may not be directly applicable to other countries.

Level of Evidence: 2
Generalized Leishmanides in an Immunodeprived Man
Authors: Fernandez-Flores Angel , Boada Aram , Fernández-Figueras Maria T.
Published: February 2017

Leishmanides have been rarely reported in the literature. In this study, the authors present a case of a 50-year-old HIV-positive man who developed a generalized cutaneous eruption of papules and plaques in which no microorganism was demonstrated by culture, microscopical examination, immunohistochemistry, or polymerase chain reaction. The patient was eventually diagnosed with laryngeal leishmaniasis, and when treated, the cutaneous lesions greatly improved.
Combined Jessner Solution and Trichloroacetic Acid Versus Trichloroacetic Acid Alone in the Treatment of Melasma in Dark-Skinned Patients
Authors: Abdel-Meguid Azza M. , Taha Emad A. , Ismail Sahar A.
Published: February 2017

BACKGROUND

Melasma is a common challenging pigmentary skin disorder especially in dark-skinned females urging them to seek medical help. Many modalities of treatment are available, but none is satisfactory.

OBJECTIVE

To compare safety and efficacy of combined trichloroacetic acid (TCA) (20%–25%) and Jessner's solution versus TCA (20%–25%) alone in dark patients with melasma.

MATERIALS AND METHODS

The study design was a split face, right-left, assessor-blinded, randomized controlled study. Twenty-four adult female patients (skin phototypes IV–V) with bilateral melasma were treated for 6 sessions at 2 weeks intervals. Clinical assessment of the 2 sides of the face with Melasma Area and Severity Index (MASI) score was performed, and photographs were taken before and after the peeling course.

RESULTS

Both therapeutic modalities showed significant decrease in MASI score, which was significantly lower on the side treated with both Jessner solution and TCA. There were significant negative correlations between the percentage of improvement of MASI score and both age of the patients and duration of the melasma.

CONCLUSION

Dark skin melasma can be treated with both regimens safely and effectively; however, combined Jessner solution and TCA is more effective.
Nontyphoidal Salmonella Osteomyelitis in Immunocompetent Children Without Hemoglobinopathies
Authors: Gill Alicia N. , Muller Martha L. , Pavlik David F. , Eldredge Jonathan D. , Johnston Jennifer J. , Eickman Megan M. , Dehority Walter
Published: February 2017

Salmonella osteomyelitis is well-described in children with hemoglobinopathies, particularly infection with Salmonella typhi. To characterize nontyphoidal osteomyelitis in otherwise healthy children without hemoglobinopathies, we performed a retrospective review of children discharged from our institution with this condition, supplemented with a systematic literature review. Among the 46 subjects identified, common risk factors for Salmonella infection were frequently absent and complications were common.
High Frequency of Bone Marrow Depression During Congenital Toxoplasmosis Therapy in a Cohort of Children Identified by Neonatal Screening in Minas Gerais, Brazil
Authors: Carellos Ericka Viana Machado , de Andrade Juliana Queiroz , Romanelli Roberta Maia Castro , Tibúrcio Jacqueline Domingos , Januário José Nélio , Vasconcelos-Santos Daniel Vítor , Figueiredo Rosângela Maria , de Andrade Gláucia Manzan Queiroz
Published: February 2017

Background:

There are few studies reporting frequency and control of adverse events associated with congenital toxoplasmosis treatment. The objective of this study is to describe treatment adherence and adverse hematologic events in a cohort of children identified with congenital toxoplasmosis in Minas Gerais, Brazil.

Methods:

Children were treated with sulfadiazine, pyrimethamine and folinic acid and were evaluated clinically and by laboratory tests at regular intervals.

Results:

Of 146,307 live newborns who participated in the Neonatal Screening Program in Minas Gerais in 2006–2007, 190 had congenital toxoplasmosis. Among the 171 children whose treatment data were available, 73.1% completely adhered to antiparasitic therapy. Hematologic adverse events (macrocytic anemia and/or neutropenia and/or thrombocytopenia) were diagnosed in 44% of them. The most common adverse event was neutropenia (31%). In most cases, it was not severe and reversed after increase in folinic acid dosage (25.7%) or temporary treatment suspension (1.8%). No infections were observed in association with neutropenic events. Significant associations were detected between macrocytic anemia and lower weight Z score at first medical appointment (P = 0.03), and between severe neutropenia (<500/mm3) and lower weight Z score toward the end of treatment (P = 0.04).

Conclusions:

The high frequency of hematologic adverse events found, especially in malnourished children, highlight the importance of careful monitoring of these children throughout treatment, as well as considering nutritional aspects and the need for higher doses of folinic acid. With adequate monitoring, antiparasitic treatment was feasible and relatively safe in the setting of this large screening program for congenital toxoplasmosis.
Impact of Percutaneous Drainage on Outcome of Intra-abdominal Infection Associated With Pediatric Perforated Appendicitis
Authors: Bonadio William , Langer Miriam , Cueva Julie , Haaland Astrid
Published: February 2017

Background:

Perforated appendicitis can result in potentially serious complications requiring prolonged medical care. The optimal approach to successfully managing this condition is controversial.

Methods:

Review of 80 consecutive cases of pediatric acute perforated appendicitis with intra-abdominal infection (IAI) medically managed with parenteral antibiotics and percutaneous drainage (PD) during a 7-year period.

Results:

All patients received broad spectrum parenteral antibiotic therapy. One-third were hospitalized for >2 weeks. IAI was identified on admission in 60% compared with developing during hospitalization in 40% of cases. Before performing PD, the mean duration of antibiotic therapy in those who developed IAI during hospitalization was 6 days. IAI cultures yielded 127 bacterial isolates; polymicrobial infection occurred in 65% of cases. Only 7% of aspirates were sterile. The most common pathogens were Escherichia coli (82%), of which 5 isolates exhibited extended-spectrum β-lactamase production, and streptococci (40%). At the time of PD, 60% were febrile (mean duration of in-hospital fever, 7.5 days); 67% defervesced within 24 hours after the procedure. Posthospitalization abdominal complications (recurrent IAI or appendicitis) occurred in one-third of patients.

Conclusions:

Children with perforated appendicitis and IAI often have a complicated and prolonged clinical course. Medical management consisting solely of parenteral antibiotic therapy is frequently ineffective in resolving IAI. Rapid clinical improvement commonly follows PD.
Upper Eyelid Reconstruction Using a Blepharoplasty Flap
Authors: McVeigh Katherine Anne , Caesar Richard
Published: February 2017

Purpose:

The blepharoplasty flap is a relatively simple but under-recognized surgical technique for repairing defects that result from excision of broad-based lesions on the upper eyelid that lie between the eyelid crease and the eyelashes. As this has not been previously published in the literature, the authors aim to increase the awareness of this technique.

Methods:

The eyelid crease is marked. A line is drawn perpendicular to the crease line along the aspect of the lesion closest to the centre of the eyelid, dividing the eyelid into 4 quarters. The lesion is excised along with the area lying diagonally. An advancement flap is then fashioned from excess skin of the upper eyelid and moved inferiorly to close the defect.

Results:

The resulting cosmetic results seen postoperatively have been excellent.

Conclusions:

The blepharoplasty flap is a style of surgical advancement flap that utilizes the tissue that would normally be excised during blepharoplasty. This straightforward technique can prove useful in the surgical repertoire due to its potential to be widely adopted in surgical practice.
Recommendations for a first Core Outcome Measurement set for complex regional PAin syndrome Clinical sTudies (COMPACT)
Authors: Grieve Sharon , Perez Roberto S.G.M. , Birklein Frank , Brunner Florian , Bruehl Stephen , Harden R. Norman , Packham Tara , Gobeil Francois , Haigh Richard , Holly Janet , Terkelsen Astrid , Davies Lindsay , Lewis Jennifer , Thomassen Ilona , Connett Robyn , Worth Tina , Vatine Jean-Jacques , McCabe Candida S.
Published: February 2017

Complex regional pain syndrome (CRPS) is a persistent pain condition that remains incompletely understood and challenging to treat. Historically, a wide range of different outcome measures have been used to capture the multidimensional nature of CRPS. This has been a significant limiting factor in the advancement of our understanding of the mechanisms and management of CRPS. In 2013, an international consortium of patients, clinicians, researchers, and industry representatives was established, to develop and agree on a minimum core set of standardised outcome measures for use in future CRPS clinical research, including but not limited to clinical trials within adult populations. The development of a core measurement set was informed through workshops and supplementary work, using an iterative consensus process. “What is the clinical presentation and course of CRPS, and what factors influence it?” was agreed as the most pertinent research question that our standardised set of patient-reported outcome measures should be selected to answer. The domains encompassing the key concepts necessary to answer the research question were agreed as follows: pain, disease severity, participation and physical function, emotional and psychological function, self-efficacy, catastrophizing, and patient's global impression of change. The final core measurement set included the optimum generic or condition-specific patient-reported questionnaire outcome measures, which captured the essence of each domain, and 1 clinician-reported outcome measure to capture the degree of severity of CRPS. The next step is to test the feasibility and acceptability of collecting outcome measure data using the core measurement set in the CRPS population internationally.
Effect of Methylphenidate on Emotional Dysregulation in Children With Attention-Deficit/Hyperactivity Disorder + Oppositional Defiant Disorder/Conduct Disorder
Authors: Kutlu Ayse , Akyol Ardic Ulku , Ercan Eyup Sabri
Published: February 2017

Background and Aim

Emotional dysregulation (ED) is a frequent feature of attention-deficit/hyperactivity disorder (ADHD). It can be observed as a dysregulation profile or a deficient emotional self-regulation (DESR) profile. Oppositional defiant disorder/conduct disorder (ODD/CD) comorbidity is prevalent in ADHD and known to be related with ED. The first-line treatment of ADHD includes psychostimulants, but their effects on ED are not well studied. This study aimed to evaluate the outcomes of methylphenidate (MPH) treatment on ED in ADHD + ODD/CD cases.

Methods

A total of 118 ADHD + ODD/CD patients with a mean age of 9.0 ± 1.9 years were treated with MPH for 1 year. Also, parents of cases were recruited for a parent-training program, which initiated after first month of MPH treatment. Symptom severity was assessed at baseline and 12th month by Turgay Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition–Based Child and Adolescent Behavior Disorders Screening and Rating Scale–Parent Form, Children Depression Inventory, Child Behavior Checklist 4–18 years, and Parental Acceptance and Rejection Questionnaire–Mother Form.

Results

Emotional dysregulation (DESR + DP) was present in 85.6% of cases. Conduct disorder was significantly higher in patients with DP, whereas ODD was significantly higher in the DESR and non-ED groups (P < 0.0001). Symptoms of ADHD and ED were significantly improved with 1-year of MPH treatment (P < 0.05). The improvement in ED was independent of improvement in ADHD symptoms and parent training (P < 0.05).

Conclusions

Emotional dysregulation is highly prevalent in disruptive behavioral disorders as ODD and CD, which are comorbid with ADHD. The MPH treatment is effective on ED independently from other clinical determinants.
Differential Risk of Peptic Ulcer Among Users of Antidepressants Combined With Nonsteroidal Anti-inflammatory Drugs
Authors: Shin Ju-Young , Song Inmyung , Lee Jin-Ho , Yoon Jong Lull , Kwon Jun Soo , Park Byung-Joo
Published: February 2017

Background

Selective serotonin reuptake inhibitors (SSRIs) have been reported to have an increased risk of gastrointestinal adverse events, and the risk may be further increased by combined use of nonsteroidal anti-inflammatory drugs (NSAIDs). However, little has been known about the risk of peptic ulcer associated with other classes of antidepressants or individual antidepressants combined with NSAIDs.

Methods

We conducted a retrospective cohort study to define the risk of peptic ulcer associated with combined use of antidepressants and NSAIDs, as compared with use of antidepressants alone. Using the Korean Health Insurance Review and Assessment Service database, we identified a total of 1,127,622 patients who began receiving antidepressants between 2009 and 2012. Propensity-based matching and Cox proportional hazards models were used to compare the risk of peptic ulcer between antidepressant users with NSAIDs and those without NSAIDs matched in a 1:1 ratio, for a total of 768,850 patients.

Results

The risk of peptic ulcer did not increase with combined use of overall antidepressants and NSAIDs, as compared with antidepressant use alone (hazard ratio [HR], 1.02; 95% confidence interval [CI], 0.99–1.06). A slightly increased risk was observed for combined use of NSAIDs with tricyclic antidepressants (HR, 1.15; 95% CI, 1.09–1.21) and with SSRIs (HR, 1.08; 95% CI, 1.01–1.16).

Conclusion

We found that although concomitant use of NSAIDs and antidepressants was not associated with an increased risk of peptic ulcer for antidepressants in general, it was so for some specific classes including tricyclic antidepressants and SSRIs. However, we cannot rule out the possibility that the increased risk was solely due to NSAID use.
Effects of an 8-Week Aerobic Dance Program on Health-Related Fitness in Patients With Schizophrenia
Authors: Cheng Shu-Li , Sun Huey-Fang , Yeh Mei-Ling
Published: February 2017

Background:

Both psychiatric symptoms and the side effects of medication significantly affect patients with schizophrenia. These effects frequently result in a sedentary lifestyle and weight gain, which increase the risk of cardiovascular disease and premature death.

Purpose:

This study developed an aerobic dance program for patients with schizophrenia and then evaluated the effect of this program on health-related fitness outcomes.

Methods:

An experimental research design was used. Sixty patients with schizophrenia were recruited from a daycare ward and rehabilitation center at a psychiatric hospital in Taiwan. Paticipants were assigned randomly into an experimental group, which received the 8-week aerobic dance program intervention, and a control group, which received no intervention. All of the participants were assessed in terms of the outcome variables, which included bodyweight, body mass index, muscular endurance, flexibility, and cardiorespiratory endurance. These variables were measured before the intervention (pretest) as well as at 8 weeks (posttest) and 12 weeks (follow-up) after the intervention. This study used a generalized linear model with a generalized estimating equation method to account for the dependence of repeated measurements and to explore the effects of the intervention on health-related fitness outcomes.

Results:

Twenty-six participants were in the experimental group, and 28 were in the control group. Significant between-group differences were observed at posttest and in the follow-up for all of the health-related fitness outcomes with the exception of muscular endurance.

Conclusions/Implications for Practice:

This study suggests that an 8-week aerobic dance program may be an effective intervention in patients with schizophrenia in terms of improving bodyweight, body mass index, flexibility, and cardiorespiratory endurance for a period of at least 4 months. Furthermore, although muscular endurance was postively affected during the short-term period, the benefits did not extend into the follow-up examination. On the basis of these findings, aerobic dance is recommended as a nonpharmacological intervention for patients with schizophrenia who are in daycare or rehabilitation settings.
Automatic Cochlear Duct Length Estimation for Selection of Cochlear Implant Electrode Arrays
Authors: Rivas Alejandro , Cakir Ahmet , Hunter Jacob B. , Labadie Robert F. , Zuniga M. Geraldine , Wanna George B. , Dawant Benoit M. , Noble Jack H.
Published: February 2017

Hypothesis:

Cochlear duct length (CDL) can be automatically measured for custom selection of cochlear implant (CI) electrode arrays.

Background:

CI electrode array selection can be influenced by measuring the CDL, which is estimated based on the length of the line that connects the round window and the lateral wall of the cochlea when passing through the modiolus. CDL measurement remains time consuming and inter-observer variability has not been studied.

Methods:

We evaluate an automatic approach to directly measure the two-turn (2T) CDL using existing algorithms for localizing cochlear anatomy in computed tomography (CT). Pre-op CT images of 309 ears were evaluated. Two fellowship-trained neurotologists manually and independently measured CDL. Inter-observer variability between measurements across expert and automatic observers is assessed. Inter-observer differences for choice of electrode type are also investigated.

Results:

Manual measurement of CDL by experts tends to underestimate cochlea size and has high inter-observer variability, with mean absolute differences between expert CDL estimations of 1.15 mm. Our results show that this can lead to a large number of cochleae for which a different electrode array type would be selected by different observers, depending on the specific threshold value of CDL used to decide between array type.

Conclusion:

Choosing the best CI electrode array is an important task for optimizing hearing outcomes. Manual cochleae length measurements are user-dependent, and errors impact upon the CI electrode array choice for certain patients. Measuring cochlea length automatically is less time consuming and generates more repeatable results. Our automatic approach could make use of CDL for patient-customized treatment more clinically adoptable.
The Role of Rho/Rho-Kinase Pathway in the Pathogenesis of Cholesteatoma
Authors: Yeşilova Mesut , Görür Kemal , Ismi Onur , Özcan Cengiz , Büyükafşar Kansu
Published: February 2017

Objective:

To assess the role of Rho/Rho-kinase pathway in the pathogenesis of cholesteatoma.

Materials and Methods:

Thirty-eight patients with cholesteatoma, who had gone mastoidectomies were enrolled in this prospective study. Cholesteatomas matrix (CM) and a piece of the external ear canal skin (EECS as control) were taken and transferred to the liquid nitrogen and kept at −86 °C for Rho A and Rho-kinase (ROCK) analysis with Western blotting and commercial ELISA kits (Cell Biolabs Inc., San Diego, CA). The tissues were homogenized by an appropriate ice-cold lysis buffer. Following centrifugation, the supernatant was taken and total protein amount was detected by the Bradford method. Thereafter, tissue homogenates were subjected to sodium dodecyl sulphate (SDS)-polyacrylamide gel electrophoresis electrophoresis then transferred to nitrocellulose membrane where it was treated with specific monoclonal primary antibody against to ROCK-2 and HRP-conjugated seconder antibody, respectively. The protein blots were visualized with commercial x-ray film and dansitometrically analyzed by the Scion Image Program (Cell Biolabs Inc., San Diego, CA). In another series of experiments, Rho-kinase activities were assessed by ROCK-2 ELISA kits.

Results:

There were no statistical differences in Rho A translocation between CM and EECS. However, ROCK activity was found to be lower in CM than EECS as detected by ELISA kits. Furthermore, ROCK protein expression was also significantly lower in CM than EECS as demonstrated by Western blotting.

Conclusion:

Given Rho-kinase could take essential roles in cell differentiation, the results of this study implicate that down-regulated Rho-kinase could be responsible for the keratinocyte undifferentiation seen in cholesteatoma pathogenesis.
Intraoperative Bleeding and the Risk of Residual Cholesteatoma: A Multivariate Analysis
Authors: le Nobel Gavin J. , Cushing Sharon L. , Papsin Blake C. , James Adrian L.
Published: February 2017

Objective:

Residual cholesteatoma most frequently occurs where visualization and surgical access are restricted by anatomic constraints. Other factors that compromise surgical field visualization might also increase rates of residual cholesteatoma. We evaluated whether impaired surgical field clarity from bleeding increases rates of residual cholesteatoma.

Study Design:

Prospective cohort study.

Setting:

Tertiary care hospital.

Patients:

Consecutive series of children having intact canal wall surgery for cholesteatoma.

Interventions:

Impact of bleeding on surgical field clarity was assessed intraoperatively on a six-point scale.

Main Outcome Measures:

Presence of residual cholesteatoma was established at follow up clinical encounters, second stage procedures, and with magnetic resonance imaging. Multiple logistic regression was used to determine the influence of surgical field clarity and other factors on rates of residual cholesteatoma.

Results:

Surgery was completed on 232 ears and residual cholesteatoma found in 45 (19%) ears. Multivariate regression analysis of cases completed with atticotomy or tympanoplasty demonstrated that surgical field clarity was a significant predictor of residual cholesteatoma (OR [odds ratio] 4, 95%CI 1.05–15; p = 0.04). Cholesteatoma extent was the most significant predictor of residual cholesteatoma when including cases requiring combined approach tympanomastoidectomy (OR 2.2, 95%CI 1.4–3.3; p < 0.001).

Conclusions:

Impaired surgical field clarity from intraoperative bleeding is associated with increased risk of residual cholesteatoma in surgery for meso/epitympanic cholesteatoma. These findings are of particular significance for endoscopic ear surgery in which management of bleeding can be more difficult and support the use of techniques, such as hypotensive general anesthesia, that minimize surgical site bleeding and improve surgical field visualization.
Operative Mortality Rates of Acoustic Neuroma Surgery: A National Cancer Database Analysis
Authors: McClelland Shearwood , Kim Ellen , Murphy James D. , Jaboin Jerry J.
Published: February 2017

Introduction:

Optimal acoustic neuroma (AN) management involves choosing between three treatment modalities: microsurgical excision, radiation, or observation with serial imaging. The reported in-hospital mortality rate of surgery for AN in the United States is 0.5%. However, there has yet to be a nationwide examination of the AN surgery mortality rate encompassing the period beyond initial hospital discharge.

Methods:

The National Cancer Data Base (NCDB) from 2004 to 2013 identified AN patients receiving surgery. Multivariate logistic regression assessed 30-day operative mortality, adjusting for several variables including patient age, race, sex, income, geographic region, primary payer for care, tumor size, and medical comorbidities.

Results:

Ten thousand one hundred thirty six patients received surgery as solitary treatment for AN. Mortality at 30 days postoperatively occurred in 49 patients (0.5%); only a Charlson/Deyo score of 2 (odds ratio [OR] = 6.6;95% confidence interval [CI] = 2.6–16.6; p = 0.002) was predictive of increased mortality. No other patient demographic including African–American race, minimum age of 65 or government insurance was predictive of 30-day operative mortality.

Conclusions:

The 30-day mortality rate following surgery for AN is 1 of 200 (0.5%), equivalent to the established in-hospital operative mortality rate, and 2.5 times higher than the cumulative assessment from single-center studies. No patient demographic other than increasing medical comorbidities reached significance in predicting 30-day operative mortality. The nearly identical rates of 30-day and in-hospital mortality from separate nationwide analyses indicate that nearly all of the operative mortality occurs before initial postoperative discharge from the hospital. This mortality rate provides a framework for comparing the true risks and benefits of surgery versus radiation or observation for AN.
Assessment of Bleeding and Thrombosis Based on Aspirin Responsiveness after Continuous-Flow Left Ventricular Assist Device Placement
Authors: Floroff Catherine K. , Rieger Krista L. , Veasey Tara M. , Strout Sara E. , DeNino Walter F. , Meadows Holly B. , Stroud Martha R. , Toole John M. , Heyward Dawn P. , Brisco-Bacik Meredith A. , Cook Jennifer L. , Lazarchick John , Uber Walter E.
Published: February 2017

Pump thrombosis (PT) is a severe complication of left ventricular assist device (LVAD) support. This study evaluated PT and bleeding after LVAD placement in patients responsive to a standard aspirin dose of 81 mg using platelet inhibition monitoring compared with initial nonresponders who were then titrated upward to achieve therapeutic response. Patients ≥ 18 years of age with initial placement of HeartMate II LVAD at our institution and at least one VerifyNow Aspirin test performed during initial hospitalization were included. The primary endpoints were bleeding and PT compared between initial aspirin responders and nonresponders. Of 85 patients, 19 (22%) were nonresponsive to initial aspirin therapy. Responders and nonresponders showed similar survival (p = 0.082), freedom from suspected/confirmed PT (p = 0.941), confirmed PT (p = 0.273), bleeding (p = 0.401), and incidence rates in PT and bleeding. Among the initial responders (<500 vs. 500–549 aspirin reaction units), there were no significant differences in survival (p = 0.177), freedom from suspected/confirmed PT (p = 0.542), confirmed PT (p = 0.159), bleeding (p = 0.879), and incidence of PT and bleeding. Platelet function testing may detect resistance to standard aspirin regimens used in LVAD patients. Dose escalation in initially nonresponsive patients to achieve responsiveness may confer a similar PT risk to patients initially responsive to standard aspirin dosing without increased bleeding risk.
Efficacy of Flow Monitoring During ECMO
Authors: Badheka Aditya , Stucker Sara E. , Turek Joseph W. , Raghavan Madhavan L.
Published: February 2017

The hypothesis that blood flow monitoring could serve as an effective early indicator of distal obstruction during extracorporeal membrane oxygenation (ECMO) was tested under controlled experimental conditions. The ECMO circuit typically includes (or could be easily modified to include) a shunt that bifurcates from the main line returning a small amount of blood to the pump with access points for drug infusions. Distal circuit obstructions in the oxygenator and beyond will result in an increased diversion of flow from the distal line to the shunt. Thus, elevations in flow through the shunt can serve as a marker for distal circuit obstruction. An ECMO training circuit was adapted with a resistance chamber that simulates controlled and varying levels of distal obstructions. Experiments were conducted under pediatric and adult pump target flow rates simulating different levels of distal obstructions while documenting the shunt flow and pressure drop across the obstruction. There was measurable and statistically significant elevation in the shunt flow at all flow rates because of different levels of obstruction from baseline values and hence consistent with the hypothesis that shunt flow can serve as an indicator of distal obstruction in the ECMO circuit. Flow monitoring is over the tube, hands free, continuous, and easy to implement. Therefore, it has the potential to serve as an early nonspecific indicator of elevated distal resistance in the ECMO circuit, which can then trigger other measurements (such as pressure drop across the oxygenator) for a more specific assessment of the source for distal resistance.
Hepatocyte Antigen Expression in Barrett Esophagus and Associated Neoplasia
Authors: Shah Sejal S. , Chandan Vishal S.
Published: February 2017

Hepatocyte antigen or hepatocyte paraffin 1 (Hep Par 1) is widely used as a diagnostic immunomarker for hepatocellular carcinoma. It has also been identified as a rate-limiting enzyme of the urea cycle, carbamoyl phosphate synthetase 1. Hep Par 1 has been detected in non-neoplastic small intestinal epithelium, but its expression in Barrett esophagus and its related neoplasia has not been well investigated. We immunohistochemically evaluated expression of Hep Par 1 on 75 cases of Barrett esophagus (25 cases without dysplasia, 16 cases with low-grade dysplasia, 25 cases with high-grade dysplasia, and 9 cases with intramucosal adenocarcinoma) on endoscopic biopsies and endoscopic mucosal resections. All 25 cases without dysplasia (100%) showed granular cytoplasmic Hep Par 1 staining (24 diffuse and 1 focal). Of the 16 cases with low-grade dysplasia, 12 (75%) were positive (5 diffuse and 7 focal), whereas 4 (25%) were negative (P=0.018). Of the 25 cases with high-grade dysplasia, 9 (36%) showed focal positivity, whereas 16 (64%) were negative (P=0.0001). Similarly of the 9 cases of intramucosal adenocarcinomas 3 (33%) were focally positive, whereas 6 (67%) were negative (P=0.0001). Hep Par 1 is diffusely expressed in non-neoplastic Barrett esophagus while it is frequently lost in related dysplasia and adenocarcinoma, suggesting decreased level of HepPar1 may represent an early event in Barrett-related tumor genesis. This warrants additional investigation to look for the possible role of carbamoyl phosphate synthetase 1 in the pathogenesis of Barrett-related neoplasia.