bluuebunny/crossref_metadata_2025 huggingface dataset:
Venomous Snakebite in Thailand I: Medically Important Snakes
Authors: Chanhome Lawan , Cox Merel J. , Wilde Henry , Jintakoon Piboon , Chaiyabutr Narongsak , Sitprija Visith
Published: March 2018

Thailand has an abundance of venomous snakes. Among the neurotoxic family Elapidae, there are three species of the genus Naja (cobras), three of the genus Bungarus (kraits), and the king cobra of the genus Ophiophagus. Other Elapidae snakes in Thailand include sea snakes and Asian coral snakes of the genus Calliophis. They have potent venoms but rarely bite humans. Tissue and hemotoxic snakes are represented by family Viperidae, subfamilies Viperinae and Crotalinae. They remain an occupational hazard for farmers and rubber tappers, causing serious morbidity but only rare deaths, since competent treatment is now widely available throughout Thailand. Purified equine antivenin is manufactured locally for the monocled and Siamese spitting cobras (Naja kaouthia and N. siamensis), king cobra (Ophiophagus hannah), banded krait (Bungarus fasciatus), most green pit vipers (Trimeresurus sp.), Malayan pit viper (Calloselasma rhodostoma), and the Siamese Russell's viper (Daboia russelli siamensis).
SDSS-IV MaNGA: the spectroscopic discovery of strongly lensed galaxies
Authors: Talbot Michael S , Brownstein Joel R , Bolton Adam S , Bundy Kevin , Andrews Brett H , Cherinka Brian , Collett Thomas E , More Anupreeta , More Surhud , Sonnenfeld Alessandro , Vegetti Simona , Wake David A , Weijmans Anne-Marie , Westfall Kyle B
Published: March 2018

We present a catalogue of 38 spectroscopically detected strong galaxy–galaxy gravitational lens candidates identified in the Sloan Digital Sky Survey IV (SDSS-IV). We were able to simulate narrow-band images for eight of them demonstrating evidence of multiple images. Two of our systems are compound lens candidates, each with two background source-planes. One of these compound systems shows clear lensing features in the narrow-band image. Our sample is based on 2812 galaxies observed by the Mapping Nearby Galaxies at APO (MaNGA) integral field unit (IFU). This Spectroscopic Identification of Lensing Objects (SILO) survey extends the methodology of the Sloan Lens ACS Survey (SLACS) and BOSS Emission-Line Survey (BELLS) to lower redshift and multiple IFU spectra. We searched ∼1.5 million spectra, of which 3065 contained multiple high signal-to-noise ratio background emission-lines or a resolved [O ii] doublet, that are included in this catalogue. Upon manual inspection, we discovered regions with multiple spectra containing background emission-lines at the same redshift, providing evidence of a common source-plane geometry which was not possible in previous SLACS and BELLS discovery programs. We estimate more than half of our candidates have an Einstein radius ≳ 1.7 arcsec, which is significantly greater than seen in SLACS and BELLS. These larger Einstein radii produce more extended images of the background galaxy increasing the probability that a background emission-line will enter one of the IFU spectroscopic fibres, making detection more likely.
Behavioral Variant Frontotemporal Dementia as a Serious Complication of Spontaneous Intracranial Hypotension
Authors: Schievink Wouter I , Maya M Marcel , Barnard Zachary R , Moser Franklin G , Jean-Pierre Stacey , Waxman Alan D , Nuño Miriam
Published: March 2018

BACKGROUND

Behavioral variant frontotemporal dementia (bvFTD) is a devastating early onset dementia. Symptoms of bvFTD may be caused by spontaneous intracranial hypotension (SIH), a treatable disorder, but no comprehensive study of such patients has been reported.

OBJECTIVE

To describe detailed characteristics of a large cohort of patients with SIH and symptoms of bvFTD.

METHODS

We identified patients with SIH who met clinical criteria for bvFTD. Patients were compared to a cohort of SIH patients without bvFTD.

RESULTS

The mean age for the 21 men and 8 women was 52.9 yr (range, 37–65 yr). All 29 patients with bvFTD symptoms had hypersomnolence. Magnetic resonance imaging showed brain sagging in all patients, cerebrospinal fluid (CSF) opening pressure low in about half of patients, but a spinal CSF leak could not be detected in any patient. All patients underwent epidural blood patching, but 26 patients eventually underwent 1 or more surgical procedures. Overall, a good outcome was obtained in 21 patients (72%); 20 (91%) of 22 patients who had not undergone prior Chiari surgery compared to 1 (14%) of 7 patients who did undergo Chiari surgery (P < .003). Compared to SIH patients without symptoms of bvFTD (n = 547), those with bvFTD symptoms were older, more often male, less often demonstrated CSF leak on spinal imaging, and more often underwent surgery (P < .02).

CONCLUSION

bvFTD in SIH is rare and associated with brain sagging and hypersomnolence. Spinal CSF leaks are rarely detected. bvFTD symptoms are often refractory to the usual percutaneous procedures but most patients can be cured.
Systemic Exercise-Induced Hypoalgesia Following Isometric Exercise Reduces Conditioned Pain Modulation
Authors: Alsouhibani Ali , Vaegter Henrik Bjarke , Hoeger Bement Marie
Published: March 2018

Objective

Physically active individuals show greater conditioned pain modulation (CPM) compared with less active individuals. Understanding the effects of acute exercise on CPM may allow for a more targeted use of exercise in the management of pain. This study investigated the effects of acute isometric exercise on CPM. In addition, the between-session and within-session reliability of CPM was investigated.

Design

Experimental, randomized crossover study.

Setting

Laboratory at Marquette University.

Subjects

Thirty healthy adults (19.3±1.5 years, 15 males).

Methods

Subjects underwent CPM testing before and after isometric exercise (knee extension, 30% maximum voluntary contraction for three minutes) and quiet rest in two separate experimental sessions. Pressure pain thresholds (PPTs) at the quadriceps and upper trapezius muscles were assessed before, during, and after ice water immersions.

Results

PPTs increased during ice water immersion (i.e., CPM), and quadriceps PPT increased after exercise (P < 0.05). CPM decreased similarly following exercise and quiet rest (P > 0.05). CPM within-session reliability was fair to good (intraclass correlation coefficient [ICC] = 0.43–0.70), and the between-session reliability was poor (ICC = 0.20–0.35). Due to the variability in the systemic exercise-induced hypoalgesia (EIH) response, participants were divided into systemic EIH responders (N = 9) and nonresponders (N = 21). EIH responders experienced attenuated CPM following exercise (P = 0.03), whereas the nonresponders showed no significant change (P > 0.05).

Conclusions

Isometric exercise decreased CPM in individuals who reported systemic EIH, suggesting activation of shared mechanisms between CPM and systemic EIH responses. These results may improve the understanding of increased pain after exercise in patients with chronic pain and potentially attenuated CPM.
Understanding health policy to improve primary care management of obesity
Authors: Bowen Pamela G. , Lee Loretta T. , McCaskill Gina M. , Bryant Pamela H. , Hess Mary Annette , Ivey Jean B.
Published: March 2018

NPs are ideal candidates for implementing positive health changes for obese patients. Providers have medical expertise and can promote obesity reduction strategies to their patients. Increased awareness of the influence of health policy and clinical implications for obesity management are needed.
Intraoperative Sedation With Dexmedetomidine is Superior to Propofol for Elderly Patients Undergoing Hip Arthroplasty
Authors: Mei Bin , Meng Gaige , Xu Guanghong , Cheng Xinqi , Chen Shishou , Zhang Ye , Zhang Ming , Liu Xuesheng , Gu Erwei
Published: March 2018

Background:

Peripheral nerve block is a preferable method for elderly patients receiving hip arthroplasty. Sedation with dexmedetomidine may reduce postoperative delirium (POD). The aim of this study was to investigate whether intraoperative sedation with dexmedetomidine, as a supplementary to peripheral nerve block for elderly patients receiving total hip arthroplasty, can decrease the prevalence of POD.

Methods:

A prospective, randomized controlled study was conducted with patients 65 years of age or older who underwent total hip arthroplasty between June 2016 and June 2017. The patients were randomly assigned to receive a lumbosacral plexus plus T12 paravertebral block supplemented with propofol or dexmedetomidine for sedation. Incidence of POD was the primary endpoint and was determined with the confusion assessment method, and incidence of postoperative cognitive dysfunction (POCD) was assessed with the mini-mental state examination. The time of ambulation, discharge time, and complications over a 30-day postsurgery period were also recorded.

Results:

A total of 296 patients were randomly assigned to 2 groups. The patients sedated with dexmedetomidine had lower incidences of POD and POCD and were out of bed and discharged sooner than the patients sedated with propofol. There was no difference in complications between the 2 groups.

Conclusions:

As a supplementary to peripheral nerve block, intraoperative sedation with dexmedetomidine could be associated with a lower incidence of POD, which may have benefits on reducing the incidence of early POCD and offering a better short-term recovery for elderly patients receiving hip arthroplasty.
Effects of Prone Positioning on Transpulmonary Pressures and End-expiratory Volumes in Patients without Lung Disease
Authors: Kumaresan Abirami , Gerber Robert , Mueller Ariel , Loring Stephen H. , Talmor Daniel
Published: March 2018

Background

The effects of prone positioning on esophageal pressures have not been investigated in mechanically ventilated patients. Our objective was to characterize effects of prone positioning on esophageal pressures, transpulmonary pressure, and lung volume, thereby assessing the potential utility of esophageal pressure measurements in setting positive end-expiratory pressure (PEEP) in prone patients.

Methods

We studied 16 patients undergoing spine surgery during general anesthesia and neuromuscular blockade. We measured airway pressure, esophageal pressures, airflow, and volume, and calculated the expiratory reserve volume and the elastances of the lung and chest wall in supine and prone positions.

Results

Esophageal pressures at end expiration with 0 cm H2O PEEP decreased from supine to prone by 5.64 cm H2O (95% CI, 3.37 to 7.90; P < 0.0001). Expiratory reserve volume measured at relaxation volume increased from supine to prone by 0.15 l (interquartile range, 0.25, 0.10; P = 0.003). Chest wall elastance increased from supine to prone by 7.32 (95% CI, 4.77 to 9.87) cm H2O/l at PEEP 0 (P < 0.0001) and 6.66 cm H2O/l (95% CI, 3.91 to 9.41) at PEEP 7 (P = 0.0002). Median driving pressure, the change in airway pressure from end expiration to end-inspiratory plateau, increased in the prone position at PEEP 0 (3.70 cm H2O; 95% CI, 1.74 to 5.66; P = 0.001) and PEEP 7 (3.90 cm H2O; 95% CI, 2.72 to 5.09; P < 0.0001).

Conclusions

End-expiratory esophageal pressure decreases, and end-expiratory transpulmonary pressure and expiratory reserve volume increase, when patients are moved from supine to prone position. Mean respiratory system driving pressure increases in the prone position due to increased chest wall elastance. The increase in end-expiratory transpulmonary pressure and expiratory reserve volume may be one mechanism for the observed clinical benefit with prone positioning.
Acute correction of proximal tibial varus deformity in adolescent Blount disease with a low-profile Ilizarov frame
Authors: EL Ghafar Khaled Abd , Samir Shadi , Diab Ramy Ahmed
Published: March 2018

Background:

Adolescent tibia vara usually presents with genu varum deformity and is commonly associated with internal tibial torsion. The Ilizarov technique is one of the accepted techniques for correction of this deformity. Acute correction has the advantage of a shorter duration in the fixator and less patient discomfort. Using the Ilizarov construct with two rings decreases bulkiness of the frame and improves compliance.

Methods:

Thirteen male patients with adolescent Blount disease, seven of whom had bilateral deformities (total 20 knees), were managed by extra-focal tibial valgus lateral translation osteotomy with a low- profile Ilizarov frame fixation. The frame was removed after full union, and patients were followed-up for 18 mo. Patients were assessed clinically using intercondylar distance and radiographically by measuring the distal lateral femoral angle and proximal medial tibial angle on CT scanogram.

Results:

All patients achieved correction of the tibial varus deformity. The intercondylar distance improved from 12.1 cm on average preoperatively to 5 cm on average postoperatively. The mean preoperative deviation of the medial proximal tibial angle was 22 degrees while the mean postoperative deviation was 2.4 degrees (ranging from 0-8.5 degrees). The mean duration to union of the osteotomy was 9 wk (range, 7-10 wk). Pin track infection occurred in 8 limbs.

Conclusions:

Extra-focal percutaneous valgus lateral translation osteotomy and fixation with a low-profile Ilizarov frame allows accurate deformity correction, shorter duration in the fixator, and better patient comfort and satisfaction.
The utility and limitations of using trabecular bone score with FRAX
Authors: Martineau Patrick , Leslie William D.
Published: March 2018

Purpose of review

Trabecular bone score (TBS) is a texture index derived from the lumbar spine dual-energy X-ray absorptiometry which can assess skeletal quality and provide information about fracture risk independent of bone mineral density (BMD). TBS is useful in assessing osteoporotic fracture risk, with lower TBS values associated with increased fracture risk. In this article, we review the current state of TBS, including its utility and limitations in the assessment and management of osteoporosis, with particular emphasis on the recent literature.

Recent findings

Ten-year fracture risk assessment using the FRAX tool can be improved through the use of a TBS adjustment. The use of TBS-adjusted FRAX can change management in a modest but significant number of patients, particularly in those close to an intervention threshold. Change in lumbar spine TBS for patients undergoing antiresorptive treatment is not a useful indicator of antifracture effect.

Lumbar spine TBS provides information complementary to conventional BMD, and has been shown to be clinically useful for enhancing fracture risk prediction.
Cost-Effectiveness Analysis of Syndesmotic Screw Versus Suture Button Fixation in Tibiofibular Syndesmotic Injuries
Authors: Ramsey Duncan C. , Friess Darin M.
Published: March 2018

Objectives:

To evaluate the cost effectiveness of suture buttons compared with syndesmotic screws for repair of tibiofibular syndesmotic injuries.

Methods:

A decision tree model was constructed to describe outcomes after syndesmosis repair using suture buttons and syndesmotic screws from the perspective of a capitated health care system. Outcomes were uneventful healing, removal of symptomatic implants, deep infection, and persistent diastasis requiring revision. Weighted literature averages were used to estimate variables for a baseline model. Outcomes were measured in quality adjusted life years. Procedure and implant costs were derived from Medicare reimbursement rates and the University Health System Consortium. An incremental cost-effectiveness ratio threshold of $50,000 per quality-adjusted life years was used to evaluate cost effectiveness.

Results:

The baseline model did not identify suture buttons to be cost effective. Sensitivity analysis demonstrates the model to be exquisitely sensitive to small changes in reoperation rates and implant price. At median University Health System Consortium implant prices, if the removal rate for symptomatic screws is below 13.7%, then screws are cost effective. If the screw removal rate is greater than 17.5%, then a suture button is cost effective. Within this interval, detailed analysis of the model suggests that screws may be the cost-effective strategy, but that determination should be taken with caution.

Conclusions:

Moving away from the practice of routinely removing all syndesmotic screws has changed the financial landscape of syndesmosis repair. At their median cost, suture buttons are likely to be cost effective over screws for symptomatic screw removal rates greater than 17.5%. Cost effectiveness is sensitive to changes in implant removal rates and the number of devices used per patient.

Level of Evidence:

Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Do Immediate Postoperative Radiographs Change Patient Management After Fracture Fixation? A Systematic Review
Authors: Teo Tammie , Schaeffer Emily , Cooper Anthony , Mulpuri Kishore
Published: March 2018

Objectives:

To evaluate whether immediate (0–3 days) postoperative radiography leads to alterations in the management of patients postfracture fixation.

Data Sources:

Systematic review of English-language articles in the MEDLINE (1946–2016), EMBASE (1974–2016), CDSR (2005–2016), CENTRAL (1948–2016), and Google Scholar databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Study Selection:

Randomized or non–randomized controlled trials and prospective or retrospective cohort studies that addressed surgical management of the upper extremity, lower extremity or hip fractures were eligible for review. All included studies needed to have performed radiography within 0–3 days of surgery and reported any directly resulting management changes.

Data Extraction:

Data were independently extracted by 2 reviewers using a standardized data collection form with predefined data fields for demographics, interventions, study methods, complications, and management outcomes.

Data Synthesis:

A random-effects model was applied, and pooled effects for absolute benefit increase (ABI) and number needed to treat (NNT) were calculated.

Conclusions:

Combining the 11/12 articles that reported by patient numbers, the ABI of immediate postoperative radiography for management change was 0.13% [95% confidence interval (CI), 0.00078%–0.60%; NNT = 753]. The ABI for identification of complications was 0.22% (95% CI, 0.0015%–1.24%; NNT = 453). Current literature suggests that immediate postoperative radiography does not lead to management change in most patients after fracture fixation. More comprehensive reporting, along with further prospective comparative research, is encouraged.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Quantifying the Location of the Radial Nerve in Children for Intraoperative Use
Authors: Nielsen Ena , Andras Lindsay M. , Skaggs David L.
Published: March 2018

Background:

In adults, a relative “safe zone” for lateral approaches to the elbow has been well described in efforts to reduce iatrogenic injury, typically a minimum of 6 cm proximal to the lateral epicondyle. To avoid iatrogenic injury to the radial nerve intraoperatively, we investigated the distance of the nerve from the distal humeral physis in children.

Methods:

All patients who had axial and coronal T1-weighted magnetic resonance imagings of the humerus and elbow between 2005 and 2015 were eligible. Patients were excluded if there was any pathology causing significant alteration to the normal anatomy of the distal humerus or surrounding soft tissue. The axial cut in which the radial nerve was positioned along a line passing through the center of the humerus in the transverse plane was identified, and the location of the nerve was marked. This axial cut was cross-referenced with the corresponding coronal view. The distance along the lateral edge of the humerus in a straight line from the marked location of the radial nerve to the distal humeral physis was measured.

Results:

In total, 21 magnetic resonance imagings of 20 patients met the inclusion criteria. The mean distance of the radial nerve proximally from the distal humeral physis was as follows by age group: below 1-year old=1.7 cm (range, 1.2 to 2.5 cm); 1 to 2-years old=2.8 cm (range, 1.8 to 3.2 cm); 4 to 5-years old=5.3 cm (range, 5.1 to 5.5 cm); 6-years old and above=7.3 cm (range, 6.0 to 9.2 cm). For below 6-years old, when age was multiplied by 1 cm to define a predicted safe zone all radial nerves were found proximal to this. All patients 6 years and above had measurements that fell into the adult range of >6 cm, whereas no patients below 6-years old had measurements in this range.

Conclusions:

The distance of the radial nerve proximally from the distal humeral physis can be safely approximated for children below 6 years of age by multiplying patient age in years by 1 cm. By the age of 6 the distance of the radial nerve falls within the adult range (>6 cm).

Level of Evidence:

Level III.
The Growth of Trochlear Dysplasia During Adolescence
Authors: Parikh Shital N. , Rajdev Neil , Sun Qin
Published: March 2018

Background:

Femoral trochlear dysplasia is a known risk factor for patellar instability. The growth pattern of the normal trochlea is known, but there have been no studies investigating the growth and development of the dysplastic trochlea. The purpose of this study was to assess the growth pattern of trochlear dysplasia in adolescents.

Methods:

In a retrospective analysis, magnetic resonance images of adolescents with patellar instability and trochlear dysplasia were evaluated. These images were measured for lateral and medial condylar height, trochlear height, cartilaginous and bony trochlear bump, and cartilaginous and bony sulcus angle. The type of trochlear dysplasia was classified as per Dejour classification. These measurements were plotted against age, and their growth patterns were evaluated using statistical methods.

Results:

Of 235 knees with patellar instability, trochlear dysplasia was present in 175 knees (74% knees) and these were further analyzed. With increasing age, the mean lateral and medial condylar heights and mean trochlear height showed statistically significant increase (P<0.01). Cartilaginous trochlear bump (slope=0.15, P=0.013) and bony trochlear bump (slope=0.22, P<0.01) increased with age, with some reaching the pathologic value by age of 15.1 years. After age 11 years, there were no significant changes for cartilaginous and bony sulcus angles (cartilage: slope=0.03, P=0.96; bony: slope=−0.90, P=0.11). The mean cartilaginous sulcus angle was significantly greater than the mean bony sulcus angle (P<0.01). All Dejour types of trochlear dysplasia were present across all age groups.

Conclusions:

All linear measurements of trochlear dysplasia (condylar height, trochlear height, trochlear bump) increased with age. However, the shape of trochlear dysplasia, as reflected by sulcus angle and Dejour classification, did not change with increasing age. The shape of trochlear dysplasia is most likely a genetic predisposition and does not necessarily change during skeletal growth.

Level of Evidence:

Level II—diagnostic, cross-sectional.
Whole Recombinant Saccharomyces cerevisiae Yeast Expressing Ras Mutations as Treatment for Patients With Solid Tumors Bearing Ras Mutations: Results From a Phase 1 Trial
Authors: Cohn Allen , Morse Michael A. , O’Neil Bert , Whiting Samuel , Coeshott Claire , Ferraro John , Bellgrau Donald , Apelian David , Rodell Timothy C.
Published: March 2018

We are developing whole, heat-killed, recombinant Saccharomyces cerevisiae yeast, engineered to encode target proteins, which stimulate immune responses against malignant cells expressing those targets. This phase 1 trial, enrolling patients with advanced colorectal or pancreas cancer, was designed to evaluate safety, immunogenicity, response, and overall survival of ascending doses of the GI-4000 series of products, which express 3 different forms of mutated Ras proteins. The study enrolled 33 heavily pretreated subjects (14 with pancreas and 19 with colorectal cancer), whose tumors were genotyped before enrollment to identify the specific ras mutation and thereby to identify which GI-4000 product to administer. No dose limiting toxicities were observed and no subject discontinued treatment due to a GI-4000 related adverse event (AE). The majority of AEs and all fatal events were due to underlying disease progression and AE frequencies were not significantly different among dose groups. GI-4000 was immunogenic, as Ras mutation-specific immune responses were detected on treatment in ∼60% of subjects. No objective tumor responses were observed but based on imaging, clinical status and/or biochemical markers, stable disease was observed in 6 subjects (18%) on day 29, while 1 subject had stable disease at days 57 and 85 follow-up visits. The median overall survival was 3.3 months (95% confidence interval, 2.3–5.3 mo), and 5 subjects survived past the 48-week follow-up period. No significant dose-dependent trends for survival were observed. This first clinical trial in humans with GI-4000 demonstrated a favorable safety profile and immunogenicity in the majority of subjects.
Combination immunotherapies implementing adoptive T-cell transfer for advanced-stage melanoma
Authors: Foley Kendra C. , Nishimura Michael I. , Moore Tamson V.
Published: March 2018

Immunotherapy is a promising method of treatment for a number of cancers. Many of the curative results have been seen specifically in advanced-stage melanoma. Despite this, single-agent therapies are only successful in a small percentage of patients, and relapse is very common. As chemotherapy is becoming a thing of the past for treatment of melanoma, the combination of cellular therapies with immunotherapies appears to be on the rise in in-vivo models and in clinical trials. These forms of therapies include tumor-infiltrating lymphocytes, T-cell receptor, or chimeric antigen receptor-modified T cells, cytokines [interleukin (IL-2), IL-15, IL-12, granulocyte-macrophage colony stimulating factor, tumor necrosis factor-α, interferon-α, interferon-γ], antibodies (αPD-1, αPD-L1, αTIM-3, αOX40, αCTLA-4, αLAG-3), dendritic cell-based vaccines, and chemokines (CXCR2). There are a substantial number of ongoing clinical trials using two or more of these combination therapies. Preliminary results indicate that these combination therapies are a promising area to focus on for cancer treatments, especially melanoma. The main challenges with the combination of cellular and immunotherapies are adverse events due to toxicities and autoimmunity. Identifying mechanisms for reducing or eliminating these adverse events remains a critical area of research. Many important questions still need to be elucidated in regard to combination cellular therapies and immunotherapies, but with the number of ongoing clinical trials, the future of curative melanoma therapies is promising.
Power in the Blood
Authors: Harris Marilyn D.
Published: March 2018

Community blood drives provide a significant quantity of the donated blood needed in the U.S. annually. The American Red Cross collaborates with thousands of blood drive sponsors to make donating easier for individuals. Faith community nurses (FCNs) can promote blood donation by involving churches as sponsors for blood drives. This article shares details on the partnership of the Red Cross and a host church; church member statements about motivation to donate, as well as inability to participate, further inform FCNs.
High-Density Lipoprotein Functionality as a New Pharmacological Target on Cardiovascular Disease: Unifying Mechanism That Explains High-Density Lipoprotein Protection Toward the Progression of Atherosclerosis
Authors: Favari Elda , Thomas Michael J. , Sorci-Thomas Mary G.
Published: March 2018

The formation of the atherosclerotic plaque that is characterized by the accumulation of abnormal amounts of cholesterol-loaded macrophages in the artery wall is mediated by both inflammatory events and alterations of lipid/lipoprotein metabolism. Reverse transport of cholesterol opposes the formation and development of atherosclerotic plaque by promoting high density lipoprotein (HDL)-mediated removal of cholesterol from peripheral macrophages and its delivery back to the liver for excretion into the bile. Although an inverse association between HDL plasma levels and the risk of cardiovascular disease (CVD) has been demonstrated over the years, several studies have recently shown that the antiatherogenic functions of HDL seem to be mediated by their functionality, not always associated with their plasma concentrations. Therefore, assessment of HDL function, evaluated as the capacity to promote cell cholesterol efflux, may offer a better prediction of CVD than HDL levels alone. In agreement with this idea, it has recently been shown that the assessment of serum cholesterol efflux capacity (CEC), as a metric of HDL functionality, may represent a predictor of atherosclerosis extent in humans. The purpose of this narrative review is to summarize the current evidence concerning the role of cholesterol efflux capacity that is important for evaluating CVD risk, focusing on pharmacological evidences and its relationship with inflammation. We conclude that HDL therapeutics are a promising area of investigation but strategies for identifying efficacy must move beyond the idea of simply raising static HDL–cholesterol levels and toward methods of measuring the dynamics of HDL particle remodeling and the generation of lipid-free apolipoprotein A-I (apoA-I). In this way, apoA-I, unlike mature HDL, can promote the greatest extent of cholesterol efflux relieving cellular cholesterol toxicity and the inflammation it causes.
Effects of Resistance Exercise Training on Doxorubicin-Induced Cardiotoxicity
Authors: Pfannenstiel Keith , Hayward Reid
Published: March 2018

Although highly effective, doxorubicin (DOX) use is limited by a dose-dependent cardiotoxicity. The purpose of this study was to determine whether resistance training (RT) would protect against DOX-induced cardiac dysfunction and determine whether any observed functional preservation is a result of reduced lipid peroxidation or a preservation of the cardiac myosin heavy chain (MHC) isoform distribution. Rats were resistance-trained or remained sedentary for 12 weeks, then treated with 12.5 mg/kg DOX or 0.9% saline. Five days after DOX exposure, cardiac function, lipid peroxidation, and MHC isoform expression were quantified. RT preserved cardiac function and attenuated the α-to β-MHC shift that occurs with DOX treatment. No significant differences in lipid peroxidation were observed between sedentary and RT animals treated with DOX. These data suggest that resistance-type exercise can provide protection against DOX-induced cardiac dysfunction, which may be a result of a preservation of the cardiac MHC isoform distribution.
Contraceptive Management for Women Who Are at High Risk of Thrombosis
Authors: GRAY BEVERLY , FLOYD SERINA , JAMES ANDRA H.
Published: March 2018

Managing contraception for women at high risk for thrombosis poses unique challenges. Combined estrogen and progestin contraceptives increase the risk of both venous and arterial thrombosis. They are contraindicated in women with a history of thrombosis and in other women at high risk for thrombosis. However, progestin-only contraceptives are generally considered safe in this patient population. This paper reviews the evidence linking hormonal contraception and clotting risk, outlines appropriate contraceptive methods for women at high risk for thrombosis, discusses surgical risk for sterilization in the setting of current or past thrombosis, and includes a review of the safety of hormonal methods for women who are fully anticoagulated. In general, long-acting reversible contraception is safe for women with a history of thrombosis and may offer additional noncontraceptive benefits for women who are on anticoagulant therapy, such as improved bleeding profiles.
NOVEL ENDOSCOPE-ASSISTED VITREOUS SURGERY COMBINED WITH ATMOSPHERIC ENDOSCOPIC TECHNIQUE AND/OR SUBRETINAL ENDOSCOPIC TECHNIQUE FOR RHEGMATOGENOUS RETINAL DETACHMENT WITH GRADE C PROLIFERATIVE VITREORETINOPATHY
Authors: Kaga Tatsushi , Yokoyama Sho , Kojima Takashi , Mitamura Hayato , Mori Toshio , Matsuda Taisuke , Sato Hiroyuki , Yoshida Norihiko , Ichikawa Kazuo
Published: March 2018

Purpose:

The purpose of this study was to investigate the clinical outcomes of novel endoscope-assisted vitreous surgery techniques in patients with rhegmatogenous retinal detachment complicated by Grade C proliferative vitreoretinopathy.

Methods:

Eight consecutive patients who had undergone endoscope-assisted vitreous surgery for rhegmatogenous retinal detachment complicated by Grade C proliferative vitreoretinopathy were investigated. The peripheral vitreous was cut under air with the aid of endoscopic view (atmospheric endoscopic technique), and the subretinal proliferation was removed under subretinal endoscopic observation (subretinal endoscopic technique).

Results:

Retinal reattachment was achieved after the primary surgery without a large retinotomy and scleral buckling in each case. The mean follow-up was 16.8 months (range, 8–28 months). Atmospheric endoscopic technique was performed in all cases, and subretinal endoscopic technique was performed in three cases. After surgery, the mean best-corrected visual acuity significantly improved from 20/778 to 20/111 (P = 0.014). Although microretinal breaks occurred during the removal of vitreous using atmospheric endoscopic technique in all cases, there were no severe postoperative complications, such as retinal detachment or proliferative vitreoretinopathy.

Conclusion:

Endoscope-assisted vitreous surgery with atmospheric endoscopic technique and/or subretinal endoscopic technique is safe and effective in the treatment of rhegmatogenous retinal detachment with Grade C proliferative vitreoretinopathy.
Empowered to Serve: Implementing Community Stroke Outreach Using Peer Educators to Improve Readiness to Act Among Local Community Members
Authors: Omelchenko Nataliya , Saban Karen L. , Andresen Pamela , Klopp Audrey , Lau Janice
Published: March 2018

The purpose of this project was to develop a community-based volunteer group of peer educators to provide stroke education to local residents aimed at increasing stroke awareness and action readiness using the American Heart Association and American Stroke Association’s “Empowered to Serve” evidence-based curriculum. The “Don’t Miss a Stroke” module addresses the recognition of stroke warning signs, actions to take during a stroke, and stroke prevention. A total of 16 volunteers were recruited and subsequently trained. Six volunteers organized community events during the initial 3 months of the project, reaching more than 300 community members. Most participants (84.9%) identified as female, with a mean age of 63 years. Analysis of variance revealed significant improvements in knowledge regarding stroke immediately after the class, which was present 1 month later (F
2,144 = 4.832, P = .009). This approach to raising community awareness about stroke emergencies was effective and did not require significant financial investment. Easy access to the curriculum and availability of free printed materials minimized the overall program costs and enhanced the quality of the educational content.
Paroxysmal Sympathetic Hyperactivity and Environmental Factors: A Pilot Study
Authors: Letzkus Lisa , Addison Nancy , Turner Lauren , Conaway Mark , Quatrara Beth
Published: March 2018

Problem: Paroxysmal sympathetic hyperactivity (PSH) is a complicated phenomenon that presents as autonomic instability and muscle overactivity in individuals who experience severe brain injury. Identifying potential modifiable environmental nociceptive stimuli is necessary for developing interventions that impact clinical outcomes. Objective: The aim of this study was to identify physical environmental nociceptive stimuli that could hinder recovery for children who experience PSH after severe brain injury. Methodology: This study measured quantitative physical characteristics coupled with data from semistructured interviews, with parents and clinical nurses, to explore the elusive PSH phenomenon after severe brain injury in children. Results: Eight subjects were enrolled in the cohort study. Temperature showed a statistically significant association with PSH (P = .02), with lower temperatures associated with an increased chance of PSH. Blankets were also associated with PSH (P = .009), with the use of blankets associated with a greater chance of PSH. Persons, gown, position, head-of-bed elevation, incontinence of urine and stool, light level, and noise level did not point to a statistically significant association with PSH. Six nursing interviews were conducted with 2 guardian interviews. Themes that are emerging from the qualitative interviews included the priorities of strategies to target auditory, tactile, and visual stimuli. Conclusion: Paroxysmal sympathetic hyperactivity environmental strategies need to be explored further in subsequent studies. Environmental interventions could complement pharmacological strategies for the management of this elusive phenomenon with the goal of improving outcomes in children who experience severe brain injury and show PSH.
An Unreported Cause of Intrathecal Baclofen Withdrawal Symptoms in a Woman With Spastic Cerebral Palsy Who Received Intrathecal Gablofen
Authors: Duraski Sylvia A. , Sayyad Anjum
Published: March 2018

This article details an unreported potential cause of withdrawal symptoms in a patient with cerebral palsy who experienced intrathecal baclofen withdrawal shortly after placement of a baclofen pump with subsequent refill with Gablofen. Initial implantation of the baclofen pump with Lioresal occurred after a successful hospital trial of intrathecal injection via lumbar puncture. However, later, the patient did experience signs and symptoms of baclofen withdrawal after a pump refill was performed with Gablofen.
Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers
Authors: Iliaz Raim , Ozpolat Tahsin , Baran Bulent , Demir Kadir , Kaymakoglu Sabahattin , Besisik Fatih , Akyuz Filiz
Published: March 2018

Objectives

Spontaneous bacterial peritonitis (SBP) is a common and high-mortality infectious complication of patients with cirrhosis. New inflammatory markers are associated with morbidity/mortality in various diseases. The aim of our study was to find the 30-day mortality rate of SBP and their predictors.

Patients and methods

Seventy patients with cirrhosis complicated with SBP and 55 non-SBP controls were enrolled into the study, and patients were evaluated for mortality rate and its predictors.

Results

The 30-day and 3-month mortality rates in the SBP group were 26.1 and 50.7%, respectively. Mortality rates were higher in the SBP group than in the controls. Symptoms at hospital admission and cell counts in ascitic fluid made no difference in predicting 30-day mortality. Patients with SBP with high serum neutrophil counts, high neutrophil–lymphocyte ratio, high C reactive protein (CRP)/albumin ratio, and high model for end-stage liver disease (MELD) score had higher 30-day mortality rates. We determined optimal cutoff values of MELD scores and serum neutrophil counts for predicting 30-day mortality as 20.5 and 6850/mm3, respectively. The sensitivity and specificity for the MELD cutoff value were 83.3 and 80.4%, respectively. We also followed up patients for 60 months after SBP; the patients with high inflammatory markers and MELD scores at the time of SBP diagnosis had worse survival compared with the group with lower levels.

Conclusion

Our results suggest that SBP has high 30-day mortality. MELD scores and inflammatory markers (CRP, CRP albumin ratio, neutrophil–lymphocyte ratio) may be used to predict mortality in patients with SBP.
Hand of FATe: lipid metabolism in hematopoietic stem cells
Authors: Lee Man K.S. , Al-sharea Annas , Dragoljevic Dragana , Murphy Andrew J.
Published: March 2018

Purpose of review

Hematopoietic stem cells (HSCs) reside in the bone marrow and are important in replenishing all cells in the blood through a process termed hematopoiesis. One of the defining characteristics of HSCs is that they must be able to balance their self-renewal capacity with their differentiation into committed blood cells in various blood lineages. For these events to occur, HSCs must be tightly regulated in the bone marrow by intrinsic and extrinsic factors to maintain steady hematopoiesis.

Recent findings

Recently, the effect on how metabolism regulates HSC function has received a great amount of attention. In particular, lipids have been found to participate in mitochondrial activity to maintain HSCs, a role previously overlooked due to HSCs being thought of as mostly glycolytic. Moreover, there has been a re-emergence of how adipocytes in the bone marrow can regulate HSCs.

As these areas evolve, more studies are required to determine the exact contribution of lipids toward HSC maintenance. These studies will allow newer therapeutic targets to help reduce abnormal hematopoiesis such as myelopoiesis, which contributes to many metabolic diseases.
Approach to pulmonary vascular disease in the ICU
Authors: Brown Georgia , Humpl Tilman
Published: March 2018

Purpose of review

Pulmonary vascular disease (PVD) complicates the course of many cardiovascular, pulmonary and other systemic diseases in children. The physiological sequelae (pulmonary hypertension and elevated pulmonary vascular resistance) can overwhelm the right ventricle and lead to circulatory collapse. Despite the common end-point, the preceding pathophysiology is complex and variable and requires a tailored approach to diagnosis and management. In this article, we will review the most recent evidence and explore an approach to current controversies in the diagnosis and management of common or challenging patient subgroups.

Recent findings

New methods of interpreting data derived from echocardiography and cardiac magnetic resonance imaging may assist in risk stratification and response to therapy. In specific patient subgroups, standard pharmacological therapies to reduce right ventricle afterload may be overutilized, ineffective and in some cases harmful. In the patient failing pharmacological therapy, new and novel techniques are being explored including temporary extracorporeal mechanical circulatory support, pumpless lung assist devices and novel surgical and catheterization procedures.

PVD is a diverse entity, and attention to the underlying pathophysiology is essential for appropriate management. Despite significant advances in our understanding, the majority of data comes from small uncontrolled studies and must be interpreted with caution.
Stroma — A Double-Edged Sword in Pancreatic Cancer
Authors: Gu Jichun , Saiyin Hexige , Fu Deliang , Li Ji
Published: March 2018

Pancreatic cancer is a uniformly lethal malignancy with an abundant dense desmoplastic stroma. Because of its dense stroma, conventional drugs were considered to not penetrate this physical barrier, and this caused a systemic drug resistance. Thus, abolishing this barrier with targeted agents is considered to improve the efficiency of chemotherapeutic treatment. The Hedgehog (Hh) signaling pathway is a critical regulator of pancreas development and plays diversified roles in pancreatic cancer stroma and neoplastic cells. Increasing Hh expression in neoplastic cells added desmoplastic stroma accumulation in orthotopic tumors, and Hh inhibitors that target the stroma have an ability to prolong the overall survival of Pdx-1-Cre/KrasG12D/p53R172H mice models via deleting the stromal components and increasing vascularity in pancreatic tumor. However, the failure of translation from bench to bedside indicate the complexity of the relationship between Hh signaling and desmoplastic stroma, and more insights into the complex relationships between Hh signaling pathway and stroma, even tumor cells, might help redesign Hh-targeted therapy. In this review, we discuss the possible mechanism of translation of Hh inhibitor in the clinic from pathology to molecular mechanism.
Root Fracture as Complication of Surgically Assisted Rapid Maxillary Expansion
Authors: Carvalho Pedro Henrique de Azambuja , Garcia Robson Rodrigues , Estrela Cristiane Bonanato , Pereira Filho Valfrido Antônio
Published: March 2018

A 23 year old male patient was submitted to surgical assisted rapid maxillary expansion (SARME). There were any postoperative complications until the finish of orthodontic expansion process. However, in the 30th postoperative day, patient mentioned pain in upper central incisor. Periapical radiography evidenced a root fracture of central upper right incisor. After endodontic treatment, the fractured apex was removed. After 3 years of follow-up, the patient finished orthodontics, and the damaged tooth was in good aspect. Apical fracture is an unexpected complication of SARME. However, follow-up and correct treatment lead to a good prognosis for tooth maintenance.
Delayed Diagnosis of Gorlin–Goltz Syndrome: The Importance of the Multidisciplinary Approach
Authors: Figueira Jéssica Araújo , Batista Fábio Roberto de Souza , Rosso Karina , Veltrini Vanessa Cristina , Pavan Angelo José
Published: March 2018

Gorlin–Goltz syndrome (GGS), also known as nevoid basal cell carcinoma syndrome, is an autosomal dominant inherited disorder with high penetrance and variable expressivity. The classic triad originally described by Gorlin and Goltz in 1960 is composed of multiple nevoid basal cell carcinomas (NBCCs), odontogenic keratocysts (OKCs) in the jaws and bifid ribs. in 1977, this triad was modified by Rayner et al, and to GGS diagnosis, the OKCs had to appear in combination with calcification of the cerebellar falx or palmar and plantar pits. It may occur that although GGS syndrome is a well-known condition, only the specific symptom could be observed by different specialists. Therefore, the patient cannot be placed in an always complex clinical panel. The authors introduce an example in this report. In the present case, the patient had NBCCs, OKCs, and probably other signs of GGS since 1998, and has been treated for this conditions separated, without a diagnosis of a syndromic condition. A 54-year-old white woman was referred to the oral medicine service due to cyst located in the right mandibular body. She had history of skin cancer and undergone surgeries and radiotherapies for the lesions treatment, scars on the skin face due to the lesions removed, and a new ulcerated lesion on the back of was diagnosed. In addition, the patient presented frontal and parietal bossing leading to increased cranial circumference, hypertelorism, strabismus, broad base, and mandibular prognathism. To the image examination, skull radiography revealed calcification of the falx cerebri; on chest X-ray bifid rib was observed and spine radiography showed vertebral osteophytes. Panoramic radiograph showed a well-defined bilocular radiolucent image located in posterior and anterior mandibular region. The whole elements induced us to investigate the patient's past medical history, which revealed that since 1998 had the diagnosis of NBCC and OKC. A multidisciplinary approach becomes necessary for the diagnosis and follow-up of patients with GGS, considering the complexity of the clinical manifestations. Therefore, it is of primary importance for dental surgeons and dermatologists to know the signs and symptoms of GGS to perform early diagnosis and to avoid progression of the oral cysts or metastasis of the skin lesions.