bluuebunny/crossref_metadata_2025 huggingface dataset:
Cathelicidin-inspired antimicrobial peptides as novel antifungal compounds
Authors: van Eijk Martin , Boerefijn Stephanie , Cen Lida , Rosa Marisela , Morren Marnix J H , van der Ent Cornelis K , Kraak Bart , Dijksterhuis Jan , Valdes Ivan D , Haagsman Henk P , de Cock Hans
Published: March 2020

Fungal infections in humans are increasing worldwide and are currently mostly treated with a relative limited set of antifungals. Resistance to antifungals is increasing, for example, in Aspergillus fumigatus and Candida auris, and expected to increase for many medically relevant fungal species in the near future. We have developed and patented a set of cathelicidin-inspired antimicrobial peptides termed ‘PepBiotics’. These peptides were initially selected for their bactericidal activity against clinically relevant Pseudomonas aeruginosa and Staphylococcus aureus isolates derived from patients with cystic fibrosis and are active against a wide range of bacteria (ESKAPE pathogens). We now report results from studies that were designed to investigate the antifungal activity of PepBiotics against a set of medically relevant species encompassing species of Aspergillus, Candida, Cryptococcus, Fusarium, Malassezia, and Talaromyces. We characterized a subset of PepBiotics and show that these peptides strongly affected metabolic activity and/or growth of a set of medically relevant fungal species, including azole-resistant A. fumigatus isolates. PepBiotics showed a strong inhibitory activity against a large variety of filamentous fungi and yeasts species at low concentrations (≤1 μM) and were fungicidal for at least a subset of these fungal species. Interestingly, the concentration of PepBiotics required to interfere with growth or metabolic activity varied between different fungal species or even between isolates of the same fungal species. This study shows that PepBiotics display strong potential for use as novel antifungal compounds to fight a large variety of clinically relevant fungal species.
Ultrarelativistic astrophysics using multimessenger observations of double neutron stars with LISA and the SKA
Authors: Thrane Eric , Osłowski Stefan , Lasky Paul D
Published: March 2020

Recent work highlights that tens of Galactic double neutron stars are likely to be detectable in the millihertz band of the space-based gravitational-wave observatory, LISA, some of which might be detectable as radio pulsars using the Square Kilometer Array (SKA). We point out that the joint LISA + SKA detection of a fgw ≳ 1 mHz binary, corresponding to a binary period of ≲400 s, would enable precision measurements of ultrarelativistic phenomena. We show that, given plausible assumptions, multimessenger observations of ultrarelativistic binaries can be used to constrain the neutron star equation of state with remarkable fidelity. It may be possible to measure the mass–radius relation with a precision of ≈0.2 per cent after 10 yr of observations with the SKA. Such a measurement would be roughly an order of magnitude more precise than possible with other proposed observations. We summarize some of the other remarkable science made possible with multimessenger observations of millihertz binaries, and discuss the prospects for the detection of such objects.
The atomic hydrogen content of the post-reionization Universe
Authors: Spinelli Marta , Zoldan Anna , De Lucia Gabriella , Xie Lizhi , Viel Matteo
Published: March 2020

We present a comprehensive analysis of atomic hydrogen (H i) properties using a semi-analytical model of galaxy formation and N-body simulations covering a large cosmological volume at high resolution. We examine the H i mass function and the H i density, characterizing both their redshift evolution and their dependence on hosting halo mass. We analyse the H i content of dark matter haloes in the local Universe and up to redshift z = 5, discussing the contribution of different galaxy properties. We find that different assembly history plays a crucial role in the scatter of this relation. We propose new fitting functions useful for constructing mock H i maps with halo occupation distribution techniques. We investigate the H i clustering properties relevant for future 21 cm intensity mapping (IM) experiments, including the H i bias and the shot-noise level. The H i bias increases with redshift and it is roughly flat on the largest scales probed. The scale dependence is found at progressively larger scales with increasing redshift, apart from a dip feature at z = 0. The shot-noise values are consistent with the ones inferred by independent studies, confirming that shot noise will not be a limiting factor for IM experiments. We detail the contribution from various galaxy properties on the H i power spectrum and their relation to the halo bias. We find that H i poor satellite galaxies play an important role at the scales of the one-halo term. Finally, we present the 21 cm signal in redshift space, a fundamental prediction to be tested against data from future radio telescopes such as Square Kilometre Array.
Improved pion mean fields and masses of singly heavy baryons
Authors: Kim June-Young , Kim Hyun-Chul
Published: March 2020

A singly heavy baryon can be viewed as $N_c-1$ ($N_c$ being the number of colors) light valence quarks bound by the pion mean fields that are created by the presence of the $N_c-1$ valence quarks self-consistently, while the heavy quark inside a singly heavy baryon is regarded as a static color source. We investigate how the pion mean fields are created by the presence of $N_c$, $N_c-1$, and $N_c-2$ light valence quarks, which correspond to the systems of light baryons, singly heavy baryons, and doubly heavy baryons. As the number of colors decreases from $N_c$ to $N_c-1$, the pion mean fields undergo changes. As a result, the valence quark contributions to the moments of inertia of the soliton become larger than for $N_c$ valence quarks, whereas the sea quark contributions decrease systematically. On the other hand, the presence of the $N_c-2$ valence quarks is not enough to produce the strong pion mean fields, which leads to the classical soliton not being formed. This indicates that the pion mean-field approach is not suitable to describe doubly heavy baryons. We show that the mass spectra of the singly heavy baryons are better described by the improved pion mean fields, compared with the previous work in which the pion mean fields are assumed to be intact with $N_c$ varied.
Pipeline Risk in Leveraged Loan Syndication
Authors: Bruche Max , Malherbe Frederic , Meisenzahl Ralf R
Published: March 2020

What is the economic role played by arrangers of leveraged loans, and what are the risks they face? We provide evidence that arrangers solve a demand discovery problem. Investors have incentives to feign little interest in the loan to obtain better terms. To deter such behavior, arrangers underprice hot deals and ration investors on cold deals. The risk associated with demand discovery is often shared between borrowers and arrangers. One implication is that to ration investors on cold deals, arrangers retain larger loan shares. This motive for retention is different from the monitoring incentive motive previously considered in the literature.
Distress Related to Attenuated Psychotic Symptoms: Static and Dynamic Association With Transition to Psychosis, Nonremission, and Transdiagnostic Symptomatology in Clinical High-Risk Patients in an International Intervention Trial
Authors: Nelson Barnaby , Yuen Hok Pan , Amminger G Paul , Berger Gregor , Chen Eric Y H , de Haan Lieuwe , Hartmann Jessica A , Hickie Ian B , Lavoie Suzie , Markulev Connie , Mossaheb Nilufar , Nieman Dorien H , Nordentoft Merete , Polari Andrea , Riecher-Rössler Anita , Schäfer Miriam R , Schlögelhofer Monika , Smesny Stefan , Tedja Amy , Thompson Andrew , Verma Swapna , Yung Alison R , McGorry Patrick D
Published: March 2020

This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the “Neurapro” clinical trial of omega-3 fatty acids. Three hundred and four UHR patients were recruited across 10 early intervention services. Data from baseline assessment, regular assessments over 12 months, and medium term follow-up (mean = 3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and nonremission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioral case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modeling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.
Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy
Authors: Lamont Rachel , Rosic Tea , Sanger Nitika , Samaan Zainab
Published: March 2020

Background and Objectives

Substance use disorders are highly prevalent among individuals with psychotic disorders and are associated with negative outcomes. This study aims to explore differences in characteristics and treatment outcomes for individuals with psychotic disorders when compared with individuals with other nonpsychotic psychiatric disorders enrolled in treatment for opioid use disorder (OUD).

Methods

Data were collected from a prospective cohort study of 415 individuals enrolled in outpatient methadone maintenance treatment (MMT). Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview. Participants were followed for 12 months. Participant characteristics associated with having a psychotic disorder versus another nonpsychotic psychiatric disorder were explored by logistic regression analysis.

Results

Altogether, 37 individuals (9%) with a psychotic disorder were identified. Having a psychotic disorder was associated with less opioid-positive urine drug screens (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95, 0.99, P = .046). Twelve-month retention in treatment was not associated with psychotic disorder group status (OR = 0.73, 95% CI = 0.3, 1.77, P = .485). Participants with psychotic disorders were more likely to be prescribed antidepressants (OR = 2.12, 95% CI = 1.06, 4.22, P = .033), antipsychotics (OR = 3.57, 95% CI = 1.74, 7.32, P = .001), mood stabilizers (OR = 6.61, 95% CI = 1.51, 28.97, P = .012), and benzodiazepines (OR = 2.22, 95% CI = 1.11, 4.43, P = .024).

Discussion and Conclusions

This study contributes to the sparse literature on outcomes of individuals with psychotic disorders and OUD-receiving MMT. Rates of retention in treatment and opioid use are encouraging and contrast to the widely held belief that these individuals do more poorly in treatment. Higher rates of coprescription of sedating and QTc-prolonging medications in this group may pose unique safety concerns.
Social Investment Policy, Economic Growth, and Welfare States: Channels of Pro-Growth Effects of Policy
Authors: Sakamoto Takayuki
Published: March 2020

Social investment (SI) policies have been popular among industrial countries in the past two decades. Governments hope that SI policies will promote productivity and economic growth by creating high-skill labor forces that can adapt to the imperatives of the new knowledge economy and technological advances, or that can create new technologies themselves. They also hope that SI policies will mitigate new social risks, such as single-parent families and workers in precarious employment by better preparing workers for jobs and promoting social inclusion. However, little research exists that empirically investigates whether or not SI policies really produce these positive outcomes. Of all economic outcomes, this paper focuses on economic growth and the channels of economic growth—multifactor productivity (MFP), physical capital investment, and labor input—and investigates whether SI policies promote growth in GDP and its channels. Data from 17 industrial countries are analyzed. The analysis finds that family support, education, and ALMP spending (all measured as spending per child, student, and an unemployed person, respectively) is positively associated with MFP and GDP growth, and that MFP growth is the main channel through which SI policies enhance GDP growth. Education spending boosts the growth of all of MFP, physical capital stock, labor input, and GDP growth via those channels. While family support does not promote the growth of labor input, the results suggest that larger family support spending leads to higher levels of labor input. Overall, these types of SI spending have generally positive effects on economic growth.
Nursing Student Perceptions of Home Visit Simulation Scenarios
Authors: Thompson Cheryl W. , Moscola Stephanie , Buckland Scottie Thompson
Published: March 2020

Ensuring quality clinical placement in community health nursing courses is challenging as faculty cannot observe all nursing students and little consistency is found in student experiences. Simulation can supplement traditional clinical experiences. Two home visit scenarios with learning objectives were developed. Students conducted the scenarios in the role of nurse or nursing student and completed evaluations of the experience. The findings suggest students perceived they were able to meet the learning objectives in each scenario regardless of which role was played. Home visit simulations were beneficial to student learning in the community health nursing course.
Developing Skills Labs for Obstetric and Pediatric Nursing Students
Authors: Allert Jenny , Brunel Mallory
Published: March 2020

Specialty areas of nursing, for example, obstetrics and pediatrics, require a unique set of skills and specialized care. Nursing students often enter these areas for their clinical rotations having had little didactic classroom education. For faculty, it is challenging to prepare students to enter the clinical setting feeling competent, confident, and with the critical thinking skills required for an optimal experience. This article reports on a process to develop a skills lab with both skills and simulation components designed specifically to prepare students to enter the clinical setting with greater competence, confidence, and critical thinking.
A Behavioral Epigenetics Model to Predict Oral Feeding Skills in Preterm Infants
Authors: Griffith Thao , White-Traut Rosemary , Janusek Linda Witek
Published: March 2020

Background:

Preterm infants experience a multitude of prenatal and postnatal stressors, resulting in cumulative stress exposure, which may jeopardize the timely attainment of developmental milestones, such as achieving oral feeding. Up to 70% of preterm infants admitted to the neonatal intensive care unit experience challenges while initiating oral feeding. Oral feeding skills require intact neurobehavioral development. Evolving evidence demonstrates that cumulative stress exposure results in epigenetic modification of glucocorticoid-related genes. Epigenetics is a field of study that focuses on phenotypic changes that do not involve alterations in the DNA sequence. Epigenetic modification of glucocorticoid-related genes alters cortisol reactivity to environmental stimuli, which may influence neurobehavioral development, and is the essence of the evolving field of Preterm Behavioral Epigenetics. It is plausible that early-life cumulative stress exposure and the ensuing epigenetic modification of glucocorticoid-related genes impair neurobehavioral development required for achievement of oral feeding skills in preterm infants.

Purpose:

The purpose of this article is to build upon the evolving science of Preterm Behavioral Epigenetics and present a conceptual model that explicates how cumulative stress exposure affects neurobehavioral development and achievement of oral feeding skills through epigenetic modification of glucocorticoid-related genes.

Methods/Results:

Using the Preterm Behavioral Epigenetics framework and supporting literature, we present a conceptual model in which early-life cumulative stress exposure, reflected by DNA methylation of glucocorticoid-related genes and altered cortisol reactivity, disrupts neurobehavioral development critical for achievement of oral feeding skills.

Implications for Practice and Research:

Future investigations guided by the proposed conceptual model will benefit preterm infant outcomes by introducing epigenetic-based approaches to assess and monitor preterm infant oral feeding skills. Furthermore, the proposed model can guide future investigations that develop and test epigenetic protective interventions to improve clinical outcomes, representing an innovation in neonatal care.
Intraoperative Issues and Clinical and Radiographic Outcomes of Femur Fractures Treated With Flexible Nails: A Comparison of Cases Utilizing Skeletal Traction and a Traction Table to Cases Using Manual Traction Only
Authors: Canavese Federico , Alberghina Flavia , Cravino Mattia , Paonessa Matteo , Dimeglio Alain , Andreacchio Antonio
Published: March 2020

Introduction:

The use of the orthopaedic traction table (OTT) during elastic stable intramedullary nailing (ESIN) in the management of displaced diaphyseal femur fractures (DFFs) is still debated. In most centers, children with displaced DFF are treated using an OTT. In some other institutions, however, fracture reduction and stabilization by ESIN are performed on a radiolucent table without an OTT. The aim of this study was to evaluate the clinical and radiologic outcome of children with displaced DFF managed by ESIN with and without the use of an OTT.

Methods:

Charts and radiographs were retrospectively reviewed for all pediatric patients sustaining DFF managed by ESIN from 2011 to 2017 at 2 different institutions. In all, 69 consecutive children with displaced DFF were recorded, of whom 35 underwent operative treatment by ESIN with the use of an OTT with skeletal traction (Group A), and 34 by ESIN without OTT (Group B). The titanium elastic nails outcome measure scale score and Beaty radiologic criteria were used to evaluate the results.

Results:

Average patient age at time of injury was 9 years (range, 5 to 13) and 10 years (range, 4 to 15) in Groups A and B, respectively. The mean follow-up was 54 months (range, 24 to 96). Overall, complications were observed in 6 patients (8.6%). Complication rate was higher among children managed without OTT (11.8%) than among children treated with OTT (2.5%); no complication related to pin insertion for skeletal traction was recorded. However, the number of patients with a poor outcome according to the titanium elastic nails outcome score was higher in Group A (20%) than in Group B (5.8%). Beaty radiologic criteria were comparable between the 2 groups. Mean length of surgery and mean cumulative time of radiation exposure during surgery were similar between the 2 groups.

Conclusions:

Overall, both techniques work equally well although patients treated by ESIN with the use of an OTT and skeletal traction tended to have a lower rate of complications and radiologic outcome was worse than for patients treated without using an OTT; however, no statistically significant difference was found.

Despite their limitations, the results of this study suggest that displaced DFF can be safely managed by ESIN with or without the use of intraoperative OTT and skeletal traction, according to the surgeon’s preference. Further studies are now needed to consolidate these conclusions and clarify the role of the OTT.

Level of Evidence:

Level III.
Baseline Patient Characteristics Commonly Captured Before Surgery Do Not Accurately Predict Long-Term Outcomes of Lumbar Microdiscectomy Followed by Physiotherapy
Authors: Willems Stijn J. , Coppieters Michel W. , Rooker Servan , Heymans Martijn W. , Scholten-Peeters Gwendolyne G.M.
Published: March 2020

Study Design.

Prospective cohort study.

Objective.

To develop and internally validate prognostic models based on commonly collected preoperative data for good and poor outcomes of lumbar microdiscectomy followed by physiotherapy.

Summary of Background Data.

Lumbar microdiscectomy followed by physiotherapy is a common intervention for lumbar radiculopathy. Postoperatively, a considerable percentage of people continues to experience pain and disability. Prognostic models for recovery are scarce.

Methods.

We included 298 patients with lumbar radiculopathy who underwent microdiscectomy followed by physiotherapy. Primary outcomes were recovery and secondary outcomes were pain and disability at 12 months follow-up. Potential prognostic factors were selected from sociodemographic and biomedical data commonly captured preoperatively. The association between baseline characteristics and outcomes was evaluated using multivariable logistic regression analyses.

Results.

At 12 months follow-up, 75.8% of the participants met the criterion for recovery. Variables in the model for good recovery included: younger age, leg pain greater than back pain, high level of disability, and a disc herniation at another level than L3–L4. The model for poor recovery included: lower educational level, prior back surgery, and disc herniation at L3–L4. Following internal validation, the explained variance (Nagelkerke R
2) and area under the curve for both models were poor (≤0.02 and ≤0.60, respectively). The discriminative ability of the models for disability and pain were also poor.

Conclusion.

The outcome of microdiscectomy followed by postoperative physiotherapy cannot be predicted accurately by commonly captured preoperative sociodemographic and biomedical factors. The potential value of other biomedical, personal, and external factors should be further investigated.

Level of Evidence: 3
Delta Wiring Technique to Treat Bony Mallet Finger: No Need of Transfixation Pin
Authors: Garg Bipul K. , Rajput Shravan S. , Purushottam Gajbe I. , Jadhav Kishor B. , Chobing Habung
Published: March 2020

Extension-block pinning is a popular surgical treatment method for mallet fractures but is associated with several pitfalls. Transfixation Kirschner wires used in the extension-block pinning technique may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine the result of the delta wiring technique in mallet fractures with fracture fragment involving more than one-third of the distal phalanx articular surface. The authors are reporting 5 cases of mallet fractures treated with delta wiring technique with good functional and radiologic outcomes. Radiologic outcomes were evaluated on the basis of postoperative and follow-up x-rays and functional outcomes were evaluated using Crawford’s criteria. Five patients (4 males, 1 female) with a mean age of 26.8 years (range, 20 to 33 y) were included. The mean time between the injury and surgery was 5 days (range, 3 to 7 d), and the mean follow-up period was 8.6 months (range, 8 to 10 mo). Radiographic bone union was achieved in all patients within an average of 6.4 weeks (range, 6 to 7 wk). At the final follow-up, the distal interphalangeal joint had an average degree of flexion of 73 degrees (range, 70 to 75 degrees) and an average extension deficit of 5.40 (range, 0 to 8 degrees). According to Crawford’s criteria, 1 patient had excellent results and 4 patients had good results. No patient reported pain at the final follow-up with a visual analog scale score mean of 0.6 (range, 0 to 2). Satisfactory clinical and radiologic outcomes were obtained with the delta wiring technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.
Burnout in Pediatric Critical Care Medicine Fellows*
Authors: Suttle Markita L. , Chase Margaret A. , Sasser William C. , Moore-Clingenpeel Melissa , Maa Tensing , Werner Jason A. , Bone Meredith F. , Boyer Donald L. , Marcdante Karen J. , Mason Katherine E. , McCabe Megan E. , Mink Richard B. , Su Felice , Turner David A. ,   for the Education in Pediatric Intensive Care (E.P.I.C.) Investigators
Published: March 2020

Objectives:

Assess the overall level of burnout in pediatric critical care medicine fellows and examine factors that may contribute to or protect against its development.

Design:

Cross-sectional observational study.

Setting:

Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine fellowship programs across the United States.

Subjects:

Pediatric critical care medicine fellows and program directors.

Interventions:

Web-based survey that assessed burnout via the Maslach Burnout Inventory, as well as other measures that elicited demographics, sleepiness, social support, perceptions about prior training, relationships with colleagues, and environmental burnout.

Measurements and Main Results:

One-hundred eighty-seven fellows and 47 program directors participated. Fellows from 30% of programs were excluded due to lack of program director participation. Average values on each burnout domain for fellows were higher than published values for other medical professionals. Personal accomplishment was greater (lower burnout) among fellows more satisfied with their career choice (β 9.319; p ≤ 0.0001), spiritual fellows (β 1.651; p = 0.0286), those with a stress outlet (β 3.981; p = 0.0226), those comfortable discussing educational topics with faculty (β 3.078; p = 0.0197), and those comfortable seeking support from their co-fellows (β 3.762; p = 0.0006). Depersonalization was higher for second year fellows (β 2.034; p = 0.0482), those with less educational debt (β –2.920; p = 0.0115), those neutral/dissatisfied with their career choice (β –6.995; p = 0.0031), those with nursing conflict (β –3.527; p = 0.0067), those who perceived burnout among co-fellows (β 1.803; p = 0.0352), and those from ICUs with an increased number of patient beds (β 5.729; p ≤ 0.0001). Emotional exhaustion was higher among women (β 2.933; p = 0.0237), those neutral/dissatisfied with their career choice (β –7.986; p = 0.0353), and those who perceived burnout among co-fellows (β 5.698; p ≤ 0.0001). Greater sleepiness correlated with higher burnout by means of lower personal accomplishment (r = –1.64; p = 0.0255) and higher emotional exhaustion (r = 0.246; p = 0.0007). Except for tangible support, all other forms of social support showed a small to moderate correlation with lower burnout.

Conclusions:

Pediatric critical care medicine fellows in the United States are experiencing high levels of burnout, which appears to be influenced by demographics, fellow perceptions of their work environment, and satisfaction with career choice. The exclusion of fellows at 30% of the programs may have over or underestimated the actual level of burnout in these trainees.
Early Development of Infants with Turner Syndrome
Authors: Pretzel Rebecca Edmondson , Knickmeyer Rebecca C. , DeRamus Margaret , Duquette Peter , Okoniewski Katherine C. , Reinhartsen Debra B. , Cornea Emil , Gilmore John H. , Goldman Barbara D. , Davenport Marsha L. , Hooper Stephen R.
Published: March 2020

Objective:

To examine the early cognitive, temperament, and adaptive functioning of infants and toddlers with Turner syndrome (TS).

Methods:

Cognitive abilities were measured using the Mullen Scales of Early Learning at 1 year of age for 31 girls with TS and compared with neurotypical female (N = 53) and male (N = 54) control groups. Temperament (Carey Toddler Temperament Scales) and adaptive functioning (Vineland Adaptive Behavior Scales–Second Edition) were measured at 1 year of age and compared with normative data. An exploratory analysis of cognitive/developmental trajectories was also conducted comparing age 12-month to 24-month time points for 22 TS subjects.

Results:

Infants with TS performed largely within the average range for adaptive behavior, temperament, and early cognitive development with some increased risk for delays in language and significant increased risk for delays in motor skills (p < 0.001). Although exploratory, there was some suggestion of slower rates of progression in fine-motor and visual reception skills from 12 to 24 months of age.

Conclusions:

Infants and toddlers with TS exhibit a relatively positive neurodevelopmental profile overall, with some indication of an increasing gap in function in fine-motor and visual perceptual abilities as compared to neurotypical peers. It is unclear whether these apparent differences represent normal variability in this very young population or, perhaps, are early precursors of later phenotypic characteristics of TS in the school-age and young adult years.
Ethics in Eye Banking: Understanding Professional Attitudes Toward Industry Changes
Authors: Ahmad Samera , Vong Gerard , Pentz Rebecca D. , Dixon Margie , Davis Keenan W. , Khalifa Yousuf M.
Published: March 2020

Purpose:

To describe the ethical attitudes of corneal surgeons and eye bank leadership toward for-profit entities in corneal donation, processing, and distribution.

Methods:

Fifty postfellowship corneal surgeons practicing in the United States and 25 eye bank leaders (eg, eye bank directors, CEOs, or presidents) for the Eye Bank Association of America–accredited eye banks completed a 22-question interview, focusing on corneal donation industry changes, including the entry of for-profit institutions.

Results:

Most participants in both study groups agreed that they have concerns with the entry of for-profit businesses into eye banking (62% corneal surgeons, 68% eye bank leadership), although physicians partnered with a for-profit corneal processor were significantly more likely to have no concerns with the entry of for-profits into eye banking than corneal surgeons partnered with a nonprofit processor (P = 0.04). The most frequently identified concerns with the entry of for-profit businesses into corneal banking were the hypothetical loss of donor trust (56% corneal surgeons, 64% eye bank leadership, P = 0.04) and the potential exploitation of donor generosity (72% corneal surgeons, 60% eye bank leadership). Qualitative theme analysis suggests that both study groups may view increased research/innovation as a potential benefit (64% corneal surgeons, 66% eye bank leadership) of for-profits in eye banking.

Conclusions:

Key stakeholders in eye banking do hold relevant ethical beliefs toward recent industry changes, and these attitudes should be considered in the future creation of the ethical corneal donation policy. Further research is needed to assess the attitudes of potential donors and donor families.
The Adnexal Phenotype of Sagging Eye Syndrome
Authors: Ugradar Shoaib , Joshi Sarala , Goldberg Robert A. , Demer Joseph L.
Published: March 2020

Purpose:

The sagging eye syndrome (SES) describes a condition that presents with age-related distance esotropia, alone or in combination with cyclovertical strabismus. It has a high prevalence in those aged over age 40 years presenting with binocular diplopia. The authors aim to characterize the adnexal phenotype of those who have been diagnosed with SES.

Methods:

In this case–control study, patients were recruited from a prospectively maintained clinical and imaging database. The inclusion criteria required that subjects be above the age of 18 years and have a diagnosis of age-related distance esotropia or cyclovertical strabismus due to SES. Age-matched controls were selected from a validated database of normal faces that were not affected by any medical or surgical conditions. The margin to reflex distance from the upper eyelid, margin to reflex distance to the lower eyelid, the tarsal platform show, intracanthal distance, and inferior scleral bow were measured. Differences in the measurements between patients and controls were analyzed using a 2-tailed Student t tests.

Results:

Twenty-two patients and 22 age-matched controls (11 males and 11 females per group) were included for study. Females with SES had a significantly greater margin to reflex distance to the lower eyelid and inferior scleral bow, with a lower tarsal platform show and margin to reflex distance from the upper eyelid than controls. Male patients with SES had a significantly greater margin to reflex distance to the lower eyelid and inferior scleral bow with a significantly lower margin to reflex distance from the upper eyelid and tarsal platform show than controls.

Discussion:

This study supports the growing body of evidence which suggests that the SES represents age-related mechanical changes in the orbit that manifest as a specific adnexal phenotype.
Infantile Endoscopic Dacryocystorhinostomy: Indications, Anatomical Considerations, and Outcomes
Authors: Bothra Nandini , Vasanthapuram Varshitha Hemanth , Ali Mohammad Javed
Published: March 2020

The purpose of this case series is to report the demographic profile, indications, anatomical considerations, and outcomes of Endonasal endoscopic DCR in the infants. Five eyes of 3 infants underwent IEnDCR with a mean age of 4.26 months (range: 23 days–8 months). There were 2 males and 1 female. Two of the infants underwent bilateral surgery. The indication for surgery in the infant undergoing unilateral surgery was recurrent acute dacryocystitis and lacrimal abscess formation secondary to refractory and complex congenital nasolacrimal duct obstruction. Infants undergoing bilateral lacrimal surgery had refractory complex congenital nasolacrimal duct obstruction and were in need for an early intraocular surgery for associated ocular morbidities. Mitomycin-C (0.02% for 3 minutes) and silicone intubation was used in all cases. At follow up of 9 months, all the 3 infants demonstrated anatomical and functional success. The surgical technique requires certain modifications in order to cater to the unique challenges. It is safe and effective in experienced hands and can be considered as an alternative to an external DCR in infants.
Pilosebaceous Malignant Transformation of Dermoid Cyst in the Orbit
Authors: Concepcion-Torio Kate , Park Ji Woong , Woo Kyung In , Suh Yeon-Lim , Kim Yoon-Duck
Published: March 2020

Dermoid cysts may occur in the orbit, most commonly in the superolateral area. Malignant transformation of such lesions has been previously reported; however, most turn out to be squamous cell carcinoma. The authors’ patient initially presented with mild proptosis and limitation in extraocular movements. Preliminary biopsy showed whitish amorphous material and abundant hairs filling the thin-walled cyst, consistent with dermoid cyst. The patient underwent tumor resection via lateral orbitotomy with bone window and transorbital endoscopic approach for the dural involvement. Final biopsy showed dermoid cyst with pilosebaceous malignant transformation showing p53 expression and 30% of Ki-67 index. Adjuvant radiotherapy was performed. To the best of the authors’ knowledge, this is the first reported case of this type. Despite its rarity, there should always be a high index of suspicion and complete work-up for an accurate diagnosis.
Electron Microscopic Features of Canalicular Concretions
Authors: Ali Mohammad Javed , Heichel Jens , Singh Swati , Paulsen Friedrich
Published: March 2020

Purpose:

The aim of this study was to examine electron microscopic features of canalicular concretions obtained from patients with canaliculiths.

Methods:

Canalicular concretions were obtained from 10 patients diagnosed as canaliculiths and were immediately fixed for ultrastructural analysis. Surface structure and transmission electron microscopical sections were studied. Multiple longitudinal and transverse ultrathin sections were obtained at different levels and all were studied using standard protocols of scanning electron microscopy and transmission electron microscopy.

Results:

Three different types of canalicular concretions were noted; predominantly coccoid and bacilloid, predominantly filamentous, and mixed varieties. The surfaces and the cut sections showed typical and distinctive features for each of the concretion types. The filamentous subtypes were common accounting for 50% (5/10) of all canalicular concretions. The surface of predominantly filamentous concretions revealed typical honeycomb patterns, the walls and base of which were formed by definitive and peculiar arrangement of Actinomyces. Transmission electron microscopy confirmed the findings of scanning electron microscopy and demonstrated typical structural features of Actinomyces and some other bacteria undergoing binary fission. The most interesting feature was the lack of immune cells and blood products within the substance of canalicular concretions as compared with the mucopeptide concretions.

Conclusions:

Ultrastructural features of canalicular concretions reveal 3 distinct microbial subtypes and opens up avenues toward better understanding of the etiopathogenesis of canaliculiths and possible structural resistance to host defenses or antibiotics.
Prognostic significance of X-linked inhibitor of apoptosis protein in patients with gastrointestinal tract cancers
Authors: Ieong Chengcheng , Yang Hong , Ma Junpeng , Lai Wenli
Published: March 2020

Background:

The aim of this meta-analysis was to systematically evaluate the prognostic significance of X-linked inhibitor of apoptosis protein (XIAP) in patients with gastrointestinal tract (GIT) cancers.

Methods:

PubMed, Web of Science, EMBASE, Cochrane Library and China National Knowledge Infrastructure were searched for potentially eligible literature. The baseline characteristics and relevant data were extracted. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to assess the prognostic role of XIAP in patients with GIT cancers.

Results:

Twelve studies with 2,477 patients were included. The pooled HRs of higher expression of XIAP for overall survival (OS) and recurrence free survival (RFS) in patients with GIT cancers were 1.64 (95% CI, 1.27–2.13) and 1.06 (95% CI, 0.96–1.16), respectively. Subgroup analysis and sensitivity analysis were also performed. No significant publication bias was found.

Conclusion:

Our results suggested that XIAP could be a prognostic marker for OS but not RFS in patients with GIT cancers. Higher expression of XIAP was related to poorer OS. These findings may help evaluate the prognosis of patients and assist future research on novel therapeutic strategies of GIT cancers by targeting XIAP. However, more well-designed studies are warranted to verify the results.
The outcome of human mosaic aneuploid blastocysts after intrauterine transfer
Authors: Hong Baoli , Hao Yan
Published: March 2020

To explore whether mosaic/aneuploid embryos can be transferred when there is no normal embryo available for transplant.

The clinical pregnancy outcomes and amniocentesis outcomes of transplanted mosaic embryos during 28 preimplantation genetic testing (PGT) cycles were retrospectively analyzed. Chromosomes of 4 donated mosaic blastocysts were comprehensively screened by next-generation sequencing.

About 10 (35.7%) of the 28 transferred mosaic embryos were implanted and had a gestational sac. But 5 women miscarried due to lack of fetal heartbeat between the 7th and 12th week of pregnancy. Five women had full-term pregnancies and gave birth to 5 healthy babies. Three of the 4 donated mosaic blastocysts had normal trophectoderm and inner cell mass, but the other 1 had abnormal embryonic cell mass.

When no normal transplantable embryo is available in the PGT cycles, but the underlying risk must be fully informed.
Eleven-year follow-up of reconstruction with autogenous iliac bone graft and implant-supported fixed complete denture for severe maxillary atrophy
Authors: Lee Jae-Hyun , Yeo In-Sung Luke
Published: March 2020

Rationale:

The iliac bone graft procedure is one of the treatment options for individuals with extremely resorbed alveolar bones. An autogenous block bone graft can allow the use of an implant-supported fixed dental prosthesis, rather than conventional removable dentures, by completely edentulous patients. However, the iliac bone graft technique is an invasive procedure and should be carefully selected based on its long-term clinical results. This case report describes 11-year long-term outcomes for implant-supported complete denture on the grafted iliac bone.

Patient concerns:

A 68-year-old Asian man was referred for oral rehabilitation with fixed dental prostheses. The patient had been unsatisfied with his removable dental prostheses in masticatory performance.

Diagnosis:

Radiographical examination revealed severely atrophied maxilla.

Interventions:

The atrophied maxilla was reconstructed with an iliac block bone graft, after which an implant-supported fixed complete denture was placed.

Outcomes:

During 11 years of follow-up, several prosthetic and mechanical complications were encountered. Nevertheless, no biological complications were observed. Marginal bone levels around the implants were well-maintained on the radiographs after 11 years of prosthetic use.

Lessons:

Iliac bone graft can be chosen as a predictable treatment option that allows patients with extremely atrophic maxilla to use a fixed dental prosthesis instead of a removable denture.
r-tPA with loading dose of clopidogrel and aspirin therapies for capsular warning syndrome attributed to middle cerebral artery atherosclerotic stenosis
Authors: Xu Jinghan , Zhuang Meiting , Bao Guanshui , Zhai Yu , Yang Guo-Yuan , Xue Gang , Li Qiang
Published: March 2020

Rationale:

The capsular warning syndrome (CWS) is a rare and special type of transient ischemic attacks (TIAs) syndrome. The pathophysiology of CWS is very complicate, and intracranial atherosclerotic stenosis (ICAS) is rare cause. Moreover, the effective and standard therapy has not yet been established.

Patient concerns:

A 47-year-old man experienced repeated and exacerbated TIAs of right hemiparesis and dysarthria. Fourteen hours after the first episode of TIAs, he developed more severe right hemiparesis and dysarthria, the National Institute of Health Stroke Scale (NIHSS) score was 12 points, and did not recover in a long time.

Diagnosis:

The computed tomography (CT) angiography displayed high stenosis in the M1 segment of the left middle cerebral artery. The patient was diagnosed as CWS with ICAS.

Interventions:

Loading dose of clopidogrel and aspirin were started but were ineffective, then we used recombinant tissue plasminogen (r-tPA) for thrombolysis therapy after repeat CT scan that showed small acute infarcts in the right putamen and no bleeding.

Outcomes:

The patient was successfully treated by r-tPA intravenous thrombolysis after loading dose of dual-anti-platelet. He recovered rapidly, and the NIHSS score was 0 point, modified Rankin Scale score was 0 point, and Barthel Index score was 100 points at 3-month follow-up.

Lessons:

r-tPA combined with loading dose of dual antiplatelet appears safe and effective in carefully selected CWS patients with ICAS. The collection of similar cases and further randomized controlled trial research would be desirable.
Divergence of group a rotavirus with genetic variations before and after introduction of rotavirus vaccines in northern Taiwan
Authors: Chen Ying-Fang Elaine , Lee Chung-Chan , Chiu Cheng-Hsun , Chang Yu-Chung , Tsai Chi-Neu , Chao Hsun-Ching , Kong Shu-Sing , Chen Shih-Yen
Published: March 2020

Despite the development of vaccines in 2006, rotavirus is still a major cause of acute gastroenteritis worldwide. This study was performed to analyze the presence of circulating rotaviruses before and after the introduction of rotavirus vaccines to allow phylogenetic comparisons of vaccine strains in northern Taiwan.

Rotavirus genotyping and sequencing of rotavirus VP7 and VP4 PCR products were performed by Reverse Transcriptase Polymerase Chain Reaction and DNA autosequencing. Phylogenies were constructed by the neighbor-joining and maximum-likelihood methods using CLUSTAL W software included in the MEGA software package (version 6.0).

Between April 2004 and December 2012, a total of 101 rotavirus specimens from pediatric patients with acute gastroenteritis hospitalized in Chang Gung Children's Hospital were amplified, and their VP4 and VP7 sequences were determined. These 101 specimens consisted of 55 pre-vaccine strains (G1 [13, 23.6%], G2 [12, 21.8%], G3 [16, 29.1%], and G9 [14, 25.5%]) and 46 post-vaccine strains (G1 [25, 54.3%], G2 [12, 26.1%], G3 [5, 10.9%], and G9 [4, 8.7%]). The most common combination of the G and P types was G2P[4], accounting for 36% cases, followed by G9P[8] (25%), G1P[8] (20%), G3P[4] (15%), G3P[8] (10%), G1P[4] (5%), and G2P[8] (5%). Phylogenetic analysis showed that only the G1 and P[8] genotypes clustered in the same lineages with the rotavirus vaccine strains.

Based on our results, the inclusion of G9, modified G2 and G3 with target lineages, and the combination G2P[4] and G9P[8] in the rotavirus vaccines in Taiwan is warranted as a vaccination strategy.
Effect of subcutaneous needling on visual analogue scale, IgG and IgM in patients with lumbar disc herniation
Authors: Yang Jiangxia , Yang Chen , Wang Yajie , Li Ning , Yao Xingzhang , Yang Bowen , Xu Xia , Li Xingyong
Published: March 2020

Background:

Lumbar disc herniation (LDH) is a disease commonly seen in clinical practice. In the majority of such patients presenting in clinic, the symptoms can be relieved or even abolished after non-surgical treatment. Floating needle therapy has attracted considerable attention as a promising non-surgical technique to treat LDH, as demonstrated in previous studies. The purpose of the present study was to evaluate the outcomes of patients treated using this therapy in a single blind and randomized controlled trial by recording patient report questionnaires and objective test data, and to explore the feasibility and preliminary effects of floating needle therapy for patients with LDH.

Methods:

A total of 80 patients who fulfilled the inclusion criteria were randomly divided into a Fu's subcutaneous needling (FSN) group and an acupuncture group then treated in accordance with procedures appropriate for a single blind and randomized controlled trial. The FSN group received 12 FSN therapy sessions over a 3-week period, and the acupuncture group received acupuncture therapy at specified points using acupuncture needles. The principal measurements were scored using the visual analogue scale (VAS), Japanese Orthopedic Association (JOA) Score, and Oswestry disability index (ODI) before and 3 weeks after treatment. Secondary measurements included immune function IgG and IgM measurements performed at the same time and adverse reactions during treatment.

Results:

The results of this trial will be published on the website of China Clinical Trial Registration Center (http://www.chictr.org.cn/searchprojen.aspx) and in peer-reviewed journals or academic conferences.

Conclusions:

This study will explore the feasibility and preliminary effects of floating needle therapy for the treatment of patients with LDH.

Registration:

PROSPERO (registration number ChiCTR1900024045).