bluuebunny/crossref_metadata_2025 huggingface dataset:
Plazomicin: A New Aminoglycoside
Authors: Saravolatz Louis D , Stein Gary E
Published: July 2019

Plazomicin (ACHN-490) is a novel parenteral aminoglycoside developed to target multidrug-resistant Enterobacteriaceae. It has recently been approved by the Food and Drug Administration for the management of complicated urinary tract infections and pyelonephritis caused by susceptible organisms. When compared with meropenem, plazomicin was not inferior. The adverse-event profile for plazomicin was comparable to meropenem except for an increased additional rise in serum creatinine in the plazomicin arm compared with the meropenem arm. This review focuses on the mode of action, antimicrobial activity, pharmacokinetics, clinical indications, and safety profile of this drug. Considerations for formulary addition and its place in therapy are also discussed.
Traumatic aorto-pulmonary artery fistula: a case report
Authors: Meel Ruchika , Govindasamy Thumone , Gonçalves Ricardo
Published: July 2019

Background 

Aorta-pulmonary (A-P) artery fistula following a stab wound to the chest with superimposed infective endocarditis (IE) is a rare, often unrecognized presentation. Herein, we report a case of A-P fistula due to stab chest assessed by two- and three-dimensional (3D) imaging.

Case summary 

A 30-year-old man presented with a history of being stabbed in the chest with a screwdriver. The chest wall laceration was sutured, an intercostal drain inserted for a haemopneumothorax, and he was subsequently discharged. He presented 3 weeks later with exertional dyspnoea, fever, rigours, and loss of weight. On examination, he had a wide pulse pressure and a harsh continuous murmur in the 2nd left intercostal space associated with a palpable thrill. Blood tests revealed raised infective markers and anaemia. All blood cultures were sterile. On echocardiography, the aortic and pulmonary valve was severely damaged, with suspicion of superimposed vegetations secondary to IE. There was severe aortic and pulmonary valve regurgitation. A fistulous connection was noted between the aorta and main pulmonary artery, just below the commissure adjoining the right and left coronary sinus of the aortic valve. On 3D imaging, the defect was quantified. The patient was subsequently referred for aortic and pulmonary valve replacement and closure of the A-P fistula. The presence of multiple vegetations was confirmed intraoperatively. He also received a 6-week course of intravenous antibiotics.

Discussion 

We have described a rare case of an A-P fistula due to a stab wound to the chest complicated by IE. In a patient with stab wound to the chest, a high index of suspicion of cardiac involvement must be maintained, and a careful search for intracardiac shunts must be made on echocardiography, prior to discharge. Furthermore, in addition to two-dimensional imaging, 3D imaging proved useful in providing a comprehensive assessment of the morphology of the lesion prior to surgery.
Evolutionary Dynamics of Sex Chromosomes of Paleognathous Birds
Authors: Xu Luohao , Wa Sin Simon Yung , Grayson Phil , Edwards Scott V , Sackton Timothy B
Published: July 2019

Standard models of sex chromosome evolution propose that recombination suppression leads to the degeneration of the heterogametic chromosome, as is seen for the Y chromosome in mammals and the W chromosome in most birds. Unlike other birds, paleognaths (ratites and tinamous) possess large nondegenerate regions on their sex chromosomes (PARs or pseudoautosomal regions). It remains unclear why these large PARs are retained over >100 Myr, and how this retention impacts the evolution of sex chromosomes within this system. To address this puzzle, we analyzed Z chromosome evolution and gene expression across 12 paleognaths, several of whose genomes have recently been sequenced. We confirm at the genomic level that most paleognaths retain large PARs. As in other birds, we find that all paleognaths have incomplete dosage compensation on the regions of the Z chromosome homologous to degenerated portions of the W (differentiated regions), but we find no evidence for enrichments of male-biased genes in PARs. We find limited evidence for increased evolutionary rates (faster-Z) either across the chromosome or in differentiated regions for most paleognaths with large PARs, but do recover signals of faster-Z evolution in tinamou species with mostly degenerated W chromosomes, similar to the pattern seen in neognaths. Unexpectedly, in some species, PAR-linked genes evolve faster on average than genes on autosomes, suggested by diverse genomic features to be due to reduced efficacy of selection in paleognath PARs. Our analysis shows that paleognath Z chromosomes are atypical at the genomic level, but the evolutionary forces maintaining largely homomorphic sex chromosomes in these species remain elusive.
Geography Shapes the Population Genomics of Salmonella enterica Dublin
Authors: Fenske Gavin J , Thachil Anil , McDonough Patrick L , Glaser Amy , Scaria Joy
Published: July 2019

Salmonella enterica serotype Dublin (S. Dublin) is a bovine-adapted serotype that can cause serious systemic infections in humans. Despite the increasing prevalence of human infections and the negative impact on agricultural processes, little is known about the population structure of the serotype. To this end, we compiled a manually curated data set comprising of 880 S. Dublin genomes. Core genome phylogeny and ancestral state reconstruction revealed that region-specific clades dominate the global population structure of S. Dublin. Strains of S. Dublin in the UK are genomically distinct from US, Brazilian, and African strains. The geographical partitioning impacts the composition of the core genome as well as the ancillary genome. Antibiotic resistance genes are almost exclusively found in US genomes and are mediated by an IncA/C2 plasmid. Phage content and the S. Dublin virulence plasmid were strongly conserved in the serotype. Comparison of S. Dublin to a closely related serotype, S. enterica serotype Enteritidis, revealed that S. Dublin contains 82 serotype specific genes that are not found in S. Enteritidis. Said genes encode metabolic functions involved in the uptake and catabolism of carbohydrates and virulence genes associated with type VI secretion systems and fimbria assembly respectively.
Hybrid Genome Assembly of a Neotropical Mutualistic Ant
Authors: Hartke Juliane , Schell Tilman , Jongepier Evelien , Schmidt Hanno , Sprenger Philipp P , Paule Juraj , Bornberg-Bauer Erich , Schmitt Thomas , Menzel Florian , Pfenninger Markus , Feldmeyer Barbara
Published: July 2019

The success of social insects is largely intertwined with their highly advanced chemical communication system that facilitates recognition and discrimination of species and nest-mates, recruitment, and division of labor. Hydrocarbons, which cover the cuticle of insects, not only serve as waterproofing agents but also constitute a major component of this communication system. Two cryptic Crematogaster species, which share their nest with Camponotus ants, show striking diversity in their cuticular hydrocarbon (CHC) profile. This mutualistic system therefore offers a great opportunity to study the genetic basis of CHC divergence between sister species. As a basis for further genome-wide studies high-quality genomes are needed. Here, we present the annotated draft genome for Crematogaster levior A. By combining the three most commonly used sequencing techniques—Illumina, PacBio, and Oxford Nanopore—we constructed a high-quality de novo ant genome. We show that even low coverage of long reads can add significantly to overall genome contiguity. Annotation of desaturase and elongase genes, which play a role in CHC biosynthesis revealed one of the largest repertoires in ants and a higher number of desaturases in general than in other Hymenoptera. This may provide a mechanistic explanation for the high diversity observed in C. levior CHC profiles.
“Rising” States and Global Reach: Measuring “Globality” among BRICS/MIKTA Countries
Authors: Cooper Andrew F
Published: July 2019

Global reach is equated with national ambition. In the contemporary international system, one measure of global reach for states is their inclusion in global summits. This association is particularly compelling for putative “rising” states from the Global South, among the BRICS (China, India, and Brazil) and also a less well-known forum, MIKTA (Mexico, South Korea, Turkey, and Indonesia) groupings. Yet the standard means of examining the attributes of rising states via country specific and impressionistic studies appears to reveal that these rising powers are similar in many respects but there are significant differences as well. To help identify these differences we turn to a concept and data referred to as “globality.” We believe that this concept is helpful in more accurately analyzing the global reach of rising Global South countries. Though not that well known in the international relations literature, globality emphasizes agency by self-aware actors. Globality can be operationalized by tracing certain dimensions: institutional/diplomatic range; trade profile; and the trajectory of official development assistance. Broadly, the conclusion drawn from such a globality analysis substantiates a sharp distinction between the BRICS members and the MIKTA countries. The BRICS countries have some considerable capacity for global reach while it turns out that the MIKTA countries are regionally entrapped and thus less capable of global projection. Moreover, the specifics in terms of this pattern of differentiation are salient as well. The overall confirmation of an interconnection between subjective impressions of hierarchy and objective measurements of global projection, underscore the contrast between BRICS and MIKTA in summitry dynamics.
Effect of Irradiating Puparia of Oriental Fruit Fly (Diptera: Tephritidae) on Adult Survival and Fecundity for Sterile Insect Technique and Quarantine Purposes
Authors: Yusof Suhana , Mohamad Dzomir Ahmad Zainuri , Yaakop Salmah
Published: July 2019

The aim of this study was to investigate the effect of gamma irradiation on survivability (adult emergence, sex ratio, adult longevity), fecundity (eggs hatchability, number of eggs produced), and morphological differences in the size of the ovary and testes of unirradiated and irradiated adults of Oriental fruit fly [Bactrocera dorsalis (Hendel)]. A dose of 100 Gy was determined as the minimum needed for inhibitory effects against B. dorsalis that would not deter adult emergence, sex ratio (male:female), and adult longevity, with 82.6 ±7.02, 1:1.09, and 107 ± 24.5, respectively. Doses from 50 to 400 Gy range did not completely prevent the adult emergence; however, the emergence decreased by increasing the radiation dose. Adult survivability significantly decreased among all the treatment groups of B. dorsalis, except for the 50 Gy and unirradiated flies. At a dose of 50 Gy, fertile females showed a significant reduction in fecundity by not producing eggs after mating with the sterile males. Meanwhile, the number of eggs laid decreased with increasing dose and no fertile egg was hatched starting at 100 Gy of irradiation. Testes and ovaries of 20-d old flies irradiated as pupae were smaller than those of control flies. In this study, 100 Gy was concluded as the minimum effective dose for the disinfestation and sterilization of B. dorsalis puparia. Results represent new findings used as a basis for sterile insect technique and quarantine programs for managing B. dorsalis, particularly in Malaysia.
Endogenous Partial Insurance and Inequality
Authors: Mengus Eric , Pancrazi Roberto
Published: July 2019

In this paper, we propose a model of endogenous partial insurance and we investigate its implications for macroeconomic outcomes, such as wealth inequality, asset accumulation, interest rate, and consumption smoothing. To this end, we include participation costs to state-contingent asset markets into an otherwise standard Aiyagari (1994) model. We highlight the resulting nonmonotonic relationship between wealth and insurance-market participation when insurance is costly. Poor households remain uninsured, middle-class households participate in the insurance market, whereas rich households decide to self-insure by only purchasing risk-free assets. After theoretically characterizing the endogenous partial insurance equilibrium, we quantify its effect, emphasizing the roles of a participation channel and an interest rate channel.
Wedge resection versus segmentectomy in patients with stage I non–small-cell lung cancer unfit for lobectomy
Authors: Tsutani Yasuhiro , Kagimoto Atsushi , Handa Yoshinori , Mimae Takahiro , Miyata Yoshihiro , Okada Morihito
Published: July 2019

Objective

The present study aimed to compare the outcomes of wedge resection and segmentectomy in patients with clinical stage I non–small-cell lung cancer (NSCLC) who were unfit for lobectomy.

Methods

Between April 2007 and December 2015, 99 patients with stage I NSCLC who were considered unfit for lobectomy and had undergone sublobar resection were identified. Propensity scores were estimated for multivariable analyses, and surgical outcomes were compared between patients who underwent wedge resection and those who underwent segmentectomy.

Results

Sixty patients underwent wedge resection and 39 underwent segmentectomy. Severe postoperative complications (>Grade IIIa) were more frequent in segmentectomy (15.4%) than in wedge resection (3.3%, P = 0.054). Propensity score-adjusted multivariable analysis revealed that operative procedure was an independent predictive factor for severe postoperative complication (segmentectomy, odds ratio = 8.18; P = 0.021). Overall survival (OS) and recurrence-free survival (RFS) were not significantly different between wedge resection (5-year OS, 61.3%, 5-year RFS, 49.4%) and segmentectomy (5-year OS, 68.2%, 5-year RFS, 56.8 %, P = 0.95, P = 0.93, respectively). Propensity score-adjusted multivariable Cox analysis revealed that operative procedure was not an independent factor for OS (segmentectomy, hazard ratio = 1.21, P = 0.62) or RFS (segmentectomy, hazard ratio = 1.07, P = 0.84).

Conclusion

Segmentectomy was more toxic but failed to show the superiority of survival compared with wedge resection. Wedge resection may be the optimal procedure for patients with clinical stage I NSCLC who are considered to be unfit for lobectomy.
Testing the Ability of Airborne LiDAR to Measure Forage Resources for Wild Ungulates in Conifer Forests
Authors: Hull Iver T , Shipley Lisa A
Published: July 2019

Vegetation in the forest understory is a key food resource for wild ungulates like deer (Odocoileus spp.) because the amount of nutritious forage influences animal productivity and density. Therefore, measuring the abundance of understory vegetation available to wildlife populations is often a key objective for wildlife managers. Field-based methods for measuring understory vegetation across remote landscapes are time- and resource-intensive, so we compared estimates of understory vegetation density derived from airborne light detection and ranging (LiDAR) returns with vegetation biomass sampled directly on 65 field plots across 4 years and >250,000 hectares of xeric conifer forests in northeastern Washington. We found that LiDAR-derived estimates of understory vegetation density were only able to predict field-sampled vegetation biomass when the two sampling methods occurred within 3 years of each other, and overstory canopy cover was <50 percent. Our results demonstrate limitations in the ability of LiDAR, at the intensity and frequency currently applied for multiuse purposes, to measure the quantity of forage. However, further testing with synchronous field sampling and higher-density laser pulses holds promise.
Evolution of the Cholesterol Biosynthesis Pathway in Animals
Authors: Zhang Tingting , Yuan Dongwei , Xie Jun , Lei Yongxing , Li Jianguo , Fang Gangqi , Tian Ling , Liu Jiacheng , Cui Yingying , Zhang Min , Xiao Youli , Xu Yongzhen , Zhang Jianzhen , Zhu Maoyan , Zhan Shuai , Li Sheng
Published: July 2019

Cholesterol plays essential roles in animal development and disease progression. Here, we characterize the evolutionary pattern of the canonical cholesterol biosynthesis pathway (CBP) in the animal kingdom using both genome-wide analyses and functional experiments. CBP genes in the basal metazoans were inherited from their last common eukaryotic ancestor and evolutionarily conserved for cholesterol biosynthesis. The genomes of both the basal metazoans and deuterostomes retain almost the full set of CBP genes, while Cnidaria and many protostomes have independently experienced multiple massive losses of CBP genes that might be due to the geologic events during the Ediacaran period, such as the appearance of an exogenous sterol supply and the frequent perturbation of ocean oxygenation. Meanwhile, the indispensable utilization processes of cholesterol potentially strengthened the maintenance of the complete set of CBP genes in vertebrates. These results strengthen both biotic and abiotic roles in the macroevolution of a biosynthesis pathway in animals.
Identification of subsets of IDH-mutant glioblastomas with distinct epigenetic and copy number alterations and stratified clinical risks
Authors: Li Kay Ka-Wai , Shi Zhi-Feng , Malta Tathiane M , Chan Aden Ka-Yin , Cheng Shaz , Kwan Johnny Sheung Him , Yang Rui Ryan , Poon Wai Sang , Mao Ying , Noushmehr Houtan , Chen Hong , Ng Ho-Keung
Published: July 2019

Background

IDH-mutant glioblastoma is classified by the 2016 CNS WHO as a group with good prognosis. However, the actual number of cases examined in the literature is relatively small. We hypothesize that IDH-mutant glioblastoma is not a uniform group and should be further stratified.

Methods

We conducted methylation profiles and estimated copy number variations of 57 IDH-mutant glioblastomas.

Results

Our results showed that 59.6% and 40.4% of tumors belonged to glioma-CpG island methylator phenotype (G-CIMP)-high and G-CIMP-low methylation subgroups, respectively. G-CIMP-low subgroup was associated with significantly worse overall survival (OS) as compared to G-CIMP-high (P = .005). CDKN2A deletion (42.1%) was the most common gene copy number variation, and was significantly associated with G-CIMP-low subgroup (P = .004). Other frequent copy number changes included mesenchymal–epithelial transition (MET) (5.3%), CCND2 (19.3%), PDGFRA (14.0%), CDK4 (12.3%), and EGFR (12.3%) amplification. Both CDKN2A deletion (P = .036) and MET amplification (P < .001) were associated with poor OS in IDH-mutant glioblastomas. Combined epigenetic signature and gene copy number variations separated IDH-mutant glioblastomas into Group 1 (G-CIMP-high), Group 2 (G-CIMP-low without CDKN2A nor MET alteration), and Group 3 (G-CIMP-low with CDKN2A and/or MET alteration). Survival analysis revealed Groups 1 and 2 exhibited a favorable OS (median survival: 619 d [20.6 mo] and 655 d [21.8 mo], respectively). Group 3 exhibited a significant shorter OS (median survival: 252 d [8.4 mo]). Multivariable analysis confirmed the independent prognostic significance of our Groups.

Conclusions

IDH-mutant glioblastomas should be stratified for risk with combined epigenetic signature and CDKN2A/MET status and some cases have poor outcome.
Impact of volume of irradiation on survival and quality of life in glioblastoma: a prospective, phase 2, randomized comparison of RTOG and MDACC protocols
Authors: Kumar Narendra , Kumar Ridu , Sharma Suresh C , Mukherjee Anindya , Khandelwal Niranjan , Tripathi Manjul , Miriyala Raviteja , Oinam Arun S , Madan Renu , Yadav Budhi S , Khosla Divya , Kapoor Rakesh
Published: July 2019

Background

Though conformal partial-brain irradiation is the standard adjuvant treatment for glioblastoma, there is no consensus regarding the optimal volume that needs to be irradiated. European Organisation for Research and Treatment of Cancer (EORTC) and The University of Texas MD Anderson Cancer Center (MDACC) guidelines differ from the Radiation Therapy Oncology Group (RTOG) in their approach toward peritumoral edema, whereas RTOG and MDACC guidelines differ from EORTC in the concept of boost phase. A scarcity of randomized comparisons has resulted in remarkable variance in practice among institutions.

Methods

Fifty glioblastoma patients were randomized to receive adjuvant radiotherapy using RTOG or MDACC protocols. Apart from dosimetric and volumetric analysis, acute toxicities, recurrence patterns, progression-free survival (PFS), overall survival (OS), and quality of life (QoL) were compared using appropriate statistical tests.

Results

Both groups were comparable with respect to demographic characteristics. Dosimetric analysis revealed significantly lower boost-phase planning treatment volumes and V60 Gy in the MDACC arm (chi-squared, P = .001 and .013, respectively). No significant differences were observed in doses with respect to organs at risk, acute toxicity, or recurrence patterns (chi-squared, P > .05). On the log-rank test, median PFS (8.8 months vs 6.1 months, P = .043) and OS (17 months vs 12 months, P = .015) were statistically superior in the MDACC group.

Age, extent of resection, and proportion of whole brain receiving prescription dose were associated with improved PFS and OS on regression analysis. QoL of patients was significantly better in the MDACC group in all domains except cognitive, as assessed with the EORTC Quality of Life Questionnaire (QLQ-C30) and Brain Cancer Module (QLQ-BN20) (general linear model, P < .05).

Conclusions

Use of limited-margin MDACC protocol can potentially improve survival outcomes apart from QoL of glioblastoma patients, as compared with the RTOG protocol.
A Rare Association between Myasthenia Gravis and a Growth Hormone Secreting Pituitary Macroadenoma: A Single Case Report
Authors: Farfouti M T , Ghabally M , Roumieh G , Farou S , Shakkour M
Published: July 2019

Myasthenia Gravis (MG) is a chronic autoimmune neuromuscular disease. Although it is well known that patients with myasthenia gravis have a higher incidence of other autoimmune disorders, however, its association with pituitary adenomas is extremely rare. We believe that our case represents the 8th of this association and the 2nd case involving a GH-secreting adenoma. Here we report a case of a 45-year old Syrian woman who presented with typical complaints of myasthenia gravis as she was suffering from variable painless and effort-related dysphagia and dysarthria. Her complaints became more evident at the end of the day, while acromegaly only manifested as a 4-month history of headache and a special facies that was noted by the physician. Brain MRI scan demonstrated a 3.21 x 2.42 x 2.35 cm pituitary mass for which the patient underwent a trans-sphenoidal pituitary tumor resection. In addition, postoperative histopathological investigations confirmed the diagnosis of a GH-secreting macroadenoma. On following up, it was observed that her myasthenic symptoms improved significantly on Pyridostigmin and Prednisolone. In conclusion, the presence of headache in a myasthenic patient should raise the attention for other underlying causes including pituitary tumors.
Cytopenias among patients with rheumatic diseases using methotrexate: a meta-analysis of randomized controlled clinical trials
Authors: Vanni Kathleen M M , Lyu Houchen , Solomon Daniel H
Published: July 2019

Objective

To conduct a systematic literature review and meta-analysis to estimate the incidence of anaemia, leucopoenia, neutropenia and thrombocytopenia associated with MTX plus folic acid among patients with rheumatic diseases.

Methods

We searched MEDLINE, PubMed and EMBASE through August 2016 for all randomized controlled clinical trials with a MTX monotherapy arm. We excluded randomized controlled clinical trials for cancer and included only double-blind studies that reported on haematologic adverse events. Studies were excluded if patients did not receive folic acid or leucovorin supplementation. Full text articles were assessed by two independent reviewers. Incidence estimates were calculated using random-effects models.

Results

Of 1601 studies identified, 30 (1.87%) were included, representing 3858 patients; all had RA. Seventeen trials reported on anaemia (n = 2032), 17 reported on leucopoenia (n = 2220), 16 reported on neutropenia (n = 2202) and 12 reported on thrombocytopenia (n = 1507). The incidence for any anaemia was 2.55% (95% CI 0.60–5.47%), any leucopoenia 1.17% (95% CI 0.16–2.80%), any neutropenia 1.77% (95% CI 0.33–4.00%), and any thrombocytopenia 0.19% (95% CI 0.00–0.86%). Four cases of severe anaemia were reported, as defined by authors, along with three cases of severe neutropenia. No cases of severe leucopoenia, severe thrombocytopenia or pancytopenia were reported.

Conclusion

Cytopenias are an uncommon side effect of low-dose MTX with folic acid supplementation among RA patients. Further research is needed to reach a more precise estimate.
Anaphylaxis in adolescents
Authors: Comberiati Pasquale , Spahn Joseph , Peroni Diego G.
Published: July 2019

Purpose of review

The frequency of hospitalization for anaphylaxis has increased over the last 20 years across Europe, Australia, and North America, particularly, for food and medication triggers. Adolescents show the highest risk for morbidity and fatality from food-induced anaphylaxis, yet there is little high-quality evidence addressing the reasons for this disproportionate vulnerability.

Recent findings

Recent data seem to suggest a possible increasing burden of food-induced anaphylaxis among adolescents. Trends in anaphylaxis mortality are stable in North America and the United Kingdom, but not in Australia where the incidence of fatal anaphylaxis has recently doubled. The age distribution of fatal anaphylaxis varies according to the nature of the culprit trigger, with data suggesting an age-related predisposition to fatal food anaphylaxis in adolescents and young adults. Adolescence represents a critical phase of transition when rapid and substantial physical, emotional, and social changes occur. Therefore, adolescents show challenges in self-management that are different from other age groups, contributing to a higher risk of poor anaphylaxis outcomes.

The purpose of this review is to summarize recent data on epidemiology and elicitors of anaphylaxis in adolescents and to address currently known barriers and potential facilitators to self-management of anaphylaxis in this vulnerable age group.
Genicular nerve ablation: a systematic review of procedure outcomes for chronic knee pain
Authors: Zeitlinger Lauren , Kopinski Judith , DiPasquale Thomas
Published: July 2019

Background:

Chronic pain caused by knee osteoarthritis is becoming more common among the elderly. Furthermore, patients who would otherwise benefit from total joint arthroplasty are not candidates for surgery due to increasingly high rates of obesity and diabetes. Genicular nerve ablation has become an attractive alternative to arthroplasty in these patients. This systematic review sought to assess the effectiveness and safety of genicular nerve ablation.

Methods:

A literature search of PubMed, Medline, clinicaltrials.gov, and Google Scholar was conducted for studies performing genicular nerve ablation with radiofrequency. Clinical and patient-centric outcomes were obtained.

Results:

Eleven studies and 194 knees were included in this analysis. Our review revealed that visual analog pain scores decreased from an average score of 8/10 to 1.9/10, 2.3/10, 2/10, and 4/10 at 3, 6, and 12 mo after genicular ablation, respectively. Additionally, Oxford Knee Scores and scores on the Western Ontario and McMaster Universities Arthritis Index showed improvements that were sustained at least up to 12 wk and 1 yr, respectively. There were very few procedural complications.

Conclusions:

Genicular nerve ablation with radiofrequency has demonstrated favorable outcomes with low complication rates.
Orthopaedic foot and ankle surgeons’ approach to elective surgery in the smoking patient population: a survey study
Authors: Hames Michael A. , Dean Erin Prewitt , Ishikawa Susan N. , Murphy G. Andrew , Richardson David R.
Published: July 2019

Background:

The changes in healthcare by which physicians may be rewarded or fined based on outcomes compared with national average outcomes give surgeons more incentive to engage patients in practices that will improve results. Smoking cessation has been linked to improvements in surgical outcomes, and the perioperative period may offer the greatest opportunity to achieve cessation. The purpose of this study was to assess the approach of orthopaedic foot and ankle surgeons to smoking patients with foot and ankle conditions.

Methods:

An e-mail was sent to members of the American Orthopaedic Foot and Ankle Society (AOFAS) with an embedded link to a survey that allowed anonymous responses. Responses were collected during several time points. The survey questions yielded categorical answers that were either dichotomous or multiple choice.

Results:

Of 1892 possible respondents, 785 participated in the survey, an overall response rate of 41.5%. Some questions had fewer responses dependent on answering yes or no to a previous question. Seven hundred and eight (91.5%) of 774 surgeons reported worse outcomes in smokers; 437 (60.4%) of 724 reported counseling all smoking patients, and 696 (96.5%) of 721 when planning surgery; 616 (79.2%) of 778 would delay or deny surgery based on tobacco use; and 321 (49.5%) of 648 never check systemic nicotine levels preoperatively, 50 (7.7%) always check before surgery, 57 (8.8%) check frequently, and 34% check only rarely or on occasion.

Conclusions:

Achieving smoking cessation is an important factor in reducing perioperative complications and improving outcomes. Orthopaedic foot and ankle surgeons recognize this and most are likely to delay bony procedures at least 4 wk to allow cessation. Most foot and ankle surgeons counsel their smoking patients to quit before surgery, but many do not use other promising options (such as nicotine replacement and supervised cessation programs) to achieve this goal.

Level of Evidence:

Level IV, case study.
Evaluating Online Continuing Professional Development Regarding Weight Management for Pregnancy Using the New World Kirkpatrick Model
Authors: Walker Ruth , Bennett Christie , Kumar Arunaz , Adamski Melissa , Blumfield Michelle , Mazza Danielle , Truby Helen
Published: July 2019

Introduction:

Clinical practice guidelines advocate the importance of continuing professional development (CPD) that supports health professionals (HPs) to discuss the sensitive topic of maternal weight management with women. However, there is a lack of accredited CPD related to this important area of preconception and antenatal care. Therefore, aims were to evaluate HPs' reactions to accredited online CPD regarding weight management for pregnancy and their knowledge, attitudes, confidence, and commitment to provide women with advice after completing the course.

Methods:

A mixed-methods evaluation was based on the New World Kirkpatrick Model (NWKM). Accredited online CPD was developed by experts in maternal nutrition and weight management. Participants completed a questionnaire before (n = 136) and after (n = 65) the weight management components of the course. McNemar and Wilcoxon signed-rank tests were used to evaluate paired data (n = 36) (p < .05). Deductive content analyses explored free-text responses (n = 65).

Results:

Participants' reactions to the online CPD were encouraging, facilitating increases in perceptions of the importance of weight management for pregnancy and confidence to provide advice. Quantitative measures assessed no change in participants' knowledge; however, qualitative analyses revealed an increase in participants' knowledge of communication strategies that they intend to apply in practice.

Discussion:

The NWKM facilitated an evaluation of HPs' encouraging reactions to online CPD and the affective constructs of education including attitudes, confidence, and commitment to provide advice. Online CPD should be developed with collaboration between universities/professional associations and health care providers, so that evaluation of organizational change and clinical outcomes is possible.
Adverse Childhood Experiences and Family Resilience Among Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder
Authors: Schneider Mallory , VanOrmer Jessica , Zlomke Kimberly
Published: July 2019

Objectives:

The purpose of the present study was to (1) examine the differences in adverse childhood experiences (ACEs) among children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and comorbid ASD/ADHD and healthy neurodevelopmental controls; (2) explore the levels of family resilience across diagnostic categories; (3) identify the differences in family resilience by the number of ACEs; and (4) explore the interaction between ACEs and the diagnostic category on family resilience.

Method:

Participants were 2083 children between the ages of 6 and 17 years (M = 12.23, SD = 3.36) from the 2016 National Survey of Children's Health. The majority of the sample were male (68.7%) and white (78.6%).

Results:

Overall, youth diagnosed with solely ADHD had the highest number of ACEs (Madj = 1.94). In addition, individuals who endorsed exposure to 1 ACE reported higher levels of family resilience in comparison to those who reported 0 ACEs or 2 or more ACEs. Family resilience did not differ between youth who experienced 2 or more ACEs and youth who experienced 0 ACEs. Youth diagnosed with comorbid ASD/ADHD had the lowest levels of family resilience. Interestingly, family resilience did not differ between ADHD and neurotypical youth.

Conclusion:

Youth diagnosed with ADHD seem to be at the highest risk for ACEs. Those with comorbid ASD/ADHD report the lowest levels of family resilience when controlling for exposure to ACEs. Families of youth with ASD had lower levels of family resilience than those of neurotypical youth when controlling for exposure to ACEs, whereas families of youth with solely ADHD displayed similar levels of family resilience in comparison to neurotypical youth and their families. Results have implications for prevention and intervention with ASD and/or ADHD youth and their families.
Characterizing the Learning-to-Drive Period for Teens with Attention Deficits
Authors: Bishop Haley J. , Curry Allison E. , Stavrinos Despina , Mirman Jessica H.
Published: July 2019

Objective:

Motor vehicle collisions are the leading cause of death among teenagers, accounting for approximately 1 in 3 deaths for this age group. A number of factors increase crash risk for teen drivers, including vulnerability to distraction, poor judgment, propensity to engage in risky driving behaviors, and inexperience. These factors may be of particular concern and exacerbated among teens learning to drive with attention deficits. To our knowledge, our study is among the first to systematically investigate the experiences of novice adolescent drivers with attention deficits during the learner period of a Graduated Drivers Licensing program.

Method:

Survey and on-road driving assessment (ODA) data were used to examine parent and teen confidence in the teens' driving ability, driving practice frequency, diversity of driving practice environments, and driving errors among teens with attention deficits as defined by attention-deficit/hyperactivity disorder (ADHD) diagnosis or parent-reported trouble staying focused (TSF).

Results:

When teens' driving skill was evaluated at the conclusion of the learner period, teens with ADHD exhibited more driving errors than their typically developing (TD) counterparts (p= 0.034). Teens with TSF were more likely to have their ODA terminated (p= 0.019), had marginally lower overall driving scores (p= 0.098), and exhibited more critical driving errors (p= 0.01) compared with TD teens.

Conclusion:

These findings may have implications on the learning-to-drive period for adolescents with attention deficits. Adjustments may need to be made to the learner period for teens with attention deficits to account for attention impairments and to better instill safe driving behavior.
Pacemakers, Deep Brain Stimulators, Cochlear Implants, and Nerve Stimulators: A Review of Common Devices Encountered in the Dermatologic Surgery Patient
Authors: Tripathi Shivani V. , Hurst Eva A.
Published: July 2019

BACKGROUND

In dermatologic and procedural surgery settings, there are commonly encountered devices in patients. Safe surgical planning requires familiarity with these devices.

OBJECTIVE

To review the current implanted devices in patients and recommendations for surgical planning around these devices.

METHODS AND MATERIALS

A comprehensive review using PubMed and published device recommendations was performed, searching for those most relevant to dermatologic surgery.

RESULTS

Devices such as pacemakers and implantable cardiac defibrillators, deep brain stimulators, cochlear implants, and various nerve stimulators are potential devices that may be encountered in patients and specific recommendations exist for each of these devices.

CONCLUSION

Dermatologic surgeons' knowledge of implanted devices in patients is paramout to safe surgical procedures.
A Sensitive LC-MS/MS Assay for the Quantification of Methadone and its Metabolites in Dried Blood Spots: Comparison With Plasma
Authors: Davari Baharak , Kotecha Nidhi , Clavijo Claudia F. , Thomas James J. , Rzasa-Lynn Rachael , Galinkin Jeffrey L. , Christians Uwe , Sempio Cristina
Published: July 2019

Introduction:

Methadone, a synthetic narcotic, is widely used both in adults and children for pain control and as a replacement drug in opioid use disorder to prevent craving and withdrawal. To support clinical pharmacokinetic trials in neonates, infants, and children, the authors developed and validated a novel, automated, highly sensitive liquid chromatography–electrospray–tandem mass spectrometry ionization (LC-ESI-MS/MS) method for the quantification of methadone and its metabolites, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) and 2-ethyl-5-methyl-3,3-diphenylpyraline (EMDP), in samples collected as dried blood spots.

Methods:

Blood was spiked with different concentrations of methadone, EDDP, and EMDP, and blood drops were applied to filter paper cards. Punches of 6.4 mm were removed from the cards, and 600 µL of protein precipitation solution (methanol/0.2M ZnSO4, 7:3, vol/vol) containing the internal standards (methadone-d9 and EDDP-d5) at a concentration of 1 mcg/L was added. The extracts were analyzed using LC-ESI-MS/MS in combination with online extraction. The mass spectrometer was run in the positive multiple reaction monitoring mode, and the total run time was 3.2 minutes.

Results:

For the dried blood spots, the assay has a lower limit of quantification of 0.1 mcg/L for methadone, EDDP, and EMDP. The range of reliable response for methadone for the ion transition m/z = 310.2→265.1 was 0.1–100 mcg/L and for the ion transition m/z = 310.2→223.1 5–1000 mcg/L. For EDDP, on the range of reliable response for the ion transition, m/z = 278.2→234.3 was 0.1–100 mcg/L and for the ion transition m/z = 278.2→186.1 5–1000 mcg/L. The calibration range for EMDP was 0.1–100 mcg/L. Accuracy (85%–115%) and imprecision (<15%) met predefined acceptance criteria.

Discussion:

This assay allows for the measurement of small volume blood samples without the need for an intravenous blood draw, and thus, it is suitable for pharmacokinetics studies and therapeutic drug monitoring in pediatric patients.
Impact of CYP2C19 Phenotypes on Clinical Efficacy of Stiripentol in Japanese Patients With Dravet Syndrome
Authors: Yamamoto Yoshiaki , Takahashi Yukitoshi , Ikeda Hiroko , Imai Katsumi , Kagawa Yoshiyuki , Inoue Yushi
Published: July 2019

Background:

Stiripentol is a strong inhibitor of CYP2C19 and CYP3A4. This study compared the effect of stiripentol on the pharmacokinetics of clobazam and N-desmethyl-clobazam (NCLB; an active metabolite of clobazam) between different CYP2C19 phenotypes. We also evaluated the clinical impact of CYP2C19 phenotypes in Japanese patients with Dravet syndrome receiving a combination of valproic acid, clobazam, and stiripentol.

Methods:

We retrospectively reviewed 241 blood samples from 64 patients (aged 1–40 years) and calculated the concentration/dose (CD) ratio [serum level (ng/mL) divided by dose (mg/kg)] for clobazam and NCLB. Based on their CYP2C19 genotypes, patients were classified as extensive metabolizers (EM group: CYP2C19*1/*1, *1/*2, or *1/*3) or poor metabolizers (PM group: CYP2C19*2/*2, *3/*3, or *2/*3). We also reviewed the clinical records of 56 patients who commenced stiripentol therapy and calculated the retention rate for stiripentol therapy over an observation period of 208 weeks.

Results:

Concomitant administration of stiripentol led to a marked increase in the CD ratio of clobazam (1.8-fold in the EM group and 1.5-fold in the PM group). In addition, stiripentol increased the CD ratio of NCLB by 6.6-fold in the EM group, but decreased it by 0.7-fold in the PM group. The estimated retention rate with stiripentol therapy was higher, and the duration of retention was longer in the EM group than in the PM group (1378 versus 933 days, P < 0.001). In patients with the PM phenotype, the adjusted hazard ratio for ceasing stiripentol therapy was 6.7 (95% confidence interval: 1.8–24.7, P < 0.005).

Conclusions:

The effect of stiripentol on the pharmacokinetics of NCLB was significantly different between patients with the EM and PM phenotypes, which could influence the clinical response of Japanese patients with Dravet syndrome receiving the combination of valproic acid, clobazam, and stiripentol.
Reassessment of Internal Thyroid Doses to 1,080 Children Examined in a Screening Survey after the 2011 Fukushima Nuclear Disaster
Authors: Kim Eunjoo , Yajima Kazuaki , Hashimoto Shozo , Tani Kotaro , Igarashi Yu , Iimoto Takeshi , Ishigure Nobuhito , Tatsuzaki Hideo , Akashi Makoto , Kurihara Osamu
Published: July 2019

The dose reconstruction of populations potentially affected by the accident at the Fukushima Daiichi nuclear power plant in March 2011 is of great importance. However, it has been difficult to assess internal thyroid doses to Fukushima residents (mainly from their intake of 131I) due to the lack of direct measurements. For the residents, only about 1,300 data points related to 131I are available, and 1,080 of the data points were obtained from the screening campaign that was conducted by the Nuclear Emergency Response Local Headquarters at the end of March 2011 in Kawamata Town, Iwaki City, and Iitate Village. Here, we reassessed thyroid doses to 1,080 subjects aged ≤15 y old using new age-specific conversion factors to determine 131I thyroid contents from net signals of the devices used, with consideration for the possible uncertainty related to the measurements. The results demonstrated that thyroid equivalent doses to the subjects were <30 mSv (excluding outliers). We also demonstrate dose distributions of each age group from the above three municipalities and those of subjects from Minamisoma City and Fukushima City. One of the findings was that the 131I intake was similar among different age groups in each of the three municipalities. This was consistent with the assumption that ingestion was a dominant route of intake rather than inhalation. The range of thyroid doses to Iitate Village residents was similar to that to Iwaki City residents even though the 131I concentration in tap water was much higher in Iitate Village than Iwaki City. The range of thyroid doses to Minamisoma City residents was similar to that to Iitate Village and Iwaki City residents, and the range for Fukushima City residents was smallest among the five municipalities. Since the major route of intake has remained unclear, this paper presents the plausible upper and lower thyroid doses, between which the actual doses are thought to mostly exist, based on two intake scenarios: single inhalation and repeated ingestion. Further research is thus necessary to extract useful evidence from the individual evacuation behaviors for improving the present internal thyroid dose assessment.
The Radiation Safety Officer as an Advocate for Patient Safety
Authors: Morgan Thomas L.
Published: July 2019

The role of the radiation safety officer is to maintain radiation exposures as low as reasonably achievable. Traditionally, the focus has been on reducing or eliminating unnecessary occupational exposure to employees and ensuring exposure of visitors and members of the public is maintained below regulatory limits. Over the last three decades there has been increasing concern expressed in the medical literature on the potential risks of radiation exposure to patients undergoing diagnostic medical imaging procedures. This paper will discuss the need for advocacy and processes by which the radiation safety officer can expand the focus of a medical radiation safety program to include advocacy for applying the principles and practices of maintaining exposures as low as reasonably achievable to patients.
A Quasi-experimental Study of a Skin Cancer Intervention to Increase Knowledge and Change Behaviors Among Irish Nursing and Agricultural Students
Authors: Siegel Victoria , Everitt-Reynolds Ann , Siegel Leeann
Published: July 2019

Skin cancer rates are increasing in Ireland, making skin cancer prevention a serious public healthcare issue. We replicated a quasi-experimental study assessing the effectiveness of an educational skin cancer intervention. This intervention was effective as an educational adjunct in teaching American nursing students. The current study, conducted at a college in Ireland, was intended to evaluate its effectiveness among Irish nursing (n = 115) and agricultural (n = 60) students. Students were assigned to one control group and two intervention groups: lecture only, and lecture and skin analyzer machine. It was hypothesized that both the lecture-only and lecture and skin analyzer machine groups would have higher posttest scores than the control group in three domains: “knowledge” (skin cancer knowledge), “behavior” (adoption of sun protective behaviors), and “role” (willingness and self-efficacy to assume the role of teaching others about skin cancer). Our findings supported the study’s hypotheses. Among both nursing and agricultural students, both intervention groups had higher scores than the control groups in posttest measures of behavior, knowledge, and role. This study revealed that both the lecture-only and lecture and skin analyzer machine interventions are effective teaching methodologies to personalize the risk of sun damage.
The Lymphatic Theory of Notalgia Paresthetica
Authors: Willeford Carleen
Published: July 2019

Notalgia paresthetica is a dermatologic condition with prominent primarily left unilateral pruritis and raised erythematous rash with hyperpigmentation at the medial or inferior scapula. The etiology is unknown. A comprehensive review of the literature was performed with a structured analysis of previous theories. There is no consistent imaging or functional test to support any of the previously proposed mechanisms. A new theory is presented with a unifying theme of all previous treatments and is supported with results of the first electrical impedance myography testing in this condition.