bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-care Moderates the Relationship Between Symptoms and Health-Related Quality of Life in Heart Failure
Authors: Auld Jonathan P. , Mudd James O. , Gelow Jill M. , Hiatt Shirin O. , Lee Christopher S.
Published: September 2017

Background:

Physical symptoms and depression in heart failure (HF) are key drivers of health-related quality of life (HRQOL). Heart failure self-care behaviors are believed to influence how symptoms affect HRQOL.

Objective:

The goal of this study was to determine if HF self-care behaviors moderate the relationships between physical and depressive symptoms and HRQOL.

Methods:

In a cohort of adults with moderate to advanced HF, multivariate linear regression was used to evaluate the interaction between self-care behaviors (Self-care of HF index maintenance and management scales) and physical HF symptoms (HF Somatic Perception Scale) on emotional HRQOL (emotional dimension of Minnesota Living With HF Questionnaire). The interaction between self-care behaviors and depression (9-item Patient Health Questionnaire) was evaluated on physical HRQOL (physical dimension of Minnesota Living With HF Questionnaire).

Results:

The mean age of the sample (N = 202) was 57 ± 13 years, 50% were women, and 61% had New York Heart Association class III or IV HF. Controlling for age, Seattle HF score, functional ability, and comorbidities, self-care maintenance and management moderated the relationship between physical HF symptoms and emotional HRQOL. Only self-care maintenance moderated the relationship between depression and physical HRQOL.

Conclusion:

In HF, HRQOL is dependent on both the severity of physical and depressive symptoms and the level of engagement in HF self-care behaviors. Future research should consider both self-care behaviors and symptoms when examining patient HRQOL.
A 6-Month Prospective Trial of a Personalized Behavioral Intervention + Long-Acting Injectable Antipsychotic in Individuals With Schizophrenia at Risk of Treatment Nonadherence and Homelessness
Authors: Sajatovic Martha , Ramirez Luis F. , Fuentes-Casiano Edna , Cage Jamie , Tatsuoka Curtis , Aebi Michelle E. , Bukach Ashley , Cassidy Kristin A. , Levin Jennifer B.
Published: September 2017

Purpose

Long-acting injectable antipsychotics (LAI) can optimize adherence for high-risk serious mental illness (SMI). This customized adherence-enhancement approach delivered by social worker interventionists was combined with LAI (CAE-L) of paliperidone palmitate for homeless, poorly adherent individuals with SMI.

Methods

This 6-month prospective, uncontrolled trial of CAE-L in 30 recently homeless individuals with SMI assessed adherence using the Tablets Routine Questionnaire, injection frequency, and SMI symptoms measured by the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, and Clinical Global Impressions. The Social and Occupational Functioning Assessment Scale measured social function. Standardized scales assessed extrapyramidal effects.

Findings

Patients' mean age was 43.6 (SD, 9.53) years, and they were mainly minorities (86.7% African American) and single/never married (72.4%). Rate of substance abuse within the past year was 40.0%, and rate of incarceration within the past 6 months was 32.1%. Four participants (13.3%) terminated the study prematurely. Customized adherence enhancement + LAI was associated with good adherence to LAI (92.9%) and improved adherence with oral drug as measured by Tablets Routine Questionnaire (P = 0.02). There were significant improvements in Positive and Negative Syndrome Scale (P < 0.01), Brief Psychiatric Rating Scale (P < 0.001), Clinical Global Impressions (P = 0.003), and Social and Occupational Functioning Assessment Scale (P = 0.005). There were no significant extrapyramidal effects.

Implications

While findings must be tempered by the methodological limitations, CAE-L seems associated with multiple domains of improvement in homeless/recently homeless individuals with SMI. Adverse effects limit tolerability in some individuals, and not all will remain engaged. However, LAI combined with a patient-centered behavioral approach can improve outcomes for some high-risk individuals with SMI.
Statewide Longitudinal Progression of the Whole-Patient Measure of Safety in South Carolina
Authors: Turley Christine B. , Brittingham Jordan , Moonan Aunyika , Davis Dianne , Chakraborty Hrishikesh
Published: September 2017

Meaningful improvement in patient safety encompasses a vast number of quality metrics, but a single measure to represent the overall level of safety is challenging to produce. Recently, Perla et al. established the Whole-Person Measure of Safety (WPMoS) to reflect the concept of global risk assessment at the patient level. We evaluated the WPMoS across an entire state to understand the impact of urban/rural setting, academic status, and hospital size on patient safety outcomes. The population included all South Carolina (SC) inpatient discharges from January 1, 2008, through to December 31, 2013, and was evaluated using established definitions of highly undesirable events (HUEs). Over the study period, the proportion of hospital discharges with at least one HUE significantly decreased from 9.7% to 8.8%, including significant reductions in nine of the 14 HUEs. Academic, large, and urban hospitals had a significantly lower proportion of hospital discharges with at least one HUE in 2008, but only urban hospitals remained significantly lower by 2013. Results indicate that there has been a decrease in harm events captured through administrative coded data over this 6-year period. A composite measure, such as the WPMoS, is necessary for hospitals to evaluate their progress toward reducing preventable harm.
Evidence for Misspecification of a Nationally Used Quality Measure for Substance Use Treatment
Authors: Mattke Soeren , Predmore Zachary , Sloss Elizabeth , Wilks Asa , Watkins Katherine E.
Published: September 2017

Objectives:

The National Committee for Quality Assurance's (NCQA) measure “Initiation and Engagement of Alcohol and Other Drug Dependence Treatment” captures the proportion of substance use patients with (1) treatment initiation within 14 days and (2) treatment engagement within 30 days thereafter. The definition of treatment considers only counseling but not medication-assisted treatment (MAT), although MAT is supported by current guidelines. Our research question is whether this omission results in meaningful measurement error.

Study Design and Methods:

We analyze claims data for members of commercial health plans to investigate whether including MAT would meaningfully change the measure rate and health plan rankings.

Results:

Including MAT increased both the initiation and engagement rates. The initiation and engagement rates increased 2.4% (38.9–39.8%) and 9.9% (12.9–14%), respectively. These differences imply that 19% of health plans would change their ranking by at least one quintile for the initiation measure and 27% for the engagement measure.

Conclusions:

The current specifications result in erroneous conclusions about the quality of care provided by different health plans. Our results suggest that aligning the measure specifications with guideline recommendations, as recently proposed by NCQA, would result in more accurate information.
Development and Feasibility of Self-Management Application in Left-Ventricular Assist Devices
Authors: Casida Jesus M. , Aikens James E. , Craddock Heidi , Aldrich Matthew W. , Pagani Francis D.
Published: September 2017

Despite major advancements in mechanical circulatory support, the self-management (SM) for patients with a left-ventricular assist device (LVAD) remains complex and challenging for patients and their caregivers. We have developed a mobile phone application (VAD Care App) to organize and simplify the LVAD SM process. This article describes the development and feasibility study of the app as an SM tool for LVAD patients and caregivers requiring support from ventricular assist device (VAD) coordinators. The specific aim was to evaluate the app’s acceptability and usability and the users’ competency. App features included an automated alert, data collection/reporting, and dynamic real-time interaction systems embedded in the LVAD SM process. Beta-testing of the prototype was completed by five adults. For the feasibility study, we employed a mixed-method descriptive research design involving nine patients and nine caregivers from two VAD centers in the Midwest. We asked them to use the app daily for more than 30 days and complete an app Evaluation Questionnaire and an interview. The questionnaire uses a five-point rating scale (1 = strongly disagree to 5 = strongly agree) evaluating usability, acceptability, and competency domains. Data generated from the questionnaires and interviews were analyzed with descriptive statistics and content analytic procedures. A total of 16 users (eight patients [all male] and eight caregivers [seven female]) aged 22 to 68 years completed the 30 day study. Median acceptability, usability, and competency scores were 4.6, 4.5, and 4.7, respectively. Based on the data, it is feasible for patients and caregivers to use an app as an LVAD SM tool warranting further research.
Benign vocal fold lesions: update on nomenclature, cause, diagnosis, and treatment
Authors: Naunheim Matthew R. , Carroll Thomas L.
Published: September 2017

Purpose of review

The management of benign vocal fold lesions (BVFLs) continues to evolve. This article will review the recent literature surrounding the nomenclature, cause, diagnosis, and treatment of BVFLs, including polyps, nodules, cysts, and reactive lesions.

Recent findings

The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. Though these lesions are known to be the result of phonotrauma, investigation into inflammatory mediators, apoptosis, and laryngopharyngeal reflux provide further elucidation of their underlying pathophysiology. The future of diagnosis, for which direct fiberoptic visualization and stroboscopy are the current gold standard, may utilize narrow-band imaging and videokymography; the clinical utility of ultrasound and optical coherence tomography is more remote. Angiolytic laser therapy and intralesional steroid injection are acceptable options for treatment of BVFLs. Voice therapy and microsurgical excision are mainstays of treatment.

Recent clinical and basic science research has expanded upon an extensive literature surrounding the nomenclature, cause, diagnosis, and treatment of benign subepithelial vocal fold lesions. There remains a strong need for the advancement of rigorous diagnostic principles, evaluation of therapeutic interventions, and development of best practices guidelines.
Status dystonicus in childhood
Authors: Lumsden Daniel E. , King Mary D. , Allen Nicholas M.
Published: September 2017

Purpose of review

Dystonia is a common paediatric neurological condition. At its most severe, dystonia may lead to life-threatening complications, a state termed status dystonicus. This review provides an update on the definition, causes, management and outcome of childhood status dystonicus.

Recent findings

High-quality studies in childhood status dystonicus are lacking, though an increasing number of case series have been published. Status dystonicus appears to occur more frequently in children compared with adults, with a clear precipitant identified in around two-thirds of cases. Although febrile illness remains the commonest trigger for status dystonicus, unplanned interruption to deep brain stimulation (DBS) is increasingly reported as a precipitant. In parallel with this, neurosurgical intervention for status dystonicus appears to have become more widely used, though optimum timing and patient selection remains unclear. In most cases, a multistaged approach is required; we propose an ‘ABCD’ approach – Addressing precipitants, Beginning supportive measures, Calibrating sedation and Dystonia specific medications. Outcomes following status dystonicus appear to have slightly improved in recent years, potentially as a consequence of increasing use of DBS, though mortality has remained around 10%.

Future work is needed to inform evidence-based guidelines for the management of status dystonicus. One of many pressing questions is the precise indication, and timing of interventions such as DBS.
P2X7R Blockade Prevents NLRP3 Inflammasome Activation and Pancreatic Fibrosis in a Mouse Model of Chronic Pancreatitis
Authors: Zhang Gui-Xian , Wang Man-Xue , Nie Wei , Liu Da-Wei , Zhang Yi , Liu Hong-Bin
Published: September 2017

Objectives

The aim of this study was to investigate the role of P2X7R (purinergic 2X7 receptor) and NLRP3 (NACHT, LRR, and PYD domains–containing protein 3) inflammasome activation in the process of pancreatic fibrosis in a mouse model of chronic pancreatitis (CP).

Methods

Chronic pancreatitis was induced by repeated intraperitoneal injections of 50 μg/kg cerulein for 6 weeks in mice. P2X7R antagonist oxidized ATP (OxATP) or brilliant blue G (BBG) was administered after the last cerulein injection for 2 weeks. Pancreatic chronic inflammation and fibrosis were evaluated by histological score, Sirius red staining, and alpha-smooth muscle actin immunohistochemical staining. We further determined pancreatic P2X7R, NLRP3, and caspase-1 expressions in gene and protein levels and the pancreatic concentrations of caspase-1, interleukin 1β (IL-1β), and IL-18.

Results

The pancreatic P2X7R, NLRP3, and caspase-1 expressions in gene and protein levels and the pancreatic concentrations of caspase-1, IL-1β, and IL-18 were all reduced significantly in both the OxATP and BBG groups (P < 0.05). The pancreatic chronic inflammation and the fibrosis indices were all remarkably attenuated (P < 0.05).

Conclusions

P2X7R antagonist OxATP and BBG significantly decreased pancreatic chronic inflammation and fibrosis in a mouse CP model and suggested that blockade of P2X7R-NLRP3 inflammasome signaling pathway may represent a novel therapeutic strategy for CP and its fibrotic process.
Severe Neonatal Cholestasis in Cerebrotendinous Xanthomatosis
Authors: Gong Jing‐Yu , Setchell Kenneth D.R. , Zhao Jing , Zhang Wujuan , Wolfe Brian , Lu Yi , Lackner Karolin , Knisely A.S. , Wang Neng‐Li , Hao Chen‐Zhi , Zhang Mei‐Hong , Wang Jian‐She
Published: September 2017

Objectives:

Cerebrotendinous xanthomatosis (CTX) is caused by defects in sterol 27‐hydroxylase (CYP27A1, encoded by CYP27A1), a key enzyme in the bile acid synthesis pathway. CTX usually presents as neurologic disease in adults or older children. The rare reports of CTX manifest as neonatal cholestasis assess the cholestasis as transient, with patient survival. Our experience differs.

Methods:

Homozygous or compound heterozygous CYP27A1 mutations were detected in 8 neonatal cholestasis patients by whole exome sequencing, panel sequencing, or Sanger sequencing. Their clinical and biochemical data were retrospectively reviewed. Immunostaining for CYP27A1 was conducted in liver of 4 patients. Mass spectrometry was used to analyze patients’ urine samples.

Results:

All 8 infants had severe cholestasis. Five died from, or were transplanted for, liver failure; 3 cleared their jaundice eventually. Marking for CYP27A1 was weak or absent in 3 of the 4 patient specimens. Mass spectrometry of urine revealed a predominance of sulfated and doubly conjugated (sulfated‐glucuronidated) bile alcohols. No patient harbored a putatively pathogenic mutation in genes other than CYP27A1 that have been implicated in cholestatic liver disease.

Conclusions:

CTX manifest as neonatal cholestasis has a bile acid profile different from CTX manifest in later life, and thus may be overlooked. Immunostaining, mass spectrometry of urine, and genetic studies can support one another in making the diagnosis. A substantial proportion of CTX patients with severe neonatal cholestasis may die or need liver transplantation. CTX manifest in infancy as severe cholestasis warrants further investigation of biochemical diagnostic criteria and best management.
Body Composition Predicts Growth in Infants and Toddlers With Chronic Liver Disease
Authors: Hurtado-López Erika F. , Vásquez-Garibay Edgar M. , Trujillo Xóchitl , Larrosa-Haro Alfredo
Published: September 2017

This cross-sectional study was conducted on 15 infants and toddlers with chronic liver disease to validate arm anthropometry as an accurate measure of body composition (BC) compared to dual-energy x-ray absorptiometry and to predict growth from BC. The z score means of the anthropometric indicators were <−2 standard deviation, except for body fat index and subscapular skinfold, which were between −2 and +2 standard deviation. Fat mass was predicted by arm adiposity indicators and fat-free mass by arm muscle area. Bone mineral content explained 87% of variation in length. Two multiple regression models predicted length: 1 with fat mass plus fat-free mass; and the second with fat mass and bone mineral content. These observations suggest that arm anthropometry is a useful tool to estimate BC and the nutritional status in infants and toddlers with chronic liver disease. Length and head circumference can be predicted by fat mass, fat-free mass, and bone mineral content.
Cholangiocarcinoma Among Children and Adolescents
Authors: Newsome Jennifer R. , Venkatramani Rajkumar , Heczey Andras , Danysh Heather E. , Fishman Douglas S. , Miloh Tamir
Published: September 2017

Objective:

Cholangiocarcinoma (CCA) is a biliary malignancy found primarily in adults. The incidence of CCA in children is unknown. The aim of this study was to describe characteristics of CCA in children and adolescents.

Methods:

Using the Surveillance, Epidemiology, and End Results Program (SEER 18) database, we identified incident cases of CCA diagnosed at <20 years of age during the period of 1973 to 2013. Additionally, we reviewed published case reports describing pediatric patients with CCA. We calculated descriptive statistics for CCA cases identified in SEER and in case reports. Kaplan–Meier analysis was performed to determine median and 3‐year overall survival (OS) rates.

Results:

We identified 15 children and adolescents diagnosed as having CCA from SEER 18 with an incidence rate of 0.0036 per 100,000. Two‐thirds of cases were male, and the majority were white (n = 10). The median age at diagnosis was 17 years (range: 11–19 years). Nine tumors were intrahepatic, 3 extrahepatic, and 3 unspecified. One‐third had distal metastases at diagnosis. Eight patients underwent surgical resection including liver transplant in two. Six patients were alive at the time of follow‐up. Patients without surgical treatment did not survive. Three‐year OS was 50%. Twenty‐two children with CCA were found in the literature with a median age at diagnosis of 15 years (range: 3–18 years). Half were male, and 90% had an underlying gastrointestinal comorbidity. Three‐year OS was 35.3%.

Conclusions:

CCA in children and adolescents is rare with poor survival. A high proportion of cases had a history of biliary disease. Surgical resection is necessary for cure.
Evans Syndrome as First Manifestation of Primary Immunodeficiency in Clinical Practice
Authors: Martínez-Valdez Libny , Deyà-Martínez Angela , Giner María T. , Berrueco Rubén , Esteve-Solé Ana , Juan Manel , Plaza-Martín Ana M. , Alsina Laia
Published: September 2017

Background:

Evans syndrome (ES) is a rare immune disorder in children, manifested by simultaneous or sequential autoimmune cytopenias (ACs) of unknown cause and having a chronic course with periods of exacerbation and remission. Some primary immunodeficiencies (PIDs) may present with autoimmune manifestations without infections, masking suspicion of them. The PIDs that can typically manifest as ES are autoimmune lymphoproliferative syndrome and common variable immunodeficiency (CVID).

Materials and Methods:

Review of clinical charts and laboratory results of pediatric patients followed-up in the outpatient clinic of PID with a diagnosis of ES and humoral immunodeficiency.

Results:

Three pediatric patients, a boy and 2 girls, presented with corticosteroid-dependent ES. In the diagnostic approach, autoimmune lymphoproliferative syndrome was ruled out, and during follow-up, patients showed laboratory signs of humoral immune deficiency and were diagnosed with CVID. After initiating the recommended treatment for CVID with AC, patients improved without new exacerbations.

Conclusions:

These cases highlight the importance of detection of possible PID in the context of ES and the establishment of CVID treatment to control AC.
Ambulatory High-dose Methotrexate Administration in Pediatric Osteosarcoma Patients at a Single Institution in Argentina
Authors: Villegas Rubio Jose A. , Cacciavillano Walter , Rose Adriana , Zubizarreta Pedro , Scopinaro Marcelo
Published: September 2017

Background:

The purpose of this study was to evaluate the feasibility and safety of ambulatory high-dose methotrexate (HDMTX) administration with oral hydration, alkalinization, and leucovorin rescue. HDMTX (12 g/m2) was given intravenously over 4 hours after urine alkalinization. Families and patients were instructed to continue ambulatory oral hydration and alkalinization to monitor urine pH and to adjust bicarbonate according to our institution’s treatment algorithm. Clinical status and MTX levels were controlled every 24 hours, and oral leucovorin dose was adjusted accordingly.

Results:

From April 2007 to December 2010, 150 of 447 courses of HDMTX (31.4%) were given on an outpatient basis, and 91.2% were successfully completed. The main causes of failure were poor oral tolerance (n=6) and fever (n=4). Most patients (81%) had MTX levels of <10 μmol/L 24 hours post-HDMTX; only in 1 course the levels were >50 μmol/L (50.96 μmol/L). Neutropenia grade III/IV was observed in 18.3% of the courses, grade III/IV leukopenia in 2.7%, and grade III/IV thrombocytopenia and anemia in 4.7%. Around 39% were associated with grade III/IV hepatic toxicity (asymptomatic hypertransaminasemia), grade III-IV gastrointestinal toxicity (vomiting and diarrhea) (5%), grade III-IV mucositis (4%), and none of the patients developed renal toxicity.

Conclusions:

Ambulatory HDMTX administration is feasible and safe in a population with poor resources in a developing country.
Food Insecurity
Authors: Patil Shivajirao P. , Craven Kay , Kolasa Kathryn M.
Published: September 2017

In this article, we present a case from our Interprofessional Diabetes Clinic to describe assessment and impact of food insecurity on a patient’s overall health and how the healthcare providers’ recognition of food insecurity changed the management of a patient with type 2 diabetes mellitus, obesity, and depression. This approach to treating patients with food insecurity may also apply to individuals with diabetes who regularly skip meals; are inconsistent with their carbohydrate intake, for whatever reason; or routinely engage in fasting. Healthcare professionals should screen all patients for food insecurity, educate patients to use appropriate coping strategies, adjust medications to minimize adverse effects, recognize that food insecurity is cyclical for most, connect patients with community resources, and advocate for services in clinics and hospitals.
The Impact of Fluid Overload on Outcomes in Children Treated With Extracorporeal Membrane Oxygenation: A Multicenter Retrospective Cohort Study*
Authors: Selewski David T. , Askenazi David J. , Bridges Brian C. , Cooper David S. , Fleming Geoffrey M. , Paden Matthew L. , Verway Mark , Sahay Rashmi , King Eileen , Zappitelli Michael
Published: September 2017

Objective:

To characterize the epidemiology of fluid overload and its association with mortality and duration of extracorporeal membrane oxygenation in children treated with extracorporeal membrane oxygenation.

Design:

Retrospective cohort study.

Setting:

Six tertiary children’s hospital ICUs.

Patients:

Seven hundred fifty-six children younger than 18 years old treated with extracorporeal membrane oxygenation for greater than or equal to 24 hours from January 1, 2007, to December 31, 2011.

Interventions:

None.

Measurements and Main Results:

Overall survival to extracorporeal membrane oxygenation decannulation and hospital discharge was 74.9% (n = 566) and 57.7% (n = 436), respectively. Median fluid overload at extracorporeal membrane oxygenation initiation was 8.8% (interquartile range, 0.3–19.2), and it differed between hospital survivors and non survival, though not between extracorporeal membrane oxygenation survivors and non survivors. Median peak fluid overload on extracorporeal membrane oxygenation was 30.9% (interquartile range, 15.4–54.8). During extracorporeal membrane oxygenation, 84.8% had a peak fluid overload greater than or equal to 10%; 67.2% of patients had a peak fluid overload of greater than or equal to 20% and 29% of patients had a peak fluid overload of greater than or equal to 50%. The median peak fluid overload was lower in patients who survived on extracorporeal membrane oxygenation (27.2% vs 44.4%; p < 0.0001) and survived to hospital discharge (24.8% vs 43.3%; p < 0.0001). After adjusting for acute kidney injury, pH at extracorporeal membrane oxygenation initiation, nonrenal complications, extracorporeal membrane oxygenation mode, support type, center and patient age, the degree of fluid overload at extracorporeal membrane oxygenation initiation (p = 0.05), and the peak fluid overload on extracorporeal membrane oxygenation (p < 0.0001) predicted duration of extracorporeal membrane oxygenation in survivors. Multivariable analysis showed that peak fluid overload on extracorporeal membrane oxygenation (adjusted odds ratio, 1.09; 95% CI, 1.04–1.15) predicted mortality on extracorporeal membrane oxygenation; fluid overload at extracorporeal membrane oxygenation initiation (adjusted odds ratio, 1.13; 95% CI, 1.05–1.22) and peak fluid overload (adjusted odds ratio, 1.18; 95% CI, 1.12–1.24) both predicted hospital morality.

Conclusions:

Fluid overload occurs commonly and is independently associated with adverse outcomes including increased mortality and increased duration of extracorporeal membrane oxygenation in a broad pediatric extracorporeal membrane oxygenation population. These results suggest that fluid overload is a potential target for intervention to improve outcomes in children on extracorporeal membrane oxygenation.
A Novel Registration-Based Semiautomatic Mandible Segmentation Pipeline Using Computed Tomography Images to Study Mandibular Development
Authors: Chuang Ying Ji , Doherty Benjamin M. , Adluru Nagesh , Chung Moo K. , Vorperian Houri K.
Published: September 2017

Objective

We present a registration-based semiautomatic mandible segmentation (SAMS) pipeline designed to process a large number of computed tomography studies to segment 3-dimensional mandibles.

Method

The pipeline consists of a manual preprocessing step, an automatic segmentation step, and a final manual postprocessing step. The automatic portion uses a nonlinear diffeomorphic method to register each preprocessed input computed tomography test scan on 54 reference templates, ranging in age from birth to 19 years. This creates 54 segmentations, which are then combined into a single composite mandible.

Results

This pipeline was assessed using 20 mandibles from computed tomography studies with ages 1 to 19 years, segmented using both SAMS-processing and manual segmentation. Comparisons between the SAMS-processed and manually-segmented mandibles revealed 97% similarity agreement with comparable volumes. The resulting 3-dimensional mandibles were further enhanced with manual postprocessing in specific regions.

Conclusions

Findings are indicative of a robust pipeline that reduces manual segmentation time by 75% and increases the feasibility of large-scale mandibular growth studies.
Adaptive Statistical Iterative Reconstruction–V Versus Adaptive Statistical Iterative Reconstruction: Impact on Dose Reduction and Image Quality in Body Computed Tomography
Authors: Gatti Marco , Marchisio Filippo , Fronda Marco , Rampado Osvaldo , Faletti Riccardo , Bergamasco Laura , Ropolo Roberto , Fonio Paolo
Published: September 2017

Objective

The aim of this study was to evaluate the impact on dose reduction and image quality of the new iterative reconstruction technique: adaptive statistical iterative reconstruction (ASIR-V).

Methods

Fifty consecutive oncologic patients acted as case controls undergoing during their follow-up a computed tomography scan both with ASIR and ASIR-V. Each study was analyzed in a double-blinded fashion by 2 radiologists. Both quantitative and qualitative analyses of image quality were conducted.

Results

Computed tomography scanner radiation output was 38% (29%–45%) lower (P < 0.0001) for the ASIR-V examinations than for the ASIR ones. The quantitative image noise was significantly lower (P < 0.0001) for ASIR-V. Adaptive statistical iterative reconstruction–V had a higher performance for the subjective image noise (P = 0.01 for 5 mm and P = 0.009 for 1.25 mm), the other parameters (image sharpness, diagnostic acceptability, and overall image quality) being similar (P > 0.05).

Conclusions

Adaptive statistical iterative reconstruction–V is a new iterative reconstruction technique that has the potential to provide image quality equal to or greater than ASIR, with a dose reduction around 40%.
Noninvasive Computed Tomography–Derived Fractional Flow Reserve Based on Structural and Fluid Analysis: Reproducibility of On-site Determination by Unexperienced Observers
Authors: Ri Keiken , Kumamaru Kanako K. , Fujimoto Shinichiro , Kawaguchi Yuko , Dohi Tomotaka , Yamada Sou , Takamura Kazuhisa , Kogure Yosuke , Yamada Norikazu , Kato Etsuro , Irie Ryusuke , Takamura Tomohiro , Suzuki Michimasa , Hori Masaaki , Aoki Shigeki , Daida Hiroyuki
Published: September 2017

Objective

The aim of this study was to evaluate the reproducibility of computed tomography (CT)–derived fractional flow reserve (FFR) determined on site by inexperienced observers using a postprocessing software based on structural and fluid analysis.

Methods

Using 21 coronary vessels in 7 patients who underwent 320-row coronary CT angiography and catheter-FFR, 2 independent inexperienced observers (A: a student radiation technologist; B: a nonmedical staff) determined the CT-FFR using a postprocessing software. After a 20-minute training session, both observers postprocessed all vessels and readjusted their settings after another training/feedback. These CT-FFRs were compared with values determined by an expert analyst.

Results

The mean processing times were 23 ± 4 minutes (automatic), 71 ± 5 minutes (observer A), and 57 ± 7 minutes (observer B) per patient. The initial correlations with expert data were r = 0.92 (observer A) and 0.73 (observer B) and increased to 0.83 for observer B after additional training. The final absolute difference with the expert data was 0.000 to 0.020. The correlation between catheter-FFR and expert CT-FFR was r = 0.76.

Conclusions

The CT-derived FFR on-site postprocessing software showed good reproducibility for measurements by inexperienced observers.
Avoidance of Tracheostomy Using Mandibular Distraction in an Infant With Severe Condylar Dysplasia and Airway Obstruction
Authors: Archual Anthony J. , Black Jonathan S.
Published: September 2017

Craniofacial microsomia (CFM) is a common craniofacial anomaly characterized by asymmetric malformation of the mandible, ear, and other structures including the upper airway. The degree of mandibular hypoplasia is classified using a scheme developed by Pruzansky and modified by Kaban. Severe condylar dysplasia is the hallmark of Pruzansky–Kaban types IIB and III. Distraction osteogenesis has emerged as a treatment modality for mandibular hypoplasia in this setting for the treatment of asymmetry and airway obstruction. However, its use to resolve upper airway obstruction and avoid tracheostomy in infants with types IIB and III is not reported in the literature. The authors present a patient with successful distraction osteogenesis in a patient with CFM resulting in a Pruzansky IIB micrognathia. The authors achieved resolution of upper airway obstruction and avoidance of tracheostomy.
Surgical residents' interpretation of diagnostic radiologic imaging in the traumatically injured patient
Authors: Fakhoury Elias , Abolghasemi Daria , McKinney Justin , Naumova Alena , Wessner Scott , Elsawy Osama , Zuberi Jamshed , Madlinger Robert V.
Published: September 2017

BACKGROUND

Senior surgical residents are of paramount importance in directing further therapeutic modalities based on their interpretation of critical diagnostic imaging. We propose that senior surgical residents are proficient with interpreting radiologic imaging studies in the trauma patient.

METHODS

A prospective cohort study was performed comparing surgery resident interpretations of computed tomography (CT) scans of the head, maxillofacial bones, spine (cervical, thoracic, lumbar), chest, abdomen, pelvis, and chest X-rays versus final radiologists' reports at a Level II trauma center from September 2014 to May 2015. A Cohen κ coefficient and a statistical analysis of variance testing were used to make multiple comparisons of the data.

RESULTS

There were 951 trauma alerts activated in the period stated. Of these, 860 met our age inclusion criteria (age, > 18 years). There were 204 images included with an overall accuracy of 81.3%. Residents were more than 70% successful interpreting seven of nine categories. They achieved an accuracy of 84.6%, 62.5%, and 75% in the cervical, thoracic, and lumbar spine categories, respectively. Forty-one of 50 CT scans of the head were interpreted correctly. Maxillofacial CT scans proved to be the weakest category, with only 50% read accurately. In regard to CT scans of the abdomen and pelvis, 80% proficiency was achieved. Abdominal x-rays were read correctly in all instances and chest x-rays 83.3%. On κ analysis, there was an overall moderate agreement between the two groups with K = 0.449, and an overall p less than 0.0005 (Table 1). A perfect agreement existed with abdominal x-rays.

CONCLUSION

Senior surgical residents are capable of interpreting critical images obtained in the trauma setting. When discordance existed with attending radiologists' interpretation, it did not change the clinical outcome or result in any critically missed findings.

Level of Evidence

Therapeutic/Care Management study, Level IV.
Management of Emergency Electroconvulsive Therapy in the Intensive Care Unit for Life-Threatening Psychiatric Conditions
Authors: Bulteau Samuel , Laforgue Edouard-Jules , Chimot Loïc , Dumont Romain , Loutrel Olivier , Etcheverrigaray François , Victorri-Vigneau Caroline , Massri Alexandre , Vanelle Jean-Marie , Sauvaget Anne
Published: September 2017

Catatonia can lead to severe complications and may be lethal but is often underdiagnosed. The clinical presentation can be similar to coma. In these situations, electroconvulsive therapy (ECT) can be used as first-line treatment to enable extubation, recovery of autonomy, and rapid discharge from intensive care. We report 4 cases of patients hospitalized in the intensive care unit with comatose clinical presentation and life-threatening condition caused by catatonia. All patients received ECT sessions, after which the catatonic symptoms partially or fully remitted. We discuss the clinical identification, general considerations, ECT feasibility, and parameters in the intensive care unit, as well as the differential diagnosis, drug precautions, and prevention concerns.
Diamond thin films: giving biomedical applications a new shine
Authors: Nistor P. A. , May P. W.
Published: September 2017

Progress made in the last two decades in chemical vapour deposition technology has enabled the production of inexpensive, high-quality coatings made from diamond to become a scientific and commercial reality. Two properties of diamond make it a highly desirable candidate material for biomedical applications: first, it is bioinert, meaning that there is minimal immune response when diamond is implanted into the body, and second, its electrical conductivity can be altered in a controlled manner, from insulating to near-metallic.
In vitro,
diamond can be used as a substrate upon which a range of biological cells can be cultured.
In vivo
, diamond thin films have been proposed as coatings for implants and prostheses. Here, we review a large body of data regarding the use of diamond substrates for
in vitro
cell culture. We also detail more recent work exploring diamond-coated implants with the main targets being bone and neural tissue. We conclude that diamond emerges as one of the major new biomaterials of the twenty-first century that could shape the way medical treatment will be performed, especially when invasive procedures are required.
Sequencing of the variable region of
rpsB
to discriminate between
Streptococcus pneumoniae
and other streptococcal species
Authors: Wyllie Anne L. , Pannekoek Yvonne , Bovenkerk Sandra , van Engelsdorp Gastelaars Jody , Ferwerda Bart , van de Beek Diederik , Sanders Elisabeth A. M. , Trzciński Krzysztof , van der Ende Arie
Published: September 2017

The vast majority of streptococci colonizing the human upper respiratory tract are commensals, only sporadically implicated in disease. Of these, the most pathogenic is Mitis group member,
Streptococcus pneumoniae
. Phenotypic and genetic similarities between streptococci can cause difficulties in species identification. Using ribosomal S2-gene sequences extracted from whole-genome sequences published from 501 streptococci, we developed a method to identify streptococcal species. We validated this method on non-pneumococcal isolates cultured from cases of severe streptococcal disease (
n
= 101) and from carriage (
n
= 103), and on non-typeable pneumococci from asymptomatic individuals (
n
= 17) and on whole-genome sequences of 1157 pneumococcal isolates from meningitis in the Netherlands. Following this, we tested 221 streptococcal isolates in molecular assays originally assumed specific for
S. pneumoniae
, targeting
cpsA
,
lytA
,
piaB
,
ply
, Spn9802,
zmpC
and capsule-type-specific genes. Cluster analysis of S2-sequences showed grouping according to species in line with published phylogenies of streptococcal core genomes. S2-typing convincingly distinguished pneumococci from non-pneumococcal species (99.2% sensitivity, 100% specificity). Molecular assays targeting regions of
lytA
and
piaB
were 100% specific for
S. pneumoniae
, whereas assays targeting
cpsA
,
ply
, Spn9802,
zmpC
and selected serotype-specific assays (but not capsular sequence typing) showed a lack of specificity. False positive results were over-represented in species associated with carriage, although no particular confounding signal was unique for carriage isolates.
Epigenetic inactivation of tumour suppressor coding and non-coding genes in human cancer: an update
Authors: Llinàs-Arias Pere , Esteller Manel
Published: September 2017

Cancer cells undergo many different alterations during their transformation, including genetic and epigenetic events. The controlled division of healthy cells can be impaired through the downregulation of tumour suppressor genes. Here, we provide an update of the mechanisms in which epigenetically altered coding and non-coding tumour suppressor genes are implicated. We will highlight the importance of epigenetics in the different molecular pathways that lead to enhanced and unlimited capacity of division, genomic instability, metabolic shift, acquisition of mesenchymal features that lead to metastasis, and tumour plasticity. We will briefly describe these pathways, focusing especially on genes whose epigenetic inactivation through DNA methylation has been recently described, as well as on those that are well established as being epigenetically silenced in cancer. A brief perspective of current clinical therapeutic approaches that can revert epigenetic inactivation of non-coding tumour suppressor genes will also be given.
Region-specific RNA m
6
A methylation represents a new layer of control in the gene regulatory network in the mouse brain
Authors: Chang Mengqi , Lv Hongyi , Zhang Weilong , Ma Chunhui , He Xue , Zhao Shunli , Zhang Zhi-Wei , Zeng Yi-Xin , Song Shuhui , Niu Yamei , Tong Wei-Min
Published: September 2017

N
6
-methyladenosine (m
6
A) is the most abundant epitranscriptomic mark found on mRNA and has important roles in various physiological processes. Despite the relatively high m
6
A levels in the brain, its potential functions in the brain remain largely unexplored. We performed a transcriptome-wide methylation analysis using the mouse brain to depict its region-specific methylation profile. RNA methylation levels in mouse cerebellum are generally higher than those in the cerebral cortex. Heterogeneity of RNA methylation exists across different brain regions and different types of neural cells including the mRNAs to be methylated, their methylation levels and methylation site selection. Common and region-specific methylation have different preferences for methylation site selection and thereby different impacts on their biological functions. In addition, high methylation levels of fragile X mental retardation protein (FMRP) target mRNAs suggest that m
6
A methylation is likely to be used for selective recognition of target mRNAs by FMRP in the synapse. Overall, we provide a region-specific map of RNA m
6
A methylation and characterize the distinct features of specific and common methylation in mouse cerebellum and cerebral cortex. Our results imply that RNA m
6
A methylation is a newly identified element in the region-specific gene regulatory network in the mouse brain.
Learning of efficient behaviour in spatial exploration through observation of behaviour of conspecific in laboratory rats
Authors: Takano Yuji , Ukezono Masatoshi , Nakashima Satoshi F. , Takahashi Nobuaki , Hironaka Naoyuki
Published: September 2017

Recent studies have suggested that rodent behaviour is influenced by the behaviour of surrounding conspecifics (e.g. emotional contagion and prosocial behaviour). However, little is known about deferred imitation and complex observational learning in rats. The purpose of this study was to reveal whether rats can learn from another rat's experiences. In a maze, observer rats watched the foraging behaviour of other rats (demonstrators) and then foraged in turn. The results showed that demonstrators explored inefficiently, but observers explored more efficiently after observing inefficient exploration by the demonstrators. This observational learning probably involved the acquisition of an efficient strategy through spatial exploration.
Investigating the association between social interactions and personality states dynamics
Authors: Gundogdu Didem , Finnerty Ailbhe N. , Staiano Jacopo , Teso Stefano , Passerini Andrea , Pianesi Fabio , Lepri Bruno
Published: September 2017

The recent personality psychology literature has coined the name ofpersonality statesto refer to states having the same behavioural, affective and cognitive content (described by adjectives) as the corresponding trait, but for a shorter duration. The variability in personality states may be the reaction to specific characteristics of situations. The aim of our study is to investigate whether specific situational factors, that is, different configurations of face-to-face interactions, are predictors of variability of personality states in a work environment. The obtained results provide evidence that within-person variability in personality is associated with variation in face-to-face interactions. Interestingly, the effects differ by type and level of the personality states:adaptationeffects for Agreeableness and Emotional Stability, whereby the personality states of an individual trigger similar states in other people interacting with them andcomplementarityeffects for Openness to Experience, whereby the personality states of an individual trigger opposite states in other people interacting with them. Overall, these findings encourage further research to characterize face-to-face and social interactions in terms of their relevance to personality states.
Molecular trade-offs in RNA ligases affected the modular emergence of complex ribozymes at the origin of life
Authors: Dhar Nisha , Weinberg Marc S. , Michod Richard E. , Durand Pierre M.
Published: September 2017

In the RNA world hypothesis complex, self-replicating ribozymes were essential. For the emergence of an RNA world, less is known about the early processes that accounted for the formation of complex, long catalysts from small passively formed molecules. The functional role of small sequences has not been fully explored and, here, a possible role for smaller ligases is demonstrated. An established RNA polymerase model, the R18, was truncated from the 3′ end to generate smaller molecules. All the molecules were investigated for self-ligation functions with a set of oligonucleotide substrates without predesigned base pairing. The smallest molecule that exhibited self-ligation activity was a 40-nucleotide RNA. It also demonstrated the greatest functional flexibility as it was more general in the kinds of substrates it ligated to itself although its catalytic efficiency was the lowest. The largest ribozyme (R18) ligated substrates more selectively and with greatest efficiency. With increase in size and predicted structural stability, self-ligation efficiency improved, while functional flexibility decreased. These findings reveal that molecular size could have increased from the activity of small ligases joining oligonucleotides to their own end. In addition, there is a size-associated molecular-level trade-off that could have impacted the evolution of RNA-based life.
Into the dark: patterns of middle ear adaptations in subterranean eulipotyphlan mammals
Authors: Koyabu Daisuke , Hosojima Misato , Endo Hideki
Published: September 2017

Evolution of the middle ear ossicles was a key innovation for mammals, enhancing the transmission of airborne sound. Radiation into various habitats from a terrestrial environment resulted in diversification of the auditory mechanisms among mammals. However, due to the paucity of phylogenetically controlled investigations, how middle ear traits have diversified with functional specialization remains unclear. In order to identify the respective patterns for various lifestyles and to gain insights into fossil forms, we employed a high-resolution tomography technique and compared the middle ear morphology of eulipotyphlan species (moles, shrews and hedgehogs), a group that has radiated into various environments, such as terrestrial, aquatic and subterranean habitats. Three-dimensional geometric morphometric analysis was conducted within a phylogenetically controlled framework. Quantitative shapes were found to strongly reflect the degree of subterranean lifestyle and weakly involve phylogeny. Our analyses demonstrate that subterranean adaptation should include a relatively shorter anterior process of the malleus, an enlarged incus, an enlarged stapes footplate and a reduction of the orbicular apophysis. These traits arguably allow improving low-frequency sound transmission at low frequencies and inhibiting the low-frequency noise which disturbs the subterranean animals in hearing airborne sounds.