bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermal Desorption Technique for Analysis of Aerosolized Methylchloroisothiazolinone/Methylisothiazolinone (CMIT/MIT) in Inhalation Toxicity Testing
Authors: Kim Yong-Hyun , Jo Seongwon , An Young-Ji , Choi Seong-Jin , Lee Kyuhong
Published: November 2019

When assessing the inhalation toxicity of diverse inhalable substances, a first step is accurate quantitative analysis. In this study, we developed a method for the quantitative analysis of methylisothiazolinone (MIT) and methylchloroisothiazolinone (CMIT), main components in humidifier disinfectants. A simple thermal desorption (TD) method was used to analyze the CMIT/MIT. Using this method, sample loss during aerosolization was minimized compared with other more complicated pretreatment methods, like solvent absorption and extraction (SV). The results of the TD and SV methods were compared to determine the optimal analytical system for CMIT/MIT analysis. In both methods, the concentration of MIT increased systematically with increasing the CMIT/MIT aerosol concentration (R2 > 0.98). The MIT contents in the aerosol given by the two analytical methods were somewhat similar (MIT content = 1.52% (sample solution), 1.43% (TD) and 1.18% (SV)). In contrast, the measured CMIT content in the aerosol was different depending on the type of pretreatment used. The CMIT content was 2.90% for the TD method, while that for the solvent method recorded 0.75% (CMIT content of the sample solution = 4.66%). We confirmed that the sample loss of the CMIT with high reactivity occurred in the complicated sampling and pretreatment steps of the SV method.
The human DEPhOsphorylation Database DEPOD: 2019 update
Authors: Damle Nikhil P , Köhn Maja
Published: November 2019

The human Dephosphorylation Database (DEPOD) is a manually curated resource that harbors human phosphatases, their protein and non-protein substrates, dephosphorylation sites and the associated signaling pathways. We report here an update to DEPOD by integrating and/or linking to annotations from 69 other open access databases including disease associations, phosphorylating kinases, protein interactions, and also genome browsers. We also provide tools to visualize protein interactions, protein structures, phosphorylation networks, evolutionary conservation of proteins, dephosphorylation sites, and short linear motifs within various proteins. The updated version of DEPOD contains 254 human phosphatases, 336 protein and 83 non-protein substrates, and 1215 manually curated phosphatase-substrate relationships. In addition, we have improved the data access as all the data in DEPOD can now be easily downloaded in a user-friendly format. With multiple significant improvements, DEPOD continues serving as a key resource for research on phosphatase-kinase networks.

Database URL: www.depod.org
Association between time interval from neoadjuvant chemoradiotherapy to surgery and complete histological tumor response in esophageal and gastroesophageal junction cancer: a national cohort study
Authors: Klevebro F , Nilsson K , Lindblad M , Ekman S , Johansson J , Lundell L , Ndegwa N , Hedberg J , Nilsson M
Published: November 2019

The optimal time interval from neoadjuvant therapy to surgery in the treatment of esophageal cancer is not known. The aim of this study was to investigate if a prolonged interval between completed neoadjuvant chemoradiotherapy and surgery was associated with improved histological response rates and survival in a population-based national register cohort. The population-based cohort study included patients treated with neoadjuvant chemoradiotherapy and esophagectomy due to cancer in the esophagus or gastroesophageal junction. Patients were divided into two groups based on the median time from completed neoadjuvant treatment to surgery. The primary outcome was complete histological response. Secondary outcomes were lymph node tumor response, postoperative complications, R0 resection rate, 90-day mortality, and overall survival. In total, 643 patients were included, 344 (54%) patients underwent surgery within 49 days, and 299 (47%) after 50 days or longer. The groups were similar concerning baseline characteristics except for a higher clinical tumor stage (P = 0.009) in the prolonged time to surgery group. There were no significant differences in complete histological response, R0 resection rate, postoperative complications, 90-day mortality, or overall survival. Adjusted odds ratio for ypT0 in the prolonged time to surgery group was 0.99 (95% confidence interval: 0.64–1.53). Complete histological response in the primary tumor (ypT0) was associated with significantly higher overall survival: adjusted hazard ratio: 0.55 (95% CI 0.41–0.76). If lymph node metastases were present in these patients, the survival was, however, significantly lower: adjusted hazard ratio for ypT0N1: 2.30 (95% CI 1.21–4.35). In this prospectively collected, nationwide cohort study of esophageal and junctional type 1 and 2 cancer patients, there were no associations between time to surgery and histological complete response, postoperative outcomes, or overall survival. The results suggest that it is safe for patients to postpone surgery at least 7 to 10 weeks after completed chemoradiotherapy, but no evidence was seen in favor of recommending a prolonged time to surgery after neoadjuvant chemoradiotherapy for esophageal cancer. A definitive answer to this question requires a randomized controlled trial of standard vs. prolonged time to surgery.
Baseline neutrophil–lymphocyte ratio holds no prognostic value for esophageal and junctional adenocarcinoma in patients treated with neoadjuvant chemotherapy
Authors: van Hootegem S J M , Smithers B M , Gotley D C , Brosda S , Thomson I G , Thomas J M , Gartside M , Barbour A P
Published: November 2019

Background: Several studies have reported that neutrophil–lymphocyte ratio (NLR) can predict survival in esophageal and gastroesophageal junction adenocarcinoma, as it reflects systemic inflammation. Hence, we aimed to determine whether baseline NLR holds prognostic value for esophageal adenocarcinoma patients treated with neoadjuvant chemotherapy (nCT) followed by surgery. Methods: We studied the data of 139 patients that received nCT before undergoing esophagectomy with curative intent, all identified from a prospectively maintained database (1998–2016). Pretreatment hematology reports were used to calculate the baseline NLR. A receiver operating characteristic curve (ROC-curve) was plotted to determine an optimal cutoff value. NLR quartiles were used to display possible differences between groups in relation to overall survival (OS) and disease-free survival (DFS) using the method of Kaplan–Meier. Cox regression analysis was performed to assess the prognostic value of NLR. Results: The median OS and DFS times were 46 months (interquartile range [IQR]: 19–166) and 30 months (IQR: 13–166], respectively, for the entire cohort. The ROC-curve showed that NLR has no discriminating power for survival status (area under the curve = 0.462) and therefore no optimal cutoff value could be determined. There were no statistically significant differences in median OS times for NLR quartiles: 65 (Q1), 32 (Q2), 45 (Q3), and 46 months (Q4) (P = 0.926). Similarly, DFS showed no difference between quartile groups, with median survival times of 27 (Q1), 19 (Q2), 36 (Q3), and 20 months (Q4) (P = 0.973). Age, pN, pM, and resection margin were independent prognostic factors for both OS and DFS. On the contrary, NLR was not associated with OS or DFS in univariable and multivariable analyses. Conclusion: Baseline NLR holds no prognostic value for esophageal and gastroesophageal junction adenocarcinoma patients treated with nCT in this study, in contrast to other recently published papers. This result questions the validity of NLR as a reliable prognostic indicator and its clinical usefulness in these patients.
Switching from vitamin K antagonist to dabigatran in atrial fibrillation: differences according to dose
Authors: Vinding Naja Emborg , Staerk Laila , Gislason Gunnar Hilmar , Torp-Pedersen Christian , Bonde Anders Nissen , Rørth Rasmus , Lee Christina J -Y , Olesen Jonas Bjerring , Køber Lars , Fosbøl Emil Loldrup
Published: November 2019

Aims

In atrial fibrillation (AF) patients 150 mg b.i.d. dabigatran is the standard dose, yet guidelines recommend 110 mg b.i.d. when bleeding risk is high. It is unknown to which extend these recommendations are followed in patients switching from vitamin K antagonist (VKA) to dabigatran. The aim of this study was to investigate if AF patients are switched from VKA to the appropriate dose of dabigatran.

Methods and results

Using nationwide registries (22 August 2011 to 31 December 2012), we identified VKA-experienced AF patients with available creatinine values who switched to dabigatran. European guidelines criteria 2012 on dabigatran dosing were examined: age ≥80 years, HAS-BLED ≥3, estimated glomerular filtration rate (eGFR)<50 mL/min/1.73 m2, or use of interacting drugs. We identified 1626 VKA-experienced AF patients who switched to dabigatran 110 mg (820 patients) or 150 mg (806 patients). Patients who switched to 110 mg compared with 150 mg were older [median age 82 years (Q1–Q3: 77–86) vs. 68 years (Q1–Q3: 64–74)], more often females (54% vs. 35%), had a higher comorbidity burden, higher proportion with CHA2DS2–VASc score ≥2 (98% vs. 80%), and more with a HAS-BLED score ≥3 (46% vs. 28%). Patients switched to 110 mg had a higher absolute risk of mortality compared with patients switched to 150 mg. Overall, 26% were inappropriately dosed and 14% were switched to 110 mg although the higher dose was indicated. Furthermore, 39% of patients switched to 150 mg fulfilled one or more criteria for 110 mg, this mostly driven by high HAS-BLED scores (28.2% of patients on 150 mg). Female sex, age ≥80 years, eGFR < 50 mL/min/1.73 m2, drugs interacting with dabigatran, and prior bleeding were associated with switch to 110 mg. Patients inappropriately dosed had similar risk of mortality as patients appropriately dosed.

Conclusion

Among VKA-experienced AF patients one in four were switched to a dabigatran dose contrary to guideline recommendations.
Fault dip variations related to elastic layering
Authors: Nespoli M , Belardinelli M E , Bonafede M
Published: November 2019

In this paper we model the crack growth in an elastic medium constituted by two welded half-spaces with different rigidities. We implement a 2D Boundary Element Method (BEM) computing shear and normal tractions acting on the crack and the slip accommodating stress drop from an arbitrary initial configuration to a final frictional configuration. The direction of crack growth follows the criterion of maximum energy release (strain and gravitational energy) provided that it overcomes the surface fracture energy and the work dissipated by friction. The energetic criterion leads to estimates of the dip angle of seismic faults depending on the amplitude of the initial stress and it includes the classical Anderson's results as a particular case. Moreover, in presence of a sharp rigidity contrast, the direction of crack growth is strongly deflected. The model simulates non-planar, complex, fault geometries, as in the case of detachment and listric faults and it explains the increase of dip angles for both normal and reverse faults, when they enter soft sedimentary layers.
Feeding and growth of Atlantic cod (Gadus morhua L.) in the eastern Baltic Sea under environmental change
Authors: Neuenfeldt Stefan , Bartolino Valerio , Orio Alessandro , Andersen Ken H , Andersen Niels G , Niiranen Susa , Bergström Ulf , Ustups Didzis , Kulatska Nataliia , Casini Michele
Published: November 2019

Five decades of stomach content data allowed insight into the development of consumption, diet composition, and resulting somatic growth of Gadus morhua (Atlantic cod) in the eastern Baltic Sea. We show a recent reversal in feeding level over body length. Present feeding levels of small cod indicate severe growth limitation and increased starvation-related mortality. For young cod, the low growth rate and the high mortality rate are manifested through a reduction in size-at-age. The low feeding levels are likely the result of a decrease in benthic prey abundance due to increased hypoxic areas, while decreasing abundances of pelagic species in the area of cod distribution have prevented a compensatory shift in diet. Our study emphasizes that environmental forcing and the decline in pelagic prey caused changes in consumption and growth rates of small cod. The food reduction is amplified by stunted growth leading to high densities of cod of smaller size competing for the scarce resources. The average growth rate is negative, and only individuals with feeding levels well above average will survive, though growing slowly. These results suggest that the relation between consumption rate, somatic growth and predatorprey population densities is strongly environmentally mediated.
Foreign Policy Preferences in Ukraine: Trade and Ethnolinguistic Identity
Authors: Beesley Celeste
Published: November 2019

Individuals tend to favor important trade partners in their foreign policy preferences. Cultural affinity is also known to influence individuals’ foreign policy stances. This study examines how citizens prioritize international relations with trading partners in the face of ethnolinguistic divisions. Using survey data on foreign policy preferences paired with data on bilateral trade between Ukraine and its two largest trade partners (Russia and the European Union [EU]), I find that ethnolinguistic identity and relative trade exposure both affect foreign policy preferences and that these effects introduce cross-cutting cleavages. Ukrainian-speaking Ukrainians in regions where the economic importance of trade with Russia is relatively higher are more likely to favor foreign policy oriented toward Russia than Ukrainian speakers elsewhere. Similarly, Russian speakers in areas with high levels of trade with the EU have more EU-oriented foreign policy preferences.
A Comparison of Acute Toxicity Endpoints for Adult Honey Bees with Technical Grade Active Ingredients and Typical End-use Products as Test Substance
Authors: Spruill Susan E , O'Neill Bridget F , Hinarejos Silvia , Cabrera Ana R
Published: November 2019

The honey bee, Apis mellifera L. (Hymenoptera: Apidae), is a model organism for pollinators in risk assessment frameworks globally. The acute toxicity tests with adult honey bees for contact and oral exposure are part of the requirements for pesticide registration and are typically conducted with the active ingredient. A question often asked is if the typical end-use product (TEP) is more toxic than the technical grade active ingredient (TGAI) to honey bees. We explored this question by mining publicly available databases from regulatory agencies worldwide, where testing with the TEP is required. The objective of this study was to determine whether TEPs are comparable in toxicity to the TGAI. The dataset was analyzed via a 3 × 3 contingency table with toxicity categories, as the data cannot be computed for regression analysis. Of the 151 active ingredients with reported endpoints for contact exposure, 28 were classified as either moderately or highly toxic, 123 were classified as practically nontoxic, and 3 were inconclusive. Only two (1.3%) were reclassified from nontoxic to moderately toxic as the TEP. Of the 141 active ingredients with reported endpoints for oral exposure, 23 were classified as moderately or highly toxic, 113 were classified as practically nontoxic, and 5 were inconclusive. Only five (3.6%) were reclassified from nontoxic to moderately toxic as the TEP. Fewer than 5% of the total TEPs evaluated (contact and oral) were shown to be more toxic than the TGAI, suggesting that the risk assessments of TGAIs would be sufficiently protective to pollinators at the screening laboratory level.
The great collector and his man in Rome
Authors: Dall’Aglio Stefano
Published: November 2019

This article analyses the relationship between one of early modern Italy’s most illustrious collectors, Prince and Cardinal Leopoldo de’ Medici (1617–1675), and his principal agent in Rome, Ottavio Falconieri (1636–1675). It draws on an extraordinary new source: a volume containing 350 original letters sent by Leopoldo to Ottavio, never before seen by any other scholar. Letters written by Leopoldo are rare documents: they provide a unique insight into his expectations, instructions and reactions, showing the active role he always played in the collecting process. These new letters also demonstrate that Falconieri was far more than just an art agent: he was Leopoldo’s point of reference in Rome, a man with whom the cardinal shared many interests, ranging from literature to astronomy, from poetry to natural science, and Falconieri’s indefatigable collecting work went well beyond antiquities to include books, scientific instruments, curiosities and much more.
The Eolian Harp: Coleridge’s Middle Voice?
Authors: Allen Blake
Published: November 2019

Samuel Taylor Coleridge’s conversation poem, The Eolian Harp, configures a complex and highly significant relationship between activity and passivity. A merely passive poet, under the influence of natural or divine inspiration, would in Coleridge’s view be reduced to a mere automaton. Yet the poem is often thought to represent just such a poet. Similarly, it is thought to represent Sara, the speaker’s interlocutor, as a surrogate self. I shall argue, instead, that the poem presents the self in a ‘middle voice’, at once active and passive, such that inspiration does not efface human agency. I shall also consider the senses in which Sara evinces a middle voice and thus a distinct and substantial subjectivity. The implications of this argument for Coleridge’s broader corpus, and for some recent critiques of his aesthetics, will be suggested.
A guide to computational methods for G-quadruplex prediction
Authors: Puig Lombardi Emilia , Londoño-Vallejo Arturo
Published: November 2019

Guanine-rich nucleic acids can fold into the non-B DNA or RNA structures called G-quadruplexes (G4). Recent methodological developments have allowed the characterization of specific G-quadruplex structures in vitro as well as in vivo, and at a much higher throughput, in silico, which has greatly expanded our understanding of G4-associated functions. Typically, the consensus motif G3+N1–7G3+N1–7G3+N1–7G3+ has been used to identify potential G-quadruplexes from primary sequence. Since, various algorithms have been developed to predict the potential formation of quadruplexes directly from DNA or RNA sequences and the number of studies reporting genome-wide G4 exploration across species has rapidly increased. More recently, new methodologies have also appeared, proposing other estimates which consider non-canonical sequences and/or structure propensity and stability. The present review aims at providing an updated overview of the current open-source G-quadruplex prediction algorithms and straightforward examples of their implementation.
Unmet needs and recommendations to improve meningioma care through patient, partner, and health care provider input: a mixed-method study
Authors: Zamanipoor Najafabadi Amir H , van de Mortel Johannes P M , Lobatto Daniel J , Brandsma Dieta R , Peul Wilco C , Biermasz Nienke , Taphoorn Martin J B , Dirven Linda , van Furth Wouter R
Published: November 2019

Background

It has been suggested that lack of ongoing registration of patient-centered outcomes has resulted in existing care trajectories that have not been optimized for sequelae experienced by meningioma patients. This study aimed to evaluate the structure of current meningioma care and identify issues and potential high-impact improvement initiatives.

Methods

Using the grounded theory approach, a thematic framework was constructed based on the Dutch Comprehensive Cancer Organisation survey about issues in meningioma care trajectories. This framework was used during 3 semistructured interviews and 2 focus groups with patient-partner dyads (n = 16 participants), and 2 focus groups with health care providers (n = 11 participants) to assess issues in current meningioma care trajectories and possible solutions, including barriers to and facilitators for implementation.

Results

Identified issues (n = 18 issues) were categorized into 3 themes: availability and provision of information, care and support, and screening for (neurocognitive) rehabilitation. A lack of information about the intervention and possible outcomes or complications, lack of support after treatment focusing on bodily and psychological functions, and reintegration into society were considered most important. Sixteen solutions were suggested, such as appointment of case managers (solution for 11/18 issues, 61%), assessment and treatment by physiatrists (22%), and routine use of patient-reported outcome measures for patient monitoring (17%). Barriers for these solutions were lack of budget, capacity, technology infrastructure, and qualified personnel with knowledge about issues experienced by meningioma patients.

Conclusions

This study identified issues in current multidisciplinary meningioma care that are considered unmet needs by patients, partners, and health care providers and could guide innovation of care.
A Counterfactual Approach to Explanation in Mathematics
Authors: Baron Sam , Colyvan Mark , Ripley David
Published: November 2019

Our goal in this paper is to extend counterfactual accounts of scientific explanation to mathematics. Our focus, in particular, is on intra-mathematical explanations: explanations of one mathematical fact in terms of another. We offer a basic counterfactual theory of intra-mathematical explanations, before modelling the explanatory structure of a test case using counterfactual machinery. We finish by considering the application of counterpossibles to mathematical explanation, and explore a second test case along these lines.
Hypoxia decreases the T helper cell-suppressive capacity of synovial fibroblasts by downregulating IDO1-mediated tryptophan metabolism
Authors: Kaul Nathalie-Christin , Mohapatra Soumya R , Adam Isabell , Tucher Christine , Tretter Theresa , Opitz Christiane A , Lorenz Hanns-Martin , Tykocinski Lars-Oliver
Published: November 2019

Objective

The development of RA is linked to local infiltration of immune cells and to changes in the phenotype of synovial fibroblasts. Synovial fibroblasts possess the capacity to suppress T cell responses through indoleamine 2, 3-dioxygenase 1 (IDO1)-mediated tryptophan metabolism. However, synovial fibroblasts from RA patients are restricted in this immune-modulatory function. Moreover, hypoxic conditions are detected within synovial tissues of RA patients, with oxygen tensions of only 3.2% O2. This study aims at investigating the effects of hypoxia on the interaction between T cells and synovial fibroblasts, particularly on the T cell-suppressive capacities of synovial fibroblasts.

Methods

Synovial fibroblasts were cultured with Th cells under normoxic and hypoxic conditions (3% O2). Th cell proliferation was detected by flow cytometry. Tryptophan and kynurenine amounts were measured by HPLC. IDO1 expression and signal transducer and activator of transcription 1 (STAT1) phosphorylation were quantified by real-time PCR or western blot, and cytokine secretion by ELISA.

Results

Hypoxic conditions strongly diminished the Th cell-suppressive capacities of both OA synovial fibroblasts and RA synovial fibroblasts. Accordingly, IDO1 mRNA and protein expression, STAT1 phosphorylation and tryptophan metabolism were greatly reduced in OA synovial fibroblasts by hypoxia. MMP-3, IL-6, IL-10 and IFNγ secretion were significantly decreased under hypoxia in synovial fibroblast-Th cell co-cultures, while IL-17A levels were elevated. Supplementation with IFNγ, a well-known inducer of IDO1 expression, could rescue neither IDO1 expression nor Th cell suppression under hypoxic conditions.

Conclusion

Hypoxia strongly affected the crosstalk between synovial fibroblasts and Th cells. By reducing the efficiency of synovial fibroblasts to restrict Th cell proliferation and by increasing the expression of IL-17A, hypoxia might have implications on the pathophysiology of RA.
Behavioral interventions for pediatric insomnia: one treatment may not fit all
Authors: Kahn Michal , Juda-Hanael Michal , Livne-Karp Efrat , Tikotzky Liat , Anders Thomas F , Sadeh Avi
Published: November 2019

Study Objectives

Behavioral interventions for pediatric insomnia are cost-effective and benefit most families, but there is no evidence indicating which treatments are most suitable for specific patient populations. This randomized controlled trial evaluated the moderating role of infant separation anxiety in two brief interventions for infant sleep problems.

Methods

Ninety-one infants aged 9–18 months (61% boys) with pediatric insomnia were randomized to either Checking-in, a Graduated extinction protocol which involves gradual separation from parents, or to the Camping-out intervention, in which parental presence is maintained. Sleep was measured using actigraphy and parent reports. Infant separation anxiety was observed in the laboratory. Assessments were completed at baseline, post-treatment and 6-month follow-up.

Results

Improvement in sleep was demonstrated following both interventions and maintained at follow-up. Separation anxiety did not change significantly following treatment. Infant separation anxiety moderated treatment efficacy, with greater benefit for infants with high separation anxiety in the Camping-out compared to the Checking-in intervention.

Conclusions

This study provides support for considering infant separation anxiety in the effort to personalize treatment for pediatric insomnia. Pediatricians should incorporate evaluation of infant separation anxiety to assessment processes, and favor more gentle treatment approaches, such as Camping-out, over Graduated extinction for highly anxious infants.

Clinical Trial Registration

NCT01489215.
A centrosome‐localized calcium signal is essential for mammalian cell mitosis
Authors: Helassa Nordine , Nugues Charlotte , Rajamanoharan Dayani , Burgoyne Robert D. , Haynes Lee P.
Published: November 2019

Mitosis defects can lead to premature ageing and cancer. Understanding mitosis regulation therefore has important implications for human disease. Early data suggested that calcium (Ca2+) signals could influence mitosis, but these have hitherto not been observed in mammalian cells. Here, we reveal a prolonged yet spatially restricted Ca2+ signal at the centrosomes of actively dividing cells. Local buffering of the centrosomal Ca2+ signals, by flash photolysis of the caged Ca2+ chelator diazo‐2‐acetoxymethyl ester, arrests mitosis. We also provide evidence that this Ca2+ signal emanates from the endoplasmic reticulum. In summary, we characterize a unique centrosomal Ca2+ signal as a functionally essential input into mitosis.—Helassa, N., Nugues, C., Rajamanoharan, D., Burgoyne, R. D., Haynes, L. P. A centrosome‐localized calcium signal is essential for mammalian cell mitosis. FASEB J. 33, 14602‐14610 (2019). www.fasebj.org
Elevated Serum Titanium Levels in Children With Early Onset Scoliosis Treated With Growth-friendly Instrumentation
Authors: Li Ying , Graham Chelsea K. , Robbins Christopher , Caird Michelle S. , Farley Frances A.
Published: November 2019

Background:

A previous study showed significantly higher serum titanium levels in patients with early-onset scoliosis (EOS) treated with traditional growing rods (TGR) and magnetically controlled growing rods (MCGR) compared with controls. Children with vertical expandable prosthetic titanium rib (VEPTR) were not assessed. The purpose of this study was to compare serum titanium levels in EOS patients treated with TGR, MCGR, and VEPTR. We hypothesized that EOS patients treated with all forms of growth-friendly instrumentation (GFI) have elevated serum titanium levels.

Methods:

This was a prospective cross-sectional case series. Serum titanium levels were collected from patients with GFI who were enrolled in an EOS database. Blood samples were collected at a clinic visit or lengthening/exchange procedure between April and December 2018. The normal range for serum titanium is 0 to 1 ng/mL. Analyses were conducted using analysis of variance and Bonferroni post hoc test.

Results:

A total of 23 patients (2 TGR, 8 MCGR, 13 VEPTR) were analyzed. There was a significant difference in age at the time of blood sample collection (12.5 vs. 9.8 vs. 7.5 y, P=0.015) and serum titanium level (1.5 vs. 4.5 vs. 7.6 ng/mL, P=0.021) between TGR, MCGR, and VEPTR, respectively. All of the MCGR and VEPTR patients had a serum titanium level ≥2 ng/mL. Binary comparisons showed that VEPTR had a significantly higher serum titanium level than TGR (P=0.046). There was no difference in serum titanium level when MCGR was compared with TGR and VEPTR. Time from implant insertion to blood sample collection, number of rods currently implanted, total number of rods implanted throughout treatment, and number of lengthenings per patient was similar between the groups.

Conclusions:

Elevated serum titanium levels may be present in EOS patients treated with all forms of GFI. Although our TGR patients had indwelling implants for the longest period of time, they had the lowest serum titanium level. Repetitive chest wall motion during respiration may lead to continued wear and metal ion release with VEPTR.

Level of Evidence:

Level II—therapeutic.
A Review of the Use of Telemedicine in Dermatologic Surgery
Authors: Sohn Grace K. , Wong David J. , Yu Siegrid S.
Published: November 2019

BACKGROUND

Telemedicine is an emerging field with numerous applications within medicine. Previous review articles describe its use within plastic surgery and otolaryngology but none, to the authors' knowledge, within dermatologic surgery.

OBJECTIVE

To provide a review of the applications of telemedicine within dermatologic surgery.

MATERIALS AND METHODS

A PubMed search of articles published on teledermatology was conducted in July 2018. Articles were selected based on their relevance to dermatologic surgery and reviewed for their discussion of the applications of telemedicine in surgical and cosmetic dermatology.

RESULTS

The initial search resulted in 156 articles. Eleven ultimately met inclusion criteria: 2 in referral and consultation, 5 in telepathology, 2 in intraoperative uses, and 2 in postprocedural care.

CONCLUSION

For preoperative consultation, teledermatology enables the surgeon to plan ahead and increases access to care by reducing the number of clinic visits. Telepathology has the potential to allow intraoperative consultation with a dermatopathologist to achieve accurate tumor clearance without delay. Smartglasses represent a promising technology for greater care coordination and a teaching tool. Postprocedural monitoring via text messaging provides convenient access to expert advice and early detection of postoperative complications. With increasing technologic advancements, telemedicine holds great potential to augment the dermatologic surgeon's daily practice.
Simple Effective Ways to Care for Skin Wounds and Incisions
Authors: Lalonde Don , Joukhadar Nadim , Janis Jeff
Published: November 2019

Plastic surgeons are medicine’s wound experts. Many of the world’s poor cannot afford expensive wound management programs. All humans suffer open and closed wounds at some point in their life and must look after them. The purpose of this paper is to provide basic information to the public in very simple terms on how to safely and inexpensively manage wounds. This paper is directed to all nonmedical people, medical students, and other doctors who may not be content experts in this field.
Adopting Graduate Competencies in Opioid Prescribing for Massachusetts Physician Assistant Programs: A Statewide Public Health Response
Authors: White Susan E. , Altongy-Magee Kristy , Cooper Christopher , Hixon Jennifer , Honda Trenton , Milch Charles , Murphy Richard , Riethle Theresa , Walker Lisa , Berkowitz Oren
Published: November 2019

Opioid addiction has become a national epidemic. Morbidity and mortality from prescription and synthetic opioid use and abuse have increased at an alarming rate in recent years. Ensuring that physician assistant (PA) graduates have the knowledge to become safe prescribers of medications, including opiates, is a goal of PA training programs. Achieving that goal requires fostering PA student competence regarding current issues in pain control, drug use and misuse, polypharmacy, diversion, self-medication, and substance use disorder. We present a public health approach to addressing that need. Our approach involved developing consensus among the 9 PA programs in Massachusetts concerning the adoption and implementation of statewide, graduate core competencies for the prevention and management of prescription drug misuse. The process implemented in Massachusetts could be used as a model in other states and might be relevant to addressing other public health crises. We present the adopted competencies as well as individual PA programs' curricular approaches.
Treatment of First-time Patellar Dislocations and Evaluation of Risk Factors for Recurrent Patellar Instability
Authors: Martin R. Kyle , Leland Devin P. , Krych Aaron J. , Dahm Diane L.
Published: November 2019

Approximately one-third of skeletally mature patients with primary patellar dislocation will experience recurrent patellar instability over time. Because of the multifactorial combination of features contributing to overall stability of the patellofemoral joint, first-time patella dislocation presents a challenge to the treating physician. A detailed patient history, focused physical examination, and appropriate diagnostic imaging are essential for identifying risk factors for recurrent instability. Individual risk factors include young patient age, patella alta, trochlear dysplasia, and lateralization of the tibial tubercle. In combination these factors may pose even greater risk, and recently published predictive scoring models offer clinicians objective criteria to identify patients most at risk for recurrence. In patients at low risk of recurrence, nonoperative management can be effective, with “a la carte” surgical treatments gaining popularity in those with a higher than acceptable risk of re-dislocation.
Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population
Authors: Fan Lei , Ou Dingqiang , Huang Xuna , Pang Mao , Chen Xiu-Xing , Yang Bu , Wang Qi-You
Published: November 2019

Background:

It is unclear whether surgery or conservative treatment is more suitable for elderly patients with type II and type III odontoid fractures. We performed this meta-analysis to compare the efficacy of surgical and conservative treatments for type II and type III odontoid fractures.

Methods:

A literature search was performed in PubMed, Embase, Web of Science, and Cochrane Library in January 2017. Only articles comparing surgery with conservative treatment in elderly patients with type II and type III odontoid fractures were selected. After 2 authors independently assessed the retrieved studies, 18 articles were included in this meta-analysis, and the primary endpoints were the nonunion rate and mortality rate. The secondary outcomes were patient satisfaction, complications, and the length of the hospital stay. The quality of the included studies was evaluated using the modified Newcastle–Ottawa scale. Sensitivity analyses were performed for high-quality studies, and the publication bias was evaluated using a funnel plot.

Results:

Lower nonunion (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.18–0.40, P < .05) and mortality rates (OR: 0.52, 95% CI: 0.34–0.79, P < .05) confirmed the superiority of surgery in treating type II and type III fractures. The secondary outcomes differed. Patients in the surgery group felt more satisfied with the outcome (OR: 3.44, 95% CI: 1.19–9.95, P < .05), and the complications were similar in the 2 groups (OR: 1.14, 95% CI: 0.78–1.68, P = .5), whereas patients in conservative groups spent less time in the hospital (OR: 5.10, 95% CI: 2.73–7.47, P < .05). The results of the subgroup analyses and sensitivity analysis were similar to the original outcomes, and no obvious publication bias was observed in the funnel plot.

Conclusion:

Most elderly (younger than 70 years) patients with type II or type III odontoid fractures should be considered candidates for surgical treatment, due to the higher union rate and lower mortality rate, while statistically significant differences were not observed in the population with an advanced age (older than 70 years). Therefore, the selection of the therapeutic approach for elderly patients with odontoid fractures requires further exploration. Simultaneously, based on our meta-analysis, a posterior arthrodesis treatment was significantly superior to the anterior odontoid screw treatment.
Rare presentation of an isolated bilateral cerebral peduncular infarction
Authors: Fu Xiaoxue , Li Hongyu , Tian Xiaoquan , Wang Wei , Liu Hong
Published: November 2019

Rationale:

Due to the rarity of bilateral cerebral peduncular infarction (BCPI), its symptoms and prognosis are not clear. It is necessary to collect cases of pure cerebral peduncular infarction, explore the etiology and anatomy of midbrain infarction in depth, and develop meaningful tools for explaining clinical symptoms and predicting prognosis of patients.

Patient concerns:

We here provide a case of isolated BCPI with uncommon symptoms of ataxia, dysarthria, sensory disturbance, normal muscular strength, and full eye movements.

Diagnoses:

Diffusion weighted images and apparent diffusion coefficient map of our patient revealed acute and isolated bilateral peduncle cerebrum infarction.

Interventions:

Drugs that could improve circulation and antiplatelet were used in therapy.

Outcomes:

The infarct size was enlarged and new infarction was identified in the splenium of the corpus callosum and pons. The patient developed progressed disorder of consciousness and died at the eleventh day.

Lessons:

We inferred that the symptoms of ataxia, dysarthria, sensory disturbance, and mild paresis of the extremities could be prominent features of patients with pure cerebral peduncular infarction. We hypothesize that pure BCPI is also related to severe basilar artery stenosis or occlusion and there is no collateral circulation from PCA. This may explain the corresponding distribution of cerebral peduncular infarction and its poor prognosis. For these reasons, exploring etiology and anatomy of midbrain infarction in depth would have clinical value for predicting symptoms and prognosis.
Association between prenatal exposure to bisphenol a and birth outcomes
Authors: Zhou Zhitong , Lei Yuyang , Wei Wei , Zhao Yuxin , Jiang Yizhou , Wang Ningning , Li Xiaofeng , Chen Xin
Published: November 2019

Background:

Previous studies investigated the relation of prenatal exposure to bisphenol A (BPA) and birth outcomes, but these results were inconsistent. The aim of this study was to investigate the relation of prenatal exposure to BPA and birth outcomes, provide comprehensive results based on current studies.

Methods:

The PubMed, Cochrane databases, and Web of Science databases were searched systematically by two researchers respectively from their inceptions to Oct. 2018, using the following keywords “bisphenol A, birth weight, birth length, head circumference, gestational age, birth outcomes”. We extracted β coefficient and 95% confidence interval (CI) or β coefficient and standard deviation (SD) from included study. The subgroup analysis was performed to evaluate the potential heterogeneity between studies. We conducted sensitivity analysis by excluding the each individual study to assess the results whether were stable. Finally, the publication bias was performed by accumulative forest plot.

Results:

Seven studies with 3004 participants met the inclusion criteria. BPA had significant positively association with birth weight (β = 21.92, 95%CI: 1.50–42.35, P = .04). No significant associations were found between BPA and birth length, head circumference and gestational age (All of P > .05).

Conclusion:

This meta-analysis demonstrated that the BPA was positively associated with birth weight. Therefore, further studies are needed to investigate the critical sensitive period of influencing fetal development and to investigate the difference on gender.
Psychosocial dimensions of hand transplantation: lessons learned from solid organ transplantation
Authors: Smith Patrick J. , Cendales Linda C.
Published: November 2019

Purpose of review

The present review examines psychosocial factors emerging as predictive of clinical outcomes among solid organ transplant (SOT) recipients, with possible extensions to vascular composite allograft (VCA) and hand transplantation, in particular. The Chauvet Workgroup report and International Society of Heart and Lung Transplantation consensus guidelines are used to delineate areas of commonality between SOT and VCA, as well as unique features contributing to post-VCA psychosocial risk.

Recent findings

Increasing evidence suggests that depression, cognitive function, and other posttransplant psychosocial factors consistently associate with clinical risk in SOT. However, the mechanisms precipitating these psychosocial risk factors are likely diverse in their cause, with large individual differences across SOT and VCA. Transdiagnostic dimensions may serve as mechanistic factors, increasing the risk of adverse clinical outcomes and suggesting potential treatment strategies for risk mitigation. Psychosocial dimensions including psychological flexibility, self-efficacy, and posttraumatic growth are discussed as potential contributory factors.

Psychosocial factors hold importance in predicting posttransplant clinical outcomes. Emerging transdiagnostic factors may provide insight into mechanisms and potential treatments.
Racial Differences in the Incidence and Survival of Patients With Neuroendocrine Tumors
Authors: Shen Chan , Gu Dian , Zhou Shouhao , Xu Ying , Sarshekeh Amir Mehrvarz , Halperin Daniel , Shih Ya-Chen T. , Yao James C. , Dasari Arvind
Published: November 2019

Objectives

The incidence of neuroendocrine tumors (NETs) has been steadily increasing. Racial differences in the incidence and survival are mostly unknown. This study examines the racial differences and the underlying causes.

Methods

We conducted a retrospective, population-based study using datasets from Surveillance, Epidemiology, and End Results (SEER) cancer registry and SEER data linked with Medicare claims (SEER-Medicare). We examined the incidence rates and the effects of patient demographics, clinical characteristics, and socioeconomic factors on survival.

Results

Of the 15,786 and 1731 cases from SEER and SEER-Medicare, 1991 and 163 were blacks, respectively. We found that blacks had higher NET incidence for all stages, with the largest difference noted in the local stage (4.3 vs 2.6 per 100,000 in whites). We found worse survival for distant-stage black patients, although they more often had clinical factors typically associated with better prognosis in NETs. However, they were also found to have significant unfavorable differences in socioeconomic and sociodemographic factors.

Conclusions

Blacks have higher incidence of NETs and worse survival compared with other races, especially whites. The influences of neighborhood socioeconomic, sociodemographic, and marital status suggest that social determinants, support mechanisms, and access to health care may be contributing factors.
A Quality Improvement Intervention to Decrease Postoperative Opioid Prescriptions in Pediatric Oncology Patients
Authors: Mansfield Sara A. , El Gohary Yousef , Kimble Amy , Wynn Lynn , Hall Elizabeth A. , Anghelescu Doralina L. , Davidoff Andrew M. , Murphy Andrew J.
Published: November 2019

Purpose:

This quality improvement initiative aimed to minimize opioid prescribing after oncologic pediatric surgery.

Methods:

Retrospective surgical data collected at a pediatric cancer hospital from July 2016 to June 2018 included hospitalization details, oral morphine equivalents prescribed, unplanned visits/calls because of pain, and parental/patient satisfaction with pain control. The quality improvement initiative promoted opioid prescription at discharge on the basis of prior inpatient requirements and education regarding nonopioid analgesia. Upon commencing this project in July 2018, we collected data prospectively.

Results:

The retrospective and the prospective cohorts included 271 and 99 patients, respectively. Mean (SD) oral morphine equivalents (mg/kg) prescribed upon discharge was significantly reduced in the prospective (0.75±1.34) versus retrospective cohorts (5.48±6.94, P<0.001). The unplanned visits/calls regarding pain were 23 (retrospective, 8.5%) and 2 (prospective, 2.0%). In total, 44 patients (44.4%) received an opioid prescription at discharge in the prospective cohort, significantly fewer than retrospective cohort (251, 92.6%, P<0.001), and used a mean of 34.3 of 159.8 (21.5%) doses dispensed. Length of stay was comparable (P=0.88) between cohorts. Prospective satisfaction rate was 96.2%, leaving 3 patients (3.8%) not satisfied with their pain control regimen.

Conclusions:

Dramatic reduction of opioid prescriptions after oncologic surgery can be achieved without detriment to patient satisfaction or readmissions.

Level of Evidence:

Level V.
Does the postural stability of patients with Parkinson’s disease affect the physical activity?
Authors: Aktar Burcin , Donmez Colakoglu Berril , Balci Birgul
Published: November 2019

Postural instability is one of the cardinal features in Idiopathic Parkinson’s disease. It is a significant factor of disability in Parkinson’s disease. We aimed to examine the physical activity levels in patients with Parkinson’s disease comparing with healthy subjects and their association with the postural stability. Fifty-six Parkinson’s disease patients and 58 healthy subjects were involved. The disease-specific disability of patients was determined by using Modified Hoehn and Yahr Scale and Movement Disorder Society Unified Parkinson’s Disease Rating Scale. The physical activity levels of participants were evaluated using SenseWear Arm Band activity monitor. The participants used the activity monitor for seven consecutive days. The postural stability was assessed using NeuroCom Balance Master system. The Parkinson’s disease group was found to take fewer steps and to have shorter duration of sleep and sedentary behavior but a higher level of energy expenditure than the healthy control group (P < 0.05). In Parkinson’s disease group, the data obtained from the activity monitor were found to be in correlation with disease-specific disability and the parameters of NeuroCom Balance Master system (P < 0.05). We found that the physical activity levels of patients with a mild or moderate stage of Parkinson’s disease were lower compared to healthy subjects and were affected by the disease-specific symptoms, dynamic postural instability, and walking function. To increase the activity level in Parkinson’s disease, these factors should be aimed to improve, as well as designing the personalized physiotherapy programs starting from the early-mid stage.