bluuebunny/crossref_metadata_2025 huggingface dataset:
Short article: Hormone therapy for severe gastrointestinal bleeding due to multiple angiodysplastic lesions
Authors: Torrente Iranzo Silvia , Sarasqueta Eizaguirre Cristina , Gonzalez Canalizo Valentin , Segues Merino Nerea M. , Ortega Rezola Paula , Wong Arteta Jhonatan , Medina Del Valle Andrea , Cosme Jimenez Ángel , Bujanda Luis
Published: January 2019

Objective

This study aims to assess the efficacy of hormone therapy in patients with severe gastrointestinal bleeding due to multiple angiodysplastic lesions.

Patients and methods

Between May 2010 and July 2017, we included 12 consecutive patients with anaemia or recurrent bleeding due to angiodysplasia who had been started on hormone therapy. The therapy given was a combination of levonorgestrel (between 0.10 and 0.25 mg) and ethinylestradiol (between 0.02 and 0.05 mg). We determined the mean number of transfusions required in the 6 months before and after the start of the treatment, as well as the mean haemoglobin levels, number of admissions for anaemia due to gastrointestinal bleeding and length of hospital stay in these periods.

Results

The mean age of patients included was 77.83 years old and 75% were male. The follow-up period after treatment initiation was 6 months. Of the 12 patients included, only one stopped the treatment owing to it not being effective. Overall, 83.3% of the patients reported subjective improvement. Furthermore, we found significant differences comparing before and after starting treatment regarding the mean number of transfusions (7±4.8 vs. 3.4±4.6; P=0.005), the mean haemoglobin levels (9.5±1.2 vs. 10.8±2.6; P=0.034) and the mean number of admissions (1.6±1.6 vs. 0.2±0.4; P=0.024). On the contrary, differences between pretreatment and post-treatment length of hospital stay were not significant.

Conclusion

Hormone therapy is a potentially useful therapeutic tool in patients with refractory bleeding and anaemia due to angiodysplasia.
Ocular radiation exposure during endoscopic retrograde cholangiopancreatography: a meta-analysis of studies
Authors: Menon Shyam , Mathew Ray , Kumar Mayur
Published: January 2019

Background

The increasing complexity involved in procedures requiring fluoroscopy such as endoscopic retrograde cholangiopancreatography (ERCP) results in heightened screening times with attendant radiation exposure during these procedures. There is increasing awareness of tissue-reactions to the lens of the eye due to radiation exposure, with evidence suggesting that threshold doses may be lower than previously considered.

Materials and methods

A literature search was performed to identify studies involving ERCP in which radiation exposure was reported. Demographic data and data on fluoroscopy time and ocular exposure were extracted. Fixed and random-effects meta-analyses were conducted.

Results

Twenty-six studies (8016 procedures) were identified, of which 10 studies (818 procedures) contained data on ocular exposure. The mean screening time per procedure was 3.9 min with a mean of three images captured per procedure. On fixed effects meta-analysis, the point estimate for the effective ocular exposure dose per procedure was 0.018 (95% confidence interval: 0.017–0.019) mSv. On random-effects meta-analysis, the effective ocular exposure dose was 0.139 (0.118–0.160) mSv (Q=2590.78, I
2=99.5, P<0.001). On comparing these point estimates to the ocular dose limit of 20 mSv/year, 1111 ERCPs (using fixed effects data) and 144 ERCPs (using random-effects data), with a mean of 627 ERCPs/individual/year, could deliver an ocular radiation dose equivalent to this dose limit.

Conclusion

Ocular radiation exposures in high-volume ERCP operators (>200 procedures/year) and operators performing complex ERCPs involving prolonged fluoroscopy, need to exercise caution in relation to ocular exposure. Shielding using lead-lined glasses may be reasonable in this group.
Metabolic Changes in Children that Received Chemotherapy
Authors: Soto-Vega Elena , Carrillo-Vicente Luis S. , Vázquez Juan C. , Pérez de Celis Herrero María C. , Muñoz-Pérez María J.
Published: January 2019

Cancer treatments are associated with short and long-effects. Epidemiological reports have revealed clinical features of metabolic syndrome (MS), obesity or overweight in young cancer survivors. The aim of the study was to examine the prevalence of unhealthy weight status and risk factors associated with MS related to chemotherapy. We study 52 pediatric cancer patients and analyze cholesterol, triglycerides, glycosylated hemoglobin, body mass index, waist circumference (WC), FINDRISC test. All the parameters were analyzed according to the percentile corresponding to sex and age of each child. The data show an important modification in weight, body mass index, and WC as in triglycerides, and cholesterol that could be associated with the development of MS. The variance analysis showed that the WC, triglycerides, and cholesterol are statistically correlated in our population. A follow-up for MS in children cancer survivor should be considered necessary.
Miscorrelation of Functional Outcome and Sociooccupational Status of Childhood, Adolescent, and Young Adult Generation With Bone and Soft Tissue Sarcoma Patients
Authors: Fujii Hiromasa , Honoki Kanya , Ishihara Takashi , Shinomiya Toshiaki , Tsukamoto Shinji , Kido Akira , Kondoh Yumiko , Kishi Shingo , Shima Midori , Tanaka Yasuhito
Published: January 2019

Few studies have examined the relationship between functional outcome and sociooccupational or psychological status in adolescent and young adults (AYA) generation and childhood sarcoma patients. We retrospectively analyzed clinical (prognostic and functional) and sociooccupational outcomes in 50 patients; 22 children aged under 14 years and 28 AYAs generation (15 to 29 y). There were 35 cases of bone sarcomas and 15 of soft tissue sarcomas. Limb-sparing surgery was performed in 30 of 37 extremity cases. The most prevalent problems among patients were as follows: limited activities; drop-out or delayed studies among high school and college students; limitation in job searching; and changes in social relationships. These problems were unaffected by limb-sparing. Regression analysis between functional and sociooccupational disability showed that the correlation coefficient was significant (P=0.005) in all limb-salvaged patients, but there was no significant correlation among osteosarcoma patients (P=0.07). These findings suggest that quality of life is a multidimensional measure: it depends on physical status, spiritual health, and social well-being of both patients and family members. To overcome the disadvantages of this type of disease, it is essential to provide comprehensive care at the earliest convenience using multidimensional approaches.
A 3-Year Retrospective Study of the Epidemiology of Acute Respiratory Viral Infections in Pediatric Patients With Cancer Undergoing Chemotherapy
Authors: Aydin Köker Sultan , Demirağ Bengü , Tahta Neryal , Bayram Nuri , Oymak Yeşim , Karapinar Tuba H. , Gözmen Salih , Düzgöl Mine , Erçan Bozyer Hazer , Vergin Canan , Devrim İlker
Published: January 2019

Background:

Acute viral respiratory infections are common causes of febrile episodes in children. There are still limited data about distribution of acute viral respiratory infections in children with cancer.

Objective:

The first aim of this study was to evaluate the viral etiology and seasonality of acute viral respiratory infection in pediatric patients with cancer in a 3-year study. Our second aim was to evaluate the impact of viral infections on delaying the patients’ chemotherapy or radiotherapy.

Materials and Methods:

This cross-sectional study was conducted from January 2014 to July 2017. Nasopharyngeal aspirates were analyzed in patients younger than 21 years with acute respiratory infections. Patients were treated in the Pediatric Hematology and Oncology Department of Dr. Behçet Uz Children’s Hospital with real-time multiplex polymerase chain reaction. Data were analyzed to determine the frequency and seasonality of infections. The χ2 or the Fisher exact tests were used.

Results:

A total of 219 samples of nasopharyngeal aspirates and blood were analyzed. The mean patient age was 76.8±59.3 months, with 46.3% female and 53.7% male children in a total of 108 patients. Of this total, 55% (60/108 cases) had multiple acute respiratory infections. Acute lymphoblastic leukemia (48.1%) was the most prevalent disease. The 3 most prevalent viruses were human rhinovirus (HRV) (33.1%), parainfluenza (PI) (18.7%), and coronavirus (CoV) (14.8%). In terms of the seasonal distribution of viruses, PI was most common in winter 2014, HRV in spring 2014, HRV in fall 2014, PI in winter 2015 and summer 2015, CoV in spring 2015, HRV in fall 2015, both influenza and HRV in winter 2016, both human metapneumovirus and bocavirus in spring 2016, HRV in summer 2016, both HRV and PI in fall 2016, both respiratory syncytial virus and influenza in winter 2017, HRV in spring 2017, and both HRV and adenovirus in summer 2017. The mean duration of neutropenia for patients with viral respiratory infection was 17.1±13.8 (range: 2 to 90) days. The mean duration of symptoms of viral respiratory infection was 6.8±4.2 (range: 2 to 31) days. A delay in chemotherapy treatment owing to viral respiratory infection was detected in 73 (33.3%) patients. The mean duration of delay in chemotherapy treatment was 9.6±5.4 (range: 3 to 31) days.

Conclusions:

In conclusion, we report our 3-year experience about the frequency and seasonality of respiratory viruses in children with cancer.
Watch and See Strategy in Selected Neuroblastoma Case Scenarios: Success and Limitations
Authors: Fawzy Mohamed , El Zomor Hossam , El Menawi Salma , Elkinaai Naglaa , Ahmed Gehad , Refaat Amal , Elahmadawy Mai , Zaghloul Mohamed
Published: January 2019

Neuroblastoma (NBL) in infants has the potential to regress/mature spontaneously. The literature showed some cases, subjected to initial observation, with reasonable outcome. Deferring/avoiding active treatment was investigated in selected favorable NBL cases. Patients enrolled on the watch and see strategy (W&S) had small primary tumor, localized stages 1 to 2, uncomplicated stage 4s, or stage 3. Tissue biopsy was not mandatory for infants below 6 months with localized mass. On progression, active intervention was indicated according to disease stage and risk after biological characterization. In total, 32 patients were enrolled on W&S strategy; male/female:2.6/1. Twelve had stages 1 to 2, 16 had stage 4s, and 4 were stage 3. Primary adrenal site was reported in 85% patients, and 65% patients had small mass (≤5 cm). Five-year overall and event-free survival were 100% and 80.9±7%, respectively, with a 43-month median follow-up duration. Spontaneous total/near total resolution of mass occurred in 50% patients. Median time to regression was 1.7 months, and 20.7 months until resolution. Only 19% patients witnessed progression; median time to progression was 4.8 months. W&S is a reasonable approach for localized and uncomplicated stages 3 and 4S NBL. Extended tumor size is a newly investigated entity in the present study. All progressive cases were safely rescued with 100% survival outcome.
Trametinib Toxicities in Patients With Low-grade Gliomas and Diabetes Insipidus: Related Findings?
Authors: Egan Grace , Hamilton Jill , McKeown Tara , Bouffet Eric , Tabori Uri , Dirks Peter , Bartels Ute
Published: January 2019

Low-grade gliomas (LGG) represent the most common form of primary central nervous system tumor arising in childhood. There is growing evidence to support the role of the mitogen-activated protein kinase pathway in driving tumor growth and MEK inhibitors are being investigated in clinical trials for refractory and unresectable LGGs. As MEK inhibitors progress through clinical trials, drug toxicities have been identified. We report on 2 pediatric patients with LGG and known diabetes insipidus who developed severe hyponatraemia associated with significant decreases in desmopressin doses after starting trametinib. We review potential mechanisms for this sodium imbalance by examining the interaction between MEK inhibition and aquaporin channel physiology. We recommend close monitoring of serum sodium levels and clinical status in patients with diabetes insipidus who have optic-hypothalamic gliomas and are started on treatment with MEK inhibitors.
Parental Strengths in Caring for Their Dying Child
Authors: Haley Janice Marie
Published: January 2019

Research conducted using the Haley Transcultural Strengths Assessment Interview Guide used in several studies has identified 11 sources of strength routinely utilized by parents caring for their child with intensive needs and child in hospice/palliative care. Results of past studies demonstrated this Strengths Guide (SG) interview to be an intervention bringing a heightened realization of the importance and utilization of one's inner strengths. The purpose of this study was to assess the long-term impact of this SG with a population of parents who participated in a previous study using the SG. This descriptive study was conducted using a quantitative tool, the Personal Strength Rating Scale, comparing the post-SG interview results with those results obtained 3 years later. Participants in this study were parents caring for a child receiving palliative/hospice care at home in Kenya. Results revealed the long-term retention of strengths following the SG interview 3 years previously was, for most sources of strength, equal to or greater than those obtained immediately following the SG.
Birth Tourism Among Chinese Women
Authors: Jaramillo Juanita , Goyal Deepika , Lung Carmen
Published: January 2019

Purpose:

To explore the reasons why some Chinese women travel to the United States on a tourist visa specifically to give birth, also known as birth tourism.

Study Design:

Qualitative, exploratory design.

Methods:

Using convenience and snowball sampling, Chinese women were recruited from the waiting rooms of obstetricians known to care for birth tourists. Participants completed demographic data and provided answers to questions about their reasons for traveling to give birth and their birth experience while in the United States. Qualitative content analysis methods were used to extract themes from participant narratives.

Results:

Twelve married, college-educated women, aged between 26 and 39 years, self-identifying as birth tourists from China participated in this study. Content analysis revealed two themes: (1) positive perceptions of childbirth in the United States; and (2) securing a future for their child.

Clinical Implications:

Study findings suggest Chinese birth tourists come to the United States for a better childbirth experience, and to secure future opportunities for their children. Nurses should be aware of the current political climate on immigration and birth tourism in order to promote a safe and judgment-free environment when providing care to this unique population of women.
Association Between Lactation and Postpartum Blood Pressure in Women with Preeclampsia
Authors: Burgess Adriane , McDowell Wendy , Ebersold Stacie
Published: January 2019

Purpose:

Preeclampsia affects 3% to 8% of all pregnancies. There are two distinct subtypes; early- (<34 weeks) and late-onset (≥34 weeks). Each subtype is associated with increased risk of cardiovascular disease. Lactation has been shown to improve cardiovascular outcomes. The purpose of this study was to describe lactation practices among women with each subtype of preeclampsia and determine the association between lactation and blood pressure at the initial postpartum visit.

Study Design and Methods:

This retrospective cohort study included 246 subjects; 120 early- and 126 with late-onset preeclampsia who gave birth to live singleton newborns at a large suburban tertiary referral center in south central Pennsylvania between January 2012 and June 2016. Electronic health records were reviewed and data abstracted. Univariate and bivariate analyses were conducted.

Results:

There was a significant difference in breastfeeding intent (p = .004) as well as rate of breastfeeding at maternal hospital discharge (p< .001) by preeclampsia subtype. However, there was no difference in rate of breastfeeding at the initial postpartum visit (p = .21) between subtypes. There was a significant difference in systolic (p = .03) and diastolic (p = .04) blood pressure between those breastfeeding and those who were not breastfeeding at the initial postpartum visit.

Clinical Implications:

Healthcare providers should provide women with preeclampsia clear and consistent messaging about importance of breastfeeding during pregnancy and the postpartum period on its association with improved neonatal outcomes, and specifically education on the cardioprotective benefit of sustained lactogenesis.
Neural Responses to Faces of Attachment Figures and Unfamiliar Faces
Authors: Petrowski Katja , Wintermann Gloria-Beatrice , Hübner Thomas , Smolka Michael N. , Donix Markus
Published: January 2019

The neural response to faces of attachment figures compared with unfamiliar faces still remains elusive. In particular, the modulation of the neural response by the organized (secure, insecure) compared with disorganized attachment representation of the subject investigated is unknown. For the present study, 38 healthy participants (age range, 21–71 years) were recruited. Three attachment groups (secure, n = 14; insecure, n = 15; disorganized, n = 9) were assessed using the Adult Attachment Projective. The participants were shown pictures of the faces of attachment figures (romantic partner/parents) and unfamiliar faces in a blocked factorial design, using functional magnetic resonance imaging. Showing pictures of attachment figures activated parts of a neural social judgment network, important for inferring others' affective and cognitive mental states (e.g., inferior parietal lobe/superior temporal gyrus) in securely attached healthy individuals. In contrast, disorganized attached individuals with the experience of unresolved attachment trauma in their biography showed deactivations in these areas.
How a Public Health Goal Became a National Law
Authors: Schwartz Colin , Wootan Margo G.
Published: January 2019

This case study provides insights into policy strategy and advocacy best practices that resulted in passage of the Healthy, Hunger-Free Kids Act of 2010, a public health law that resulted in improvements to school foods and beverages across the country. Congress reauthorizes child nutrition programs such as the National School Lunch Program and School Breakfast Program every 5 years. The Healthy, Hunger-Free Kids Act of 2010 is the legislation that reauthorized the child nutrition programs through September 30, 2015, and continues in effect today. We conducted stakeholder interviews and reviewed the legislative and regulatory history of the Healthy, Hunger-Free Kids Act of 2010 and advocates’ files. We formed an external advisory committee which helped to develop the interview questions and list of interviewees and reviewed the content of the case study. This case study focuses on the provisions that address the nutritional quality of school meals, snacks, and beverages and covers the period from 2004 to 2016. Overall, the case study demonstrates a number of key lessons to help inform other nutrition and public health policy initiatives, as well as continued implementation and defense of school nutrition. For instance, how advocates used research to develop and advocate for policy change, compromises that were needed to advance the policies, changes in attitudes about school food policy over time, framing and messaging, the role of state and local policy that contributed to national change, and how challenges were resolved between stakeholders.
Loss of Heterozygosity (LOH) at 17p13 and 22q13 are Shared by Breast and Thyroid Carcinomas for Metastasis
Authors: Lin Xiaoqi , Finkelstein Sydney D. , Silverman Jan F.
Published: January 2019

Many genomic mutations have been identified to be related to the metastasis of malignancies from various primary sites. In this study, we attempted to identify the loss of heterozygosity (LOH) that might be involved in metastasis of breast ductal carcinoma (BDC) and papillary thyroid carcinoma (PTC). We retrieved 14 BDC cases with metastasis and 19 BDC cases without metastasis as well as 12 PTC cases with metastasis and 14 PTC cases without metastasis. Analysis of 13 polymorphic microsatellite repeat markers targeting 1p34-36, 3p24-26, 9p21, 10q23, 17p13, 17q21, 21q22, and 22q13 was performed on DNA isolated from primary tumors. The results showed that LOH at 17p13 and 22q13 was shared by both BDC and PTC for metastasis. More detailed studies to identified genes in these shared loci of LOH may provide further insight into the molecular mechanisms underlying metastases in these 2 tumor types, and possibly other malignancies as well.
Poly D,L-Lactide-Co-Glycolic Acid Grafting Material in Sinus Lift
Authors: Mastrangelo Filiberto , Quaresima Raimondo , Sebastianelli Ilaria , Dedola Alberto , Kuperman Shiri , Azzi Lorenzo , Mortellaro Carmen , Muttini Aurelio , Mijiritsky Eitan
Published: January 2019

The poly D,L-lactide-co-glycolic acid (PLGA) is a copolymer used in many therapeutic devices for its high rates of biodegradability and biocompatibility. The principal aim of the research was to evaluate the new bone formation, after 16 (T1) and 28 weeks (T2), in sheep maxillary sinus lift in vivo model using PLGA.

Computerized tomography analysis, X-ray microanalysis, and scanning electron microscope analysis of secondary electrons (SE) and the backscattered electrons (BSE) of the samples were detected.

After 28 weeks, the computed tomography analysis showed a 22% increase of UH density in the grafting areas. The X-ray microanalysis of the samples showed calcium and phosphorus increase at T1 and T2 follow-up period and the carbon and oxygen concentration decrease. The SE evaluation showed a rapid superficial resorption of the biomaterials at T1 and a completely bone reorganization of biomaterial at T2. The BSE analysis confirmed the SE data and showed the direct and intimate contact between bone and PLGA with a higher calcification in T2 compared to T1.

Certainly, still other experiments and a larger number of samples will be necessary to be analyzed to determine the behavior of the PLGA in the bone regeneration; however, the PLGA used in maxillary sinus lift animal model, seem to promote new bone formation that continues increase at 28 weeks after grafting.
Importance of Three-Dimensional Modeling in Cranioplasty
Authors: Aydin Hasan Emre , Kaya Ismail , Aydin Nevin , Kizmazoglu Ceren , Karakoc Feridun , Yurt Hidayet , Hüsemoglu Resit Bugra
Published: January 2019

Cranioplasty is a reconstruction operation made to protect intracranial structures. It is applied for the closure of bone defects occurring due to causes such as trauma, tumor, infection, and infarct. Many different products changing from autologous bone grafts to synthetic materials are used for cranioplasty. Three-dimensional printers that are among the popular innovations of today are used gradually more in medical area as in every field of life and they make the surgical operation easier. When customizable materials are combined with technology, the authors come across successful results and less complications. The aim of the authors’ study was to show a 3-dimensional modeling method in 2 patients the authors applied cranioplasty and the advantages provided by this method for the surgeon and the patient.
Ischemic Time in Free-Flap Surgery With Arteriovenous Bundle Interposition Graft: Comparison of Two Anastomosis Sequences
Authors: Kim Yong-Ha , Kim Jae-Won , Kim Tae-gon , Lee Jun-Ho , Chung Kyu Jin , Yeo Chi-Ho
Published: January 2019

Background:

During free-tissue transfer for scalp reconstruction, pedicle lengthening may be required when finding a recipient vessel is difficult because of defects from previous surgery. Arteriovenous (AV) bundle interposition grafting is a good option. This study compared 2 sequences of AV bundle interposition grafting when flap pedicle lengthening is needed.

Methods:

Two anastomosis methods were used. In the recipient lengthening type (R type), the flap was harvested and the AV bundle was harvested from a donor vessel for lengthening. In the flap lengthening type (F type), the flap was harvested first. Next, in contrast to that in the R type method, the authors performed anastomosis with a flap pedicle and bundle before the AV bundle was harvested.

Results:

The mean flap pedicle length was 8.75 cm (range, 5–11 cm). The AV bundle had a mean length of 9.25 cm (range, 6–13 cm), meaning that 13 cm of additional pedicle length can be added. The mean length of the extended vascular pedicle was 18 cm (range, 14–23 cm).

Conclusion:

This study compared the results of F type and R type AV bundle interposition grafting. The F type allowed easy monitoring of the anastomosis of the flap pedicle and ensured flap stability by reducing continuous ischemic time. Finally, this study confirmed the efficacy and safety of the AV bundle interposition graft in scalp reconstruction.
Predictors of Adverse Outcomes in the Management of Mandibular Fractures
Authors: Daar David A. , Kantar Rami S. , Cammarata Michael J. , Rifkin William J. , Alfonso Allyson R. , Wilson Stelios C. , Rodriguez Eduardo D.
Published: January 2019

Background:

Mandibular fractures are the most common isolated facial fractures in the United States. Various risk factors have been associated with increased rates of postoperative complications. However, national outcome reports are limited and data are conflicting. Using a national multi-institutional database, the authors sought to analyze 30-day outcomes after mandibular fracture repair and determine risk factors for complications, readmission, and reoperation.

Methods:

Retrospective review of the American College of Surgeons National Surgical Quality Improvement database was performed to identify patients undergoing surgical treatment of mandibular fractures between 2010 and 2015 using current procedural terminology codes. Primary outcomes included: wound complications, overall complications, as well as readmission and reoperation rates. Multivariate regression analysis was performed to adjust for confounders.

Results:

A total of 953 patients were eligible for analysis. Mean patient age was 34.5 years, 84% were males, and 50% were active smokers. Wound complications, overall complications, 30-day reoperation, and readmission occurred in 4.0%, 7.9%, 2.2%, and 33% of patients, respectively. Age was a significant risk factor for 30-day readmission (odds ratio [OR] = 1.06, P = 0.01), reoperation (OR = 1.05, P = 0.01), and overall complications (OR = 1.03, P = 0.02) on multivariate analysis, and smoking was a significant risk factor for 30-day reoperation (OR = 4.86, P = 0.03).

Conclusion:

The analysis identified age as an independent risk factor for readmission, reoperation, and overall complications. Smokers were also nearly 5 times as likely to undergo additional surgery. This is particularly important given that over half of patients were active smokers, highlighting the importance of perioperative patient education and smoking cessation within this population.
An Unreported Complication After Fetoscopic Myelomeningocele Closure
Authors: Ewing Donald C. , Dempsey Robert , Belfort Michael A. , Olutoye Oluyinka O. , Whitehead William E. , Hollier Larry H. , Buchanan Edward P.
Published: January 2019

Myelomeningocele (MMC) is a type of open neural tube defect characterized by exposure of the spinal cord through a defect in the skin and posterior hindbrain herniation through the foramen magnum. Outcomes vary but common morbidities include paraplegia, hydrocephalus, neurogenic bladder, scoliosis, and tethered cord. Fetal surgery, although not a cure, has been shown to decrease the risk of associated morbidity.

A study of a neonate born at 39 5/7 weeks gestation status-post in utero fetoscopic MMC repair at 24 weeks gestation was presented in this study along with a concise review of the literature. Fasciocutaneous advancement flaps were made in utero to facilitate a tension-free midline closure and were left to heal secondarily. The neonate underwent uncomplicated spontaneous vaginal delivery but was noted to have a right flank hernia through the relaxing incision in addition to delayed healing of the left relaxing incision. According to authors, iatrogenic flank hernia following fetoscopic MMC repair has not been previously reported in the literature. Both defects were repaired primarily in layers with undermining and retroperitoneal domain was reestablished with imbrication of the overlying muscle on the right side. The authors report their experience to contribute to the scarce literature describing postnatal complications arising from this novel procedure.
Successful Reconstruction of Agnathia by Intraoral Expansion and Free Vascularized Fibula Flap
Authors: Ishida Kunihiro
Published: January 2019

A successful surgical reconstruction case of a 9-year-old boy with agnathia is presented. The reconstruction was preceded by intraoral expansion of the oral lining and submandibular skin. Four months after initiation of the expansion, the mandible was reconstructed by free vascularized fibula osteocutaneous flap. The 14.5 cm segment of harvested fibula was osteotomized in 4 places to build a replica of the mandible with 3 cm ascending ramus, 3.5 cm body and 1.5 cm symphysis, fixated by titanium micro plating system. The reconstructed mandible was placed between the expanded oral lining and the submandibular skin, with its condylar head placed under the glenoid fossa. After reconstruction, he looked more natural with a chin projection, which he never had. His mother was very happy to see his son being able to show his feeling with facial expression. At last follow-up, he is 14 years and 10 months old, 5 years and 2 months after surgery leading a happy life with his family.
Use of Continuous EEG Monitoring in Children Presenting With Encephalopathy Following Convulsive Status Epilepticus
Authors: Yuliati Asri , Weber Amanda R. B.
Published: January 2019

Purpose:

The Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society recommends continuous EEG (cEEG) monitoring in patients with persistent encephalopathy following convulsive status epilepticus. This recommendation is based on data, which correlates prolonged nonconvulsive seizures and nonconvulsive status epilepticus with worse neurologic outcomes. Compliance with these recommendations may be limited by barriers such as inadequate resource and staff availability. We surveyed members of the Child Neurology Society to determine the barriers that prevent them from appropriately using cEEG, and how they have successfully overcome such obstacles.

Methods:

A survey was electronically distributed to Child Neurology Society members, which assessed demographics, current clinical practices, and cEEG utilization in critically ill children, with an emphasis on resource availability and strategies to overcome resource limitations.

Results:

One hundred forty-six physicians from Child Neurology Society completed the survey. Fifty-three (39.8%) respondents use cEEG to detect nonconvulsive seizures/nonconvulsive status epilepticus in most (>90%) of their pediatric patients who present with persistent encephalopathy following convulsive status epilepticus. Forty-four respondents (34.4%) perceive barriers to performing cEEG monitoring, and 107 (84.9%) of the respondents are implementing changes to overcome barriers. The two most commonly reported barriers included inadequate availability of technicians and EEG machines. The most common changes included hiring new EEG technologists and purchasing new machines. Other barriers included identification of appropriate patients and availability of remote EEG monitoring capabilities.

Conclusions:

Barriers, such as resource limitations, prevent compliance with the American Clinical Neurophysiology Society cEEG monitoring recommendations. Recognizing common limitations and learning from each other about successful strategies to overcome these barriers may improve care.
Large scale analysis of the diversity and complexity of the adult spinal cord neurotransmitter typology
Authors: Pedroni Andrea , Ampatzis Konstantinos
Published: January 2019

The development of nervous system atlases is a fundamental pursuit in neuroscience, since they constitute a fundamental tool to improve our understanding of the nervous system and behavior. As such, neurotransmitter maps are valuable resources to decipher the nervous system organization and functionality. We present here the first comprehensive quantitative map of neurons found in the adult zebrafish spinal cord. Our study overlays detailed information regarding the anatomical positions, sizes, neurotransmitter phenotypes, and the projection patterns of the spinal neurons. We also show that neurotransmitter co-expression is much more extensive than previously assumed, suggesting that spinal networks are more complex than first recognized. As a first direct application of this atlas, we investigated the neurotransmitter diversity in the putative glutamatergic V2a interneuron assembly of the adult zebrafish spinal cord. These studies shed new light on the diverse and complex functions of this important interneuron class in the neuronal interplay governing the precise operation of the central pattern generators.
Characterizing the Dynamical Complexity underlying Meditation
Authors: Escrichs Anira , Sanjuan Ana , Atasoy Selen , López-González Ane , Garrido César , Càmara Estela , Deco Gustavo
Published: January 2019

Over the past 2,500 years, contemplative traditions have explored the nature of the mind using meditation. More recently, neuroimaging research on meditation has revealed differences in brain function and structure in meditators. Nevertheless, the underlying neural mechanisms are still unclear. In order to understand how meditation shapes global activity through the brain, we investigated the spatiotemporal dynamics across the whole-brain functional network using the Intrinsic Ignition Framework. Recent neuroimaging studies have demonstrated that different states of consciousness differ in their underlying dynamical complexity, i.e., how the broadness of communication is elicited and distributed through the brain over time and space. In this work, controls and experienced meditators were scanned using functional magnetic resonance imaging (fMRI) during resting-state and meditation (focused attention on breathing). Our results evidenced that the dynamical complexity underlying meditation shows less complexity than during resting-state in the meditator group but not in the control group. Furthermore, we report that during resting-state, the brain activity of experienced meditators showed higher metastability (i.e., a wider dynamical regime over time) than the one observed in the control group. Overall, these results indicate that the meditation state operates in a different dynamical regime than the resting-state.
Causal relevance of obesity on the leading causes of death in women and men: A Mendelian randomization study
Authors: Censin Jenny C , Bovijn Jonas , Ferreira Teresa , Pulit Sara L , Mägi Reedik , Mahajan Anubha , Holmes Michael V , Lindgren Cecilia M
Published: January 2019

Background

Obesity traits are causally implicated with risk of cardiometabolic diseases. It remains unclear whether there are similar causal effects of obesity traits on other non-communicable diseases. Also, it is largely unexplored whether there are any sex-specific differences in the causal effects of obesity traits on cardiometabolic diseases and other leading causes of death. We therefore tested associations of sex-specific genetic risk scores (GRSs) for body mass index (BMI), waist-hip-ratio (WHR), and WHR adjusted for BMI (WHRadjBMI) with leading causes of mortality, using a Mendelian randomization (MR) framework.

Methods and Findings

We constructed sex-specific GRSs for BMI, WHR, and WHRadjBMI, including 565, 324, and 338 genetic variants, respectively. These GRSs were then used as instrumental variables to assess associations between the obesity traits and leading causes of mortality using an MR design in up to 422,414 participants from the UK Biobank. We also investigated associations with potential mediators and risk factors, including smoking, glycemic and blood pressure traits. Sex-differences were subsequently assessed by Cochran’s Q-test (Phet).

Up to 227,717 women and 194,697 men with mean (standard deviation) age 56.6 (7.9) and 57.0 (8.1) years, body mass index 27.0 (5.1) and 27.9 (4.2) kg/m2and waist-hip-ratio 0.82 (0.07) and 0.94 (0.07), respectively, were included. Mendelian randomization analysis showed that obesity causes coronary artery disease, stroke (particularly ischemic), chronic obstructive pulmonary disease, lung cancer, type 2 and 1 diabetes mellitus, non-alcoholic fatty liver disease, chronic liver disease, and acute and chronic renal failure. A 1 standard deviation higher body mass index led to higher risk of type 2 diabetes in women (OR 3.81; 95% CI 3.42-4.25, P=8.9×10−130) than in men (OR 2.78; 95% CI 2.57-3.02, P=1.0×10−133, Phet=5.1×10−6). Waist-hip-ratio led to a higher risk of chronic obstructive pulmonary disease (Phet=5.5×10−6) and higher risk of chronic renal failure (Phet=1.3×10−4) in men than women.

A limitation of MR studies is potential bias if the genetic variants are directly associated with confounders (pleiotropy), but sensitivity analyses such as MR-Egger supported the main findings. Our study was also limited to people of European descent and results may differ in people of other ancestries.

Conclusions

Obesity traits have an etiological role in the majority of the leading global causes of death. Sex differences exist in the effects of obesity traits on risk of type 2 diabetes, chronic obstructive pulmonary disease, and renal failure, which may have implications on public health.
Comprehensive identification of survival-associated genes for cancers
Authors: Liu Hongde , Luo Kun , Li Huamei , Sun Xiao
Published: January 2019

Prognostic signature is important in estimating cancer risk, subtyping cancer, and planning treatment. A single gene as a prognostic marker would facilitate the development of a clinical test. Here we showed that the number of prognostic and diagnostic genes differ greatly across cancers. By considering both the survival difference and the fold change of expression in cancer, we revealed the prognostic genes for each cancer and found twenty two genes with both diagnostic and prognostic capacity. The universal prognostic genes (CDC20, CDCA8, ASPM, ERCC6L, and GTSE1) mainly function in the spindle assembly checkpoint, and show more statistical links to mutated pathways, suggesting that expression of these genes can be altered by mutations from many pathways. Briefly, we systematically identified the prognostic genes and revealed the associations between the prognostic genes and genes mutated in cancer.
Keywords: Prognostic gene; Cancer; Mutation; Diagnosis
The pattern of Comorbidities and Associated Risk Factors among Colorectal Cancer Patients in Spain: CoMCoR study
Authors: Luque-Fernandez Miguel Angel , Redondo-Sánchez Daniel , Rodríguez-Barranco Miguel , Carmona-García Ma Carmen , Marcos-Gragera Rafael , Sánchez María José
Published: January 2019

Colorectal cancer is the second most frequently diagnosed cancer in Spain. Cancer treatment and outcomes can be influenced by tumor characteristics, patient general health status and comorbidities. Numerous studies have analyzed the influence of comorbidity on cancer outcomes, but limited information is available regarding the frequency and distribution of comorbidities in colorectal cancer patients, particularly elderly ones, in the Spanish population. We developed a population-based high-resolution cohort study of all incident colorectal cancer cases diagnosed in Spain in 2011 to describe the frequency and distribution of comorbidities, as well as tumor and healthcare factors. We then characterized risk factors associated with the most prevalent comorbidities, as well as dementia and multimorbidity, and developed an interactive web application to visualize our findings. The most common comorbidities were diabetes (23.6%), chronic obstructive pulmonary disease (17.2%), and congestive heart failure (14.5%). Dementia was the most common comorbidity among patients aged ≥75 years. Patients with dementia had a 30% higher prevalence of being diagnosed at stage IV and the highest prevalence of emergency hospital admission after colorectal cancer diagnosis (33%). Colorectal cancer patients with dementia were nearly three times more likely to not be offered surgical treatment. Age ≥75 years, obesity, male sex, being a current smoker, having surgery more than 60 days after cancer diagnosis, and not being offered surgical treatment were associated with a higher risk of multimorbidity. Patients with multimorbidity aged ≥75 years showed a higher prevalence of hospital emergency admission followed by surgery the same day of the admission (37%). We found a consistent pattern in the distribution and frequency of comorbidities and multimorbidity among colorectal cancer patients. The high frequency of stage IV diagnosis among patients with dementia and the high proportion of older patients not being offered surgical treatment are significant findings that require policy actions.
Digital phenotyping by consumer wearables identifies sleep-associated markers of cardiovascular disease risk and biological aging
Authors: Teo Jing Xian , Davila Sonia , Yang Chengxi , Pua Chee Jian , Yap Jonathan , Tan Swee Yaw , Sahlén Anders , Chin Calvin Woon-Loong , Teh Bin Tean , Rozen Steven G , Cook Stuart Alexander , Yeo Khung Keong , Tan Patrick , Lim Weng Khong
Published: January 2019

Despite growing adoption of consumer wearables, the potential for sleep metrics from these devices to contribute to sleep-related biomedical research remains largely uncharacterized. Here we analyze sleep tracking data, along with questionnaire responses and multi-modal phenotypic data, generated from 482 normal volunteers. First, we provide a detailed comparison of wearable-derived and self-reported sleep metrics, particularly total sleep time (TST) and sleep efficiency (SE). We then identified demographic, socioeconomic and lifestyle factors associated with wearable-derived sleep duration. We also analyzed our multi-modal phenotypic data and showed that wearable-derived TST and SE are associated with various cardiovascular disease risk markers, whereas self-reported measures were not. Using whole-genome sequencing data, we estimated leukocyte telomere length and showed that volunteers with insufficient sleep also exhibit premature telomere attrition. Our study highlights the potential for sleep metrics generated by consumer wearables to provide novel insights into data generated from population cohort studies.
The native European Aedes geniculatus mosquito species can transmit Chikungunya virus
Authors: Prudhomme Jorian , Fontaine Albin , Lacour Guillaume , Gantier Jean-Charles , Diancourt Laure , Velo Enkelejda , Bino Silva , Reiter Paul , Mercier Aurélien
Published: January 2019

Europe is the world’s leading tourism destination and is receiving every year travelers from areas with active arbovirus transmission. There is thus a threat of mosquito-borne virus emergence in Europe due to the presence of the invasive mosquito vector Aedes albopictus. Little attention has been paid about the possible role of indigenous mosquito species as vectors of emerging arboviruses. Here, we assessed the vector competence dynamic of Ae. geniculatus, a European anthropophilic mosquito species, for chikungunya virus (CHIKV) in comparison with Ae. albopictus.

We revealed that Ae. geniculatus was highly susceptible to CHIKV infection and could transmit the virus. By specifically exploring the vector competence dynamic in both mosquito species, we revealed that the cumulative distribution of CHIKV incubation period in Ae. geniculatus was delayed by several days as compared to Ae. albopictus.

Our results strengthen the importance of considering indigenous species as potential vectors for emerging arboviruses. They also revealed the importance of considering variation in arbovirus dissemination or transmission dynamics in mosquitoes when performing vector competence assays. We will discuss the implications of our results on a CHIKV outbreak dynamic in a theoretical framework.

Sentence summary

The European mosquito Aedes geniculatus is highly susceptible to CHIKV infection but disseminate and transmit the virus several days later than Ae. albopictus.
Genome-wide Association Study of Alcohol Consumption and Use Disorder in Multiple Populations (N = 274,424)
Authors: Kranzler Henry R. , Zhou Hang , Kember Rachel L. , Smith Rachel Vickers , Justice Amy C. , Damrauer Scott , Tsao Philip S. , Klarin Derek , Rader Daniel J. ,   Regeneron Genetics Center Research Team, Cheng Zhongshan , Tate Janet P. , Becker William C. , Concato John , Xu Ke , Polimanti Renato , Zhao Hongyu , Gelernter Joel ,   on behalf of the VA Million Veteran Program
Published: January 2019

Although alcohol consumption level and alcohol use disorder (AUD) diagnosis are both moderately heritable, their genetic risks and overlap are not well understood. We conducted genome-wide association studies of these traits using longitudinal Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) scores (reflecting alcohol consumption) and AUD diagnoses from electronic health records (EHRs) in a single, large multi-ancestry Million Veteran Program sample. Meta-analysis across population groups (N = 274,424) identified 18 genome-wide significant loci, 5 of which were associated with both traits and 13 with either AUDIT-C (N = 8) or AUD (N = 5). A significant genetic correlation between the traits reflects this overlap. However, downstream analyses revealed biologically meaningful points of divergence. Cell-type group partitioning heritability enrichment analyses indicated that central nervous system was the most significant cell type for AUDIT-C and the only significant cell type for AUD. Polygenic risk scores (PRS) for both traits were associated with alcohol-related disorders in two independent samples. Genetic correlations for 188 non-alcohol-related traits were significantly different for the two traits, as were the phenotypes associated with the traits’ polygenic risk scores. We conclude that EHR-derived, longitudinal, repeated measures of alcohol consumption level and AUD diagnosis can facilitate genetic discovery and help to elucidate the relationship between drinking level and AUD risk. Finally, although heavy drinking is a key risk factor for AUD, it is not a sufficient cause of the disorder.