bluuebunny/crossref_metadata_2025 huggingface dataset:
Venous Thromboembolism and Pulmonary Embolism Response Teams: An Overview
Authors: Fasanya Adebayo , Silvas Kanan , Alhassan Sulaiman , Patel Kaushal , Singh Anil C. , Malik Khalid
Published: May 2017

Venous thromboembolism is a common disease with a wide array of signs and symptoms. It has been cited as the third leading cause of cardiovascular death, and if left untreated, it leads to death in 1 in 4 patients. Sophisticated diagnostic tools have allowed physician to become more accurate in diagnosing pulmonary embolism and deep vein thrombosis. The advent of new oral anticoagulants, the emergence of pulmonary embolism response teams, and protocols demonstrate recent achievements in the management of venous thromboembolism. The focus of this article is to discuss the treatment of venous thromboembolism.
Prophylaxis for Venous Thromboembolism
Authors: Ma Kiet , Alhassan Sulaiman , Sharara Rihab , Young Meilin , Singh Anil C. , Bihler Eric
Published: May 2017

Venous thromboembolisms are major risk factors for many of our hospitalized patients. These events, however, can be prevented with prophylactic measurements when administered appropriately and on a timely basis. As patients are admitted, discharged, transferred, and scheduled for procedures on an hourly basis, anticoagulation and deep vein thrombosis prophylaxis are held or discontinued in anticipation for possible procedures. This results in delay of care and intervals where patients may not be covered with any prophylactic measurements. Similarly, alterations in clinical status can quickly change such as an increase in creatinine levels or the development of a new bleed, thus requiring a revision in their deep vein thrombosis prophylaxis. Nurses, therefore, play an integral role in not only administering the medicine but also routinely assessing the patients' clinical status and, therefore, their deep vein thrombosis prophylactic regimens as well. This article will review the indications, scoring systems, common prophylactic methods, and special populations at increased risks for venous thromboembolisms.
Advanced Therapies in Venous Thromboembolism
Authors: Yadam Suman , Sharara Rihab , Naddour Mouhib , Beg Moeezullah , Singh Anil C. , Balaan Marvin
Published: May 2017

Advanced therapies are available for both deep venous thrombosis and pulmonary embolism when anticoagulation alone is not sufficient to improve clinical outcomes. In some cases, clinical deterioration ensues despite anticoagulation, and this requires unique techniques that can ameliorate the clinical course. Such advancements are described in this upcoming article.
Diagnostic Considerations of Venous Thromboembolic Disease
Authors: Alhassan Sulaiman , Leap Jennifer , Popuri Anand , Yadam Suman , Singh Anil C. , Balaan Marvin
Published: May 2017

Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE). The clinical presentation of VTE is nonspecific and requires confirmatory testing. The most common diagnostic tool for DVT is duplex ultrasonography since it is a noninvasive test with high accuracy. Contrast venography is considered the gold standard modality to diagnose DVT, but it is an invasive test. Magnetic resonance venography and computed tomography venography are alternative diagnostic methods for DVT, which can be helpful in certain circumstances. Pulmonary embolism is commonly diagnosed by computed tomography pulmonary angiography. Ventilation perfusion scanning is an alternative imaging to diagnose PE in patients who cannot receive intravenous contrast. Pulmonary angiography is still the gold standard in the diagnosis of PE and is usually needed in specific conditions. D-dimer assay can be utilized in ruling VTE out in low-risk patients. Estimating the pretest clinical probability for having VTE is the key step in guiding the clinicians and nurses to the appropriate diagnostic method for patients with suspected DVT or PE.
Special Circumstances and Populations
Authors: Singh Ashley , Foster Megan , Chapman Pamela , Hattab Yousef , Alhassan Sulaiman , Bajwa Omar
Published: May 2017

Venous thromboembolism is a condition that includes both deep venous thrombosis and pulmonary embolism. Venous thromboembolism disease can result because of a combination of risk factors, including patient-related, treatment-related, and, more specifically, cancer-related factors. It is not disease-specific or a population-specific disorder, but it is more prevalent in certain specialty populations. This article will cover those specialty populations including cancer, pregnancy, and athletes.
Prognosis and Monitoring of VTE
Authors: Naddour Mouhib , Kalani Mehboob , Hattab Yousef , Gandhi Viral , Singh Anil C. , Bajwa Omer
Published: May 2017

Venous thromboembolism (VTE) can present in a variety of different clinical settings and in a diverse, comorbid patient population, both of which will guide the clinician toward the appropriate therapeutic response. Patients who present with pulmonary embolism are at risk for hemodynamic instability, recurrence of VTE, cardiac comorbidities, and increased risk of overall mortality. Prognostication models have been clinically validated for risk stratification and prediction of mortality. Similar to pulmonary embolism, patients with deep vein thrombosis carry a higher risk of VTE recurrence and cardiac comorbidities. Consequently, VTE can be treated by a variety of methods such as anticoagulants or inferior vena cava filters, which bear their own risks and benefits. It is imperative that clinicians monitor patients for complications from VTE and the chosen therapy.
Use of Skin Biopsies Among Dermatologists
Authors: Weinstein David A. , Konda Sasank , Coldiron Brett M.
Published: May 2017

BACKGROUND

Skin biopsies are essential to establish a diagnosis in many skin diseases. Utilization has been increasing rapidly and represents a significant health care cost. There are no benchmarks or baselines to guide the practice of skin biopsies.

OBJECTIVE

To create a reference data set of biopsy behavior among dermatologists.

METHODS

Five hundred eighty-eight dermatologists belonging to the American Dermatological Association (ADA) were surveyed. Two hundred eighty-seven responded with 128 of those providing biopsy data.

RESULTS

The mean percentage of biopsies that were malignant was 44.5%. This varied by subspecialty with a mean of 41.7%, 57.4%, and 4.1% of biopsies performed by general dermatologists, Mohs micrographic surgeons, and pediatric dermatologists, respectively. By category or diagnosis, the biopsies were 22.7% basal cell carcinoma, 12.0% SCC, 10.2% benign neoplasms, 10.0% nevi, 8.0% actinic keratosis, 7.6% seborrheic keratosis, 7.5% inflammatory disorders, 6.1% SCC in situ, 5.3% dysplastic nevus, 5.1% benign skin, 1.5% melanoma in situ, 1.4% melanoma, 0.9% lentigines, 0.8% other malignancies, 0.6% infectious, 0.2% not otherwise specified, and 0.1% atypical lesions. There was a statistically significant difference in biopsy results between different dermatological subspecialties.

CONCLUSION

These results should help elucidate dermatologic practice patterns and thus create opportunities to improve dermatologic care and reduce health care costs.
Retrospective Evaluation of Topical Bimatoprost and Iris Pigmentation Change
Authors: Zaleski-Larsen Lisa A. , Ruth Nadine H. , Fabi Sabrina G.
Published: May 2017

BACKGROUND

Topical bimatoprost is a topical prostaglandin analog originally used to treat glaucoma and more recently used to cosmetically induce hypertrichosis of the eyelashes. Iris pigmentation change has been noted in the treatment of glaucoma but has not been assessed with the cosmetic periorbital application of bimatoprost.

OBJECTIVE

To evaluate for iris pigmentation change with the long-term cosmetic use of topical bimatoprost.

MATERIALS AND METHODS

A retrospective chart review in a cosmetic dermatology practice of women (N = 50) who consistently purchased topical bimatoprost over an average of 4.59 years was compared with that of age-matched non–bimatoprost patients (N = 50). A blinded evaluator assessed each patient for iris pigmentary change.

RESULTS

No iris pigmentation change was noted with the cutaneous application of bimatoprost.

CONCLUSION

The cutaneous application of bimatoprost appears to be safe with minimal risk for iris pigmentation change.
IMPROVING THE AGE-RELATED MACULAR DEGENERATION CONSTRUCT
Authors: Spaide Richard F.
Published: May 2017

Previous models of disease in age-related macular degeneration (AMD) were incomplete in that they did not encompass subretinal drusenoid deposits (pseudodrusen), subtypes of neovascularization, and polypoidal choroidal vasculopathy. In addition, Type 3 neovascularization starts in the retina and may not necessarily involve the choroid. As such, the term choroidal neovascularization is not appropriate for these eyes. The new aspects in the AMD construct are to include specific lipoprotein extracellular accumulations, namely drusen and subretinal drusenoid deposits, as early AMD. The deposition of specific types of deposit seems to be highly correlated with choroidal thickness and topographical location in the macula. Late AMD includes macular neovascularization or atrophy. The particular type of extracellular deposit is predictive of the future course of the patient. For example, eyes with subretinal drusenoid deposits have a propensity to develop outer retinal atrophy, complete outer retinal and retinal pigment epithelial atrophy, or Type 3 neovascularization as specific forms of late AMD. Given Type 3 neovascularization may never involve the choroid, the term macular neovascularization is suggested for the entire spectrum of neovascular disease in AMD. In contrast to older classification systems, the proposed system encompasses the relevant presentations of disease and more precisely predicts the future course of the patient. In doing so, the concept was developed that there may be genetic risk alleles, which are not necessarily the same alleles that influence disease expression.
STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS: RESPONSE TO TOPICAL DORZOLAMIDE THERAPY
Authors: Ajlan Radwan S. , Hammamji Karim S.
Published: May 2017

Purpose:

To report the clinical course of a patient presenting with stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) in response to topical Dorzolamide treatment.

Methods:

Case report, with multimodal imaging findings, including spectral domain optical coherence tomography and fluorescein angiography. Topical Dorzolamide Hydrochloride 2% drops were used three times per day in the affected eye.

Results:

We identified a 27-years-old male patient who presented with 1-week history of decreased vision in his left eye. Spectral domain optical coherence tomography of the affected eye showed macular splitting of the inner plexiform layer and outer plexiform layer involving the fovea with no other evidence of a hereditary or acquired predisposing condition. The patient was started on the topical treatment for 6 months with visual improvement from 20/40 to 20/30 in the left eye, after which the decision to stop topical dorzolamide therapy was made. On 3 months of follow-up, visual acuity decreased back to 20/40 in the left eye with an increase in retinal thickening on spectral domain optical coherence tomography. Topical dorzolamide was restarted three times per day in the left eye. At 1-year point after restarting treatment, visual acuity was 20/20 in the left eye, with resolved inner plexiform layer and outer plexiform layer splitting on spectral domain optical coherence tomography in the left eye.

Conclusion:

Stellate nonhereditary idiopathic foveomacular retinoschisis can be a devastating problem causing decrease in vision. To the best of our knowledge, this is the first case in the literature to report the complete resolution of SNIFR in response to topical dorzolamide hydrochloride 2% therapy. Further prospective studies are vital to better elucidate our understanding of this new disease identity.
Giant Ocular Surface Squamous Neoplasia Wrapping Whole Cornea
Authors: Kumar Dhivya Ashok , Agarwal Amar
Published: May 2017

We present a giant ocular surface squamous neoplasia (OSSN) measuring approximately 20×18 mm arising from the fornix and wrapping the entire 12 clock hours of the cornea. The surgical excision was performed with preservation of the corneal surface. A 3-mm clear margin was obtained all around the mass. The histopathology confirmed as moderately differentiated squamous cell carcinoma with clear margins. The postoperative period was uneventful, and a clear cornea without a residual scar with best corrected visual acuity of 20/20 was attained. A giant OSSN can demonstrate corneal invasion, making surgical excision both challenging and associated with complications such as subsequent scarring. Extended surgical intervention, chemotherapy, chemoreduction, and immunotherapy have been reported in giant OSSNs. However, we report a giant OSSN wrapping the entire 12 clock hours of the cornea that was managed with single surgery with complete corneal restoration.
Histopathology of Failed Descemet Membrane Endothelial Transfer
Authors: Parker Jack , Verdijk Robert M. , Müller Thomas M. , Lavy Itay , Bruinsma Marieke , Colby Kathryn , Binder Perry S. , Melles Gerrit R. J.
Published: May 2017

Objectives:

To describe the postmortem histologic features after an unsuccessful Descemet membrane endothelial transfer (DMET) and assess any potential clinical implications.

Methods:

Postmortem, an eye from a patient who previously underwent unsuccessful DMET for pseudophakic bullous keratopathy (PPBK) was harvested and processed for morphologic evaluation.

Results:

Clinically and histologically, the host cornea showed evidence of diffuse stromal edema. Although the edges of the surgical descemetorhexis were well visualized, there was no evidence of endothelial migration or repopulation of the posterior stroma from any direction. A multilayered, retrocorneal membrane was present that appeared to originate from the trabecular meshwork.

Conclusions:

Descemet membrane endothelial transfer and “descemetorhexis alone” may be insufficient treatment for eyes operated on for PPBK, that is, eyes with a significantly depleted or dysfunctional endothelium.
Effect of the Eye Tracking System on the Reproducibility of Measurements Obtained With Spectral-domain Optical Coherence Tomography in Glaucoma
Authors: Abadia Beatriz , Ferreras Antonio , Calvo Pilar , Fogagnolo Paolo , Figus Michele , Pajarin Ana B.
Published: May 2017

Purpose:

The purpose of this study was to evaluate whether the eye tracking system (ETS) improved the reproducibility of a single circle peripapillary retinal nerve fiber layer (RNFL) measurement acquired with spectral-domain optical coherence tomography (OCT).

Materials and Methods:

The sample comprised 205 individuals divided into 2 groups according to intraocular pressure and visual field outcomes. A total of 100 healthy individuals and 105 patients with open-angle glaucoma underwent imaging of the optic nerve head with OCT 3 times during the same session and 2 additional times in subsequent sessions (30 days apart). Intraclass correlation coefficient (ICC), coefficient of variation, and test-retest variability were calculated for the RNFL thickness acquired with and without the ETS enabled, and compared.

Results:

The glaucoma group mainly comprised patients with moderate glaucoma (mean deviation of standard automated perimetry, −6.73±6.2 dB). The RNFL thicknesses did not differ between acquisitions with or without the ETS activated and disabled. All ICCs were >0.9 in the control and glaucoma groups with or without the ETS activated. The best parameter in the intersession analysis (with ETS activated) was global RNFL thickness (ICC, 0.95; coefficient of variation, 2.7%; and test-retest variability, 2.87 μm). The reproducibility and repeatability of RNFL measurements did not differ significantly between acquisitions with or without the ETS in either group.

Conclusions:

The reproducibility of peripapillary RNFL thicknesses acquired with OCT was excellent. The variability between OCT measurements did not decrease with the ETS activated.
Intracorneal Hematoma After Ahmed Glaucoma Valve Implant Surgery
Authors: Al Habash Ahmed , Al Abdulsalam Omar , Al-Qarni Awad
Published: May 2017

Intracorneal hematoma or hemorrhagic descemet detachment is a rare phenomenon. It has been previously described after nonpenetrating glaucoma surgeries such as canaloplasty, viscocanalostomy, and deep sclerectomy. In this report, we describe a rare case of intracorneal hematoma as a yet nondocumented complication after Ahmed glaucoma valve implant surgery.
Vitreous Occlusion of a Glaucoma Drainage Implant—Surgical Management
Authors: Vinod Kateki , Panarelli Joseph F. , Gentile Ronald C. , Sidoti Paul A.
Published: May 2017

Vitreous occlusion of a glaucoma drainage implant (GDI) can lead to failure of the device and severely elevated intraocular pressure. The pathophysiology of tube obstruction is related to central and anterior displacement of vitreous that is drawn into and condenses within the proximal lumen of the tube. This can occur from days to years following GDI surgery. Successful management of vitreous-tube obstruction generally requires manual removal of the condensed vitreous plug with end-grasping forceps. This technique achieves reversal of tube blockage and restoration of GDI function. Amputation of the incarcerated vitreous alone with vitrectomy or neodymium:yttrium-aluminum-garnet vitreolysis does not consistently restore GDI function and risks persistent intraluminal tube obstruction.
Progressive Decrease of Peripapillary Angioflow Vessel Density During Structural and Visual Field Progression in Early Primary Open-angle Glaucoma
Authors: Holló Gábor
Published: May 2017

Purpose:

To present a case of early primary open-angle glaucoma in which retinal nerve fiber layer thickness (RNFLT), ganglion cell complex (GCC), and visual field progression were accompanied with significant progression of peripapillary angioflow vessel density (PAFD) measured with optical coherence tomographic angiography.

Methods:

A 68-year-old female patient who was under topical intraocular pressure (IOP) lowering medication for 20 years for ocular hypertension of the right and preperimetric primary open-angle glaucoma of the left eye (with reproducible inferotemporal and superotemporal neuroretinal rim and RNFL loss) was prospectively imaged with the AngioVue OCT for RNFLT, GCC thickness, and PAFD, and investigated with the Octopus Normal G2 visual field test on the same days at 6-month intervals for 18 months, while the IOP of the left eye escaped from control.

Results:

IOP of the left eye fluctuated between 14 and 30 mm Hg in the study period. RNFLT, GCC thickness, and peripapillary PAFD all decreased significantly (linear regression analysis, P=0.030, 0.040, and 0.020, respectively), and a significant 2.1 dB/y progression was seen for a superior visual field cluster. The RNFLT, peripapillary PAFD, and visual field of the right eye remained normal and unchanged.

Conclusions:

In our case IOP elevation, glaucomatous visual field conversion, and structural progression were accompanied with significant progressive decrease of peripapillary PAFD. The simultaneous thinning of RNFLT and GCC and decrease of peripapillary PAFD suggest that PAFD may potentially be an additional indicator of early progression in primary open-angle glaucoma.
Pediatric Extracorporeal Life Support Organization Registry International Report 2016
Authors: Barbaro Ryan P. , Paden Matthew L. , Guner Yigit S. , Raman Lakshmi , Ryerson Lindsay M. , Alexander Peta , Nasr Viviane G. , Bembea Melania M. , Rycus Peter T. , Thiagarajan Ravi R.
Published: May 2017

The purpose of this report is to describe the international growth, outcomes, complications, and technology used in pediatric extracorporeal life support (ECLS) from 2009 to 2015 as reported by participating centers in the Extracorporeal Life Support Organization (ELSO). To date, there are 59,969 children who have received ECLS in the ELSO Registry; among those, 21,907 received ECLS since 2009 with an overall survival to hospital discharge rate of 61%. In 2009, 2,409 ECLS cases were performed at 157 centers. By 2015, that number grew to 2,992 cases in 227 centers, reflecting a 24% increase in patients and 55% growth in centers. ECLS delivered to neonates (0–28 days) for respiratory support was the largest subcategory of ECLS among children <18-years old. Overall, 48% of ECLS was delivered for respiratory support and 52% was for cardiac support or extracorporeal life support to support cardiopulmonary resuscitation (ECPR). During the study period, over half of children were supported on ECLS with centrifugal pumps (51%) and polymethylpentene oxygenators (52%). Adverse events including neurologic events were common during ECLS, a fact that underscores the opportunity and need to promote quality improvement work.
Personalized hemodynamic management
Authors: Saugel Bernd , Vincent Jean-Louis , Wagner Julia Y.
Published: May 2017

Purpose of review

To describe personalized hemodynamic management of critically ill patients in the operating room and the ICU.

Recent findings

Several recent clinical studies have investigated different strategies for optimizing blood pressure (BP) and flow in the operating room and in the ICU. In the past, (early) goal-directed hemodynamic treatment strategies often used predefined fixed population-based ‘normal’ values as hemodynamic targets. Most hemodynamic variables, however, have large interindividual variability and are dependent on several biometric factors. Personalized BP management aims to set specific BP targets for a given patient taking into account blood flow autoregulation and any history of chronic hypertension. To optimize cardiac output and oxygen delivery, individualized hemodynamic management based on functional assessment of fluid responsiveness is used. Innovative noninvasive technologies now enable preoperative assessment of a patient's personal normal hemodynamic values, which can then be targeted in the perioperative phase. In critically ill patients admitted to the ICU, adaptive multiparametric hemodynamic monitoring can help to personalize hemodynamic management.

Personalized hemodynamic management targets personal normal values of hemodynamic variables, which are adjusted to biometric data and adapted to the clinical situation (i.e., adequate values). This approach optimizes cardiovascular dynamics based on the patient's personal hemodynamic profile.
Mitochondrial DNA in Sepsis
Authors: Harrington John S. , Choi Augustine M.K. , Nakahira Kiichi
Published: May 2017

Purpose of review

Our understanding of critical illness is transforming as we develop a better understanding of the impact pathogen-associated molecular patterns and damage-associated molecular patterns (DAMPs) have on the pathogenesis of disease. Of the known DAMPs, there is a growing interest in mitochondrial DNA (mtDNA) as a DAMP capable of propagating the inflammatory response seen in sepsis and other conditions. In this review, we describe the varying mechanisms by which mtDNA is translocated from mitochondria into cytosol and the extracellular space where it can illicit an inflammatory response. In addition, we present some of the most recent clinical studies to examine mtDNA in critical illness.

Recent findings

Basic science research provides convincing data that mtDNA can influence the immune system through toll-like receptor 9 and inflammasomes. Clinical trials provide evidence that mtDNA is elevated in critically ill patients and is associated with mortality.

Although mtDNA is a DAMP shown to be elevated in numerous conditions, the clinical ramifications of this finding remain elusive. Further work is needed to determine if mtDNA can be utilized as a biomarker of disease severity or mortality.
Endocrine disorders and hormonal therapy for adolescent acne
Authors: Nguyen Henry L. , Tollefson Megha M.
Published: May 2017

Purpose of review

Acne vulgaris is a global disease with increasing prevalence in adolescents. It has a profound impact on their quality of life, especially when endocrine disorders are also involved. Recent concerns regarding antibiotic stewardship, failures with antibiotic usage, and the development of antibiotic-resistant Propionibacterium acnes have led clinicians to consider other therapeutic options for acne treatment. The present review explores hormonal therapies for the treatment of acne vulgaris.

Recent findings

There are now four different combined oral contraceptive pills that are FDA approved for the treatment of acne since its first introduction in 1960. Recent literature has provided more information on the efficacy of different generations of combined oral contraceptive pills, their side-effects, and cancer risks. Furthermore, spironolactone has been gaining wider use among dermatologists in adolescents with endocrine dysfunction. New diagnostic guidelines and treatment recommendations have also been suggested.

Hormonal therapies are effective and well tolerated options for the treatment of acne vulgaris in adolescents with and without endocrine disorders. They can be used as monotherapy or in conjunction with benzoyl peroxide, topical retinoic acid, or antibiotics.
Statement on gender-affirmative approach to care from the pediatric endocrine society special interest group on transgender health
Authors: Lopez Ximena , Marinkovic Maja , Eimicke Toni , Rosenthal Stephen M. , Olshan Jerrold S.
Published: May 2017

Purpose of review

The purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals, as well as to improve the understanding of the rights of transgender youth.

Recent findings

Transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care.

The Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender nonconforming/transgender youth, as well as adequate mental health and medical care. This document provides a summary of relevant definitions, information and current literature on which the medical management and affirmative approach to care of transgender youth are based.
From Whom Do Student Veterans Seek Help?
Authors: Currier Joseph M. , Deiss Jessie , McDermott Ryon C.
Published: May 2017

The purpose of this brief report was to ascertain student veterans' patterns of help-seeking from professional, informal, and religious sources. In total, 350 veterans from an academic institution on the Gulf Coast completed assessments of help-seeking intentions from a range of potential sources in their communities. Analyses revealed that veterans had a neutral probability to seek help from professional sources (e.g., physicians and psychologists) but were likely to pursue informal sources (e.g., partner/spouse, friend) in a psychological/emotional crisis. However, when compared with their nonclinical counterparts, veterans with a probable need for treatment for PTSD and/or depression generally reported less probability to seek help from informal and religious sources. In addition, sex, ethnicity, and religious background each contributed a significant influence in shaping preferences for seeking help for psychological or emotional concerns. Given unmet mental health needs of student veterans, findings highlight the importance attending to help-seeking preferences in this growing population.
Gut Microbiota and the Gut-Brain Axis: New Insights in the Pathophysiology of Metabolic Syndrome
Authors: de Clercq Nicolien C. , Frissen Myrthe N. , Groen Albert K. , Nieuwdorp Max
Published: May 2017

Objective

Emerging preclinical evidence has shown that the bidirectional signaling between the gastrointestinal (GI) tract and the brain, the so-called gut-brain axis, plays an important role in both host metabolism and behavior. In this review, we discuss the potential mechanisms of the brain-gut axis in relation to the pathophysiology of metabolic syndrome.

Methods

A selective literature review was conducted to evaluate GI and brain interactions.

Results

Evidence suggests reduced microbial diversity in obesity and metabolic dysregulation. However, findings of microbiota composition in obese individuals are inconsistent, and the investigation of causality between gut microbiota and energy homeostasis is complex because multiple variables contribute to the gut microbiota composition. The microbial metabolites short chain fatty acids are found to exert numerous physiologic effects, including energy homeostasis through the regulation of GI hormones such as cholecystokinin, glucagon-like peptide 1, peptide tyrosine-tyrosine, and leptin. Preclinical studies show that modifying rodents' microbiota through fecal transplantation results in alterations of these GI hormones and subsequently an altered metabolism and behavior. However, whether and to what extent preclinical findings translate to human metabolism is unclear.

Conclusions

One of the major limitations and challenges in this field of research is interindividual variability of the microbiome. Future research needs to combine recent insights gained into tracking the dynamics of the microbiome as well as the metabolic responses. Furthermore, advanced mapping of the human microbiome is required to investigate the metabolic implications of the gut-brain axis to develop targeted interventions for obesity and metabolic syndrome.
Child deaths of undetermined intent: An analysis of circumstances using Illinois Violent Death Reporting System data
Authors: Wu Han-Wei , McLone Suzanne G. , Mason Maryann , Sheehan Karen
Published: May 2017

BACKGROUND

There is little information available about the circumstances surrounding the deaths of children aged 0 to 14 years in which the manner of death is of undetermined intent.

METHODS

We analyzed data collected in the Illinois Violent Death Reporting System to describe victim demographics, location of injury, seasonality, day of week, and circumstances surrounding the victims’ deaths.

RESULTS

From 2005 to 2010 in Cook County, Illinois, 192 cases were identified of children aged 0 to 14 years, in which the manner of death was of undetermined intent. The majority of cases were younger than 1 year (81%), male (62%), and non-Hispanic black (66%); occurred in the City of Chicago (65%); and also occurred most frequently during the months of May (15%) and July (13%) and on Sunday (19%). Circumstances of note were having information on the location of death available for the victim (90%); scene investigation was not performed/unknown/not documented (81%); and the victim not presenting with red petechiae (84%). By ethnicity, a lower proportion of Hispanic victims had parental drug information available compared with non-Hispanic victims (17% and 40%, respectively; p = 0.017); Hispanic victims were more likely than non-Hispanic victims to have a documented acute illness at the time of injury leading to death (57% and 33%, respectively; p = 0.015). The availability of scene information and the successful contact of one or both parents of the victim following the victim’s death varied by location.

CONCLUSIONS

No public health surveillance system exists for the collection of this type of death. There is not enough information provided to develop an effective intervention. The systematic, thorough collection of information surrounding these deaths is necessary to pinpoint possible contributing mechanisms of death for these children.

LEVEL OF EVIDENCE

Epidemiologic, level IV.
Pediatric injury prevention programs: Identifying markers for success and sustainability
Authors: Chaudhary Sofia , Pomerantz Wendy J. , Miller Beverly , Pan Anqi , Agarwal Maneesha
Published: May 2017

BACKGROUND

Injury is the leading cause of death in children. Although many pediatric hospitals and trauma centers provide injury prevention (IP) programming, there is no national standard. This study aims to identify characteristics of a sustainable and successful IP program by querying programs affiliated with the Injury Free Coalition for Kids (IFCK).

METHODS

The IFCK sites were sent a 30-question survey via e-mail. Questions focused on demographics, scope of IP activities, self-efficacy, and outcome measures including finances, academic productivity, and legislative advocacy. Counts and frequencies were calculated and compared using χ2 tests.

RESULTS

The survey was completed by 38 (90.4%) of 42 sites. The majority were associated with a freestanding children’s hospital (57.9%) and Level I pediatric trauma center (86.8%). Most programs (79%) had at least one dedicated full-time equivalent (FTE) staff. Research was most common on child passenger safety and teen driving. Nearly 30% of programs offered educational curricula to health care providers; these sites were more likely to have FTE support (p = 0.036). Steady sources of funding were identified for 60.5% of programs, with 47.8% citing their hospital as the primary source; 73% of respondents were confident in their program’s capacity to sustain activities; these were more likely to be larger programs (p = 0.001) with steady sources of funding (p < 0.001). Despite 73.7% of sites having academic affiliations, 60.5% had 5 or fewer publications over the previous 5 years. In the prior 2 years, 55.3% of programs impacted legislative or policy changes. Funding, size of program, and FTE had no statistical correlation with research productivity or number of legislative/policy contributions.

CONCLUSIONS

This study characterizes the variation among pediatric IP programs within IFCK sites, while highlighting the association between financial and FTE support from programs’ institutions with sustainable IP programming. These results can assist programs in identifying differences in relation to their peers.
Adolescent motor vehicle crash prevention through a trauma center–based intervention program
Authors: Layba Cathline , Griffin Lance W. , Jupiter Daniel , Mathers Charles , Mileski William
Published: May 2017

Traumatic injuries account for millions of emergency room visits and hospital admissions annually. Motor vehicle crashes (MVCs) remain a leading cause of mortality between the ages of 1 and 44 years. With the popularity of smart devices, drivers are ever more distracted on the road. Programs that educate drivers on safe actions and to raise awareness of the perils of drunk and distracted driving exist, but there are few data that demonstrate a reduction in motor vehicle injury rates. We sought to determine if the implementation of such a program in our community would impact the rates of MVCs. Assessing the effectiveness of the Save A Life Tour, a risk reduction program, this intervention was instituted at a single area high school. The numbers of adolescent drivers aged 16 to 21 years involved in MVCs treated at the regional Level I trauma center were compared over two time intervals and between two adjoining counties. The time intervals consisted of preintervention and postintervention surveillance, each over a period of 3 years. Using our trauma registry, we compared the incidence of MVC between the two counties and between the two age groups. The data were also compared with the incidence among these populations nationally. In the preintervention period, the number of adolescent MVCs treated from the catchment area was 166, and the number in the postintervention period was 105. This represented a risk reduction of 37% (p < 0.05). During the same intervals, the incidence in the nonintervention control catchment area increased by 12%. There was no significant change in the population aged 16 to 21 years over the time intervals in either area. These results suggest that ongoing educational intervention programs aimed at adolescent drunk and distracted driving can have an impact on these life-threatening behaviors and on the incidence of MVCs.

LEVEL OF EVIDENCE

Therapy, level IV.
Characteristics of EEG Seizure-Onset Patterns Recorded From Subdural Electrodes Over MRI-Visible Frontal Focal Cortical Dysplasia Type IIb Lesions
Authors: Hirozawa Daisuke , Terada Kiyohito , Matsuda Kazumi , Usui Keiko , Usui Naotaka , Tottori Takayasu , Kondo Akihiko , Araki Yasukiyo , Omote Yoshio , Kashida Yumi , Mochizuki Hideki , Inoue Yushi
Published: May 2017

Purpose:

Focal cortical dysplasia (FCD) is intrinsically epileptogenic, and an MRI-visible lesion typically constitutes the core part of the epileptogenic zone. We aimed to identify ictal EEG patterns that represent the epileptogenic zone by using subdural electrodes placed over the MRI-visible FCD lesion.

Methods:

We selected seven patients with frontal lobe epilepsy caused by pathologically proven FCD type IIb who underwent preoperative intracranial EEG evaluation with subdural electrodes followed by resection surgery with seizure-free outcome. The characteristics of ictal EEG patterns, interictal/ictal high-frequency oscillations, and ictal direct current shifts from intracranial electrodes placed over the MRI-visible lesion were analyzed.

Results:

Two seizure-onset patterns (low voltage fast activity and fast spike activity) were identified. Low voltage fast activity was seen in all patients with a lateral frontal lesion, and it was always preceded by preictal spikes. Fast spike activity occurred only in patients with a mesial frontal lesion. Interictal/ictal high-frequency oscillations and ictal direct current shifts were seen in all patients.

Conclusions:

The epileptogenic zone of frontal FCD type IIb may be characterized by EEG seizure-onset patterns consisting of low voltage fast activity and fast spike activity accompanied by ictal high-frequency oscillations and ictal direct current shifts. Further study is needed to determine whether other seizure-onset patterns exist in patients with FCD type IIb.
SSEP in Therapeutic Hypothermia Era
Authors: Maciel Carolina B. , Morawo Adeolu O. , Tsao Ching Y. , Youn Teddy S. , Labar Douglas R. , Rubens Elayna O. , Greer David M.
Published: May 2017

Purpose:

The reliability of somatosensory evoked potentials (SSEPs) in predicting outcome in comatose survivors of cardiac arrest treated with therapeutic hypothermia (TH) has been questioned. We investigated whether the absence of cortical (N20) responses was a reliable predictor of a nonawakening in the setting of TH.

Methods:

A retrospective review was conducted in cardiac arrest survivors treated with TH admitted to a single tertiary care hospital from April, 2010 to March, 2013 who underwent SSEP testing at various time points after cardiac arrest. N20 responses were categorized as normal, present but abnormal, bilaterally absent, or inadequate for interpretation. Neurologic outcome was assessed at discharge by the Cerebral Performance Category Scale (CPC).

Results:

Ninety-three SSEP studies were performed in 73 patients. Fourteen patients had absent N20 responses; all had poor outcome (CPC 4–5). Eleven patients had absent N20 s during hypothermia, three of whom had follow-up SSEPs after rewarming and cortical responses remained absent. Fifty-seven patients had N20 peaks identified and had variable outcomes. Evaluation of 1 or more N20 peaks was limited or inadequate in 11.4% of SSEPs performed during the cooling because of artifact.

Conclusions:

Somatosensory evoked potentials remain a reliable prognostic indicator in patients undergoing TH. The limited sample size of patients who had SSEP performed during TH and repeated after normothermia added to the effect of self-fulfilling prophecy limit the interpretation of the reliability of this testing when performed during cooling. Further prospective, multicenter, large scale studies correlating cortical responses in SSEPs during and after TH are warranted. Technical challenges are commonplace during TH and caution is advised in the interpretation of suboptimal recordings.
Shared Genetic Architecture between Asthma and Allergic Diseases: A Genome-Wide Cross Trait Analysis of 112,000 Individuals from UK Biobank
Authors: Zhu Zhaozhong , Lee Phil H. , Chaffin Mark D. , Chung Wonil , Loh Po-Ru , Lu Quan , Christiani David C. , Liang Liming
Published: May 2017

Clinical and epidemiological data suggest that asthma and allergic diseases are associated. And may share a common genetic etiology. We analyzed genome-wide single-nucleotide polymorphism (SNP) data for asthma and allergic diseases in 35,783 cases and 76,768 controls of European ancestry from the UK Biobank. Two publicly available independent genome wide association studies (GWAS) were used for replication. We have found a strong genome-wide genetic correlation between asthma and allergic diseases (rg= 0.75,P= 6.84×10−62). Cross trait analysis identified 38 genome-wide significant loci, including novel loci such as D2HGDH and GAL2ST2. Computational analysis showed that shared genetic loci are enriched in immune/inflammatory systems and tissues with epithelium cells. Our work identifies common genetic architectures shared between asthma and allergy and will help to advance our understanding of the molecular mechanisms underlying co-morbid asthma and allergic diseases.
Thirty-five experimental fisheries reveal the mechanisms of selection
Authors: Nusslé Sébastien , Hendry Andrew P. , Knapp Roland A. , Bogan Michael T. , Sturrock Anna M. , Carlson Stephanie M.
Published: May 2017

Fisheries have been described as large-scale evolutionary experiments; yet such “experiments” tend to be poorly replicated and therefore lack the predictive power essential for designing appropriate management strategies to minimize the effects of fisheries-induced selection. Large-scale removal of non-native trout from 35 montane lakes in California provided repeated experimental fisheries that allowed us to explore how environmental parameters affect the three potential contributors to overall selection: the fitness-trait correlation, trait variability, and fitness variability. Our results demonstrate that fishing rapidly altered the size structure of harvested populations, and that the magnitude of change was primarily driven by the fitness-trait correlation (net selectivity). Fishing-induced selection was repeatable overall but was also influenced by environmental (lake size and quality) and demographic (size structure) parameters. Decomposing fishing-induced selection into its key components can improve the management of stocks experiencing fishing-induced selection by identifying the drivers of selection and therefore the appropriate target for management.
Rehabilitation promotes the recovery of functional and structural features of healthy neuronal networks after stroke
Authors: Allegra Mascaro Anna Letizia , Conti Emilia , Lai Stefano , Di Giovanna Antonino Paolo , Spalletti Cristina , Alia Claudia , Quarta Eros , Panarese Alessandro , Sacconi Leonardo , Micera Silvestro , Caleo Matteo , Pavone Francesco Saverio
Published: May 2017

Rehabilitation is the most effective treatment for promoting the recovery of motor deficits after stroke. Despite its importance, the processes associated with rehabilitative intervention are poorly understood. One of the most challenging experimental goals is to unambiguously link specific circuit changes induced by rehabilitation to improved behavior. Here, we investigate which facets of cortical remodeling are induced by rehabilitation by combining optical imaging and manipulation tools in a mouse model of stroke. We demonstrate the progressive restoration of cortical motor maps and of cortical activity in parallel with the reinforcement of inter-hemispheric connectivity after rehabilitation. Furthermore, we reveal that the increase in vascular density goes along with the stabilization of peri-infarct neural circuitry at synaptic level. The present work provides the first evidences that rehabilitation is sufficient to promote the combined recovery of distinct structural and functional features distinctive of healthy neuronal networks.
14-3-3 Negatively Regulates Actin Filament Formation in the Deep Branching EukaryoteGiardia lamblia
Authors: Krtková Jana , Xu Jennifer , Lalle Marco , Steele-Ogus Melissa , Alas Germain C. M. , Sept David , Paredez Alexander R.
Published: May 2017

The phosphoserine/phosphothreonine-binding protein 14-3-3 is known to regulate actin, this function has been previously attributed to sequestration of phosphorylated cofilin. The deep branching eukaryoteGiardia lamblialacks cofilin and all other canonical actin-binding proteins (ABPs), and 14-3-3 was identified as an actin-associated protein inGiardia, yet its role in actin regulation was unknown. Gl14-3-3 depletion resulted in an overall disruption of actin organization characterized by ectopically distributed short actin filaments. Using phosphatase and kinase inhibitors, we demonstrated that actin phosphorylation correlated with destabilization of the actin network and increased complex formation with 14-3-3, while blocking actin phosphorylation stabilized actin filaments and attenuated complex formation.Giardia'ssole Rho family GTPase, GlRac, modulates Gl14-3-3's association with actin, providing the first connection between GlRac and the actin cytoskeleton inGiardia.Giardiaactin contains two putative 14-3-3 binding motifs, one of which (S330) is conserved in mammalian actin. Mutation of these sites reduced, but did not completely disrupt, the association with 14-3-3. Native gels and overlay assays indicate that intermediate proteins are required to support complex formation between 14-3-3 and actin. Overall, our results support a role for 14-3-3 as a negative regulator of actin filament formation.

Importance

Giardialacks canonical actin binding proteins. 14-3-3 was identified as an actin interactor but the significance of this interaction was unknown. Loss of 14-3-3 results in ectopic short actin filaments, indicating that 14-3-3 is an important regulator of the actin cytoskeleton inGiardia. Drug studies indicate that 14-3-3 complex formation is in part phospho-regulated. We demonstrate that complex formation is downstream of Giardia’s sole Rho family GTPase, GlRac, this result provides the first mechanistic connection between GlRac and actin inGiardia. Native gels and overlay assays indicate intermediate proteins are required to support the interaction between 14-3-3 and actin suggesting that 14-3-3 is regulating multiple actin complexes. Overall, we find that 14-3-3 is a negative regulator of actin filament formation inGiardia.