bluuebunny/crossref_metadata_2025 huggingface dataset:
Open Surgery for Extraction of an Embolized Pellet in the Middle Cerebral Artery From a Shotgun Injury
Authors: Monterey Michael , Kerr Keith , Dannenbaum Mark , Chen Peng Roc , Blackburn Spiros
Published: November 2018

BACKGROUND AND IMPORTANCE

Embolization of shotgun pellet from the peripheral vasculature to the cerebral vessels has been a known phenomenon that has been reported previously in the literature. However, there is no consensus on clinical indications for intervention, best modality of intervention or management upon leaving the hospital. We describe a case of a shotgun pellet in the neck that embolized to the middle cerebral artery that was treated with open surgery. Discussed is the initial management on presentation, timing of intervention from surgery and detailed surgical technique.

CLINICAL PRESENTATION

A 20-yr-old man presented after being shot at close range with a shotgun. He was neurologically intact on exam. Initial screening computed tomography (CT) of the brain noted a shotgun pellet in the region of the sylvian fissure without intracranial hemorrhage. Computed tomography angiography again displayed pellet in the vicinity of the left middle cerebral artery. He was emergently taken for an awake cerebral angiogram and subsequent surgical extraction of the shotgun pellet.

CONCLUSION

Missile embolization of a bullet fragment to the intracranial vasculature is rare and requires difficult decisions regarding management. Critical factors that are to be considered prior to treatment include neurological clinical presentation, timing of the trauma, and anatomic location of injury. Patients who are without neurological deficit that display compromised blood flow require immediate cerebral angiogram followed by surgical intervention depending on location.
Police Candidate Selection: Assessing the Effectiveness of Pre-employment Polygraph Screening
Authors: White Daniel Linn
Published: November 2018

The majority of law enforcement agencies in the USA use pre-employment polygraph screening as a pass/fail criterion for prospective applicants. However, the polygraph has a number of unresolved practical and theoretical issues that are pronounced in the pre-employment screening context. After reviewing the literature in 2003, the National Research Council concluded there is a strong risk that pre-employment polygraph screening may erroneously exclude a large number of otherwise suitable candidates. Meanwhile, police departments face increasing difficulties finding qualified candidates to hire, and are often unable to keep pace with force attrition due to retirements and other factors. In light of these facts, this study attempts to determine if the polygraph is an effective means of filtering undesirable candidates by comparing data on police officer arrests between states that mandate pre-employment polygraph screening for law enforcement personnel and those that forbid the practice as a matter of law. The results were both surprising and completely contrary to initial expectations. It was found that states using the polygraph have significantly fewer years of service at the time of arrest and more per-capita arrests than police agencies in states that forbid the practice. Based on these results and a review of the polygraph literature, this study concludes that sole reliance on polygraph results as a pass/fail criterion for police hiring is a misguided practice.
A colorectal cancer diet quality index is inversely associated with colorectal cancer in the Malmö diet and cancer study
Authors: Vulcan Alexandra , Ericson Ulrika , Manjer Jonas , Ohlsson Bodil
Published: November 2018

The World Cancer Research Fund International has concluded strong evidence for that high intake of dairy products and foods containing dietary fiber and low intake of processed meat are associated with decreased risk of colorectal cancer (CRC). As food items are consumed together, it is important to study dietary patterns. The aim of the present study was to examine the association between an a priori constructed dietary index and incident CRC and between intake of processed meat, fiber, and dairy products and CRC. In the Malmö Diet and Cancer study cohort, 923 cases of CRC were identified, during 502 136 person-years of follow-up. A Colorectal Diet Quality Index (CDQI) was constructed regarding intakes of processed meat, fiber, and dairy products in relation to CRC. Higher index indicated a higher dietary quality. Higher CDQI was associated with lower risk of CRC [hazard ratios (HR): 0.57 for highest compared with lowest quintile; 95% confidence interval (CI): 0.43, 0.75; P<0.001]. Intake of dairy products was inversely associated with risk of CRC [HR for highest vs. lowest quintile was 0.77 (CI: 0.62, 0.96); P = 0.008], as was dietary fiber [HR for highest vs. lowest quintile was 0.77 (CI: 0.61, 0.98); P = 0.043]. High intake of processed meat was associated with CRC [HR for highest vs. lowest quintile was 1.31; CI: 1.05, 1.63; P = 0.012]. High adherence to a predefined CRC-specific diet quality index was inversely associated with the risk of CRC and gave a stronger association with CRC, than when analyzing the components of the CDQI individually.
Immigration, screening, and cervical cancer incidence: an application of Age–Period–Cohort analysis
Authors: Bucchi Dania , Chiavarini Manuela , Bianconi Fortunato , Galeotti Maria E. , Gili Alessio , Stracci Fabrizio
Published: November 2018

Cervical cancer (CC) control is based on the implementation of effective screening programs. In the coming years, human papilloma virus vaccination coverage will contribute considerably toward cancer prevention. In Italy, where an organized screening program has been implemented, immigration from low/middle-income countries with a high prevalence of human papilloma virus infections has increased steadily over the last decades. To assess the impact of screening efforts in counteracting background changes, we analyzed the incidence trends of cervical intraepithelial neoplasia grade 3 carcinomas in situ (CIS) and invasive CC from 1994 to 2013 through an Age–Period–Cohort model using data of a regional population-based registry. Moreover, using Joinpoint regression, we compared the incidence of cervical lesions in native women with that observed in foreign-born women, highlighting the differences in age and screening status. The results indicate that the CC incidence trend decreased in Italian women (annual percent change = −2.7*%, 95% confidence interval = −4.3; −1.1), but increased (APC = 12.2*%, 95% confidence interval = 7.6; 17.0) in immigrants. For CIS, incidence rates show a growing trend in both groups, especially in women born abroad. For cancer, no marked changes in period-specific incidence rate ratios were detected until around 2000, when we found a slight decrease, followed by an increase. For CIS, we estimate an important upward trend in cohort-specific risks. The favorable effect of screening in preventing an increase in CC incidence has been counteracted by the progressive increase in immigrants from high-risk countries, where it is of increasing relevance to extend the use of vaccination.
Sleep disturbance in women who undergo surgical menopause compared with women who experience natural menopause
Authors: Cho Na Young , Kim Soriul , Nowakowski Sara , Shin Chol , Suh Sooyeon
Published: November 2018

Objective:

Women who undergo surgical menopause (SM) experience a relatively more acute and precipitous drop of estrogen compared with women who experience natural menopause (NM). Few studies, however, have compared sleep quality in women who experience natural versus SM.

Methods:

Participants were 526 postmenopausal women (mean age 60.2 ± 7.64). All participants completed self-report questionnaires about insomnia symptoms, sleep-interfering behaviors, depression, sleep quality, and gynecological history. Analysis of covariance was conducted to compare women who experienced NM versus SM on sleep variables. Logistic regression analysis was used to determine whether NM or SM groups predicted insomnia status. Regression-based moderation analysis was conducted to explore the moderating effect of type of menopause on the relationship between sleep-interfering behaviors and insomnia symptoms.

Results:

Among the sample, 81.6% (n = 429) reported going through NM and 18.4% (n = 97) reported going through SM. The SM group was significantly younger by 7.2 years (P < 0.001). Women in the SM group reported significantly worse sleep quality (P = 0.007), especially for sleep duration (P = 0.001) and habitual sleep efficiency (P = 0.010) compared with women in the NM group. Regression analysis indicated that individuals in the SM group were 2.131 (95% CI 1.055-4.303) times more likely to have insomnia compared with the NM group (P = 0.027). In addition, women in the SM group who displayed more sleep-interfering behaviors also had a higher severity of insomnia symptoms compared with women who experience NM (ß = 0.26, P = 0.03).

Conclusions:

Menopause can be both physically and psychologically challenging, but women who undergo SM experience worse sleep quality compared with women who experience NM, and may benefit from behavioral interventions.
The association of miR-25T>C, miR-32C>A, miR-125C>T, and miR-222G>T polymorphisms with a risk of primary ovarian insufficiency in Korean women
Authors: Cho Sung Hwan , Kim Young Ran , Kim Ji Hyang , An Hui Jeong , Kim Jung Oh , Ko Jung Jae , Lee Woo Sik , Kim Nam Keun
Published: November 2018

Objective:

The purpose of this study was to investigate the association of microRNA polymorphisms (miR-25T>C, miR-32C>A, miR-125C>T, and miR-222G>T) with primary ovarian insufficiency (POI) in Korean women.

Methods:

We conducted a case-control study of Korean women: 142 participants with POI and 266 controls with at least 1 live birth and no history of pregnancy loss.

Results:

The haplotype-based multifactor dimensionality reduction analysis revealed that the T-C-T-G (miR-25/-32/-125/-222), T-A-C-G (miR-25/-32/-125/-222), C-T-G (miR-32/-125/-222), A-C-G (miR-32/-125/-222), T-G (miR-122/-222), C-T (miR-32/-125), and C-C (miR-25/-32) inferred haplotypes were significantly less frequent in POI (P < 0.05), which suggested potential protective effects. Participants with POI had significantly increased luteinizing hormone levels (P < 0.05), but hormonal levels, including luteinizing hormone, were not significantly different between POI women and control women with miR-32/-125/-222.

Conclusions:

After considering multiple comparisons, we concluded that miR-25T>C, miR-32C>A, miR-125C>T, and miR-222G>T had no relation with POI.
Developing a Web-Based Smoking Cessation Program and Evaluating Its Effectiveness
Authors: Koyun Ayşe , Eroğlu Kafiye
Published: November 2018

This study, which is based on the Stages of Change Model, aimed to develop a Web-based smoking cessation program and to evaluate its effectiveness. An interventional study with 1 group was conducted with college students from Afyon Kocatepe University. First, the Web-Based Smoking Cessation Program was set up (www.sbp.aku.edu.tr). The sample in this study was composed of the 433 students who were site members. The appropriate stages of the program were then sent to members' e-mail addresses at monthly intervals over a period of 6 months. Second, the effectiveness of the program was evaluated at the baseline, the third, and the sixth months of the study. The study was completed with 314 students. The data were evaluated using descriptive statistics, 1-way analysis of variance, and analysis of variance for repeated measures. There were significant developments in the self-efficacy, cognitive, and behavioral processes of students in the third and sixth months of the study. Students (2.5%) had quit smoking by the third month and 4.5% by the sixth month. These results reveal that the program was able to help students quit smoking, increase their self-efficacy, and develop the process of change regarding smoking cessation.
Distinct functions of soluble guanylyl cyclase isoforms NO-GC1 and NO-GC2 in inflammatory and neuropathic pain processing
Authors: Petersen Jonas , Mergia Evanthia , Kennel Lea , Drees Oliver , Steubing Rebecca Dorothee , Real Catherine Isabell , Kallenborn-Gerhardt Wiebke , Lu Ruirui , Friebe Andreas , Koesling Doris , Schmidtko Achim
Published: November 2018

A large body of evidence indicates that nitric oxide (NO)/cGMP signaling essentially contributes to the processing of chronic pain. In general, NO-induced cGMP formation is catalyzed by 2 isoforms of guanylyl cyclase, NO-sensitive guanylyl cyclase 1 (NO-GC1) and 2 (NO-GC2). However, the specific functions of the 2 isoforms in pain processing remain elusive. Here, we investigated the distribution of NO-GC1 and NO-GC2 in the spinal cord and dorsal root ganglia, and we characterized the behavior of mice lacking either isoform in animal models of pain. Using immunohistochemistry and in situ hybridization, we demonstrate that both isoforms are localized to interneurons in the spinal dorsal horn with NO-GC1 being enriched in inhibitory interneurons. In dorsal root ganglia, the distribution of NO-GC1 and NO-GC2 is restricted to non-neuronal cells with NO-GC2 being the major isoform in satellite glial cells. Mice lacking NO-GC1 demonstrated reduced hypersensitivity in models of neuropathic pain, whereas their behavior in models of inflammatory pain was normal. By contrast, mice lacking NO-GC2 exhibited increased hypersensitivity in models of inflammatory pain, but their neuropathic pain behavior was unaltered. Cre-mediated deletion of NO-GC1 or NO-GC2 in spinal dorsal horn neurons recapitulated the behavioral phenotypes observed in the global knockout. Together, these results indicate that cGMP produced by NO-GC1 or NO-GC2 in spinal dorsal horn neurons exert distinct, and partly opposing, functions in chronic pain processing.
Delivery of a community-based nutrition education program for minority adults
Authors: Downes Loureen S. , Buchholz Susan W. , Bruster Belinda , Girimurugan Senthil B. , Fogg Louis F. , Frock Margaret S.
Published: November 2018

Background and purpose:

Chronic diseases such as heart disease, type 2 diabetes, and obesity disproportionately affect minority adults, including African Americans. Engaging in lifestyle changes such as improving dietary habits and increasing physical activity can decrease the incidence and severity of these chronic diseases. The purpose of this research study was to explore the impact of a nutrition education program on health behaviors, lifestyle barriers, emotional eating, and body mass index (BMI) in a community-based setting with a minority sample.

Methods:

A convenience sample of 47 primarily African American adults participated in two similar Full Plate Diet nutrition interventions for 6 weeks (group I) and 8 weeks (group II). Participants completed pre-assessment and post-assessment of fruit, vegetable, and fat intake, as well as pre-assessment and post-assessment on physical activity, healthy lifestyle barriers, emotional eating, and BMI.

Conclusions:

After intervention, there was a significant increase in intake of fruits and vegetables and decreased fat intake. No significant differences were found in physical activity, healthy lifestyle barriers, emotional eating, or BMI after the intervention.

Implications for practice:

A structured, community-based nutrition education program may result in improved dietary habits among African Americans.
Human trafficking: How nurse practitioners can help end modern-day slavery
Authors: Peck Jessica L.
Published: November 2018

Nurse practitioners can be a powerful frontline force by collectively raising awareness of human trafficking (HT) through education; advocating for policy change at the local/state/federal level, providing primary prevention for contributory risk factors; and building a strong HT prevention program with the Social-Ecological Model. Together, NPs can lead through practice, education, advocacy, and research to promote optimal health outcomes and to end human trafficking.
Relapsed subcutaneous panniculitis-like T cell lymphoma evaluated by FDG PET/CT
Authors: Dong Ping , Wang Li , Zhu Hongmei , Li Lin
Published: November 2018

Rationale:

Subcutaneous panniculitis-like T cell lymphoma (SPTCL) is a rare primary cutaneous T cell lymphomas expressing α/β T cell receptors that preferentially involves subcutis, and few reports have investigated the diagnosis of suspicious relapsed SPTCL using 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT).

Patient concerns:

A 15-year-old woman complaining of a growing painless subcutaneous mass on perinaeum recurred 2 months ago, suggestive of suspicious relapsed SPTCL, underwent FDG PET/CT for diagnosis and treatment follow-up.

Diagnosis:

Based on the feature of FDG PET/CT images which revealed multiple increased FDG-avid subcutaneous adipose tissue lesions on the left upper arm, the left chest and perinaeum, involvement of bilateral inguinal lymph nodes, and the effective chemotherapy, she was diagnosed with relapsed SPTCL.

Interventions and Outcomes:

Fortunately, the patient's skin lesions subsided gradually after 3 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) regimen. Besides, complete remission was observed on interim-FDG PET/CT after 3 cycles of CHOP treatment.

Lessons:

FDG PET/CT can clarify the diagnosis in suspicious relapsed SPTCL, avoiding performing skin biopsy again.
Progressive large pediatric corneal limbal dermoid management with tissue glue-assisted monolayer amniotic membrane transplantation
Authors: Cho Wan-Hua , Sung Ming-Tse , Lin Pei-Wen , Yu Hun-Ju
Published: November 2018

Rationale:

Limbal dermoids are choristomas known as congenital benign tumors found in abnormal locations. Despite the benign nature, enlarging limbal dermoids may cause visual abnormalities by cornea infiltration with fat component, visual axis invasion, gradually induced corneal astigmatism, and finally result in anisometropic amblyopia. Here we report a rare case of progressive, large pediatric corneal limbal dermoid in a newborn, managed with tissue glue-assisted monolayer amniotic membrane transplantation.

Patient concerns:

A 1-day-old male baby (gestational age, 36 ± 6 weeks; birth body weight, 2785 gram) presented to our clinic with a whitish mass on his right eye since birth.

Diagnosis:

Ocular examination revealed a solid, whitish-yellow, and ovoid mass with central keratinized epithelium over the superior limbus; the lesion covered two-thirds of the cornea with rapid progression in size. The final pathological examination revealed that the lesion is composed of keratotic lining squamous epithelium resembling epidermis, underling dermal fibrotic connective tissue, and mature fat.

Interventions:

The patient underwent deep lamellar excision followed by mitomycin C (MMC) soaking (0.2 mg/mL, 3 minutes) and tissue glue-assisted monolayer amniotic membrane transplantation with the ring conformer at 2 months of age.

Outcomes:

The ring conformer was smoothly removed 2 weeks after the operation. The patient showed a smooth healing process with less pain and rapid corneal re-epithelization. The ocular surface was stable during the follow-up visits, and no complications were detected. Only mild post-operative scarring over the incision wound was observed.

Lessons:

Although a combination of excision, lamellar keratoplasty, and multilayer amniotic membrane and limbal stem cell transplantation is advocated for the treatment of grade II and III pediatric corneal limbal dermoids, the procedure used in this study offers an alternative surgical approach. However, because of the large size of the lesion and the young age of the patient, the management of amblyopia with visual rehabilitation and corneal transplantation is still needed in the future.
Comparison of clinical outcomes between cystotome-assisted prechop phacoemulsification surgery and conventional phacoemulsification surgery for hard nucleus cataracts
Authors: Li Xin , He Ye , Su Ting , Tian Ying , Wang Yujue , Xia Xiaobo , Song Weitao
Published: November 2018

Background:

This study aimed to investigate the safety and efficacy of the cystotome-assisted prechop phacoemulsification surgery (CAPPS) and conventional phacoemulsification surgery (CPS) in patients with IV degree nucleus cataract.

Methods:

The prospective, randomized, consecutive, comparative cohort study consecutively recruited Chinese age-related cataract patients, CAPPS and CPS were performed by a seasoned surgeon. Postoperative follow-up was at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year, and the outcome measures comprised ultrasound power, effective phacoemulsification time (EPT), corrected distance visual acuity (CDVA), endothelial cell density (ECD), corneal endothelium loss rate (ECL), central corneal thickness (CCT), and intraoperative and postoperative complications.

Results:

Patients in both groups gained a better CDVA postoperatively. The ultrasound power and EPT in the CAPPS group were lower than the CPS group (P < .001). ECD value decreased at each follow-up visit and did not return to the preoperative level; CPS resulted in greater endothelial cell loss than CAPPS did, which was significant. CCT increased immediately after the surgery, and decreased thereafter. The mean CCT values returned to preoperative levels at 3 months after surgery in the CAPPS group while it took 6 months in the CPS group. The differences in cornea edema and anterior chamber flare between the 2 groups were not significant at 1 day postoperatively (P = .070 and .094, respectively), while at the 1-week time point, the differences were statistically significant (P = .002 and .001, respectively).

Conclusion:

CAPPS appears to be an excellent method for treating hard nucleus cataract.
High protein diet is of benefit for patients with type 2 diabetes
Authors: Zhao Wen-Ting , Luo Yu , Zhang Ying , Zhou Yun , Zhao Ting-Ting
Published: November 2018

Currently, the prevalence of type 2 diabetes is still increasing worldwide and has become a major public health burden.

This meta-analysis was performed to further assess high protein (HP) diet on body weight, glycemic control, and cardiovascular disease risk factors in type 2 diabetes.

A literature search was conducted in PubMed and Embase databases up to June 2018. The pooled standard mean difference (SMD) and the corresponding 95% confidence interval (CI) were calculated using RevMan 5.3 software.

In total, 18 randomized control trials involving 1099 adults with type 2 diabetes were included. Pooled results indicated that HP diet could not significantly affect blood pressure of patients with type 2 diabetes, compared with low protein (LP) diet. However, the overall analyses showed the significant effect of HP diet on triglycerides reduction (SMD = −0.20, 95% CI = −0.35 to −0.05,P = .01) in patients with type 2 diabetes, compared with LP diet. Subgroup analyses showed that the ratio of energy from fat and carbohydrate in diet could affect the effect of HP diet on weight and triglyceride.

HP diet could be indicated to obtain beneficial results in weight loss and lipid metabolism.
Evaluating the optimal radiation dose for definitive chemoradiotherapy for esophageal squamous cell carcinoma
Authors: Ke Te-Min , Fong Yao , Lin Li-Ching , Chien Yu-Wun , Yang Ching-Chieh , Lin Chia-Hui , Lin Kuei-Li , Que Jenny
Published: November 2018

The optimal radiation dose for definitive chemoradiotherapy in inoperable esophageal squamous cell carcinoma (ESCC) has been long debated. In this study, we evaluated the effect of doses greater than the conventional radiation dose (50.4 Gy) on tumor control, tumor response, overall survival (OS), and disease-free survival (DFS).

The database of patients diagnosed with inoperable ESCC from 2007 to 2015 was obtained from the cancer registry of Chi-Mei Medical Center. All categorical variables were compared using Chi-squared test. The risk of OS and DFS were estimated using Cox proportional hazards regression, and Kaplan–Meier plots presented the trend of OS and DFS with log-rank tests used to compare differences. All significance levels were set at P < .05.

A total of 84 patients were retrospectively analyzed, with 42 (50%) receiving >50.4 Gy and 42 (50%) receiving ≤50.4 Gy (50%) concurrently with chemotherapy. Univariate and multivariate analysis revealed no significant differences between higher dose and conventional dose in OS (P = .21) and DFS (P = .26). Further dose analysis of <50, 50 to 50.4, 51 to 60, and >60 Gy showed no significant differences in OS or DFS. Higher doses conveyed no significant benefit on the failure pattern, either local regional failure or distant failure (P = .42). Major prognostic factors associated with better OS on multivariate analysis were stages I and II patients (P = .03) and radiation technique using arc therapy (P = .04). No acute toxicity of grade III or higher was recorded.

The results of our study show that providing higher than conventional radiation doses concurrent with chemotherapy for inoperable ESCC does not impact OS or DSF, nor does it improve locoregional failure or distant failure. Although tumor response might be improved by radiation doses >50.4 Gy, the impact on OS and DFS remain to be studied.
Perioperative predictors of moderate and severe postoperative pain in idiopathic scoliosis patients following spinal correction and fusion operations
Authors: Fan Qingqing , Xie Han , Ma Zhengliang , Chen Zhengxiang , Yan Tianhua , Ge Weihong
Published: November 2018

To investigate the predictive factors of pain intensity during the first 48 hours after spinal correction and fusion operations for idiopathic scoliosis patients.

A total of 290 scoliosis patients who underwent posterior spinal instrumentation and fusion operations were enrolled in this study. A standard surgical and analgesic method was implemented for all participants and pain intensity was evaluated at fixed times within 48 hours after the operation. Variables including demographics (age, sex, body mass index [BMI], patient sources), surgical variables (procedure, duration of operation), intraoperative variables (total transfusion, autologous transfusion, heterogeneous transfusion, fluid intake, use of preventive analgesia) were investigated.

On univariate analysis, BMI, transfusion type and not implementing preventive analgesia were associated with more serious pain after a scoliosis correction operation. Multivariate analysis indicated that receiving heterogeneous transfusion and not implementing preventive analgesia were significant predictive factors for moderate and severe pain after the spinal correction operation.

Our research indicated that the type of transfusion and preventive analgesia were significantly associated with the severity of pain. Body mass and patient sources should be considered before surgery. For patients under high risk of moderate and severe pain, the type of transfusion must be taken into consideration. This study explored the influencing factors of postoperative pain from a novel perspective, but some limitations existed in this present study, and future studies are needed.
Surgically treated rare intestinal bleeding due to submucosal hematoma in a patient on oral anticoagulant therapy
Authors: Yu Wei-Hua , Feng Chao , Han Tie-Mei , Ji Shun-Xian , Zhang Lan , Dai Yi-Yang
Published: November 2018

Rationale:

Bleeding in the gastrointestinal tract is a common complication of oral anticoagulant therapy (AT), and it usually appears as mucosal erosion or ulcer; however, intestinal submucosal hematoma (ISH) is an uncommon cause of hemorrhage.

Patient concerns:

This report presents the case of a 70-year-old woman with acute hematochezia induced by AT. She underwent computed tomography and endoscopy.

Diagnoses:

Colon submucosal hematoma.

Interventions:

Conservative treatment had no effect, and the patient underwent emergency surgery.

Outcomes:

Surgical resection showed hemorrhage and necrosis in the left colon, and the patient recovered 24 hours after surgery and continued AT.

Lessons:

The present case indicates that the ISH should be kept in mind as a complication of AT. It can be managed conservatively in some stable patients, but emergency surgery may be needed in some serious situations.
Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure
Authors: Cai Junjun , Wang Kai , Han Tao , Jiang Huiqing
Published: November 2018

Systemic inflammatory responses are associated with the development and progression of liver failure. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), red cell distribution width (RDW), RDW-to platelet ratio (RPR), mean platelet volume (MPV), and MPV-to platelet ratio (MPR) are markers of systemic inflammation. This study aimed to evaluate the prognostic values of these inflammatory markers in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).

203 HBV-ACLF patients, 79 cirrhosis patients (LC), 63 chronic hepatitis B (CHB), and 81 healthy subjects (HS) participated in this cohort study. Complete blood counts and biochemical examinations were obtained after overnight fasting. Multivariate analyses of 90-day outcome predictors were analyzed by Cox regression models. Survival probability curves were calculated by the Kaplan–Meier method.

The levels of NLR, MLR, RDW, MPV, RPR, and MPR were significantly higher and PNI was lower in patients with liver failure at presentation compared to those in LC, CHB, and HS (P <.001). In acute-on-chronic liver failure (ACLF) patients, NLR and MLR were higher in nonsurvivors than in survivors (P <.001), while other inflammatory markers showed no difference. ROC curve analyses showed that NLR combined with MLR had the highest AUC for identified poor outcome, followed by NLR, chronic liver failure-sequential organ failure assessment (CLIF-SOFA), MLR, model for end-stage liver disease (MELD), Child-Turcotte-Pugh (CTP) and TBIL. Multivariate analyses showed that TBIL, NLR, CTP, MELD, and CLIF-SOFA were independent predictors for 90-day mortality.

Combination of NLR and MLR are more accurate prognostic markers for predicting poor outcome than either marker alone in ACLF patients. And this combination is superior to the CLIF-SOFA, MELD, CTP score, and TBIL in terms of prognostic ability.
Impact of Home-Based HIV Testing Services on Progress Toward the UNAIDS 90-90-90 Targets in a Hyperendemic Area of South Africa
Authors: Lewis Lara , Maughan-Brown Brendan , Grobler Anneke , Cawood Cherie , Khanyile David , Glenshaw Mary , Kharsany Ayesha B. M.
Published: November 2018

Background:

In several subgroups of South Africa, the percentage of HIV-positive individuals aware of their status falls well below the UNAIDS 90% target. This study examined the impact that home-based HIV testing services (HBHTS) had on knowledge of status in a hyperendemic area of South Africa.

Methods:

We analysed data from the second cross-sectional HIV Incidence Provincial Surveillance System survey (2015/2016), a representative sample (n = 10,236) of individuals aged 15–49 years. Participants completed a questionnaire, provided blood samples for laboratory testing (used to estimate HIV prevalence), and were offered HBHTS. The proportion of people living with HIV (n = 3870) made aware of their status through HBHTS was measured, and factors associated with HBHTS uptake were identified.

Results:

Knowledge of HIV-positive status at the time of the survey was 62.9% among men and 73.4% among women. Through HBHTS, the percentage of HIV-positive men and women who knew their status rose to 74.2% and 80.5%, respectively. The largest impact was observed among youth (15–24 years). Knowledge of status increased from 36.6% to 59.3% and from 50.8% to 64.8% among young men and women, respectively. In addition, 51.4% of those who had previously never tested received their first test. Key reasons for declining HBHTS among undiagnosed HIV-positive individuals included fear and self-report of an HIV-negative status.

Conclusions:

HBHTS was effective in increasing awareness of HIV-positive status, particularly among youth, men, and those who had never tested. HBHTS could have a marked impact on progress toward the UNAIDS 90-90-90 targets within these subgroups.
Brief Report: Body Mass Index and Cognitive Function Among HIV-1–Infected Individuals in China, India, and Nigeria
Authors: Jumare Jibreel , El-Kamary Samer S. , Magder Laurence , Hungerford Laura , Umlauf Anya , Franklin Donald , Ghate Manisha , Abimiku Alash'le , Charurat Man , Letendre Scott , Ellis Ronald J. , Mehendale Sanjay , Blattner William A. , Royal Walter , Marcotte Thomas D. , Heaton Robert K. , Grant Igor , McCutchan John A.
Published: November 2018

Background:

Risk of cognitive impairment is increased among persons with high or low body mass index in HIV− and HIV+ populations in resource-rich settings. We examined this association among HIV+ patients in 3 resource-limited settings.

Methods:

This secondary analysis included data of 761 HIV+ volunteers pooled from 3 prospective cohort studies conducted in China (n = 404; 53%), India (n = 200; 26%), and Nigeria (n = 157; 21%). World Health Organization (WHO) weight classifications were based on body mass index. T scores, adjusted for demographics and practice effects, were derived from a 7-domain neuropsychological battery. Neurocognitive impairment (NCI) was defined as global deficit score of ≥0.5.

Results:

Overall, prevalence of NCI at baseline was 27.7% (similar across all cohorts). The overweight/obese and underweight constituted 37.3% and 15.5% of the total participants, respectively. In a multivariable logistic regression of pooled longitudinal data, adjusting for clinical and demographic variables, the odds of global NCI were 38% higher among the overweight/obese as compared to normal weight participants [odds ratio: 1.38 (95% confidence interval: 1.1 to 1.72); P = 0.005]. Similarly, the odds of global NCI were 39% higher among the underweight as compared to normal weight participants [odds ratio: 1.39 (95% confidence interval: 1.03 to 1.87); P = 0.029].

Conclusions:

NCI among HIV-1–infected patients was more prevalent in both overweight/obese and underweight than normal weight individuals in 3 resource-limited settings, confirming observations in resource-rich settings. Mechanisms underlying these associations are unclear but likely differ for underweight and overweight persons.
Decreases in Self-Reported ART Adherence Predict HIV Viremia Among Pregnant and Postpartum South African Women
Authors: Phillips Tamsin K. , Wilson Ira B. , Brittain Kirsty , Zerbe Allison , Mellins Claude A. , Remien Robert H. , Orrell Catherine , Abrams Elaine J. , Myer Landon
Published: November 2018

Introduction:

Routine HIV viral load (VL) monitoring is recommended for patients on antiretroviral therapy, but frequent VL testing, required in pregnant and postpartum women, is often not feasible. Self-reported adherence can be valuable, but little is known about its longitudinal characteristics.

Methods:

We followed women living with HIV from antiretroviral therapy initiation in pregnancy through 18-month postpartum in Cape Town, South Africa, with repeated measurement of VL and self-reported adherence using a 3-item scale. We used generalized estimating equations [with results presented as odds ratios (ORs) with 95% confidence intervals (CIs)] to investigate the association between viremia and change in adherence over pairs of consecutive visits.

Results:

Among 2085 visit pairs from 433 women, a decrease in self-reported adherence relative to the previous visit on any of the 3 self-report items, or the combined scale, was associated with VL >50 and >1000 copies per milliliter. The best-performing thresholds to predict VL >50 copies per milliliter were a single-level decrease on the Likert response item “how good a job did you do at taking your HIV medicines in the way that you were supposed to?” (OR 2.08, 95% CI: 1.48 to 2.91), and a decrease equivalent to ≥5 missed doses or a one-level decrease in score on either of 2 Likert items (OR 1.34, 95% CI: 1.06 to 1.69).

Conclusions:

Longitudinal changes in self-reported adherence can help identify patients with viremia. This approach warrants consideration in settings where frequent VL monitoring or other objective adherence measures are not possible.
Sources of path integration error in young and aging humans
Authors: Stangl Matthias , Kanitscheider Ingmar , Riemer Martin , Fiete Ila , Wolbers Thomas
Published: November 2018

Path integration is a vital function in navigation: it enables the continuous tracking of one’s position in space by integrating self-motion cues. Path integration abilities vary across individuals but tend to deteriorate in old age. The specific causes of path integration errors, however, remain poorly characterized. Here, we combined tests of path integration performance with a novel analysis based on the Langevin diffusion equation, which allowed us to decompose errors into distinct causes that can corrupt path integration computations. Across age groups, the dominant errors were due to noise and a bias in speed estimation. Noise-driven errors accumulated with travel distance not elapsed time, suggesting that the dominant noise originates in the velocity input rather than within the integrator. Age-related declines were traced primarily to a growth in this unbiased noise. Together, these findings shed light on the contributors to path integration error and the mechanisms underlying age-related navigational deficits.
Rational reprogramming of cellular states by combinatorial perturbation
Authors: Duan Jialei , Li Boxun , Bhakta Minoti , Xie Shiqi , Zhou Pei , Munshi Nikhil V. , Hon Gary C.
Published: November 2018

Ectopic expression of transcription factors (TFs) can reprogram cell state. However, due to the large combinatorial space of possible TF cocktails, it remains difficult to identify TFs that reprogram specific cell types. Here, we develop Reprogram-Seq to experimentally screen thousands of TF cocktails for reprogramming performance. Reprogram-Seq leverages organ-specific cell atlas data with single-cell perturbation and computational analysis to predict, evaluate, and optimize TF combinations that reprogram a cell type of interest. Focusing on the cardiac system, we perform Reprogram-Seq on MEFs using an undirected library of 48 cardiac factors and separately on a directed library of 10 epicardial-related TFs. We identify a novel combination of 3 TFs which efficiently reprogram MEFs to epicardial-like cells that are transcriptionally, molecularly, morphologically, and functionally similar to primary epicardial cells. Reprogram-Seq holds promise to accelerate the generation of specific cell types for regenerative medicine.
Target-specific co-transmission of acetylcholine and GABA from a subset of cortical VIP+ interneurons
Authors: Granger Adam J. , Wang Wengang , Robertson Keiramarie , El-Rifai Mahmoud , Zanello Andrea , Bistrong Karina , Saunders Arpiar , Chow Brian , Nuñez Vicente , Gu Chenghua , Sabatini Bernardo L.
Published: November 2018

The modulation of cortex by acetylcholine (ACh) is typically thought to originate from long-range projections arising in the basal forebrain. However, a subset of VIP interneurons express ChAT, the synthetic enzyme for ACh, and are a potential local source of cortical ACh. Which neurotransmitters these VIP/ChAT interneurons (VCINs) release is unclear, and which post-synaptic cell types these transmitters target is not known. Using quantitative molecular analysis of VCIN pre-synaptic terminals, we show expression of the molecular machinery to release both ACh and GABA, with ACh release restricted to a subset of boutons. A systematic survey of potential post-synaptic cell types shows that VCINs release GABA primarily onto other inhibitory interneuron subtypes, while ACh neurotransmission is notably sparse, with most ACh release onto layer 1 interneurons and other VCINs. Therefore, VCINs are an alternative source of cortical ACh signaling that supplement GABA-mediated disinhibition with highly targeted excitation through ACh.
A Primase-Induced Conformational Switch Controls the Stability of the Bacterial Replisome
Authors: Monachino Enrico , Jergic Slobodan , Lewis Jacob S. , Xu Zhi-Qiang , Lo Allen T.Y. , L. O’Shea Valerie , Berger James M. , Dixon Nicholas E. , van Oijen Antoine M.
Published: November 2018

Recent studies of bacterial DNA replication have led to a picture of the replisome as an entity that freely exchanges DNA polymerases and displays intermittent coupling between the helicase and polymerase(s). Challenging the textbook model of the polymerase holoenzyme acting as a stable complex coordinating the replisome, these observations suggest a role of the helicase as the central organizing hub. We show here that the molecular origin of this newly-found plasticity lies in the >400-fold increase in strength of the interaction between the polymerase holoenzyme and the replicative helicase upon association of the primase with the replisome. By combiningin vitroensemble-averaged and single-molecule assays, we demonstrate that this conformational switch operates during replication and promotes recruitment of multiple holoenzymes at the fork. Our observations provide a molecular mechanism for polymerase exchange and offer a revised model for the replication reaction that emphasizes its stochasticity.
Genetic Diversity and Coexistence ofBabesiain Ticks (Acari: Ixodidae) from Northeastern China
Authors: Jiang Jia-Fu , Jiang Bao-Gui , Yuan Ting-Ting , Von Fricken Michael , Jia Na , Jiang Rui-Ruo , Zhang Yuan , Li Xin-Lou , Zheng Yuan-Chun , Huo Qiu-Bo , Sun Yi , Cao Wu-Chun
Published: November 2018

Background

Babesiosis is an emerging zoonosis in humans with significant and increasing health burden in China. A few systematic reports onBabesiaspp. was involved with ticks, especially in the human babesiosis endemic areas.

Methods

The ticks were collected from 30 individual waypoints along 2.0 km transects in two recreational forested areas in Northeastern China. Then we screened them forBabesiaspp. infection by amplifying the partial 18s rRNA gene with subsequent sequencing. Multivariate logistic regression analysis was used to access the association between infections and some related risk factors. The cluster analyses were performed using SaTScan v6.0 Software for identifying the geographic cluster of the positive samples in ticks from each waypoint.

Results

A total ofIxodes persulcatus(n=2380) andHaemaphysalis concinna(n=461) ticks were collected. The 0.97% ofI. persulcatusticks were infected with fiveBabesiaspecies, includingB. bigemina(n=6),B. divergens(n=2),B. microti(n=3),B. venatorum(n=11) and one novel strain HLJ-8. Thirteen (2.92%)H.concinnaticks containedB. bigemina(n=1),B. divergens(n=1), three genetic variants ofBabesiarepresented by HLJ-874 which was closely related toBabesiasp.MA#361-1, and eight otherBabesiavariants represented by HLJ242 which were similar toB.crassa. Each study site had 5~6 differentBabesiaspp. One waypoint was more likely to yieldB.venatorum(relative risk=15.36,P=0.045) than all other waypoints.

Conclusions

There exists a high genetic diversity ofBabesiaspp. across a relatively small sampled region. Further study is needed to understand the risks these variants pose for human health.

Author Summary

Babesiosis is the subject of increasing interest as an emerging zoonosis in humans with significant and increasing health burden of the disease at recently. In China, many probably human babesiosis cases who had a history of recent tick bite were found in Lyme endemic area in Northeastern China, where the prevalence of Babesia parasite in the ticks still was far underestimated. In the present study, we conducted a field survey for ticks to identify diversities and complexity of babesia, and then to assess the risk of human babesiosis, by means of a three years longitudinal study that mapped the location of the ticks tested positive for Babesia spp. at two forestry areas with a heavy burden of tick-borne pathogens. We firstly presented the prevalence of Babesia spp. especially the genetic diversities and coexistence of seven Babesia spp. including 2 novel species or variants at one small scale “natural foci” in northeastern China. This work is useful to understand the complexity of Babesia pathogen in China, and how the Babesia perpetuates over the long term in the environment, as well as potential risks for human health.
A combined X-ray crystallography and theoretical study of N—H...OX (X is =P and —C) hydrogen bonds in two new structures with a (C—O)2(N)P(=Y) (Y is O and S) skeleton
Authors: Vahdani Alviri Banafsheh , Pourayoubi Mehrdad , Farhadipour Abolghasem , Nečas Marek , Bertolasi Valerio
Published: November 2018

The crystal structures of N,N′-(cyclohexane-1,4-diyl)bis(O,O′-diphenylphosphoramide), C30H32N2O6P2 or (C6H5O)2P(O)(1-NH)(C6H10)(4-NH)P(O)(OC6H5)2, (I), and N,N′-(1,4-phenylene)bis(O,O′-dimethylthiophosphoramide), C10H18N2O4P2S2 or (CH3O)2P(S)(1-NH)(C6H4)(4-NH)P(S)(OCH3)2, (II), have been investigated. In the structure of (I), with an (O)2(N)P(O) skeleton, two symmetry-independent phosphoramide molecules are linked through N—H...O=P hydrogen bonds. In the structure of (II), with an (O)2(N)P(S) skeleton, the ester O atoms take part in N—H...O—C hydrogen bonds as acceptors; the P=S groups do not participate in hydrogen-bonding interactions. The strengths of these hydrogen bonds were evaluated, using quantum chemical calculations with the GAUSSIAN09 software package at the B3LYP/6-311G(d,p) level of theory. For this, LP(O) to σ*(NH) charge transfers were studied, according to the second-order perturbation theory in natural bond orbital (NBO) methodology, for a three-component cluster of hydrogen-bonded molecules for both structures, including all of the independent N—H...O hydrogen bonds observed in the crystal packing. The details of the intermolecular interactions were studied by Hirshfeld surface maps and two-dimensional fingerprint plots.
Two new cobalt(II) rhodamine 6G hydrazone complexes: structure, fluorescence and magnetism
Authors: Yuan Juan , Wang Xia , Zhang Nan , Liu Mei-Jiao , Kou Hui-Zhong
Published: November 2018

Two new CoII complexes, namely bis{N-[(6-bromopyridin-2-yl)methylidene]-2-[6-ethylamino-3-(ethyliminiumyl)-2,7-dimethyl-3H-xanthen-9-yl]benzene-1-carbohydrazonate}cobalt(II) bis(perchlorate)–dichloromethane–methanol (1/1/2), [Co(C32H30BrN5O2)2](ClO4)2·CH2Cl2·2CH3OH or [CoII(L)2](ClO4)2·CH2Cl2·2CH3OH, (1), and the bis(tetrafluoridoborate) salt, [Co(C32H30BrN5O2)2](BF4)2·CH2Cl2·2CH3OH or [CoII(L)2](BF4)2·CH2Cl2·2CH3OH, (2) (L is commonly 6-bromopyridine-2-carbaldehyde rhodamine 6G hydrazone), have been successfully constructed and characterized. The crystal structure analysis revealed that complexes (1) and (2) are mononuclear and have a CoIIN4O2 distorted octahedral structure. The large π-conjugated xanthene moiety of the L ligand causes strong intermolecular π–π stacking interactions, yielding a supramolecular one-dimensional chain. Complexes (1) and (2) display an obvious fluorescence emission near 560 nm in the solid state. Magnetic investigations show that both (1) and (2) are paramagnetic, dominated by the structural distortion and spin-orbit coupling of CoII.