bluuebunny/crossref_metadata_2025 huggingface dataset:
Anti-tumor immunity via the superoxide-eosinophil axis induced by a lipophilic component ofMycobacteriumlipomannan
Authors: Ito Toshihiro , Hirahara Kiyoshi , Onodera Atsushi , Koyama-Nasu Ryo , Yano Ikuya , Nakayama Toshinori
Published: September 2017

Mycobacterium bovis Bacille Calmette–Guérin (BCG) has been shown to possess potent anti-tumor activity particularly in various animal models, while the cellular and molecular mechanisms underlying its activity are not well understood. We found that lipomannan (BCG-LM), a lipophilic component of the mycobacterial cell envelope, specifically inhibits tumor growth and induces the infiltration of eosinophils at local tumor invasion sites. In contrast, neither lipoarabinomannan (BCG-LAM) nor the cell wall of Mycobacterium bovis BCG (BCG-CW) exerted anti-tumor immunity. BCG-LM enhances cytotoxic activity of eosinophils via the increased production of superoxide. Global transcriptomic analyses of BCG-LM-pulsed dendritic cells identified C-C motif ligand (CCL) 5 as a crucial chemokine for the anti-tumor immunity induced by BCG-LM, indicating that CCL5 plays an important role for the accumulation of eosinophils in the tumor microenvironment. Furthermore, BCG-LM and memory Th2 cells exerted a synergetic effect on tumor progression by cooperatively enhancing the eosinophil function. Thus, this study revealed an un-identified BCG-LM-mediated anti-tumor mechanism via superoxide produced by infiltrated eosinophils in the tumor microenvironment. Since BCG-LM activates this unique pathway, it may have potent therapeutic potential as immune cell therapy for cancer patients.
The Effect of Metformin on Mortality Among Diabetic Cancer Patients: A Systematic Review and Meta-analysis
Authors: Cao Xun , Wu Yaopan , Wang Jing , Liu Kuiyuan , Wang Xin
Published: September 2017

Background

Most data suggest that cancer patients with diabetes have worse outcomes, which may be reversed with metformin. Metformin might modulate the clinical outcomes of diabetic cancer patients. We performed a systematic review and meta-analysis based on published studies over the past five years to summarize the effects of metformin on diabetic cancer patients.

Methods

We systematically searched for studies that were published over the past five years. Then, we evaluated these studies for inclusion and extracted the relevant data. The summary risk estimates for the association between metformin treatment and all-cause mortality (ACM) and cancer-specific mortality (CSM) were analyzed using random or fixed-effects models. Stratified analyses by cancer site and country were also conducted.

Results

Based on the 42 studies included in our analysis (37 015 diabetic cancer patients), we found a significant benefit associated with metformin treatment on survival corresponding to 27% and 26% reductions in ACM (hazard ratio [HR] = 0.73, 95% confidence interval [CI] = 0.68 to 0.79, P < .001) and CSM (HR = 0.74, 95% CI = 0.64 to 0.86, P < .001), respectively. The ACM rates for colorectal cancer, endometrial cancer, breast cancer, prostate cancer, and ovarian cancer showed significant benefits associated with metformin treatment in our stratified analyses by cancer site. Stratified analyses by cancer site also showed a significant reduction in CSM for breast cancer. This association between metformin treatment and reduced CSM for diabetic breast cancer patients was also observed in our country subgroup analyses.

Conclusions

We found an association between metformin exposure and reduced ACM and CSM in diabetic patients with cancer. Our findings suggest that metformin treatment could be an effective treatment option for diabetic cancer patients.
Ark of the Covenant
Authors: Eichler Raanan
Published: September 2017

The ark of the covenant was, according to the Hebrew Bible (Oxford Bibliographies article in Biblical Studies “Biblical Canon”), a portable wooden chest that occupied a central position in ancient Israelite worship. The various biblical passages pertaining to the ark indicate that it was thought by their authors to contain the documentation of a covenant (Oxford Bibliographies article in Biblical Studies “Covenant”) between the Israelites and their Deity yhwh (Oxford Bibliographies article in Biblical Studies “God, Ancient Israel”), to mark that Deity’s presence, and to have been located in the holiest part of the wilderness tabernacle (Oxford Bibliographies article in Biblical Studies “Temples and Sanctuaries”) and later of Solomon’s temple (Oxford Bibliographies article in Biblical Studies “Temples and Sanctuaries”) in Jerusalem.
Media Events
Authors: Sonnevend Julia
Published: September 2017

“Media event” seems like a concept that has been around forever, but it is a relatively new invention in media research. Its origins can be found in Daniel Dayan and Elihu Katz’s canonical book titled Media Events: The Live Broadcasting of History, published in 1992 by Harvard University Press. The event that inspired Dayan and Katz was the visit of Egyptian president Anwar el-Sadat to Israel in 1977. While seemingly only a ceremonial media spectacle, this first official visit from an Arab country to Jerusalem in fact led to a (so far) lasting peace between Israel and Egypt. It was a powerful example of successful media diplomacy that captured the imagination of Dayan and Katz, so much so that they spent the next decade trying to grasp the magic of events in media. In Dayan and Katz’s strict taxonomy, an event would qualify for inclusion as a “media event” only if it fulfilled eight requirements. It had to (1) be broadcast live by television, (2) constitute an interruption of everyday life and everyday broadcasting, (3) be preplanned and scripted, and (4) be viewed by a large audience. There should also be (5) a normative expectation that viewing was obligatory and (6) a reverent, awe-filled narration, and the event had to be (7) integrative of society and (8) mostly conciliatory. Dayan and Katz presented three basic scripts of media events. These were contests (for instance, the World Cup, the Olympic Games, and the presidential debates), conquests (such as the landing on the moon and Pope John Paul II’s visit to Communist Poland), and coronations (for example, the funerals of President Kennedy and Indira Gandhi, the coronation of Elizabeth II, and the royal wedding of Charles and Diana). Overall, Dayan and Katz achieved a genuinely new understanding of events in media, inspiring further theoretical developments and empirical studies in communication studies and other disciplines. Media Events: The Live Broadcasting of History was published after the fall of the Berlin Wall, in a particularly hopeful time of history. Traumatic events, especially the 9/11 attacks, prompted many scholars, including Dayan and Katz, to revise the media event concept to include nonceremonial, unplanned events—for instance, wars, disasters, and terrorist attacks as covered by a wide variety of “new” and “old” media.
Development of a Whole-Task Simulator for Carotid Endarterectomy
Authors: Santangelo Gabrielle , Mix Doran , Ghazi Ahmed , Stoner Michael , Vates G Edward , Stone Jonathan J
Published: September 2017

BACKGROUND

Surgical education relies on operative exposure with live patients. Carotid endarterectomy (CEA) demands an experienced surgeon with a very low complication rate. The high-risk nature of this procedure and the decline in number of CEAs performed annually has created a gap in residency training.

OBJECTIVE

To develop a high-fidelity whole-task simulation for CEA that demonstrates content, construct, and face validity.

METHODS

Anatomically accurate models of the human neck were created using multilayered poly-vinyl alcohol hydrogels. Graded polymerization of the hydrogel was achieved by inducing crosslinks during freeze/thaw cycles, stiffening the simulated tissues to achieve realistic tactile properties. Venous bleeding was simulated using pressure bags and a ventricular assistive device created pulsatile flow in the carotid. Ten surgeons performed the simulation under operating room conditions, and metrics were compared among experience levels to determine construct validity. Participants completed surveys about realism and usefulness to evaluate face validity.

RESULTS

A significant difference was found in operative measures between attending and resident physicians. The mean operative time for the expert group was 63.6 min vs 138.8 for the resident group (P = .002). There was a difference in mean internal carotid artery clamp time of 43.4 vs 83.2 min (P = .04). There were only 2 hypoglossal nerve injuries, both in the resident group (P = .009).

CONCLUSION

The whole-task CEA simulator is a realistic, inexpensive model that offers comprehensive training and allows residents to master skills prior to operating on live patients. Overall, the model demonstrated face and construct validity among neurosurgery and vascular surgeons.
Balancing Barriers to Entry and Administrative Burden in Voluntary Regulation
Authors: Carter David P , Scott Tyler A , Mahallati Nadia
Published: September 2017

Voluntary programs have become a recognized instrument for achieving public and private governance goals. As a governance instrument, these programs face a design challenge: to generate societal benefits, a voluntary program must establish stringent standards that support the program’s environmental or social goals, and at the same time program costs that may deter program participation. We argue that the theoretical framework of administrative burden provides a means to consider how voluntary programs may set and adjust entry barriers to motivate participation while maintaining credibility. The framework’s applicability is illustrated through an examination of National Organic Program initiatives to reduce the administrative burden faced by agricultural producers seeking organic certification. Through a discussion drawing on the case, we identify three questions and a series of theoretical expectations for research contributing to a better understanding of the causes and consequences of voluntary program administrative burden.
Assessing the Ability of Salmonella enterica to Translocate Type III Effectors Into Plant Cells
Authors: Chalupowicz Laura , Nissan Gal , Brandl Maria T. , McClelland Michael , Sessa Guido , Popov Georgy , Barash Isaac , Manulis-Sasson Shulamit
Published: September 2017

Salmonella enterica serovar Typhimurium, a human enteric pathogen, has the ability to multiply and survive endophytically in plants. Genes encoding the type III secretion system (T3SS) or its effectors (T3Es) may contribute to its colonization. Two reporter plasmids for T3E translocation into plant cells that are based on hypersensitive response domains of avirulence proteins from the Pantoea agglomerans–beet and Xanthomonas euvesicatoria–pepper pathosystems were employed in this study to investigate the role of T3Es in the interaction of Salmonella ser. Typhimurium 14028 with plants. The T3Es of Salmonella ser. Typhimurium, SipB and SifA, which are translocated into animal cells, could not be delivered by Salmonella ser. Typhimurium into cells of beet roots or pepper leaves. In contrast, these effectors were translocated into plant cells by the phytopathogenic bacteria P. agglomerans pv. betae, Erwinia amylovora, and X. euvesicatoria. Similarly, HsvG, a T3E of P. agglomerans pv. gypsophilae, and XopAU of X. euvesicatoria could be translocated into beet roots and pepper leaves, respectively, by the plant pathogens but not by Salmonella ser. Typhimurium. Mutations in Salmonella ser. Typhimurium T3SS genes invA, ssaV, sipB, or sifA, did not affect its endophytic colonization of lettuce leaves, supporting the notion that S. enterica cannot translocate T3Es into plant cells.
PA student assessment of body mass index in children using visual cues
Authors: Berg Gina M. , Casper Paul , Ohlman Evan , Schulte Justin , Ahlers-Schmidt Carolyn R. , Nyberg Sue , Ekengren Francie
Published: September 2017

Objective:

Pediatric weight or body mass index often is underestimated by providers when relying solely upon visual cues. This study sought to determine physician assistant (PA) students' and recent graduates' ability to accurately assess BMI for age in patients ages 3 to 5 years using visual cues.

Methods:

PA students and recent graduates visually assessed pictures of three children ages 3 to 5 years—one obese, one overweight, and one with healthy weight—for BMI categorization via online survey. Responses were scored for accuracy.

Results:

Ninety-eight PA students and recent graduates completed the assessment. Accuracy for BMI categorization was low, especially in the obese and overweight children for visual assessment alone. Accuracy improved slightly when height and weight data were provided.

Conclusions:

PA student and recent graduate visual assessment for categorization of BMI is unreliable, similar to studies with other providers. PAs should be aware of discrepancy and not rely on visual assessment to determine weight-related interventions.
PAs
Authors: Mandel Ellen D. , North Shannon
Published: September 2017

The PA profession is 50 years young. Practicing PAs and current students hail from several generational categories ranging from Builders to Generation Z. This article reviews how different generations may have experienced PA program expansion, professional identity, state licensing, and prescription delegation. The authors sampled a cohort of PA program applicants about their views on what evokes optimism and concern for the PA profession. These themes mirror the recently paved professional road, while posing the all-important question: What construction lies on the horizon?
Severe type IV hiatal hernia secondary to congenital shortened esophagus
Authors: Weller Samantha , Powers Christin , Sly Bethany , Parnes Nata , Ciani Mario James
Published: September 2017

In patients with severe type IV hiatal hernias, clinicians should consider congenital shortened esophagus. This article reviews the causes of shortened esophagus and its clinical manifestations.
Meeting the Late-Career Needs of Faculty Transitioning Through Retirement: One Institution’s Approach
Authors: Cain Joanna M. , Felice Marianne E. , Ockene Judith K. , Milner Robert J. , Congdon John L. , Tosi Stephen , Thorndyke Luanne E.
Published: September 2017

Problem

Medical school faculty are aging, but few academic health centers are adequately prepared with policies, programs, and resources (PPR) to assist late-career faculty. The authors sought to examine cultural barriers to successful retirement and create alignment between individual and institutional needs and tasks through PPR that embrace the contributions of senior faculty while enabling retirement transitions at the University of Massachusetts Medical School, 2013–2017.

Approach

Faculty 50 or older were surveyed, programs at other institutions and from the literature (multiple fields) were reviewed, and senior faculty and leaders, including retired faculty, were engaged to develop and implement PPR. Cultural barriers were found to be significant, and a multipronged, multiyear strategy to address these barriers, which sequentially added PPR to support faculty, was put in place. A comprehensive framework of sequenced PPR was developed to address the needs and tasks of late-career transitions within three distinct phases: pre-retirement, retirement, and post-retirement.

Outcomes

This sequential introduction approach has led to important outcomes for all three of the retirement phases, including reduction of cultural barriers, a policy that has been useful in assessing viability of proposed phased retirement plans, transparent and realistic discussions about financial issues, and consideration of roles that retired faculty can provide.

Next Steps

The authors are tracking the issues mentioned in consultations and efficacy of succession planning, and will be resurveying faculty to further refine their work. This framework approach could serve as a template for other academic health centers to address late-career faculty development.
The Adoption of Surgical Innovations at Academic Versus Nonacademic Health Centers
Authors: Yeo Heather L. , Kaushal Rainu , Kern Lisa M.
Published: September 2017

Purpose

The value of the health care services provided by academic health centers (AHCs) in the United States increasingly is being questioned. AHCs play a prominent role in developing new surgical innovations, including new minimally invasive techniques, which are costly up front but can lead to significant benefits like decreased morbidity and lengths of stays. This study explored the role of AHCs in the adoption of these surgical innovations as a novel measure of their value.

Method

The authors combined data from the American Hospital Association and the State Inpatient Databases from California, Florida, Washington State, and New York. They compared the number and percentage of patients who received four new, innovative surgical procedures (vs. those who received the traditional procedures) at Council of Teaching Hospitals (COTH) hospitals to those at non-COTH hospitals from 2009 to 2011.

Results

Overall, 61.1% (27,175) of the procedures performed at COTH hospitals used new techniques, compared with 47.2% (41,680) at non-COTH hospitals, across all years (P < .0001). The number and percentage of procedures using the new techniques increased in all years and for all procedures.

Conclusions

Not only do AHCs play a role in developing surgical innovations but they also adopt these new techniques more quickly than other hospitals, and thereby they provide additional benefits to patients. These findings provide an important and understudied perspective on the value of AHCs.
Differential Rod Contouring is Essential for Improving Vertebral Rotation in Patients With Adolescent Idiopathic Scoliosis
Authors: Seki Shoji , Newton Peter O. , Yahara Yasuhito , Makino Hiroto , Nakano Masato , Hirano Norikazu , Kawaguchi Yoshiharu , Kimura Tomoatsu
Published: September 2017

Study Design.

A case series.

Objective.

We investigated the contributions of rod contouring and differential rod contouring (DRC) to the reduction of apical axial vertebral body rotation in patients with adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

DRC is used for posterior spinal correction and fusion. The contribution of DRC to vertebral body derotation is unclear.

Methods.

We analyzed the results of intraoperative computed tomography (CT) in 40 consecutive AIS patients with thoracic curves (Lenke type I or II, 35; type III or IV, 5). Rod contour before initial rod rotation was analyzed by x-ray. Periapical rod contour between concave and convex rod rotation (RR) were analyzed by cone-beam CT imaging. To analyze the reduction of vertebral body rotation with DRC, intraoperative cone-beam CT scans of the three apical vertebrae of the major curve of the scoliosis (120 vertebrae) were taken post-concave RR and post-convex DRC in all patients. The angle of vertebral body rotation was measured. In addition, the contribution of rod contouring to apical vertebral body derotation was analyzed. Rib hump indices (RHi) were measured by pre- and postoperative CT.

Results.

The mean vertebral body rotation angles post-concave RR and post-convex DRC were 15.3° and 9.3°, respectively, for a mean reduction of vertebral rotation in convex DRC after concave RR of 6.0° for thoracic curves (P < 0.001). The RHi was significantly improved by DRC (P < 0.05). Improved apical vertebral rotation was significantly correlated with the difference of apical rod curvature between concave and convex. Vertebral derotation was significantly higher in curves with > 10° difference between concave and convex rod curvature than differences < 10°.

Conclusion.

DRC contributed substantially to axial derotation and reducing rib hump in thoracic scoliosis. The degree of apical rod curvature correlated with the degree of apical vertebral derotation.

Level of Evidence: 4
Cystic Fibrosis Transmembrane Conductance Regulator Potentiation as a Therapeutic Strategy for Pulmonary Edema: A Proof-of-Concept Study in Pigs
Authors: Li Xiaopeng , Vargas Buonfiglio Luis G. , Adam Ryan J. , Stoltz David A. , Zabner Joseph , Comellas Alejandro P.
Published: September 2017

Objectives:

To determine the feasibility of using a cystic fibrosis transmembrane conductance regulator potentiator, ivacaftor (VX-770/Kalydeco, Vertex Pharmaceuticals, Boston, MA), as a therapeutic strategy for treating pulmonary edema.

Design:

Prospective laboratory animal investigation.

Setting:

Animal research laboratory.

Subjects:

Newborn and 3 days to 1 week old pigs.

Interventions:

Hydrostatic pulmonary edema was induced in pigs by acute volume overload. Ivacaftor was nebulized into the lung immediately after volume overload. Grams of water per grams of dry lung tissue were determined in the lungs harvested 1 hour after volume overload.

Measurements and Main Results:

Ivacaftor significantly improved alveolar liquid clearance in isolated pig lung lobes ex vivo and reduced edema in a volume overload in vivo pig model of hydrostatic pulmonary edema. To model hydrostatic pressure-induced edema in vitro, we developed a method of applied pressure to the basolateral surface of alveolar epithelia. Elevated hydrostatic pressure resulted in decreased cystic fibrosis transmembrane conductance regulator activity and liquid absorption, an effect which was partially reversed by cystic fibrosis transmembrane conductance regulator potentiation with ivacaftor.

Conclusions:

Cystic fibrosis transmembrane conductance regulator potentiation by ivacaftor is a novel therapeutic approach for pulmonary edema.
Mycobacterium avium Infection after Acupoint Embedding Therapy
Authors: Zhang Jiao , Lai Linying , Liang Liming , Bai Xinyue , Chen Minliang
Published: September 2017

Nontuberculous mycobacterium is a ubiquitous environmental organism that is unusual to cause a true infection, but it can cause severe cutaneous infections. In this case report, we present a successful treatment for a Chinese patient with Mycobacterium avium cutaneous infection after acupoint embedding therapy. We managed to conduct pathogenic detection, drug sensitive test, and multidisciplinary consultation. Finally, a systematic treatment strategy of nontuberculous mycobacterium was performed. Twenty-two-month follow-up revealed excellent outcome without any recurrence.
Repairing Bronchoesophageal Tube Fistula Using A Contralateral Latissimus Dorsi Musculocutaneous Flap
Authors: Azuma Shuchi , Sakuraba Minoru , Azumi Shogo , Fujita Takeo , Daiko Hiroyuki
Published: September 2017

A postoperative aerodigestive fistula is one of the rare but critical complications after esophagectomy, and management is challenging. The essential keys to successful treatment of these fistula are thorough debridement and complete closure followed by separation of the respiratory and digestive tract. We present a case of a recurrent bronchoesophageal fistula between the left main bronchus and neo esophagus, which was successfully treated through a contralateral approach. The fistula was debrided and closed primarily through a right thoracotomy, and the interposition of a pedicled latissimus dorsi musculocutaneous flap from the right side was carried out. The patient was able to resume oral feeding at 16th postoperative day.
Free Neurovascular Latissimus Dorsi Muscle Transplantation for Reconstruction of Hip Abductors
Authors: Barrera-Ochoa Sergi , Collado-Delfa Jose Manuel , Sallent Andrea , Lluch Alejandro , Velez Roberto
Published: September 2017

Resection of tumors affecting the hip abductors can cause significant decrease in muscle strength and may lead to abnormal gait and poor function. We present a case report showing full functional recovery after resection of a synovial sarcoma affecting the right gluteus medius and minimus muscles with reconstruction free neurovascular latissimus dorsi muscle transplantation. The latissimus dorsi muscle was harvested following standard technique and fixed to the ilium and the greater trochanter. Receptor vessels were end-to-end anastomosed to the subscapular vessels followed by an end-to-end epineural suture between the superior gluteal nerve and the thoracodorsal nerve. A year after surgery, there is no evidence of recurrent disease; electromyographic analysis shows complete reinnervation of the latissimus dorsi muscle flap, and the patient has achieved full functional recovery. Free functional latisimus dorsi transfer could be considered as a viable reconstruction technique after hip abductors resection in tumor surgery.
Adhesion of Stenotrophomonas maltophilia, Delftia acidovorans, and Achromobacter xylosoxidans to Contact Lenses
Authors: Vijay Ajay Kumar , Willcox Mark D. P.
Published: September 2017

Purpose:

Contact lens cases become contaminated with microbes during use. We wished to compare the adhesion of uncommon bacterial contaminants isolated from lens cases to contact lenses with and without organic soil.

Methods:

Strains of Delftia acidovorans (001), Stenotrophomonas maltophilia (002 and 006), and Achromobacter xylosoxidans (001) isolated from contact lens cases (test strains) and Pseudomonas aeruginosa (Paer1) isolated from eyes at the time of infiltrative response (control strain) were used. Bacteria were grown and resuspended in phosphate-buffered saline (PBS) or 10% organic soil (heat-killed Saccharomyces cerevisiae resuspended in complement inactivated bovine serum). Two silicone hydrogel (senofilcon A and comfilcon A) and one hydrogel lens (etafilcon A) lens materials were used. Bacteria (1.0×106 and 1.0×108 colony-forming units/mL; CFU/mL) adhered to lenses for 24 hr and the numbers of bacteria adherent to each lens type (with and without organic soil) were estimated by culture.

Results:

All the four test strains adhered in significantly greater numbers to contact lenses after incubation in inoculum prepared with organic soil compared with PBS—D. acidovorans 001 (0.7 log10 CFU; P<0.05), S. maltophilia 002 (1.7 log10 CFU; P<0.05), S. maltophilia 006 (0.9 log10 CFU; P<0.05), and A. xylosoxidans 001 (0.4 log10 CFU; P<0.05). However, the presence of organic soil did not increase adhesion of P. aeruginosa Paer1 (−0.1 log10 CFU; P>0.05). Achromobacter xylosoxidans 001 (P<0.01), D. acidovorans 001 (P<0.01), and S. maltophilia 002 (P<0.01) significantly differed in their adhesion to the three contact lens materials.

Conclusion:

Bacteria that are commonly found in contact lens cases adhered to contact lenses in relatively high numbers in the presence of organic soil. This might indicate that a similar phenomenon occurs in the presence of tears. This may facilitate their transfer from the lens to the cornea and the production of corneal infiltrates.
Evaluation of Pigment Distribution and Depth Analysis Methods for Decorative Soft Contact Lenses
Authors: Nomura Yusuke , Toida Hitomi , Fukui Chie , Kai Shigemi , Nakaoka Ryusuke , Kato Reiko , Uematsu Miyuki , Ono Koichi , Kanai Atsushi , Haishima Yuji
Published: September 2017

Objectives:

This study evaluates pigment component distribution and depth in decorative soft contact lenses (DSCLs) using a variety of analytical methods.

Methods:

We sampled 18 DSCLs using optical microscopy, optical coherence tomography analysis, Z-stack analysis, X-ray photoelectron spectroscopy (XPS), scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDX), and time-of-flight secondary ion mass spectrometry (TOF-SIMS) to evaluate the distribution and depth of pigment components.

Results:

Pigment distribution in DSCLs was easily observed with optical methods including Z-stack analysis. X-ray photoelectron spectroscopy, SEM/EDX, and TOF-SIMS were used to evaluate the level of pigment exposure on the lens surface and the results showed significant differences between the methods. Pigment components were detected in 16 samples by SEM/EDX, but not by XPS. Pigment components were only detected in eight samples using TOF-SIMS.

Conclusions:

It may be necessary to show that a nanometer-thick monomolecular film does not exist on the surface of DSCLs, to demonstrate the exposure of a pigment particle. Taking into account the principle behind each of the measurement methods and the resolution and sensitivity of each of the analytical methods compared, TOF-SIMS may be the most appropriate method to accurately judge pigment exposure on DSCLs. The Z-stack method may be useful for estimating the depth of pigment components in DSCLs.
Comparison of Airway Measurements for Tracheobronchial Stenosis Between Stereoscopic Bronchoscope and MD-CT
Authors: Nobuyama Seiichi , Sato Tetsuo , Handa Hiroshi , Nishine Hiroki , Inoue Takeo , Mineshita Masamichi , Miyazawa Teruomi
Published: September 2017

Background:

Stereoscopic bronchoscopy is a new diagnostic tool to measure the diameter and cross-sectional area of the airway. The stereoscopic bronchoscope, which operates the same as a standard bronchoscope, utilizes 2 lenses to measure the airway using the principles of triangulation. Furthermore, the stereoscopic bronchoscope has the capability to measure the size of the airway during intervention in real-time, including variable stenosis.

Materials and Methods:

To prospectively compare preoperative stereoscopic and multidetector computed tomography (MD-CT) images to select the appropriate stent size for airway stenosis. Stereoscopic and MD-CT images were then measured to confirm the correct placement of the stent.

Results:

Airway stenting was performed on 21 consecutive patients of whom, 15 were diagnosed with malignant and 6 with benign diseases. In total, 165 measurements were taken (134 healthy; 31 affected). For the diameter, Bland-Altman plots were used to measure data from 165 matched stereoscopic and MD-CT measurement sites (bias, 0.40±2.86 mm SD; percentage error, 33%), 134 healthy sites (bias, 0.554±2.83 mm SD; percentage error, 34%), and 31 affected sites (bias, 1.20±2.67 mm SD; percentage error, 52%). For the cross-sectional area, matched stereoscopic and MD-CT measurements were analyzed for 65 sites (bias, −10.53±92.85 mm2 SD; percentage error, 89%), 49 healthy sites (bias, −9.88±39.00 mm2 SD; percentage error, 32%), and 16 affected sites (bias, −13.12±48.81 mm2 SD; percentage error, 92%).

Conclusion:

Stereoscopic bronchoscopy was able to accurately measure the size of the airway during intervention, to assist in selecting the appropriate size of the stent.
Laser Excisional Treatment for Vaginal Intraepithelial Neoplasia to Exclude Invasion: What Is the Risk of Complications?
Authors: Sopracordevole Francesco , Moriconi Lorenzo , Di Giuseppe Jacopo , Alessandrini Lara , Del Piero Elvia , Giorda Giorgio , Buttignol Monica , De Piero Giovanni , Canzonieri Vincenzo , Ciavattini Andrea
Published: September 2017

Objective

We undertook a retrospective analysis of the incidence of complications of carbon dioxide (CO2) laser excision for high-grade vaginal intraepithelial neoplasia (HG-VaIN).

Materials and Methods

Retrospective large case series on 128 CO2 laser excisions for HG-VaIN in 106 women treated at the Department of Gynecologic Oncology, Oncologic Referral Center, Aviano, Italy. These procedures were performed under local anesthesia with a 20-W continuous laser beam focused to a 0.2-mm spot size. Complications were defined as “minor” when limited to vagina, and “major” when surrounding organs were injured or the vaginal vault was opened.

To identify possible factors associated with surgical complications, we performed a univariate analysis with the t test for continuous variables and χ2 or Fisher exact test for qualitative variables as appropriate.

Results

The overall rate of complication was 7.8% (10/128); nine of them were vaginal bleeding, and only one (0.8%) was a major complication with vaginal vault perforation.

A greater number of previous destructive treatments and of two or more previous laser vaginal excisional treatments was present in patients with complications compared with ones without complications (10% vs 3.9 %, p = .92, and 30% vs 15.2%, p = .44, respectively), although these differences were not statistically significant. A total of 10.5% (6/57) of occult vaginal cancer was detected in women with initial diagnosis of VaIN3 (HG-VaIN) on biopsy.

Conclusions

Carbon dioxide laser excision for HG-VaIN seems to be a safe approach with low rate of complications, probably because of the better accuracy achieved by CO2 laser resections, and permits diagnosis of occult invasive disease.
The Current Burden of Follow-up of Stage 1A1 Cervical Cancer
Authors: MacNab Wendy Susan , Holdsworth Tristan F. , Lindsay Rhona , Shanbhag Smruta , Siddiqui Nadeem , Burton Kevin
Published: September 2017

Objective

The aim of this study was to assess the current burden and consistency of stage 1A1 cervical cancer follow-up within Greater Glasgow and Clyde Health Board.

Methods

A retrospective review was undertaken of women diagnosed with and treated of, between 2007 and 2011, stage 1A1 cervical cancer in Greater Glasgow and Clyde Health Board. Data were collected on referral cytology, definitive method of treatment, posttreatment cytology, and rate of recurrence. Outcomes included rate of recurrence, abnormal cytology, and number of interventions during follow-up.

Results

Of the 78 women diagnosed with stage 1A1 cervical cancer, 43 had a LLETZ (large loop excision of the transformation zone) as definitive treatment. Ninety percent of stage 1A1 cervical cancers were diagnosed following abnormal screening cytology. Almost 86% of all cytology post-LLETZ were negative. Only 1 woman had a recurrence. No posthysterectomy vault smears were low-grade dyskaryosis or worse.

Conclusions

There is a very low rate of abnormal cytology after LLETZ. Vault smears are of limited benefit in the management of women posthysterectomy for stage 1A1 cervical cancer.
ASCCP Colposcopy Standards: Role of Colposcopy, Benefits, Potential Harms, and Terminology for Colposcopic Practice
Authors: Khan Michelle J. , Werner Claudia L. , Darragh Teresa M. , Guido Richard S. , Mathews Cara , Moscicki Anna-Barbara , Mitchell Martha M. , Schiffman Mark , Wentzensen Nicolas , Massad L. Stewart , Mayeaux E.J. , Waxman Alan G. , Conageski Christine , Einstein Mark H. , Huh Warner K.
Published: September 2017

Objectives

The American Society for Colposcopy and Cervical Pathology Colposcopy Standards address the role of and approach to colposcopy and biopsy for cervical cancer prevention in the United States. Working Group 1 was tasked with defining the role of colposcopy, describing benefits and potential harms, and developing an official terminology.

Methods

A systematic literature review was performed. A national survey of American Society for Colposcopy and Cervical Pathology members provided input on current terminology use. The 2011 International Federation for Cervical Pathology and Colposcopy terminology was used as a template and modified to fit colposcopic practice in the United States. For areas without data, expert consensus guided the recommendation. Draft recommendations were posted online for public comment and presented at an open session of the 2017 International Federation for Cervical Pathology and Colposcopy World Congress for further comment. All comments were considered for the final version.

Results

Colposcopy is used in the evaluation of abnormal or inconclusive cervical cancer screening tests. Colposcopy aids the identification of cervical precancers that can be treated, and it allows for conservative management of abnormalities unlikely to progress. The potential harms of colposcopy include pain, psychological distress, and adverse effects of the procedure. A comprehensive colposcopy examination should include documentation of cervix visibility, squamocolumnar junction visibility, presence of acetowhitening, presence of a lesion(s), lesion(s) visibility, size and location of lesions, vascular changes, other features of lesion(s), and colposcopic impression. Minimum criteria for reporting include squamocolumnar junction visibility, presence of acetowhitening, presence of a lesion(s), and colposcopic impression.

Conclusions

A recommended terminology for use in US colposcopic practice was developed, with comprehensive and minimal criteria for reporting.
Post–Loop Electrosurgical Excision Procedure High-Risk Human Papillomavirus Testing as a Test of Cure: The British Columbia Experience
Authors: Ceballos Kathy M. , Lee Marette , Cook Darrel A. , Smith Laurie W. , Gondara Lovedeep , Krajden Mel , van Niekerk Dirk J. , Coldman Andrew J.
Published: September 2017

Objectives

To determine whether Hybrid Capture 2 High-Risk HPV DNA Test (HC2) can be used as a test of cure in women treated for cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) and allow discharge from colposcopy follow-up with a return to a cytology-based screening program for HC2-negative women.

Materials and Methods

Data were analyzed for all women who underwent a loop electrosurgical excision procedure between August 1, 2008, and June 30, 2011, and had a valid HC2 result after loop electrosurgical excision procedure and follow-up histopathology result, to determine risk of persistent or recurrent CIN 2+ in HC2-positive and HC2-negative women.

Results

Two thousand three hundred forty women had adequate biopsies and valid HC2 results. Of 460 HC2-positive women, 118 (25.7%) were diagnosed with CIN 2+, whereas of 1,880 HC2-negative women, 35 (1.9%) had a subsequent diagnosis of CIN 2+ (p < .0002) yielding a HC2-negative predictive value of 98.1% (95% confidence interval = 97.4–98.7). Of 460 HC2-positive women, 306 initially had negative biopsies. In the subsequent 36 months, 38 of the 306 were diagnosed with CIN 2+.

Conclusions

We conclude that women with a negative HC2 test can safely return to routine annual cytology screening by primary care providers while women who test HC2 positive are at higher risk and should continue to be followed by colposcopy, even if their initial biopsy is negative.
Areas of Confusion in Pathologist-Clinician Communication as it Relates to Understanding the Vulvar Pathology Report
Authors: Heller Debra S.
Published: September 2017

Objectives

Pathologist-clinician communication has been an ongoing topic in the literature. Pathology reports are geared to assisting clinicians with patient therapy, but sometimes there are barriers to communication. This survey aims to explore clinicians' understanding of their pathology reports in the membership of the International Society for Vulvovaginal Disease (ISSVD).

Methods

An email survey was sent to all members of the ISSVD.

Results

Surveys were emailed to 397 members, with 91 responding (23 %). Most (76%) of the respondents were gynecologists, with 13% dermatologists and 6% advanced-practice nurses. Thirty-nine percent of respondents did not always understand their pathology reports, 62% did not know the difference between levels and recuts, 71% were unclear as to why levels rather than recuts would be ordered, and 26% was not familiar with the term “spongiosis.” Over 94% read the gross description on a pathology report. Over 90% reported speaking with their pathologist, which they considered important. They considered having a pathologist with specialty expertise important.

Conclusions

Clinician members of the ISSVD are particularly attuned to the importance of pathology consultation in the care of women with vulvovaginal conditions. There are still areas for potential improvement in educational efforts, particularly providing information on how pathology laboratory processes may impact the report, as well as in further education in dermatopathology terminology for those unfamiliar.
Patterns Seen During Electrode Insertion Using Intracochlear Electrocochleography Obtained Directly Through a Cochlear Implant
Authors: Harris Michael S. , Riggs William J. , Giardina Christopher K. , O’Connell Brendan P. , Holder Jourdan T. , Dwyer Robert T. , Koka Kanthaiah , Labadie Robert F. , Fitzpatrick Douglas C. , Adunka Oliver F.
Published: September 2017

Hypothesis:

Intraoperative, intracochlear electrocochleography (ECochG) will provide a means to monitor cochlear hair cell and neural response during cochlear implant (CI) electrode insertion. Distinct patterns in the insertion track can be characterized.

Background:

Conventional CI surgery is performed without a means of actively monitoring cochlear hair cell and neural responses. Intracochlear ECochG obtained directly through the CI may be a source of such feedback. Understanding the patterns observed in the “insertion track” is an essential step toward refining intracochlear ECochG as a tool that can be used to assist in intraoperative decision making and prognostication of hearing preservation.

Methods:

Intracochlear ECochG was performed in 17 patients. During electrode insertion, a 50-ms tone burst acoustic stimulus was delivered with a frequency of 500 Hz at 110 dB SPL. The ECochG response was monitored from the apical-most electrode. The amplitude of the first harmonic was plotted and monitored in near real time by the audiologist-surgeon team during CI electrode insertion.

Results:

Three distinct patterns in first harmonic amplitude change were observed across subjects during insertion: Type A (52%), overall increase in amplitude from the beginning of insertion until completion; Type B (11%), a maximum amplitude at the beginning of insertion, with a decrease in amplitude as insertion progressed to completion; and Type C (35%), comparable amplitudes at the beginning and completion of the insertion with the maximum amplitude mid-insertion.

Conclusion:

Three ECochG patterns were observed during electrode advancement into the cochlea. Ongoing and future work will broaden our scope of knowledge regarding the relationship among these patterns, the presence of cochlear trauma, and functional outcomes related to hearing preservation.
Risk Factors of Recurrence in Pediatric Congenital Cholesteatoma
Authors: Morita Yuka , Takahashi Kuniyuki , Izumi Shuji , Kubota Yamato , Ohshima Shinsuke , Yamamoto Yutaka , Takahashi Sugata , Horii Arata
Published: September 2017

Objective:

To examine the risk factors of recurrence in pediatric congenital cholesteatoma.

Study Design:

Retrospective chart review.

Setting:

University hospital.

Patients:

Sixty-seven patients having tympanic type of congenital cholesteatoma under 15-years old at surgery.

Interventions:

Canal wall-up tympanomastoidectomy (n = 30) or transcanal atticotomy/tympanoplasty (n = 37) was performed depending on cholesteatoma extension, 16 of which were followed by second-look surgery. Preoperative computed tomography (CT) before second-look surgery or follow-up CT was performed to detect residual recurrence 1 year after the surgery. Cholesteatoma found at the second surgery was also included in the recurrence. All patients had no recurrent cholesteatoma at the last follow-up (median, 61 mo after surgery).

Main Outcome Measures:

Possible predictive factors were compared between the groups.

Results:

Residual cholesteatoma and retraction cholesteatoma occurred in 21 and 6%, respectively. There was no significant difference in age, sex, and type of cholesteatoma (open or closed) between the groups; however, Potsic stage and status of stapes involvement were more advanced in the residual cholesteatoma group. All residual lesions could be detected by follow-up CT or by second-look surgery. All of four retraction cholesteatoma patients were male, young at the surgery and in stage IV.

Conclusion:

Recurrence mostly occurred as residual cholesteatoma, suggesting that CT is recommended as a follow-up tool for congenital cholesteatoma. Advanced lesions had the risk of residual cholesteatoma, suggesting that complete removal of epithelium is important. Although rare, young advanced-stage patients had risk of retraction cholesteatoma and therefore normal mucosa should be preserved as much as possible for these patients.
Drug-induced kidney disease in the ICU: mechanisms, susceptibility, diagnosis and management strategies
Authors: Awdishu Linda
Published: September 2017

Purpose of review

Acute kidney injury (AKI) is a common complication in the critically ill population, is multifactorial and associated with increased mortality. Drug-induced kidney injury is a significant contributor to the development of AKI. The purpose of this review is to provide updates in the epidemiology, susceptibility and management of drug-induced kidney disease (DIKD).

Recent findings

Recent changes in guidelines for the management of serious infections in the critically ill have resulted in an increased frequency of DIKD. Varying definitions employed in clinical trials has complicated the awareness of this adverse event. Causality assessment is often missing from studies as it is complicated by the need to evaluate competing AKI risk factors. This has led to uncertainty in the nephrotoxic risk of commonly used drugs.

Standard criteria for DIKD should be applied in clinical trials to improve our understanding of the frequency of these events. Adjudication of these events will improve the clinician's ability to evaluate the causal relationship and relative contribution of specific drugs to the AKI event.
Novel concepts for damage control resuscitation in trauma
Authors: Van Philbert Y. , Holcomb John B. , Schreiber Martin A.
Published: September 2017

Purpose of review

Traumatic injuries are a major cause of mortality worldwide. Damage control resuscitation or balanced transfusion of plasma, platelets, and red blood cells for the management of exsanguinating hemorrhage after trauma has become the standard of care. We review the literature regarding the use of alternatives to achieve the desired 1 : 1:1 ratio as availability of plasma and platelets can be problematic in some environments.

Recent findings

Liquid and freeze dried plasma (FDP) are logistically easier to use and may be superior to fresh frozen plasma. Cold storage platelets (CSPs) have improved hemostatic properties and resistance to bacterial contamination. Low titer type O whole blood can be transfused safely in civilian patients.

In the face of hemorrhagic shock from traumatic injury, resuscitation should be initiated with 1 : 1 : 1 transfusion of plasma, platelets, and red blood cells with limited to no use of crystalloids. Availability of plasma and platelets is limited in some environments. In these situations, the use of low titer type O whole blood, thawed or liquid plasma, cold stored platelets or reconstituted FDP can be used as substitutes to achieve optimal transfusion ratios. The hemostatic properties of CSPs may be superior to room temperature platelets.