bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategies to improve antibiotic use in the neonatal ICU
Authors: Willis Zachary , de St. Maurice Annabelle
Published: December 2018

Purpose of review

Neonates are at a high risk of infection and may have nonspecific signs of sepsis. Accordingly, they are heavily exposed to antimicrobials. Neonates are also uniquely at risk of both short-term and long-term complications from antibiotic exposure. This review discusses advances in antibiotic stewardship in the neonatal population.

Recent findings

Antimicrobial utilization is highly variable among NICUs in excess of case-mix variation. Rates of early-onset sepsis because of Group B Streptococcus have decreased substantially with the introduction of intrapartum antibiotic prophylaxis. Recent epidemiologic studies have created evidence-based tools to more accurately estimate a newborn's risk of early-onset sepsis. Antibiotic selection and duration for late-onset sepsis and necrotizing enterocolitis are variable among centers, with inadequate evidence to guide practice. Novel diagnostic methods and biomarkers are increasingly used to assist with diagnosing infection, but inadequate specificity in many cases may result in excess antibiotic exposure. Published antimicrobial stewardship experiences in the neonatal inpatient setting have largely been successful and well tolerated.

Recent publications have identified many ways to safely reduce antimicrobial exposure and developed strategies to implement antimicrobial stewardship in the neonatal inpatient setting. However, new approaches are needed to further improve antibiotic use and to implement these interventions more universally in NICUs.
The Effect of Gluten‐free Diet on Cardiovascular Risk Factors in Newly Diagnosed Pediatric Celiac Disease Patients
Authors: Zifman Eyal , Waisbourd‐Zinman Orith , Marderfeld Luba , Zevit Noam , Guz‐Mark Anat , Silbermintz Ari , Assa Amit , Mozer‐Glassberg Yael , Biran Neta , Reznik Dana , Poraz Irit , Shamir Raanan
Published: December 2018

Objectives:

Although gluten‐free diet (GFD) is the only proven therapy for celiac disease (CD), its effect on cardiovascular disease (CVD) risk factors is still unclear. Our aim was to determine whether adherence to GFD affects CVD risk factors among newly diagnosed pediatric CD subjects.

Methods:

We prospectively enrolled pediatric subjects undergoing upper gastrointestinal endoscopy for suspected CD. We collected anthropometric and laboratory parameters related to CVD risk factors at the time of CD diagnosis and 1 year after initiation of a GFD and evaluated changes in CVD risk factors. Paired t tests or Wilcoxon nonparametric tests were used, each when appropriate.

Results:

One hundred ten newly diagnosed CD pediatric subjects were included in the analysis. There were 64 (58.2%) girls and the mean age at diagnosis was 6.8 ± 3.4 years. Median body mass index z scores (P = 0.84), rates of underweight or overweight (P = 0.32), and rates of elevated blood pressure (P = 0.78) remained unchanged. Although median fasting insulin levels increased (1.9 vs 5.4 μU/mL, P < 0.001), insulin resistance as measured by homeostatic model assessment did not increase after 1 year of GFD (P = 0.16). Although rates of dyslipidemia remained unchanged, median high‐density lipoprotein levels increased on GFD (47 vs 51 mg/dL, P < 0.001).

Conclusions:

In this pediatric CD cohort, GFD for 1 year was not associated with increased CVD risk factors. The long‐term significance of these mild changes is yet to be determined.
Development of Acute Malnutrition Despite Nutritional Supplementation in Malawi
Authors: Kaimila Yankho , Pitman Ryan T. , Divala Oscar , Hendrixson D. Taylor , Stephenson Kevin B. , Agapova Sophia , Trehan Indi , Maleta Ken , Manary Mark J.
Published: December 2018

Malnutrition in children is most often attributed to inadequate nutrient intake. Utilizing data from 2 prospective, randomized controlled trials of complimentary feeding with supplemental legumes (n = 693, ages 6–24 months) in 2 Malawian villages, Masenjere, and Limera, we document a high rate 70/693 (10.1%) of acute malnutrition (AM). Risks for AM in this setting, as determined by Cox regression analysis, include study village (hazard ratio [HR] 3.0), prior malnutrition (HR 4.12), stunting (HR 2.87), and a marker of food insecurity (HR 1.89). Comparison of Masenjere to Limera demonstrate adequate and similar nutritional intake yet an increased rate of AM in Masenjere, 56 of 400 (14.0%) versus 14 of 293 (4.8%), and stunting, 140 of 400 (35%) versus 80 of 293 (27%), environmental enteric dysfunction 246 of 400 (71%) versus 181/293 (67%), and infectious symptoms (cough and diarrhea). Masenjere did have cleaner water and less food insecurity 200 of 399 (50.5%) versus 204 of 293 (69.6%). These findings suggest adequate complementary nutrient intake does not protect young children against AM.
Multilocus variable number tandem repeat analysis and antimicrobial susceptibility pattern of Staphylococcus epidermidis isolates in Tehran, Iran
Authors: Mirzaei Rasoul , Sadeghi Kalani Behrooz , Shokri Moghadam Mohammad , Mahdiun Faeze , Irajian Gholamreza
Published: December 2018

Objective:

Detection of sources of outbreaks caused by coagulase-negative Staphylococcus relies on molecular epidemiology methods. Little is known about the genetic diversity of the Staphylococcus epidermidis isolates isolated from various sources in Iran. We assessed the molecular epidemiology of S. epidermidis isolates collected from clinical and nonclinical sources from Tehran counties during 2014 to 2016 using MLVA (multilocus variable number tandem repeat analysis).

Methods:

One hundred and three clinical and nonclinical S. epidermidis isolates were collected from two hospitals in Tehran. Antibiotic susceptibility testing of isolates was evaluated for cefoxitin, tetracycline, erythromycin, clindamycin, mupirocin, vancomycin and linezolid according to Clinical and Laboratory Standards Institute, as well as prevalence of mecA gene was evaluated by PCR method. In addition, genetic relatedness of isolates was assessed by MLVA method.

Results:

Resistant rate to cefoxitin, tetracycline, erythromycin, clindamycin and mupirocin were 64, 36, 72, 44 and 23% in all isolates. All clinical and nonclinical isolates were susceptible to linezolid and vancomycin. In all, 49.5% of S. epidermidis isolates were multidrug resistant. Prevalence of mecA was 64%. The MLVA profile consists of a series of allele numbers, corresponding to the number of repeats at each variable number tandem repeat locus. The results of MLVA showed 64 types among all 103 isolates. There were 16 MLVA types that were common in two hospitals and 15 MLVA types were existed in various sources of S. epidermidis isolates. The diversity index obtained with MLVA was 0.989 (95% confidence interval [0.984–0.993]) for the 103 S. epidermidis isolates. A range of one to six alleles was identified at variable number tandem repeats loci with Simpson's diversity values between 0.526 and 0.781.

Conclusion:

Our study demonstrated presence of high molecular diversity among S. epidermidis isolates. In addition, the main conclusion was that some MLVA types can be disseminated over the wards and between the hospitals. In other hand, resistance to various antibiotics in S. epidermidis isolates and prevalence of methicillin-resistant S. epidermidis and multidrug resistant S. epidermidis isolates to be increasing.
Neonatal Death Caused by Interrupted Aortic Arch Associated With 22q11.2 Deletion Syndrome
Authors: Shinkawa Norihiro , Yamaguchi Masatoshi , Ozaki Mamoru , Yukawa Nobuhiro
Published: December 2018

A case of clinically unsuspected fatal interrupted aortic arch (IAA) is described. A 17-day-old Japanese girl unexpectedly entered respiratory arrest at home. On autopsy, the heart was hypertrophic, with no apparent connection between the ascending and descending aortas. The ascending aorta branched into common carotid and right subclavian arteries, whereas the left subclavian artery arose from the descending aorta, which was supplied by the ductus arteriosus, indicating type B IAA. In addition, ventricular septal defect, bicuspid aortic valve, patent foramen ovale, and thymic aplasia were identified. The immediate cause of death was assumed to be “ductal shock.” Because of the known strong association between type B and 22q11.2 deletion, her parents received genetic counseling and requested chromosomal analysis of the child. Fluorescence in situ hybridization worked well on a frozen blood sample, identifying the suspected deletion. This case was thus diagnosed as 22q11.2 deletion syndrome exhibiting IAA and thymic defect.
FDG PET/CT Imaging of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus
Authors: Zhang Wei , Fang Cheng , Liu Huipan , Chen Yue
Published: December 2018

Hepatocellular carcinoma rarely involves the major bile duct. Here, we reported a 46-year-old man with liver cancer who underwent FDG PET/CT for staging. The images showed abnormal FDG uptake in the left lobe and hilum of the liver, which was confirmed as hepatocellular carcinoma and hepatic portal bile duct tumor thrombus, respectively, by the pathology.
Incidental Detection of Plasma Cell Neoplasm on 18F-Choline PET/CT Imaging
Authors: Paudel Jiwan , Singla Navneet , Bhattacharya Anish , Basher Rajender Kumar , Mittal Bhagwant Rai
Published: December 2018

18F-Fluorocholine is a relatively new, extremely versatile radiotracer for detecting proliferative or mitogenic activity. Its diagnostic potential has been explored in cancers of the prostate, liver, esophagus, breast, brain, and lung, as well as lymphoma, sarcoma, melanoma, and parathyroid adenomas. The authors present a case where fluorocholine PET/CT performed for characterizing a space-occupying lesion in the brain revealed intensely tracer-avid skull lesions with intracranial soft tissue component and multiple other skeletal lesions. Fine-needle aspiration cytology from the skull and chest wall lesions confirmed the diagnosis of plasma cell neoplasm.
Comparisons Between PET With 11C-Methyl-l-Methionine and Arterial Spin Labeling Perfusion Imaging in Recurrent Glioblastomas Treated With Bevacizumab
Authors: Beppu Takaaki , Sato Yuichi , Sasaki Toshiaki , Terasaki Kazunori , Yamashita Fumio , Sasaki Makoto , Ogasawara Kuniaki
Published: December 2018

Purpose

The aim of this study was to clarify whether arterial spin labeling (ASL) perfusion imaging can assess biological effects from bevacizumab (BEV) therapy as reliably as PET with11C-methyl-l-methionine (11C-met-PET).

Materials and Methods

Twenty-four patients with recurrent glioblastoma were examined using both ASL and11C-met-PET before and 4 and 8 weeks after starting BEV treatment. Tumor-to-normal brain (T/N) ratios, fluctuations in T/N ratio, and tumor volumes were compared between ASL and11C-met-PET. Accuracy of predicting patient with long progression-free survival (PFS) was assessed for T/N ratios and fluctuations for ASL and11C-met-PET in each phase and in each period using receiver operating characteristic curves. Between 2 groups of patients assigned by cutoff values from receiver operating characteristic curves, PFS was compared in each phase or in each period.

Results

T/N ratios, fluctuations in ratio, and tumor volumes correlated significantly between ASL and11C-met-PET at all time points and all periods. Arterial spin labeling was eligible as a predictor for long PFS only in assessment of fluctuations in T/N ratio. However, the most accurate predictors for long PFS were T/N ratio from11C-met-PET at 8 weeks and the fluctuation from baseline to 4 weeks in T/N ratio from11C-met-PET.

Conclusions

Blood flows on ASL correlated with accumulations of11C-met on PET in recurrent glioblastoma under BEV treatment. Although11C-met-PET offered superior accuracy for predicting patients with long PFS from time points, ASL offered reliable prediction of long PFS, provided that fluctuations in T/N ratio between consecutive scans are assessed.
Point Spread Function Reconstruction for Integrated 18F-FET PET/MRI in Patients With Glioma
Authors: Rogasch Julian Manuel Michael , Albers Josefine , Steinkrüger Ferdinand L. , Lukas Mathias , Wedel Florian , Amthauer Holger , Furth Christian
Published: December 2018

Purpose

Semiquantitative 18F-FET PET assessment using the tumor's SUV or tumor-to-background ratios (TBRs) can separate gliomas from peritumoral tissue or progression from pseudoprogression. This study investigated if point spread function (PSF) reconstruction of 18F-FET PET data affects SUV-based dignity assessment.

Materials and Methods

This study is a retrospective analysis of 87 glioma patients (female, 36; male, 51; age, 48 [13–81] years) undergoing 18F-FET PET/MRI for staging (n = 17) or restaging (n = 70). PET was reconstructed using ordered-subset expectation maximization with and without PSF. Lesions were delineated with semiautomated background-adapted thresholding relative to SUVmax; background was delineated contralaterally. Comparative measurements with a National Electrical Manufacturers Association International Electrotechnical Commission PET body phantom (sphere-to-background ratios, 8:1 and 4:1) were performed.

Results

PSF showed significantly higher tumor SUVmax (median difference, +0.1; interquartile range, 0.04–0.18), SUVmean (+0.05; 0.03–0.08), TBRmax|mean (+0.1; 0.04–0.2), and TBRmean|mean (+0.06; 0.03–0.09) than non-PSF (P < 0.001). Background SUVmean was unaffected. In patients and phantom, differences between PSF and non-PSF increased with TBR and decreased with lesion's PET volume. Differences only exceeded 0.2 SUV for SUVmax or 0.1 SUV for SUVmean if TBR was greater than 3 and lesion's PET volume was less than 10 mL (d = 27 mm). Dignity assessment by PSF and non-PSF was concordant in all patients examined for staging (cutoff, TBRmean|mean > 1.6; positive, 14; negative, 3) and restaging (cutoff, TBRmax|mean > 2.0; positive, 67; negative, 3).

Conclusions

PSF increased tumor SUVmax and SUVmean compared with non-PSF 18F-FET PET/MRI data, especially in small lesions with high TBR (>3). However, dignity assessment using established TBR cutoffs was not affected.
Quick Calculation of Breast Resection Mass Using the Schnur Scale
Authors: Dvoracek Lucas A. , Gusenoff Jeffrey A. , Peter Rubin J. , Manders Ernest K.
Published: December 2018

In 1991, Dr Paul Schnur and his colleagues published an article correlating the weight of breast tissue to be removed in a breast reduction operation with the total body surface area (BSA) of the patient. They presented a very cogent argument for selecting three groups of patients: those with medical indications for operation, those who merit review, and those whose operation could be considered cosmetic. The Schnur Sliding Scale is widely used by insurance companies in the western United States in the process of preauthorizing breast reduction operations, and its use may be spreading eastward. The Schnur group presented a nomogram for calculating BSA and a scale in the form of a table for guiding a determination of whether the patient is a reconstructive patient as opposed to an aesthetic patient. We have combined the scale and the BSA nomogram for a simplified nomogram calculator that facilitates rapid determination of anticipated tissue weight of resection for a patient of a given size. This calculator yields the required weight of tissue to remove with just knowledge of the patient's height and weight and the use of a straight edge. We demonstrate and compare performance of this calculation by hand and by nomogram. There is ample evidence that the practice of applying the Schnur Sliding Scale may be prohibitive to symptomatic patients seeking reduction mammaplasty and should be abandoned. While this practice continues, our simplified Schnur Sliding Scale nomogram is meant to help easily determine the insurer-required minimum breast resection weight and thereby both improve patient counseling prior to planning surgery and assist the surgeon with achieving insurer reimbursement for the procedure while avoiding rejected claims.
Acquired Localized Hypertrichosis Following Pressure Garment and/or Silicone Therapy in Burn Patients
Authors: Uslu Asim , Sürücü Abdullah , Korkmaz Mehmet Ali , Uygur Fatih
Published: December 2018

Hypertrichosis is characterized by excessive and abnormal hair growth anywhere on the skin and may develop after prolonged local irritation, such as application of a cast, injury, or a bite. Pressure garment/silicone therapy is often used to prevent hypertrophic scar formation. The adverse effects of gel sheet application include rash, skin breakdown, cessation of scar responsiveness, pruritus, contact dermatitis, and dry skin. We report on 7 burn patients who developed hypertrichosis following application of pressure garment/silicone therapy to prevent hypertrophic scarring.
Y-Peg-in-a-Round-Hole Closure for Immediate Periareolar Mastectomy Expander Reconstruction
Authors: Grinsell Damien , Baker Caroline , Nielsen Hans Henrik Møller , Alexander K. Skaria
Published: December 2018

Introduction

Mastectomies closed with a linear scar can distort the resulting shape of the breast. We present our novel Y-peg-in-a-round-hole closure method of the mastectomy scar, which improves the shape of the reconstructed breast while maintaining reliable healing, implant coverage, and minimum scar size for covering by tattoo.

Materials and methods

A retrospective review of all breast reconstruction cases performed by the senior surgeon during the period from January 2010 to January 2017 was undertaken. Data were analyzed for wound healing problems, infection rates and mastectomy skin flap necrosis.

Results

Data were extracted for 126 consecutive patients with 154 breast reconstructions. Twelve breasts (7.7%) experienced wound healing problems, for which 7 (4.5%) required revisionary surgery. Eighteen breasts (11.7%) developed an infection requiring antibiotics, of which 8 (5.2%) needed a further operation. Four breasts (2.6%) needed removal of the implant. No patients were lost to follow-up.

Conclusion

After nipple resecting mastectomy, the Y-peg-in-a-round-hole scar minimizes radial size and contour deformity but allows for reliable wound healing.
Surgical Management of Migraine Headaches
Authors: Nagori Shakil Ahmed , Jose Anson , Roychoudhury Ajoy
Published: December 2018

Background

The aim of the present study was to systematically review and analyze the available evidence on the role of surgery in improving outcomes in patients with migraine headaches.

Methods

An electronic search of PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases was performed for English-language articles reporting results of peripheral nerve surgery for migraine headaches.

Results

The search strategy revealed a total of 1528 records, of which 23 studies were included in the review. A total of 1151 headache patients were treated in the included studies. The trigger site of migraine addressed varied across studies. Meta-analysis of data of 616 patients revealed that migraine surgery significantly reduces migraine headache frequency (random: mean, 9.52; 95% confidence interval, 7.14–11.9; P < 0.00001; I
2 = 94%). Similarly, when data of 797 patients were analyzed, there was statistically significant reduction in migraine headache intensity in patients undergoing migraine headache surgery (random: mean, 3.97; 95% confidence interval, 3.31–4.62; P < 0.00001; I
2 = 94%). On pooling of data of all 23 studies, 8.3% to 76.4% of patients reported complete elimination of headache after surgery, whereas 3.9% to 33.3% had no relief.

Conclusions

Peripheral nerve decompression surgery is highly effective in reducing migraine headache frequency and migraine headache intensity. However, not all patients benefit from the surgical procedure, with a small subset showing no improvement. Further clinical and anatomical studies are needed to define the exact mechanism of nerve compression in migraine patients and as to why a subset of patients does not respond to surgical treatment.
Gut Barrier Dysfunction Induced by Aggressive Fluid Resuscitation in Severe Acute Pancreatitis is Alleviated by Necroptosis Inhibition in Rats
Authors: Cui Qing-Rui , Ling Yi-Hong , Wen Shi-Hong , Liu Ke-Xuan , Xiang Yu-Ke , Yang Wen-Jing , Shen Jian-Tong , Li Yun-Sheng , Yuan Bao-Long , Huang Wen-Qi
Published: December 2018

Fluid resuscitation is the first-line antishock treatment in severe acute pancreatitis (SAP). Currently, although mentions of complications related to aggressive fluid resuscitation are very frequent, a lack of proper handling of complications remains. One of the most important complications is intestinal barrier injury, including intestinal ischemia-reperfusion injury following aggressive fluid resuscitation. Once injured, the intestinal barrier may serve as the source of additional diseases, including systemic inflammatory response syndrome and multiple organ dysfunction syndrome, which aggravate SAP. This study focused on the underlying mechanisms of gut barrier dysfunction in rats induced by aggressive fluid resuscitation in SAP. This study further indicated the important role of necroptosis in intestinal barrier injury which could be relieved by using necroptosis-specific inhibitor Nec-1 before aggressive fluid resuscitation, thus reducing intestinal barrier damage. We also found pancreas damage after intestinal ischemia/reperfusion challenge and indicated the effects of high mobility group protein B1 in the vicious cycle between SAP and intestinal barrier damage.
P-Selectin Is Critical for De Novo Pulmonary Arterial Thrombosis Following Blunt Thoracic Trauma
Authors: Schutzman Linda M. , Rigor Robert R. , Khosravi Nasim , Galante Joseph M. , Brown Ian E.
Published: December 2018

BACKGROUND

Thromboembolic events within the pulmonary arterial vasculature are a troublesome complication of severe blunt thoracic trauma. Mechanisms underlying these events are currently in question as pulmonary thromboembolic events in this particular trauma population tend to be diagnosed more rapidly, more frequently and without an associated systemic thrombosis. This study investigates the role of P-selectin in thrombus formation through the use of in vivo blocking antibodies. We hypothesize that P-selectin plays a pivotal role in de novo pulmonary arterial thrombosis following blunt thoracic trauma.

METHODS

A murine weight-drop model of lateral blunt thoracic trauma was used. Wild-type mice in the experimental group were given blocking antibodies against P-selectin prior to the trauma. All mice were euthanized at 24 hours for evaluation with hematoxylin-eosin staining or immunofluorescent staining for fibrin and P-selectin.

RESULTS

Injured mice that did not receive the P-selectin antibody showed a robust fourfold to fivefold increase in fibrin accumulation in both coup and contrecoup tissues (fluorescence per um of arterial wall) compared to uninjured sham mice. In contrast, mice pretreated with P-selectin blocking antibody showed no significant increase in fibrin accumulation on either side of the lungs after blunt thoracic trauma. No difference in mean fibrin deposition was found between sham controls that received the P-selectin–blocking antibody and those that received an isotype control antibody.

CONCLUSION

P-selectin expression increases at the pulmonary arterial luminal surface following blunt thoracic trauma. In addition, P-selectin–blocking in vivo prevents pulmonary arterial fibrin accumulation after blunt thoracic trauma, confirming that P-selectin is necessary for de novo pulmonary arterial thrombosis after traumatic injury.
The impact of standardized protocol implementation for surgical damage control and temporary abdominal closure after emergent laparotomy
Authors: Loftus Tyler J. , Efron Philip A. , Bala Trina M. , Rosenthal Martin D. , Croft Chasen A. , Walters Michael S. , Smith R. Stephen , Moore Frederick A. , Mohr Alicia M. , Brakenridge Scott C.
Published: December 2018

BACKGROUND

To standardize care and promote early fascial closure among patients undergoing emergent laparotomy and temporary abdominal closure (TAC), we developed a protocol addressing patient selection, operative technique, resuscitation strategies, and critical care provisions. We hypothesized that primary fascial closure rates would increase following protocol implementation with no difference in complication rates.

STUDY DESIGN

We performed a retrospective cohort analysis of 138 adult trauma and emergency general surgery patients who underwent emergent laparotomy and TAC, comparing protocol patients (n = 60) to recent historic controls (n = 78) who would have met protocol inclusion criteria. The protocol includes low-volume 3% hypertonic saline resuscitation, judicious wound vacuum fluid replacement, and early relaparotomy with sequential fascial closure. Demographics, baseline characteristics, illness severity, resuscitation course, operative management, and outcomes were compared. The primary outcome was fascial closure.

RESULTS

Baseline characteristics, including age, American Society of Anesthesiologists class, and postoperative lactate levels, were similar between groups. Within 48 hours of initial laparotomy and TAC, protocol patients received significantly lower total intravenous fluid resuscitation volumes (9.7 vs. 11.4 L, p = 0.044) and exhibited higher serum osmolarity (303 vs. 293 mOsm/kg, p = 0.001). The interval between abdominal operations was significantly shorter following protocol implementation (28.2 vs. 32.2 hours, p = 0.027). The incidence of primary fascial closure was significantly higher in the protocol group (93% vs. 81%, p = 0.045, number needed to treat = 8.3). Complication rates were similar between groups.

CONCLUSIONS

Protocol implementation was associated with lower crystalloid resuscitation volumes, a transient hyperosmolar state, shorter intervals between operations, and higher fascial closure rates with no difference in complications.

LEVEL OF EVIDENCE

Therapeutic study, level IV.
Peripheral vestibular disorders: an update
Authors: Strupp Michael , Mandalà Marco , López-Escámez Jose A.
Published: December 2018

Purpose of review

To provide an update on the most frequent peripheral vestibular disorders.

Recent findings

The on-going classification of vestibular disorders by the Bárány Society represents major progress. The diagnosis of bilateral vestibulopathy (BVP) requires quantitative testing of vestibular function. ‘Acute unilateral peripheral vestibulopathy’ (AUPVP) is now preferred over ‘vestibular neuritis.’ Menière's disease is a set of disorders with a significant genetic contribution. The apogeotropic variant of horizontal canal benign paroxysmal positional vertigo (hcBPPV) and anterior canal BPPV (acBPPV) can be distinguished from a central vestibular lesion. Vestibular paroxysmia is now an internationally accepted clinical entity. The diagnosis of SCDS is based on conclusive findings.

Diagnosis of BVP requires significantly reduced vestibular function. The clinical picture of AUPVP depends on how much the vestibular end organs or their innervation are affected. Menière's disease phenotype is a constellation of symptoms. Although diagnostic and therapeutic criteria for pc and hcBPPV are well defined, a number of less frequent and controversial are increasingly diagnosed and can be treated. Diagnosis of vestibular paroxysmia requires that a patient responds to treatment with a sodium channel blocker. The diagnosis of SCDS requires conclusive findings with various methods. There is still a great need for state-of-the-art randomized controlled treatment trials in most peripheral vestibular disorders.
Acute Phase Treatment Outcomes of Electroconvulsive Therapy in Adolescents and Young Adults
Authors: Benson Nicole M. , Seiner Stephen J. , Bolton Paula , Fitzmaurice Garrett , Meisner Robert C. , Pierce Casey , Busch Alisa B.
Published: December 2018

Objective

Electroconvulsive therapy (ECT) is a highly efficacious, well-tolerated treatment in adults. Little is known, however, about its effectiveness in adolescents and young adults. Our objectives were to assess clinical outcomes after acute phase ECT in adolescents and young adults and determine whether screening positive or negative for a substance use disorder (SUD) is associated with differences in treatment outcomes.

Methods

Study sample consisted of all patients 16 to 25 years old who received ECT from May 2011 to August 2016 and who completed self-reported SUD screens and the Behavior and Symptom Identification Scale-24 (BASIS-24) initially and completed the BASIS-24 again after the fifth ECT treatment. For 5 BASIS-24 domains, longitudinal changes in mean domain scores were assessed; mean changes by SUD screening status were also examined using linear mixed models.

Results

One hundred ninety adolescents and young adults, with mean age 21.0 ± 2.6 years, met inclusion criteria. Electroconvulsive therapy was associated with significant clinical improvement (score decreases) in all 5 BASIS-24 domains during the acute phase treatment (P < 0.001). Sixty-four percent (122/190) screened positive for SUD. Compared with adolescents and young adults screening negative for SUD, those screening positive for co-occurring SUD had greater improvement in depression/functioning (−0.37 ± 0.14, P = 0.009), interpersonal relationships (−0.27 ± 0.13, P = 0.045), and emotional lability (−0.27 ± 0.14, P = 0.044) domains after the fifth ECT treatment.

Conclusions

Electroconvulsive therapy in adolescents and young adults was associated with significantly improved clinical outcomes during acute phase treatment. Adolescents and young adults screening positive for SUD had better acute phase ECT outcomes in self-reported depression/functioning, interpersonal relationships, and emotional lability than those screening negative. More research is needed to clarify adolescents and young adult patient characteristics that may be associated with differential ECT outcomes.
Decoding the Epitranscriptional Landscape from Native RNA Sequences
Authors: Wongsurawat Thidathip , Jenjaroenpun Piroon , Wassenaar Trudy M. , Wadley Taylor D , Wanchai Visanu , Akel Nisreen S. , Franco Aime T. , Jennings Michael L. , Ussery David W. , Nookaew Intawat
Published: December 2018

Sequencing of native RNA and corresponding cDNA was performed using Oxford Nanopore Technology. The % Error of Specific Bases (%ESB) was higher for native RNA than for cDNA, which enabled detection of ribonucleotide modification sites. Based on %ESB differences of the two templates, a bioinformatic tool ELIGOS was developed and applied to rRNAs of E. coli, yeast and human cells. ELIGOS captured 91%, 95%, ∼75%, respectively, of the known variety of RNA methylation sites in these rRNAs. Yeast transcriptomes from different growth conditions were also compared, which identified an association between metabolic adaptation and inferred RNA modifications. ELIGOS was further applied to human transcriptome datasets, which identified the well-known DRACH motif containing N6-methyadenine being located close to 3’-untranslated regions of mRNA. Moreover, the RNA G-quadruplex motif was uncovered by ELIGOS. In summary, we have developed an experimental method coupled with bioinformatic software to uncover native RNA modifications and secondary-structures within transcripts.
Mechanistic insights on metabolic dysfunction in PTSD: Role of glucocorticoid receptor sensitivity and energy deficit
Authors: Somvanshi Pramod R. , Mellon Synthia H. , Flory Janine D. , Abu-Amara Duna ,   The PTSD Systems Biology Consortium, Wolkowitz Owen M. , Yehuda Rachel , Jett Marti , Marmar Charles , Doyle Francis J. , Hood Leroy , Wang Kai , Lee Inyoul , Hammamieh Rasha , Gautam Aarti , Daigle Bernie J. , Yang Ruoting
Published: December 2018

PTSD is associated with metabolic comorbidities; however it is not clear how the neuroendocrine disturbances affect metabolism. To analyze this we employed a systems biological approach using an integrated mathematical model of metabolism, HPA axis and inflammation. We combined the metabolomics, neuroendocrine, clinical lab and cytokine data from combat-exposed veterans with and without PTSD, to characterize the differences in regulatory effects. We used the pattern of fold change in metabolites representing pathway level differences as reference for metabolic control analysis (MCA) using the model. MCA revealed parameters constituting the HPA axis, inflammation and GPCR pathway that yielded metabolic dysfunction consistent with PTSD. To support this, we performed causal analysis between regulatory components and the significantly different metabolites in our sample. Causal inference revealed that the changes in glucocorticoid receptor sensitivity were mechanistically associated with metabolic dysfunction and the effects were jointly mediated by insulin resistance, inflammation, oxidative stress and energy deficit.
Efficient and specific Ly6G+cell depletion: A change in the current practices toward more relevant functional analyses of neutrophils
Authors: Faget Julien , Boivin Gael , Ancey Pierre-Benoit , Gkasti Aspasia , Mussard Julie , Engblom Camilla , Pfirschke Christina , Vazquez Jessica , Bendriss-Vermare Nathalie , Caux Christophe , Vozenin Marie-Catherine , Pittet Mikael J. , Gunzer Matthias , Meylan Etienne
Published: December 2018

Neutrophils orchestrate the innate immune response against microorganisms and are increasingly recognized to modulate cancer development in primary tumors and metastases. To address their functionin vivo, different approaches are used, the most common ones relying on antibody-mediated neutrophil depletion. By comparing the effects of two widely used antibodies, we demonstrate a strong efficacy but a lack of specificity for anti-Gr1. In contrast, anti-Ly6G lacks neutrophil-depletion capacity in C57BL/6 mice, which can be explained by an insufficient celerity of neutrophil clearance that is counterbalanced by exacerbated mobilization of immature cells. When combined with a secondary antibody, anti-Ly6G treatment results in specific and efficient neutrophil depletion. Using a mouse model of lung adenocarcinoma, we demonstrate the efficacy of this new approach to diminish primary tumor growth and propose the existence of a local intercellular communication between neutrophils and alveolar macrophages that fosters regulatory T cell proliferation in lung cancer.
Multi-omics characterization of interaction-mediated control of human protein abundance levels
Authors: Sousa Abel , Gonçalves Emanuel , Mirauta Bogdan , Ochoa David , Stegle Oliver , Beltrao Pedro
Published: December 2018

Proteogenomic studies of cancer samples have shown that copy number variation can be attenuated at the protein level, for a large fraction of the proteome, likely due to the degradation of unassembled protein complex subunits. Such interaction mediated control of protein abundance remains poorly characterized. To study this we compiled genomic, (phospho)proteomic and structural data for hundreds of cancer samples and find that up to 42% of 8,124 analyzed proteins show signs of post-transcriptional control. We find evidence of interaction dependent control of protein abundance, correlated with interface size, for 516 protein pairs, with some interactions further controlled by phosphorylation. Finally, these findings in cancer were reflected in variation in protein levels in normal tissues. Importantly, expression differences due to natural genetic variation were increasingly buffered from phenotype differences for highly attenuated proteins. Altogether, this study further highlights the importance of post-transcriptional control of protein abundance in cancer and healthy cells.
Human papillomavirus and the landscape of secondary genetic alterations in oral cancers
Authors: Gillison Maura L. , Akagi Keiko , Xiao Weihong , Jiang Bo , Pickard Robert K.L. , Li Jingfeng , Swanson Benjamin J. , Agrawal Amit D. , Zucker Mark , Stache-Crain Birgit , Emde Anne-Katrin , Geiger Heather M. , Robine Nicolas , Coombes Kevin R. , Symer David E.
Published: December 2018

Human papillomavirus (HPV) is a necessary but insufficient cause of a subset of oral squamous cell carcinomas (OSCCs) that is increasing markedly in frequency. To identify contributory, secondary genetic alterations in these cancers, we used comprehensive genomics methods to compare 149 HPV-positive and 335 HPV-negative OSCC tumor/normal pairs. Different behavioral risk factors underlying the two OSCC types were reflected in distinctive genomic mutational signatures. In HPV-positive OSCCs, the signatures of APOBEC cytosine deaminase editing, associated with anti-viral immunity, were strongly linked to overall mutational burden. In contrast, in HPV-negative OSCCs, T>C substitutions in the sequence context 5′-ATN-3′ correlated with tobacco exposure. Universal expression of HPV E6*1 and E7 oncogenes was a sine qua non of HPV-positive OSCCs. Significant enrichment of somatic mutations was confirmed or newly identified in PIK3CA, KMT2D, FGFR3, FBXW7, DDX3X, PTEN, TRAF3, RB1, CYLD, RIPK4, ZNF750, EP300, CASZ1, TAF5, RBL1, IFNGR1, and NFKBIA. Of these, many affect host pathways already targeted by HPV oncoproteins, including the p53 and pRB pathways, or disrupt host defenses against viral infections, including interferon (IFN) and nuclear factor kappa B signaling. Frequent copy number changes were associated with concordant changes in gene expression. Chr 11q (including CCND1) and 14q (including DICER1 and AKT1) were recurrently lost in HPV-positive OSCCs, in contrast to their gains in HPV-negative OSCCs. High-ranking variant allele fractions implicated ZNF750, PIK3CA, and EP300 mutations as candidate driver events in HPV-positive cancers. We conclude that virus-host interactions cooperatively shape the unique genetic features of these cancers, distinguishing them from their HPV-negative counterparts.
Silicon carbide X-ray beam position monitors for synchrotron applications
Authors: Nida Selamnesh , Tsibizov Alexander , Ziemann Thomas , Woerle Judith , Moesch Andy , Schulze-Briese Clemens , Pradervand Claude , Tudisco Salvatore , Sigg Hans , Bunk Oliver , Grossner Ulrike , Camarda Massimo
Published: December 2018

In this work, the performance of thin silicon carbide membranes as material for radiation hard X-ray beam position monitors (XBPMs) is investigated. Thermal and electrical behavior of XBPMs made from thin silicon carbide membranes and single-crystal diamond is compared using finite-element simulations. Fabricated silicon carbide devices are also compared with a 12 µm commercial polycrystalline diamond XBPM at the Swiss Light Source at the Paul Scherrer Institute. Results show that silicon carbide devices can reach equivalent transparencies while showing improved linearity, dynamics and signal-to-noise ratio compared with commercial polycrystalline diamond XBPMs. Given the obtained results and availability of electronic-grade epitaxies on up to 6 inch wafers, it is expected that silicon carbide can substitute for diamond in most beam monitoring applications, whereas diamond, owing to its lower absorption, could remain the material of choice in cases of extreme X-ray power densities, such as pink and white beams.
Report of the Executive Committee for 2017
Authors: Ashcroft A. T.
Published: December 2018

The report of the Executive Committee for 2017 is presented.
(C7H6NS)2[Nb6Cl18]·2C4H8O: first niobium cluster with an N,S-heterocyclic cation
Authors: Sperlich Eric , Köckerling Martin
Published: December 2018

The title compound bis(benzothiazolium) dodeca-μ-chlorido-hexachlorido-octahedro-hexaniobium(12 Nb—Nb) tetrahydrofuran disolvate, (C7H6NS)2[Nb6Cl18]·2C4H8O or (HBTh)2[Nb6Cl18]·2THF, is the first known niobium cluster compound to contain an N,S-heterocyclic cation. The synthesis takes place within a few hours as an one-pot reaction at room temperature of the cluster precursor compound [Nb6Cl14(H2O)4]·4H2O with SOCl2 in the presence of BTh (benzothiazole) in very high yield. The stabilization of the acidic proton of the cation is achieved by the use of tetrahydrofuran as a co-solvent and by the formation of hydrogen bonds.
Blended workplace learning: the value of human interaction
Authors: Hewett Suniti , Becker Karen , Bish Adelle
Published: December 2018

Purpose

The purpose of this paper is to study the use of blended learning in the workplace and questions whether interpersonal interaction facilitates learner engagement (specifically behavioral, cognitive and/or emotional engagement), and if so, the means by which this occurs.

Design/methodology/approach

A qualitative approach was taken to this exploratory study, a single-case study design was utilized, and data collection methods involved interviews with facilitators and past participants of a blended workplace learning (BWL) program.

Findings

Human interaction in the BWL program included learner–facilitator, learner–learner and learner–colleague interaction. Where human interaction was present, it was reported to be linked with more active behavioral engagement, higher cognitive engagement and stronger and more positive emotional engagement than where human interaction was absent.

Research limitations/implications

The single-case study design does not allow for generalizability of findings. Reliance on self-reported data through interviews without cross-validation from other forms of measurement is a further limitation of the study.

Practical implications

Effective blended learning programs for workplaces are those that provide opportunities for learners to engage through human interaction with facilitators, other learners and colleagues. The findings advance current knowledge of BWL, and have implications for human resource development professionals, and designers and facilitators of blended learning programs for workplaces.

Originality/value

The study contributes to existing literature on blended learning in the workplace and emphasizes the importance of ensuring that human interaction is still an element of blended learning to maximize the benefits to learners and organizations.
Enhancing graduates’ employability skills through authentic learning approaches
Authors: Ornellas Adriana , Falkner Kajsa , Edman Stålbrandt Eva
Published: December 2018

Purpose

The purpose of this paper is to introduce a theoretical framework based on authentic learning approaches that can be taken into consideration in higher education (HE) contexts to design activities that enable students to develop employability skills.

Design/methodology/approach

Three methods were used to develop the framework: desk research on current demand and supply of new graduate’s employability skills; interviews in four European HE institutions to identify authentic learning scenarios; and asynchronous online focus group to validate the framework.

Findings

The paper takes a competence-centred approach to the concept of employability skills and sets out a taxonomy of skills required to enhance new graduates’ employability. It also gives criteria and examples of authentic learning scenarios in HE settings that promote the acquisition of these skills.

Research limitations/implications

The framework developed remains theoretical. In a second phase, the framework will be applied to implement authentic activities in different programmes and subjects of five HE institutions, and the results will be reported in future publications.

Practical implications

The framework gives directions to create real and practical ways to enhance new graduates’ employability skills by improving the connection between HE curricula and the demands of the real world.

Originality/value

The added value of the paper lies in adopting a learner-centred, genuine and effective learning approach, such as authentic learning as a catalyst for bringing work experience to formal learning in HE institutions, in order to better develop graduates’ employability skills.
Adaptive reuse of historical buildings
Authors: Md Ali Zuraini , Zawawi Rodiah , Myeda Nik Elyna , Mohamad Nabila
Published: December 2018

Purpose

The purpose of this paper is to focus on the impacts that the adaptive reuse of historical building has on museum service quality by analysing the visitors’ expectations and perceptions through the HISTOQUAL model. It looks deeper into investigating the enhancement of adaptive reuse approach to historical buildings not only to the surrounding environment, but also to the building’s cultural significance.

Design/methodology/approach

A field survey implementing quantitative approach was conducted by using questionnaires to collect the visitors’ expectations and perceptions on their visits to the selected case study sites. The selected two case study sites are both newly adaptive reuse museums located in the heart of Kuala Lumpur. Through these case studies, the visitors’ expectations and perceptions were analysed and the differences were identified.

Findings

Positive feedback on the level of service quality provided at both museums indirectly shows the success of adaptive reuse initiative on the historical buildings towards adapting their new functions as a museum. It was also noted that foreign language leaflets and facilities for less able visitors were among the two service criteria that do not exceed the expectations of users. In general, these findings are crucial in identifying the gap within the services provided and appropriate measures that can be undertaken for further improvement.

Research limitations/implications

Further study can be employed to a larger population of study to cater for a variety of perspectives from both users and managers of the buildings.

Practical implications

This paper highlights the implications of users’ feedback towards building usability and functions. It provided imperative findings from the users’ point of view pertaining to the services provided.

Social implications

The paper illustrates the significance of social perceptions on the implications of service delivery. It also reports empirical evidence in highlighting the importance of users’ attributes towards excellent service delivery.

Originality/value

Up to present, there exists a small number of studies that look into reviewing the new functions of adaptive reuse buildings. This study now contributes to create a larger number of studies in this scope, especially within the context of Malaysia.
Sol-gel-derived gallium nitride thin films for ultraviolet photodetection
Authors: Fong Chee Yong , Ng Sha Shiong , Mohd Amin NurFahana , Yam Fong Kwong , Hassan Zainuriah
Published: December 2018

Purpose

This study aims to explore the applicability of the sol-gel-derived GaN thin films for UV photodetection.

Design/methodology/approach

GaN-based ultraviolet (UV) photodetector with Pt Schottky contacts was fabricated and its applicability was investigated. The current-voltage (I-V) characteristics of the GaN-based UV photodetector under the dark current and photocurrent were measured.

Findings

The ideality factors of GaN-based UV photodetector under dark current and photocurrent were 6.93 and 5.62, respectively. While the Schottky barrier heights (SBH) for GaN-based UV photodetector under dark current and photocurrent were 0.35 eV and 0.34 eV, respectively. The contrast ratio and responsivity of this UV photodetector measured at 5 V were found to be 1.36 and 1.68 μA/W, respectively. The photoresponse as a function of time was measured by switching the UV light on and off continuously at different forward biases of 1, 3 and 6 V. The results showed that the fabricated UV photodetector has reasonable stability and repeatability.

Originality/value

This work demonstrated that GaN-based UV photodetector can be fabricated by using the GaN thin film grown by low-cost and simple sol-gel spin coating method.