bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Penicillium sp. Causes Rot in Stored Sugar Beet Roots in Idaho
Authors: Strausbaugh Carl A. , Dugan Frank
Published: June 2017

Penicillium vulpinum along with a number of other fungi can lead to rot of stored sugar beet roots. However, Penicillium isolates associated with necrotic lesions on roots from a recent sugar beet storage study were determined to be different from P. vulpinum and other recognized Penicillium species. Phylogenies based on sequencing of the internal transcribed spacer (ITS)-5.8S, β-tubulin (BenA), and RNA polymerase II second largest subunit (RPB2) DNA regions indicate that these isolates are novel, but most closely related to the following Penicillium spp. in the section Fasiculata: P. aurantiogriseum, P. camemberti, and P. freii. Macro- and micromorphological data also support designating these isolates as a new species for which we propose the name, Penicillium cellarum sp. nov. Inoculation studies with the P. cellarum isolates on roots of the commercial sugar beet cultivar B-7 led to the formation of necrotic lesions 23 to 25 mm in diameter after 86 days in storage. These lesions were similar to those observed on sugar beet roots in commercial storage piles. These data indicate that P. cellarum is a pathogen which can cause root rot in stored sugar beet roots.
Smoking cessation
Authors: Olenik Angela , Mospan Cortney M.
Published: June 2017

Clinicians must be prepared to identify tobacco use among patients and implement behavioral interventions to help patients quit. By understanding behavioral interventions and pharmacologic options, clinicians can design an optimal quit plan for each patient. This article reviews foundations of tobacco cessation, pharmacotherapy updates, and the emergence of e-cigarettes as desirable cessation tools for patients.
Curved Planar Reformation for the Evaluation of Hydromyelia in Patients With Scoliosis Associated With Spinal Dysraphism
Authors: Yoshioka Fumitaka , Shimokawa Shoko , Koguchi Motofumi , Ito Hiroshi , Ogata Atsushi , Inoue Kouhei , Takase Yukinori , Tanaka Tatsuya , Nakahara Yukiko , Masuoka Jun , Abe Tatsuya
Published: June 2017

Study Design.

A retrospective cohort study.

Objective.

Scoliosis and hydromyelia have frequently been observed in patients with spinal dysraphism. We investigated the applicability of curved planar reformation (CPR) for evaluating hydromyelia in patients with scoliosis associated with spinal dysraphism.

Summary of Background Data.

It is quite difficult to evaluate scoliosis and hydromyelia in patients with spinal dysraphism.

Methods.

We identified 11 patients with scoliosis and a Cobb angle of >20° among 107 spinal dysraphism patients. In addition to routine T1- and T2-weighted axial and sagittal MRI, we obtained three-dimensional constructive interference in steady-state magnetic resonance imaging (MRI) as sagittal cross-section volume images. The spinal cord and hydromyelia were rendered into a single-plane, two-dimensional image using the straightened CPR technique. In cases of scoliosis with hydromyelia, the sagittal length and maximal diameters of hydromyelia and the spinal cord were measured by three examiners. Measurement errors among examiners were evaluated using standard deviation (SD) and coefficient of variation (CV).

Results.

Each series of image sets provided a straightened CPR image that clearly delineated the entire length of the linearized spinal cord in a single plane. The straightened CPR image also demonstrated the accurate lengths and estimated volume of hydromyelia. Given that three of the 11 patients underwent serial MRI during this period, we were able to accurately compare volume changes. In the sagittal length of the hydromyelia, SD and CV were smaller with the straightened CPR technique than with the conventional T2 WI sagittal section in all cases, showing a statistically significant difference between both techniques (SD: P = 0.014, CV: P = 0.013). Even in the measurements, the difference in CV between both techniques was close to statistical significance.

Conclusion.

The straightened CPR technique is useful for accurately identifying volume changes in hydromyelia, even in patients with severe scoliosis.

Level of Evidence: 1
Immunologic Response Elicited in Breast Cancer Patients Receiving a NeuGcGM3-based Vaccine as Adjuvant Therapy
Authors: Valdes-Zayas Anet , Gonzalez Zuyen , Mulens Vladimir , Vega Aliz M. , Perez Kirenia , Lorenzo-Luaces Patricia , Rubio Maria C. , Estevez Anabely , Curbelo Idelmis , Fernandez Luis E. , Crombet Tania , Mazorra Zaima
Published: June 2017

This study aimed to investigate the immunogenicity of a cancer vaccine consisting of the NeuGcGM3 ganglioside combined with the outer membrane protein complex ofNeisseria meningitidesto form very small size particles. The vaccine is administered together with Montanide ISA51, as adjuvant treatment for breast cancer patients. After surgical resection and standard first-line chemo/radiotherapy, breast cancer patients in stage II–III were enrolled in a phase III clinical trial and allocated into 2 strata, according to the number of positive lymph nodes [stratum I (0–3); stratum II (≥4)]. Subsequently, patients were randomly assigned to receive the vaccine or placebo. The treatment consisted of 5 vaccine doses (200 μg) every 2 weeks and thereafter monthly reimmunizations to complete 15 doses. The vaccine was well-tolerated and high titers of immunoglobulin M and immunoglobulin G anti-NeuGcGM3 antibodies were similarly detected in each stratum. Hyperimmune sera were able to specifically recognize and kill the NeuGcGM3-expressing L1210 tumor cell line, and these functional capacities were significantly associated with a better clinical outcome in patients of stratum II. Besides, postimmune sera had the capacity to revert in vitro the immunosuppression induced by NeuGcGM3, as measured by the prevention of CD4 downmodulation on human T lymphocytes. Vaccination had no impact on the frequency of regulatory T cells or circulating NK cells. This study demonstrated, for the first time, the immunogenicity of the NeuGcGM3/VSSP/Montanide ISA 51 vaccine in the adjuvant setting and describes the functionality of induced anti-NeuGcGM3 antibodies as potential surrogate biomarkers of clinical benefit.
Antigen Presentation by Individually Transferred HLA Class I Genes in HLA-A, HLA-B, HLA-C Null Human Cell Line Generated Using the Multiplex CRISPR-Cas9 System
Authors: Hong Cheol-Hwa , Sohn Hyun-Jung , Lee Hyun-Joo , Cho Hyun-Il , Kim Tai-Gyu
Published: June 2017

Human leukocyte antigens (HLAs) are essential immune molecules that affect transplantation and adoptive immunotherapy. When hematopoietic stem cells or organs are transplanted with HLA-mismatched recipients, graft-versus-host disease or graft rejection can be induced by allogeneic immune responses. The function of each HLA allele has been studied using HLA-deficient cells generated from mutant cell lines or by RNA interference, zinc finger nuclease, and the CRISPR/Cas9 system. To improve HLA gene editing, we attempted to generate an HLA class I null cell line using the multiplex CRISPR/Cas9 system by targeting exons 2 and 3 of HLA-A, HLA-B, and HLA-C genes simultaneously. Multiplex HLA editing could induce the complete elimination of HLA class I genes by bi-allelic gene disruption on target sites which was defined by flow cytometry and target-specific polymerase chain reaction. Furthermore, artificial antigen-presenting cells were generated by transfer of a single HLA class I allele and co-stimulatory molecules into this novel HLA class I null cell line. Artificial antigen-presenting cells showed HLA-restricted antigen presentation following antigen processing and were successfully used for the efficient generation of tumor antigen-specific cytotoxic T cells in vitro. The efficient editing of HLA genes may provide a basis for universal cellular therapies and transplantation.
Severe Ocular Myositis After Ipilimumab Treatment for Melanoma: A Report of 2 Cases
Authors: Pushkarevskaya Anna , Neuberger Ulf , Dimitrakopoulou-Strauss Antonia , Enk Alexander , Hassel Jessica C.
Published: June 2017

Ipilimumab binds and blocks cytotoxic T-lymphocyte-associated antigen-4, causing enhanced T-cell reaction, antitumor response, and significant improvement of the overall survival of patients with metastatic melanoma. Patients treated with ipilimumab can develop immune-related adverse effects, primarily dermatitis, colitis, hepatitis, and hypophysitis. Although, in phase I–III studies, 64.2% of all patients suffered from immune-related adverse effects, ocular adverse effects occurred in 1.3% only. In the cases reported below, 2 patients with metastatic melanoma developed severe ocular myositis after treatment with ipilimumab. These are the first 2 reports of successful treatment of this condition by use of a combination of methylprednisolone and mycophenolate mofetil, and, in 1 of the cases, additional medication with intravenous immunoglobulin.
Prognostic significance of cyclooxygenase 2 and phosphorylated Akt1 overexpression in primary nonmetastatic and metastatic cutaneous melanomas
Authors: Soares Ciro D. , Borges Camilla F. , Sena-Filho Marcondes , Almeida Oslei P. de , Stelini Rafael F. , Cintra Maria L. , Graner Edgard , Zecchin Karina G. , Jorge Jacks
Published: June 2017

Cyclooxygenase 2 (COX-2) and phosphorylated Akt1 (p-Akt1) are associated with tumor spreading, cell proliferation, high metabolism, and angiogenesis in solid tumors. This study aimed to investigate COX-2 and p-Akt1 expression in primary and metastatic melanomas by correlating with the cellular proliferation index (as revealed by minichromosome maintenance 2 expression) and the outcome of patients with malignant melanomas. Seventy-seven biopsies of malignant melanomas, including 42 primary nonmetastatic melanomas (PNMMs), 12 primary metastatic melanomas (PMMs), and 23 metastatic melanomas (MMs), were retrospectively selected. Tissue microarrays were developed and submitted for immunohistochemical staining for COX-2, p-Akt1, and minichromosome maintenance 2. Increased COX-2 cytoplasmic staining patterns were observed in PMM and MM when compared with PNMM (P=0.0011). Higher nuclear and cytoplasmic expression of p-Akt1 was more closely associated with PMM than with MM and PNMM (P<0.00001). Coexpression of these biomarkers was closely correlated with lower overall survival rates in melanomas. Furthermore, we observed a statistically significant positive correlation between the mitosis index and increased COX-2 expression (P=0.0135) and between p-Akt1 (P=0.0038) and the cellular proliferation index (P=0.0060). Taken together, our findings demonstrate that COX-2 and p-Akt1 play an important combined role during melanoma progression and are associated with highly metastatic tumors and survival rates in patients with MM. In addition, these biomarkers can be used to predict melanoma prognosis independently of metastatic status. However, further studies are required to elucidate the biological role of these biomarkers during the progression of MM events.
Building Cultural Competence
Authors: Cox Lauren , Crump Lauren , Struwing Renee , Gillum Deborah , Abraham Sam
Published: June 2017

College students who participate in semester abroad programs have diverse but positive experiences. Variables such as the educational institution attended by the students and the location of the study abroad can affect the experiences of the students. There is minimal research concerning students from Christian colleges who study abroad. The purpose of this study was to investigate the lived experiences of college students participating in a semester abroad program in a developing country. Seven college students were interviewed regarding their experiences by three senior nursing students who also participated in the study abroad program. Results indicated that major factors influencing students' experiences were related to cultural immersion, role relationships, challenges encountered, and personal growth. Students reported that relationships with people and faith in Christ were strengthened through the experience.
Child and parent pain catastrophizing and pain from presurgery to 6 weeks postsurgery: examination of cross-sectional and longitudinal actor-partner effects
Authors: Birnie Kathryn A. , Chorney Jill , El-Hawary Ron ,   PORSCHE Study Group
Published: June 2017

Child and parent pain catastrophizing are reported preoperative risk factors for children's acute and persistent postsurgical pain. This study examined dyadic relations between child and parent pain catastrophizing and child and parent ratings of child pain prior to (M = 4.01 days; “baseline”) and following surgery (M = 6.5 weeks; “acute follow-up”), as well changes in pain catastrophizing during this time in 167 youth (86% female; M
age
= 14.55 years) undergoing spinal fusion surgery and 1 parent (89% mothers). Actor-partner interdependence models assessed cross-sectional and longitudinal intra- and interpersonal effects. Cross-sectionally, child pain catastrophizing was positively associated with child pain at baseline and acute follow-up (actor effects: βbaseline = 0.288 and βfollow-up = 0.262; P < 0.01), and parents' ratings of child pain at baseline (partner effect: βbaseline = 0.212; P < 0.01). Parent pain catastrophizing was not cross-sectionally associated with ratings of child pain. Longitudinally, higher pain catastrophizing at baseline predicted higher pain catastrophizing at acute follow-up for children (actor effect: β = 0.337; P < 0.01) and parents (actor effect: β = 0.579; P < 0.01) with a significantly smaller effect for children (respondent × actor interaction: β = 0.121; P < 0.05). No longitudinal partner effects for catastrophizing were observed. Baseline child and parent pain catastrophizing did not predict child pain at acute follow-up. In conclusion, child, not parent, pain catastrophizing was associated with children's pre- and postsurgical pain, and showed significantly less stability over time. There is a need to better understand contributors to the stability or changeability of pain catastrophizing, the prospective relation of catastrophizing to pain, and contexts in which child vs parent pain catastrophizing is most influential for pediatric postsurgical pain.
Pain After Cochlear Implantation: An Unusual Complication?
Authors: Celerier Charlotte , Rouillon Isabelle , Blanchard Marion , Parodi Marine , Denoyelle Françoise , Loundon Natalie
Published: June 2017

Objective:

To analyze clinical signs and better define the underestimated long-term pain after implantation, to discuss etiological hypothesis, and to propose our department treatment algorithm and results.

Study Design and Setting:

Retrospective review of children implanted with complaints of atypical pain in the area of device implantation, not in the immediate postoperative period, more than or equal to 4 on the Visual Analog Pain Scale (VAPS: 0–10) in the ENT pediatric department of Trousseau and Necker Enfants Malades Hospitals between 1998 and 2015.

Patients:

All patients had full clinical and electrophysiological checking, and had normal functioning device. Exclusion criteria were: related history of local trauma, ongoing skin infection, magnet displacement, and device failure.

Intervention(s):

Treatments and outcomes were reviewed, with a minimum of 6 months follow up. Two groups were analyzed: Group PS: pain associated with local swelling (n = 9) and Group P: isolated pain (n = 11). The first-line treatment was medical. In Group PS, anti-inflammatory, pain medication, and antibiotics were used at the same time; in Group P, only anti-inflammatory and pain medication was used.

Main Outcome Measure(s):

Success was defined when complete resolution of pain and swelling (pain scale = 0).

Results:

Twenty cases out of the 1,448 implanted patients in our department (1.4%) were included. Average age at first occurrence of pain was 15 years (3–22 yr). Mean delay between surgery and pain complaint was 5.8 years (0.25–14). Mean follow up was 2 years (0.5–5 yr).

First line medical treatment was successful in eight cases (40%). Of the 12 patients who failed medical treatment and required surgery, two had resolution of pain with magnet change and 10 had resolution with reimplantation. (5/9 patients in Group PS and 7/11 in Group P).

Microbiology was performed in 10/20 cases and analysis of explanted devices was performed in 7/10 cases. Positive microbiological culture of soft tissues was positive for 3/10 cases, biofilm was positive for 5/7 cases.

Pain in the area of the implanted device can occur shortly after surgery or on long-term follow up. It has been seen in all device types. Pain may be clinically underestimated, as low VAPS grade (<5) or intermittent pain may be not reported. Low-grade infections might be a hypothesis to explain these pain. Management may include medical or surgical intervention.

Conclusion:

Pain in the implanted area can be a major complication leading to implant non-use. Rate may be underestimated because of the lack of medical report. At explantation, we recommend systematic evaluation of biofilm and device failure regardless of the suspected etiology of the pain.
Long-term Outcomes of Cochlear Implantation in Children With Congenital Cytomegalovirus Infection
Authors: Yoshida Haruo , Takahashi Haruo , Kanda Yukihiko , Kitaoka Kyoko , Hara Minoru
Published: June 2017

Objective:

To investigate the role of the developmental delay often observed in children with congenital cytomegalovirus (CMV) infection on the improvement of language understanding after cochlear implantation (CI).

Study Design:

Retrospective chart review.

Patients:

Sixteen children with severe and/or profound hearing loss due to congenital CMV infection (CMV group) and 107 congenitally deaf children (168 ears) without CMV infection as the cause of deafness (non-CMV group). Mean age at which patients underwent CI was 2.9 years in both groups. The mean follow-up period was 7.8 versus 8.2 years, respectively.

Interventions/Main Outcome Measures:

The Enjoji Scale of Infant Analytical Development was used to evaluate/compare pre- and postoperative hearing level, word recognition score, speech discrimination score, and language production and perception skills. The Picture Vocabulary Test-Revised was used to assess vocabulary understanding skill. Correlation between the final vocabulary understanding skill assessment and several factors was also examined.

Results:

Improvement in hearing thresholds (mean: 106.0 dB) was greater after the first CI, (27−45 dB; mean: 33.8 dB) compared with hearing aid (48–74 dB; mean: 63.1 dB). Similarly, language perception and production were better in the CMV group. However, in the long term, differences between good and poor cases became prominent, especially in children with motor or cognitive delay and brain abnormalities who performed poorly in the CMV group.

Conclusion:

Long-term language perception and production after CI were overall satisfactory in congenital CMV-deafened children. CI was effective, particularly in the absence of CMV-induced disorders. However, this effectiveness was limited in those with motor or cognitive delay.
Successful Treatment of Pediatric Ventricular Assist Device Thrombosis
Authors: Chetan Devin , Buchholz Holger , Bauman Mary , Anand Vijay , Holinski Paula , Conway Jennifer
Published: June 2017

Pump thrombosis represents a significant cause of morbidity and mortality in patients on continuous flow ventricular assist devices (CF-VAD). Pump thrombosis in the pediatric CF-VAD population has been reported between 11% and 44%, with the largest reported series from the PediMACS registry reporting a rate of approximately 15%. We report our early experience with four pediatric patients who developed pump thrombosis on a CF-VAD. Our limited experience suggests that the treatment of pediatric VAD thrombosis can be approached with similar principles to the adult population. Our current strategy includes:

i. Initiating treatment with bivalirudin for an isolated rise in lactate dehydrogenase (LDH) with no corresponding rapid rise in plasma-free hemoglobin which may prevent further progression.

ii. Treatment with a low-dose systemic tissue plasminogen activator (TPA) protocol as opposed to targeted therapy via catheter intervention if bivalirudin fails.

iii. If there are concerns with respect to the impact of hemolysis on kidney function or the patient is close to a previous surgery, device exchange can be considered.

The balance between achieving appropriate anticoagulation/antiplatelet therapy in the face of bleeding/hemorrhagic complications remains a challenge. There is a need for larger studies in the pediatric population to outline an algorithm for the definitive management of VAD thrombosis.
European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment
Authors: Romano Claudio , van Wynckel Myriam , Hulst Jessie , Broekaert Ilse , Bronsky Jiri , Dall'Oglio Luigi , Mis Nataša F. , Hojsak Iva , Orel Rok , Papadopoulou Alexandra , Schaeppi Michela , Thapar Nikhil , Wilschanski Michael , Sullivan Peter , Gottrand Frédéric
Published: June 2017

Objectives:

Feeding difficulties are frequent in children with neurological impairments and can be associated with undernutrition, growth failure, micronutrients deficiencies, osteopenia, and nutritional comorbidities. Gastrointestinal problems including gastroesophageal reflux disease, constipation, and dysphagia are also frequent in this population and affect quality of life and nutritional status. There is currently a lack of a systematic approach to the care of these patients. With this report, European Society of Gastroenterology, Hepatology and Nutrition aims to develop uniform guidelines for the management of the gastroenterological and nutritional problems in children with neurological impairment.

Methods:

Thirty‐one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; to define indications for surgical interventions (eg, Nissen Fundoplication, esophagogastric disconnection); and finally to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development, and Evaluation was applied to evaluate the outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation using the nominal voting technique. Expert opinion was applied to support the recommendations where no randomized controlled trials were available.
The concurrent validity and intrarater reliability of the Microsoft Kinect to measure thoracic kyphosis
Authors: Quek June , Brauer Sandra G. , Treleaven Julia , Clark Ross A.
Published: June 2017

This study aims to investigate the concurrent validity and intrarater reliability of the Microsoft Kinect to measure thoracic kyphosis against the Flexicurve. Thirty-three healthy individuals (age: 31±11.0 years, men: 17, height: 170.2±8.2 cm, weight: 64.2±12.0 kg) participated, with 29 re-examined for intrarater reliability 1–7 days later. Thoracic kyphosis was measured using the Flexicurve and the Microsoft Kinect consecutively in both standing and sitting positions. Both the kyphosis index and angle were calculated. The Microsoft Kinect showed excellent concurrent validity (intraclass correlation coefficient=0.76–0.82) and reliability (intraclass correlation coefficient=0.81–0.98) for measuring thoracic kyphosis (angle and index) in both standing and sitting postures. This study is the first to show that the Microsoft Kinect has excellent validity and intrarater reliability to measure thoracic kyphosis, which is promising for its use in the clinical setting.
The Comorbidity of Daydreaming Disorder (Maladaptive Daydreaming)
Authors: Somer Eli , Soffer-Dudek Nirit , Ross Colin A.
Published: June 2017

To determine the comorbidity profile of individuals meeting criteria for a proposed new disorder, daydreaming disorder (more commonly known as maladaptive daydreaming [MD]), the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Structured Clinical Interview for DSM-IV Dissociative Disorders were administered to 39 participants who met criteria for MD on a structured interview. We determined high rates of comorbidity: 74.4% met criteria for more than three additional disorders, and 41.1% met criteria for more than four. The most frequent comorbid disorder was attention deficit hyperactivity disorder (76.9%); 71.8% met criteria for an anxiety disorder, 66.7% for a depressive disorder, and 53.9% for an obsessive-compulsive or related disorder. Notably, 28.2% have attempted suicide. Individuals meeting criteria for MD have complex psychiatric problems spanning a range of DSM-5 disorders. This finding provides evidence that MD is different than normal daydreaming and that these individuals experience considerable distress and impairment.
Posttraumatic Stress and Distress Tolerance
Authors: Vujanovic Anka A. , Bakhshaie Jafar , Martin Colleen , Reddy Madhavi K. , Anestis Michael D.
Published: June 2017

Trauma and posttraumatic stress disorder (PTSD) symptomatology have been associated with suicidality, including ideation and behavior. The current investigation evaluated, in acute-care psychiatric inpatients, the mediating role of perceived (self-reported) distress tolerance in the association between PTSD symptom severity and suicidality, defined as a) suicidal ideation, intent, or behavior leading to current psychiatric hospitalization; b) self-reported severity of suicidal desire; and c) percentage of days of suicidality during current hospitalization. Participants were composed of 105 adults (55.2% women; mean age, 33.9; SD, 10.9) admitted to a public psychiatric acute-care inpatient hospital in a large metropolitan area; 52.3% of the participants were hospitalized for suicidality. Results indicated that PTSD symptom severity (and severity of each PTSD symptom cluster) may exert an indirect effect on suicidality, specifically suicidality as a basis for current hospital admission and self-reported severity of suicidal desire, through perceived distress tolerance. Effects were documented after controlling for theoretically relevant covariates.
Dissociation From a Cross-Cultural Perspective
Authors: Maraldi Everton de Oliveira , Krippner Stanley , Barros Maria Cristina Monteiro , Cunha Alexandre
Published: June 2017

A major issue in the study of dissociation concerns the cross-cultural validity of definitions and measurements used to identify and classify dissociative disorders. There is also extensive debate on the etiological factors underlying dissociative experiences. Cross-cultural research is essential to elucidate these issues, particularly regarding evidence obtained from countries in which the study of dissociation is still in its infancy. The aim of this article was to discuss Brazilian research on the topic of dissociation, highlighting its contributions for the understanding of dissociative experiences in nonclinical populations and for the validity and relevance of dissociative disorders in the contexts of psychiatry, psychology, and psychotherapy. We also consider the ways in which dissociative experiences are assimilated by Brazilian culture and religious expressions, and the implications of Brazilian studies for the sociocultural investigation of dissociation. We conclude by addressing the limitations of these studies and potential areas for future research.
Internet Game Addiction, Depression, and Escape From Negative Emotions in Adulthood
Authors: Kim Dong Jun , Kim Kiwon , Lee Hae-Woo , Hong Jin-Pyo , Cho Maeng Je , Fava Maurizio , Mischoulon David , Heo Jung-Yoon , Jeon Hong Jin
Published: June 2017

The aim of this study was to investigate the association between adult Internet game addiction (IGA) and mental disorders. A total of 1401 adults aged between 18 and 74 years participated in this study. The IGA group had significantly younger patients, and it showed a higher proportion of unmarried and unemployed adults, and higher rates of suicidal ideation, plan, and attempt than the non-IGA group. Multivariate logistic regression indicated that IGA was significantly associated with major depressive disorder, dysthymia, and depressive disorders adjusting for all variables. The Patient Health Questionnaire–9 score was significantly higher in the IGA group than in the non-IGA group for both young adults and middle groups. “Escape from negative emotions like nervousness, sadness, and anger” was the only significant item associated with depression among symptoms of IGA. This study suggests that adults with IGA and depression may use Internet games to escape from negative emotions.
Childhood Adversity, Cortisol Levels, and Psychosis
Authors: Faravelli Carlo , Mansueto Giovanni , Palmieri Sara , Lo Sauro Carolina , Rotella Francesco , Pietrini Francesco , Fioravanti Giulia
Published: June 2017

Although it has been proposed that the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may act as a possible pathway linking early life stress to psychosis, this relationship has not yet been fully confirmed. This study aimed to investigate the relationship between childhood adversity (CA), cortisol levels, and psychosis. Eighty-five patients with psychosis and 170 control subjects were enrolled in the study. CA was evaluated using the Florence Psychiatric Interview, and Childhood Experience of Care and Abuse Questionnaire. Positive symptoms (PS) were assessed using the Positive and Negative Syndrome Scale. Cortisol levels were evaluated in saliva samples. Patients experienced more CA and showed higher cortisol levels than controls. Patients with CA showed higher morning cortisol levels and more severe PS than those without CA. Patients with higher morning cortisol levels showed severe delusions. These findings suggest that both CA and dysregulation of the HPA axis could be related to psychosis.
Comparative Evaluation of 2 Nucleic Acid Amplification Tests for the Detection of Chlamydia trachomatis and Neisseria gonorrhoeae at Extragenital Sites
Authors: Bristow Claire C. , McGrath Mark R. , Cohen Adam C. , Anderson Laura J. , Gordon Kristie K. , Klausner Jeffrey D.
Published: June 2017

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are frequently asymptomatic, requiring highly accurate diagnostic tests and proper management to prevent further transmission. We compared two nucleic acid tests, Xpert® CT/NG (Cepheid, Sunnyvale, CA) point-of-care platform and at an offsite clinical laboratory with Aptima Combo 2® (Hologic, Inc., San Diego, CA) assay, for the detection of extragenital infection in patients at an STI clinic in Hollywood, CA.

We calculated concordance between the two assays and used the exact binomial method to calculate 95% confidence intervals (CIs) for each specimen type and pathogen.

The concordance between the two assays was 97.7% (95% CI: 95.7%,99.0%) for 393 paired CT rectal results, 98.2% (95% CI: 96.4%,99.3%) for 391 paired NG rectal results and 98.4% (95% CI: 96.8%,99.4%) for 448 paired NG pharyngeal results.

The performance of Xpert® CT/NG assay in point-of-care testing in extragenital specimens was highly similar to the laboratory-based platform.
Laboratory Evaluation of a Smartphone-Based Electronic Reader of Rapid Dual Point-of-Care Tests for Antibodies to Human Immunodeficiency Virus and Treponema pallidum Infections
Authors: Herbst de Cortina Sasha , Bristow Claire C. , Humphries Romney , Vargas Silver Keith , Konda Kelika A. , Caceres Carlos F. , Klausner Jeffrey D.
Published: June 2017

Background

Dual point-of-care tests for antibodies to human immunodeficiency virus (HIV) and Treponema pallidum allow for same-day testing and treatment and have been demonstrated to be cost-effective in preventing the adverse outcomes of HIV infection and syphilis. By recording and transmitting data as they are collected, electronic readers address challenges related to the decentralization of point-of-care testing.

Methods

We evaluated a smartphone-based electronic reader using 201 sera tested with 2 dual rapid tests for detection of antibodies to HIV and T. pallidum in Los Angeles, USA, and Lima, Peru. Tests were read both visually and with the electronic reader. Enzyme immunoassay followed by Western blot and T. pallidum particle agglutination were the reference tests for HIV and T. pallidum, respectively.

Results

The sensitivities of the 2 rapid tests for detection of HIV were 94.1% and 97.0% for electronic readings. Both tests had a specificity of 100% for detection of HIV by electronic reading. The sensitivities of the 2 rapid tests for detection of T. pallidum were 86.5% and 92.4% for electronic readings. The specificities for detection of T. pallidum were 99.1% and 99.0% by electronic reading. There were no significant differences between the accuracies of visual and electronic readings, and the performance did not differ between the 2 study sites.

Conclusions

Our results show the electronic reader to be a promising option for increasing the use of point-of-care testing programs.
Pupillometry as a Screening Tool to Detect Pseudoexfoliation Syndrome
Authors: Yasar Erdogan , Yildirim Nilgun , Atalay Eray , Tambova Emre , Colak Ertugrul
Published: June 2017

Purpose

Our objective was to evaluate the diagnostic value of a handheld pupillometer in differentiating eyes with pseudoexfoliation syndrome (PXS) from healthy controls.

Methods

This population-based, cross-sectional study was conducted in the province of Eskisehir, Turkey. Subjects 40 years of age and older were randomly recruited using stratified two-stage cluster sampling from the database of the Turkish Statistical Institute office in Eskisehir. Recruitment took place between June and October 2014. The inclusion criteria were healthy subjects who did not have a previous diagnosis of glaucoma or other issues affecting pupil dynamics. After an extensive ophthalmic examination, pupillometry was performed under standard photopic room lighting conditions. After pupillometry, the pupil was dilated and digital images of the anterior segment were taken for confirmation of PXS. An inter-eye pupil diameter difference of ≥0.4 mm was defined as pupil asymmetry.

Results

Of the 2356 invited subjects, 2017 agreed to participate (85.6%), and 1559 subjects were eligible for the study. An age-matched subgroup consisting of 529 healthy controls was randomly selected to compare with the 60 subjects who were diagnosed with PXS. The mean pupil diameters of subjects with PXS and healthy controls were 3.57 ± 0.68 mm and 3.68 ± 0.63 mm, respectively (P= .652). In the ROC analysis, the precision of pupil diameter in discriminating PXS was low (AUC 0.56, sensitivity 14%, specificity 94%). Pupil asymmetry increased the chances of having PXS by 3.46-fold.

Conclusions

Pupillometry performed poorly in the detection of PXS scoring a positive predictive value of 26%.
Causes for Pauses During Simulated Pediatric Cardiac Arrest
Authors: Kessler David Oren , Peterson Dawn Taylor , Bragg Alexis , Lin Yiqun , Zhong John , Duff Jonathan , Adler Mark , Brown Linda , Bhanji Farhan , Davidson Jennifer , Grant David , Cheng Adam
Published: June 2017

Objectives:

Pauses in cardiopulmonary resuscitation negatively impact clinical outcomes; however, little is known about the contributing factors. The objective of this study is to determine the frequency, duration, and causes for pauses during cardiac arrest.

Design:

This is a secondary analysis of video data collected from a prospective multicenter trial. Twenty-six simulated pediatric cardiac arrest scenarios each lasting 12 minutes in duration were analyzed by two independent reviewers to document events surrounding each pause in chest compressions.

Setting:

Ten children’s hospitals across Canada, the United, and the United Kingdom.

Subjects:

Resuscitation teams composed of three healthcare providers trained in cardiopulmonary resuscitation.

Interventions:

A simulated pediatric cardiac arrest case in a 5 year old.

Measurements and Main Results:

The frequency, duration, and associated factors for each pause were recorded. Communication was rated using a four-point scale reflecting the team’s shared mental model. Two hundred fifty-six pauses were reviewed with a median of 10 pauses per scenario (interquartile range, 7–12). Median pause duration was 5 seconds (interquartile range, 2–9 s), with 91% chest compression fraction per scenario (interquartile range, 88–94%). Only one task occurred during most pauses (66%). The most common tasks were a change of chest compressors (25%), performing pulse check (24%), and performing rhythm check (15%). Forty-nine (19%) of the pauses lasted greater than 10 seconds and were associated with shock delivery (p < 0.001), performing rhythm check (p < 0.001), and performing pulse check (p < 0.001). When a shared mental model was rated high, pauses were significantly shorter (mean difference, 4.2 s; 95% CI, 1.6–6.8 s; p = 0.002).

Conclusions:

Pauses in cardiopulmonary resuscitation occurred frequently during simulated pediatric cardiac arrest, with variable duration and underlying causes. A large percentage of pauses were greater than 10 seconds and occurred more frequently than the recommended 2-minute interval. Future efforts should focus on improving team coordination to minimize pause frequency and duration.
Dexmedetomidine for Sedation During Noninvasive Ventilation in Pediatric Patients*
Authors: Venkatraman Rasika , Hungerford James L. , Hall Mark W. , Moore-Clingenpeel Melissa , Tobias Joseph D.
Published: June 2017

Objectives:

To describe the use of dexmedetomidine for sedation in a large cohort of nonintubated children with acute respiratory insufficiency receiving noninvasive ventilatory support.

Design:

Single-center, retrospective, observational cohort study.

Setting:

A large quaternary-care PICU.

Patients:

The study cohort included 202 children receiving noninvasive ventilatory and a dexmedetomidine infusion within 48 hours of PICU admission over a 6-month period.

Interventions:

None.

Measurements and Main Results:

The primary respiratory diagnoses in the cohort (median age, 2 yr) included status asthmaticus (60%) and bronchiolitis (29%). Dexmedetomidine was infused for a median of 35 hours with a median hourly dose across the patient cohort of 0.61 μg/kg/hr (range, 0.4–0.8 μg/kg/hr). The target sedation level was achieved in 168 patients (83%) in the cohort for greater than or equal to 80% of the recorded values over the entire noninvasive ventilatory course, with dexmedetomidine as the only continuously administered sedative agent. While vital signs were frequently abnormal relative to age-based norms, clinical interventions were needed rarely to treat bradycardia (13%), hypotension (20%), and hypopnea (5%). The most frequently used of these interventions was a dexmedetomidine dose reduction, fluid bolus, and titration of noninvasive ventilatory support. Five patients (2.5%) required endotracheal intubation: three due to progression of their respiratory illness, one with septic shock, and one with apnea requiring resuscitation. In 194 of 202 patients (96%), the outcome of the noninvasive ventilatory course was successful with the patient being weaned from noninvasive respiratory support to nasal cannula or room air.

Conclusions:

Dexmedetomidine was often effective as a single continuous sedative infusion during pediatric noninvasive ventilatory. Cardiorespiratory events associated with its use were typically mild and/or reversible with dose reduction, fluid administration, and/or noninvasive ventilatory titration. Prospective studies comparing dexmedetomidine with other agents in this setting are warranted.
Long-Term Outcomes of Pediatric Cardiac Patients Supported by Extracorporeal Membrane Oxygenation
Authors: Elias Matthew D. , Achuff Barbara-Jo , Ittenbach Richard F. , Ravishankar Chitra , Spray Thomas L. , Fuller Stephanie , Montenegro Lisa M. , Gaynor J. William , O’Connor Matthew J.
Published: June 2017

Objective:

Extracorporeal membrane oxygenation is an important form of short-term mechanical support in children with cardiac disease, but information on long-term outcomes and quality of life is limited. The primary objective of this study was to determine the long-term outcomes of children previously supported by extracorporeal membrane oxygenation for cardiac etiologies.

Design:

A retrospective analysis was performed on patients with cardiac disease managed with extracorporeal membrane oxygenation between January 1, 1995, and December 31, 2012, at the Children’s Hospital of Philadelphia. Survivors completed patient- and parent-reported verbal and written surveys, and univariate analyses assessed risk factors for long-term outcomes.

Setting:

Tertiary-care children’s hospital.

Patients:

Patients with cardiac disease managed with extracorporeal membrane oxygenation.

Interventions:

None.

Measurements and Main Results:

Over 18 years, 396 patients were managed with extracorporeal membrane oxygenation with 43% survival to discharge. The median age at cannulation was 78 days. The majority had congenital heart disease (86%), surgery prior to extracorporeal membrane oxygenation (71%), and cardiopulmonary arrest as the primary extracorporeal membrane oxygenation indication (53%). With 6-year median follow-up, 66% are known to be deceased, including 38 deaths after hospital discharge. Among survivors at discharge, 65 (38%) completed the phone survey, and 33 (19%) completed the written survey. Negative clinical outcomes, defined as having at least significant physical limitations or “fair” or “poor” health, were present in 18% of patients. No patient- or extracorporeal membrane oxygenation–related variables were associated with negative outcomes in univariate analyses. There were significantly lower self-reported and parent-reported written Pediatric Quality of Life Inventory quality of life scores in children compared with healthy individual normative data but no differences in adolescents.

Conclusions:

In this series of pediatric cardiac patients supported by extracorporeal membrane oxygenation, mortality was 66% with 6-year median follow-up. The majority reported positive outcomes with respect to health and physical limitations, but children reported lower quality of life compared with healthy individuals.
Childhood Cognitive Ability and Age-Related Changes in Physical Capability From Midlife: Findings From a British Birth Cohort Study
Authors: Cooper Rachel , Richards Marcus , Kuh Diana
Published: June 2017

Objective

The aim of the study was to test the hypothesis that higher childhood cognitive ability is associated with reduced risk of decline in physical capability in late midlife.

Methods

Participants were 1954 men and women from the Medical Research Council National Survey of Health and Development with complete data on cognitive ability at age of 15 years and measures of grip strength and chair rise speed at ages of 53 and 60 to 64 years. Using multinomial logistic regression, associations of childhood cognitive ability with categories of change in grip strength and chair rise speed (i.e., decline, stable high, stable low, reference) were investigated. Adjustments were made for potential confounders from early life and adult mediators including health behaviors, educational level, and cognitive ability at age of 53 years.

Results

Higher childhood cognitive scores were associated with reduced risks of decline in grip strength and chair rise speed, for example, the sex-adjusted relative-risk ratio of decline (versus reference) in grip strength per 1SD increase in childhood cognitive score was 0.82 (95% confidence interval = 0.73–0.92). Higher childhood cognitive scores were also associated with reduced risk of stable low and increased likelihood of stable high chair rise speed.

Conclusions

These findings suggest that childhood cognitive ability may be related to decline in physical capability in late midlife. A number of life course pathways are implicated, including those linking childhood and adult cognitive ability. Future research aiming to identify new opportunities to prevent or minimize age-related declines in physical capability may benefit from considering the potential role of neurodevelopmental as well as neurodegenerative pathways.
Self-Perceived Viral Load and Sexual Risk Behavior Among Known HIV-Positive MSM in San Francisco, 2014
Authors: Guigayoma John , Chen Yea-Hung , Snowden Jonathan M. , Santos Glenn-Milo , Hecht Jennifer , Raymond H. Fisher
Published: June 2017

Background:

Self-perceived viral suppression status among men who have sex with men (MSM) may impact HIV risk transmission behaviors.

Methods:

We conducted a 2014 cross-sectional survey of MSM in San Francisco and assessed differences in sexual risk behavior among known HIV-positive MSM based on viral suppression of HIV. We collected demographics, self-perceived viral load status, and sexual risk behavior and tested for viral load levels through laboratory assays. Men were categorized in a hierarchical schema of sexual risk behavior categories based on responses to questions regarding recent partners' HIV status, condom use, and sexual positioning. We used Fisher exact tests to assess for differences based on self-perceived viral load status.

Results:

Out of a sample of 96 known HIV-positive men, 59 men self-reported an undetectable HIV viral load and 9 men self-reported a detectable viral load consented to confirmatory laboratory testing. The sample of self-reported undetectable men had gradually larger proportions of higher-risk sexual practices, whereas the sample of detectable men was evenly distributed across sexual practices. This association was not statistically significant (P = 0.91).

Conclusion:

Self-perceived viral suppression may influence sexual practices of known HIV-positive MSM, but small sample size, especially within the detectable category, hinders our ability to determine statistical significance. More research is necessary to assess how HIV-positive men account for viral load in sexual decision-making practices, and this research may inform resource allocation and clinical recommendations to maintain the health of MSM populations.