bluuebunny/crossref_metadata_2025 huggingface dataset:
Muzzle point pattern based techniques for individual cattle identification
Authors: Kumar Santosh , Singh Sanjay Kumar , Singh Amit Kumar
Published: January 2017

Animal biometrics based recognition systems are gradually gaining more proliferation due to their diversity of application and uses. The recognition system is applied for representation, recognition of generic visual features, and classification of different species based on their phenotype appearances, the morphological image pattern, and biometric characteristics. The muzzle point image pattern is a primary animal biometric characteristic for the recognition of individual cattle. It is similar to the identification of minutiae points in human fingerprints. This study presents an automatic recognition algorithm of muzzle point image pattern of cattle for the identification of individual cattle, verification of false insurance claims, registration, and traceability process. The proposed recognition algorithm uses the texture feature descriptors, such as speeded up robust features and local binary pattern for the extraction of features from the muzzle point images at different smoothed levels of Gaussian pyramid. The feature descriptors acquired at each Gaussian smoothed level are combined using fusion weighted sum‐rule method. With a muzzle point image pattern database of 500 cattle, the proposed algorithm yields the desired level of 93.87% identification accuracy. The comparative analysis of experimental results for proposed work and appearance‐based face recognition algorithms has been done at each level.
Estimation of maximum power point of a double diode model photovoltaic module
Authors: Sahu Himanshu Sekhar , Nayak Sisir Kumar
Published: January 2017

This study presents a robust technique to estimate the maximum power point (MPP) of a double‐diode model (DDM) photovoltaic (PV) module. The MPP of the DDM PV module under different environmental conditions (DECs) are estimated by using the simple and computationally efficient Levenberg–Marquardt method. The variation of double diode PV module parameters with the change of temperature and irradiation is analysed. The MPP of the DDM PV array at non‐standard test condition obtained from the proposed method is verified with the MPP obtained experimentally and by MATLAB simulation. A comparative study of MPP of a DDM PV module estimated from the proposed method with different existing methods is performed for different operating conditions. The maximum measurement error in power generation of a DDM PV module for different methods under DEC is presented which indicates better performance of the proposed method for the estimation of MPP of a DDM PV module.
Intradural Schwannoma Exacerbating the Symptoms of Degenerative Lumbar Stenosis: Case Report
Authors: Meguins Lucas , Abílio Raphael , Santos Herbert , Valsechi Linoel , Duarte Elísio , Morais Dionei
Published: January 2017

Introduction Schwannoma is a common intradural slow-growing, benign and encapsulated tumor that originates from the myelin sheaths of the nerve fibers. However, a lumbar schwannoma complicating the symptoms of spinal stenosis is an extremely rare association.

Aim To describe the case of a woman presenting a lumbar schwannoma in association with spinal stenosis.

Case Report A 53 year-old female was referred to neurosurgical evaluation due to the worsening of a lumbar pain that was irradiating to the left inferior leg along the anterolateral surface. A neurological examination revealed motor deficits for extension of the left leg and attenuation of the left patellar reflex. Magnetic resonance imaging (MRI) showed lumbar spinal stenosis due to flavum ligament hypertrophy and disc herniation in the L3L4 and L4L5 segments, and an expansive lesion with homogeneous contrast enhancement occupying the left neuroforamen of the L3L4 segment. The patient underwent surgical resection of the tumor and decompression of the stenotic segments with posterior screw instrumentation from L3 to L5. She presented an uneventful recovery and significant improvement of the lumbar pain, and was still free of symptoms 6 months after surgery. An anatomopathological examination defined the tumor as a schwannoma (Grade I – World Health Organization [WHO]).

Conclusion The present study highlights that lumbar schwannoma is a possible etiology complicating the symptoms of patients with previous lumbar spinal stenosis. It is important to treat both pathologies to improve the patients' symptoms.
Activating mutations and translocations in the guanine exchange factor VAV1 in peripheral T-cell lymphomas
Authors: Abate Francesco , da Silva-Almeida Ana C. , Zairis Sakellarios , Robles-Valero Javier , Couronne Lucile , Khiabanian Hossein , Quinn S. Aidan , Kim Mi-Yeon , Laginestra Maria Antonella , Kim Christine , Fiore Danilo , Bhagat Govind , Piris Miguel Angel , Campo Elias , Lossos Izidore S. , Bernard Olivier A. , Inghirami Giorgio , Pileri Stefano , Bustelo Xosé R. , Rabadan Raul , Ferrando Adolfo A. , Palomero Teresa
Published: January 2017

Significance

Guanine nucleotide exchange factor
VAV1
encodes an adaptor and signal transduction factor with important roles in T-cell receptor signaling. This study identifies activating
VAV1
recurrent mutations and
VAV1
fusions in peripheral T-cell lymphomas, directly establishing an oncogenic role for constitutive VAV1 signaling in the pathogenesis of this disease.
piggyBac
mediates efficient in vivo CRISPR library screening for tumorigenesis in mice
Authors: Xu Chunlong , Qi Xiaolan , Du Xuguang , Zou Huiying , Gao Fei , Feng Tao , Lu Hengxing , Li Shenglan , An Xiaomeng , Zhang Lijun , Wu Yuanyuan , Liu Ying , Li Ning , Capecchi Mario R. , Wu Sen
Published: January 2017

Significance

Because genome-wide CRISPR/Cas9 libraries are mostly constructed in lentiviral vectors, direct in vivo screening has not been possible as a result of low efficiency in delivery. Here, we examined the
piggyBac
(PB) transposon as an alternative vehicle to deliver a guide RNA (gRNA) library for in vivo screening. Through hydrodynamic tail vein injections, we delivered a PB-CRISPR library into mouse liver. Rapid tumor formation could be observed in less than 2 mo. By sequencing analysis of PB-mediated gRNA insertions, we identified corresponding genes mediating tumorigenesis. Our results demonstrate that PB is a simple and nonviral choice for efficient in vivo delivery of CRISPR libraries for phenotype-driven screens.
Family Medicine Physicians With Substance Use Disorder: A 5-year Outcome Study
Authors: Rose John S. , Campbell Michael D. , Yellowlees Peter , Skipper Gregory E. , DuPont Robert L.
Published: January 2017

Objectives:

There is little published evidence on how well family medicine physicians (FMPs) with substance use disorder (SUD) perform in Physician Health Programs (PHPs). We examined outcomes for FMP compared with non-FMP physicians.

Methods:

This study utilized data from a 5-year, longitudinal, cohort study involving 904 physicians with diagnoses of SUD consecutively admitted to one of 16 state PHPs between 1995 and 2001. We compared 175 FMPs to 687 other physicians. Outcome measures were relapse, successful completion of monitoring contract at 5 years, and licensed and employed at 5 years.

Results:

Of the 3 outcome variables measured: relapse, successful completion of monitoring contract at 5 years, and licensed and employed at 5 years, FMPs had similar rates of success on all variables except monitoring contract completion at 5 years when compared with the other physician cohort.

Conclusions:

In this study, FMPs with SUD do as well as other physicians in PHPs at 5 years. However, FMPs were less likely to complete the monitoring contract at 5 years as compared to the other physician cohort.
Incorporating the patient's perspective in outcomes research
Authors: Hsiao Betty , Fraenkel Liana
Published: January 2017

Purpose of review

Incorporation of the patients’ perspective in clinical research is critical to ensure that outcomes measured reflect those, which matter most to patients. This review summarizes recent efforts to include the patients’ perspective in the development of outcome measures and the importance of encouraging patient participation in decision-making and self-management.

Recent findings

Since the inclusion of fatigue as a patient-endorsed core outcome measure in rheumatoid arthritis (RA) trials, OMERACT has been instrumental in advocating for patient involvement in the development of core domains and instruments; current endeavors include cultivating an understanding of remission through the eyes of patients and gaining a sense of how to measure features of pain and ‘stiffness’ deemed as important to patients. The concept of remission was further explored in RA patients, highlighting a common goal of returning to normality; additionally, various tools have been developed to assess for unmet needs in rheumatology patients. Advances have also been made in the development and revision of patient-centered core measures in rheumatologic diagnoses outside of RA.

Incorporating the patients’ perspective is now considered an essential feature in outcomes research. Future research should focus on how best to involve patients in specific research activities.
Widespread Down-Regulation of Cardiac Mitochondrial and Sarcomeric Genes in Patients With Sepsis*
Authors: Matkovich Scot J. , Al Khiami Belal , Efimov Igor R. , Evans Sarah , Vader Justin , Jain Ashwin , Brownstein Bernard H. , Hotchkiss Richard S. , Mann Douglas L.
Published: January 2017

Objectives:

The mechanism(s) for septic cardiomyopathy in humans is not known. To address this, we measured messenger RNA alterations in hearts from patients who died from systemic sepsis, in comparison to changed messenger RNA expression in nonfailing and failing human hearts.

Design:

Identification of genes with altered abundance in septic cardiomyopathy, ischemic heart disease, or dilated cardiomyopathy, in comparison to nonfailing hearts.

Setting:

ICUs at Barnes-Jewish Hospital, St. Louis, MO.

Patients:

Twenty sepsis patients, 11 ischemic heart disease, nine dilated cardiomyopathy, and 11 nonfailing donors.

Interventions:

None other than those performed as part of patient care.

Measurements and Main Results:

Messenger RNA expression levels for 198 mitochondrially localized energy production components, including Krebs cycle and electron transport genes, decreased by 43% ± 5% (mean ± sd). Messenger RNAs for nine genes responsible for sarcomere contraction and excitation-contraction coupling decreased by 43% ± 4% in septic hearts. Surprisingly, the alterations in messenger RNA levels in septic cardiomyopathy were both distinct from and more profound than changes in messenger RNA levels in the hearts of patients with end-stage heart failure.

Conclusions:

The expression profile of messenger RNAs in the heart of septic patients reveals striking decreases in expression levels of messenger RNAs that encode proteins involved in cardiac energy production and cardiac contractility and is distinct from that observed in patients with heart failure. Although speculative, the global nature of the decreases in messenger RNA expression for genes involved in cardiac energy production and contractility suggests that these changes may represent a short-term adaptive response of the heart in response to acute change in cardiovascular homeostasis.
Early Goal-Directed Therapy for Sepsis: A Novel Solution for Discordant Survival Outcomes in Clinical Trials
Authors: Kalil Andre C. , Johnson Daniel W. , Lisco Steven J. , Sun Junfeng
Published: January 2017

Objectives:

Early goal-directed therapy has shown discordant survival outcomes in sepsis studies. We aim to find the reasons for this discordance.

Design:

Random-effects and Bayesian hierarchical analyses.

Setting:

Studies that evaluated early goal-directed therapy.

Subjects:

Patients with severe sepsis and/or septic shock.

Interventions:

Early goal-directed therapy.

Measurements and Main Results:

A total of 19,998 patients were included in the main analysis: 31 observational (n = 15,656) and six randomized (n = 4,342) studies. The analysis from 37 studies showed that early goal-directed therapy was associated with a 23% reduction in the risk of death: relative risk = 0.77 (95% CI, 0.71–0.83); p value of less than 0.0001. Mortality reduction was seen with observational studies: relative risk = 0.73 (0.67–0.80); p value of less than 0.0001 but not with randomized studies: relative risk = 0.92 (0.78–1.07); p = 0.268. Meta-regression analysis showed lower risk of death in observational compared with randomized studies: relative risk = 0.81 (0.68–0.95); p = 0.01. Differences in age, country, hospital location, era, systolic pressure, mean arterial pressure, lactate, bundle compliance, amount of fluid administered, and hemodynamic goal achievements were not associated with survival differences between studies. Factors associated with mortality differences between early goal-directed therapy and control included Acute Physiology and Chronic Health Evaluation II (relative risk = 1.05 [1.02–1.09]; p = 0.003), Sequential Organ Failure Assessment (relative risk = 1.09 [1.00–1.18]; p = 0.04), presence of shock (relative risk = 1.007 [1.002–1.013]; p = 0.006), time-to-first antibiotic (relative risk = 1.22 [1.09–1.36]; p = 0.0006), antibiotic administration within 6 hours (relative risk = 0.20 [0.09–0.45]; p = 0.0001), 4 hours (relative risk = 0.16 [0.06–0.39]; p = 0.0001), and 3 hours (relative risk = 0.09 [0.03–0.27]; p < 0.0001). The only factors that explained mortality differences between randomized and observational studies were time-to-first antibiotic (R
2 = 87%), antibiotic administration within 6 hours (R
2 = 94%), 4 hours (R
2 = 99%), 3 hours (R
2 = 99%), and appropriate antibiotic use (R
2 = 96%).

Conclusions:

Survival discordance was not associated with differences in early goal-directed therapy bundle compliance or hemodynamic goal achievement. Our results suggest that it was associated with faster and more appropriate antibiotic co-intervention in the early goal-directed therapy arm compared with controls in the observational studies but not in the randomized trials. Early goal-directed therapy was associated with increased mortality in patients with high-disease severity.
Evolution of Fibroblastic Connective Tissue Nevus in an Infant
Authors: Lynch Michael C. , Samson Thomas D. , Zaenglein Andrea L. , Chung Catherine G.
Published: January 2017

Fibroblastic connective tissue nevus (FCTN) is a rare and recently described neoplasm of fibroblastic/myofibroblastic lineage. We report a case of a 1-month-old healthy male infant who presented with a dermal plaque on the upper chest since birth. A punch biopsy demonstrated a dermal spindle-cell neoplasm with variable smooth muscle actin positivity and negative staining for CD34, consistent with myofibroma. Over the course of the next year, the remaining lesional tissue exhibited clinical softening and a surgical excisional specimen revealed histologic findings distinct from the original biopsy. These included a poorly circumscribed proliferation of bland spindle cells arranged in short fascicles centered in the dermis and extending into the subcutis with positivity for CD34, and absence of staining with smooth muscle actin features diagnostic of FCTN. Our case allowed the opportunity to see this unusual neoplasm at different stages, and we hypothesize that FCTN may undergo an early cellular phase and that time is required for these lesions to “mature” and demonstrate the more characteristic features of FCTN.
ACUTE CENTRAL SEROUS CHORIORETINOPATHY
Authors: Daruich Alejandra , Matet Alexandre , Marchionno Laetitia , De Azevedo Jean-Dominique , Ambresin Aude , Mantel Irmela , Behar-Cohen Francine
Published: January 2017

Purpose:

To evaluate the influence of clinical and multimodal imaging parameters on the duration of acute central serous chorioretinopathy (CSCR) episodes.

Methods:

Consecutive patients with first, treatment-naïve central serous chorioretinopathy episodes presenting within 20 days of symptoms onset were prospectively included. They were reevaluated 15 days to 20 days later, followed by monthly evaluation for 6 months. Subfoveal choroidal thickness (SFCT), fluorescein leakage intensity on fluorescein angiography, elevation of retinal pigment epithelium (RPE) lesions at leakage sites, focal/multifocal pattern of indocyanine green angiography (ICGA) at baseline, time-dependent pattern of subretinal fluid (SRF) resorption on OCT using volume segmentation, history of corticosteroid intake and mean blood pressure were evaluated using univariate (Log rank test) and multivariate (Cox proportional hazard regression) survival analysis.

Results:

Thirty-one patients were included (26 men, 5 women, mean age: 40.0 ± 8.9 years, range: 24–58), of which 26 (84%) had episode resolution by 6 months. Using univariate analysis, episode duration was longer in cases with subfoveal choroidal thickness ≥500 μm (P = 0.0002), retinal pigment epithelium elevation at leakage sites ≥50 μm (P = 0.033), and a peak in subretinal fluid observed during follow-up (P = 0.013), and there was a near-significant association of intense fluorescein leakage (P = 0.074) with longer episodes. Using multivariate analysis, subfoveal choroidal thickness ≥500 μm (P = 0.017), retinal pigment epithelium elevation at leakage sites ≥50 μm (P = 0.010) and patient age ≥40 years (P = 0.010) were significantly and independently associated to longer episodes. Indocyanine green angiography pattern, corticosteroid intake, and blood pressure did not influence episode duration.

Conclusion:

Older age, higher subfoveal choroidal thickness, and higher degree of retinal pigment epithelium alteration at leakage sites are independent factors of longer acute central serous chorioretinopathy episodes.
Immunogenicity and Safety of a Booster Injection of DTap-IPV//Hib (Pentaxim) Administered Concomitantly With Tetravalent Dengue Vaccine in Healthy Toddlers 15–18 Months of Age in Mexico
Authors: Melo Flor Irene Rodriguez , Morales José Juan Renteria , De Los Santos Abiel Homero Mascareñas , Rivas Enrique , Vigne Claire , Noriega Fernando
Published: January 2017

Background:

The live, attenuated, tetravalent dengue vaccine (CYD-TDV) is licensed in a number of dengue endemic countries for individuals ≥9 years of age. Before the integration of any vaccine into childhood vaccination schedules, a lack of immune interference and acceptable safety when coadministered with other recommended vaccines should be demonstrated.

Methods:

This randomized, multi-center phase III trial was conducted in Mexico. Healthy toddlers (n = 732) received a booster dose of a licensed pentavalent combination vaccine [diphtheria, tetanus, acellular pertussis, inactivated polio vaccine and Haemophilus influenzae type b (DTaP-IPV//Hib)] either concomitantly or sequentially, with the second dose of CYD-TDV administered as a 3-dose schedule. Antibody titers against diphtheria toxoid, tetanus toxoid and pertussis antigens were measured by enzyme-linked immunosorbent assay. Antibodies against poliovirus and dengue serotypes were measured using a plaque reduction neutralization test. Noninferiority was demonstrated for each of the DTaP-IPV//Hib antigens if the lower limit of the 2-sided 95% confidence interval of the difference in seroconversion rates between the 2 groups (CYD-TDV and placebo) was ≥10%. Safety of both vaccines was assessed.

Results:

Noninferiority in immune response was demonstrated for all DTaP-IPV//Hib antigens. After 3 doses of CYD-TDV, no difference was observed in the immune response for CYD-TDV between groups. There were no safety concerns during the study.

Conclusion:

Coadministration of the DTaP-IPV//Hib booster vaccine with CYD-TDV has no observed impact on the immunogenicity or safety profile of the DTaP-IPV//Hib booster vaccine. No difference was observed on the CYD-TDV profile when administered concomitantly or sequentially with the DTaP-IPV//Hib booster vaccine.
Insulin Resistance and Markers of Inflammation in HIV-infected Ugandan Children in the CHAPAS-3 Trial
Authors: Dirajlal-Fargo Sahera , Musiime Victor , Cook Adrian , Mirembe Grace , Kenny Julia , Jiang Ying , Debanne Sara , Klein Nigel , McComsey Grace A.
Published: January 2017

Background:

Few studies have investigated metabolic complications in HIV-infected African children and their relation with inflammation.

Methods:

We compared baseline and changes in insulin resistance [homeostatic model assessment of insulin resistance (HOMA-IR)] and in markers of inflammation over 48 weeks, in a subset of antiretroviral therapy (ART)–naive Ugandan children from the Children with HIV in Africa-Pharmacokinetics and Adherence/Acceptability of Simple Antiretroviral Regimens trial randomized to zidovudine-, stavudine- or abacavir (ABC)–based regimen. Nonparametric methods were used to explore between-group and within-group differences, and multivariable analysis to assess associations of HOMA-IR.

Results:

One-hundred eighteen children were enrolled, and median age (interquartile range) was 2.8 years (1.7–4.3). Baseline median HOMA-IR (interquartile range) was 0.49 (0.38–1.07) and similar between the arms. At week 48, median relative changes in HOMA-IR were 14% (−29% to 97%) in the zidovudine arm, −1% (−30% to 69%) in the stavudine arm and 6% (−34% to 124%) in the ABC arm (P ≤ 0.03 for all the arms compared with baseline, but P = 0.90 for between-group differences). Several inflammation markers significantly decreased in all study arms; soluble CD14 increased on ABC and did not change in the other 2 arms. In multivariate analysis, only changes in soluble CD163 were positively associated with HOMA-IR changes.

Conclusions:

In ART-naive Ugandan children, HOMA-IR changed significantly after 48 weeks of ART and correlated with monocyte activation.
Intraoperative ketamine reduces immediate postoperative opioid consumption after spinal fusion surgery in chronic pain patients with opioid dependency: a randomized, blinded trial
Authors: Nielsen Rikke Vibeke , Fomsgaard Jonna Storm , Siegel Hanna , Martusevicius Robertas , Nikolajsen Lone , Dahl Jørgen Berg , Mathiesen Ole
Published: January 2017

Perioperative handling of surgical patients with opioid dependency represents an important clinical problem. Animal studies suggest that ketamine attenuates central sensitization and hyperalgesia and thereby reduces postoperative opioid tolerance. We hypothesized that intraoperative ketamine would reduce immediate postoperative opioid consumption compared with placebo in chronic pain patients with opioid dependency undergoing lumbar spinal fusion surgery. Primary outcome was morphine consumption 0 to 24 hours postoperatively. Secondary outcomes were acute pain at rest and during mobilization 2 to 24 hours postoperatively (visual analogue scale), adverse events, and persistent pain 6 months postoperatively. One hundred fifty patients were randomly assigned to intraoperative S-ketamine bolus 0.5 mg/kg and infusion 0.25 mg·kg−1·h−1 or placebo. Postoperatively, patients received their usual opioids, paracetamol and IV patient-controlled analgesia with morphine. In the final analyses, 147 patients were included. Patient-controlled analgesia IV morphine consumption 0 to 24 hours postoperatively was significantly reduced in the ketamine group compared with the placebo group: 79 (47) vs 121 (53) mg IV, mean difference 42 mg (95% confidence interval −59 to −25), P < 0.001. Sedation was significantly reduced in the ketamine group 6 and 24 hours postoperatively. There were no significant differences regarding acute pain, nausea, vomiting, hallucinations, or nightmares. Back pain at 6 months postoperatively compared with preoperative pain was significantly more improved in the ketamine group compared with the placebo group, P = 0.005. In conclusion, intraoperative ketamine significantly reduced morphine consumption 0 to 24 hours after lumbar fusion surgery in opioid-dependent patients. The trend regarding less persistent pain 6 months postoperatively needs further investigation.
Epigenetic upregulation of CXCL12 expression mediates antitubulin chemotherapeutics–induced neuropathic pain
Authors: Xu Ting , Zhang Xiao-Long , Ou-Yang Han-Dong , Li Zhen-Yu , Liu Cui-Cui , Huang Zhen-Zhen , Xu Jing , Wei Jia-You , Nie Bi-Lin , Ma Chao , Wu Shao-Ling , Xin Wen-Jun
Published: January 2017

Clinically, Microtubule-targeted agents–induced neuropathic pain hampers chemotherapeutics for patients with cancer. Here, we found that application of paclitaxel or vincristine increased the protein and mRNA expression of CXCL12 and frequency and amplitude of miniature excitatory post synaptic currents (mEPSCs) in spinal dorsal horn neurons. Spinal local application of CXCL12 induced the long-term potentiation of nociceptive synaptic transmission and increased the amplitude of mEPSCs. Inhibition of CXCL12 using the transgenic mice (CXCL12−/+
) or neutralizing antibody or siRNA ameliorated the mEPSC's enhancement and mechanical allodynia. In addition, paclitaxel and vincristine both could increase the phosphorylation of signal transducer and activator of transcription 3 (STAT3) and the acetylation of histone H4 in the CXCL12-expressing neurons. Immunoprecipitation and chromatin immunoprecipitation assays demonstrated that antitubulin chemotherapeutics increased the binding of STAT3 to the CXCL12 gene promoter and the interaction between STAT3 and p300, and contributed to the enhanced transcription of CXCL12 by increasing the acetylation of histone H4 in CXCL12 gene promoter. Inhibition of STAT3 by intrathecal injection of adeno-associated virus encoding Cre and green fluorescent protein into STAT3flox/flox
mice or inhibitor S3I-201 into rats suppressed the CXCL12 upsurge by decreasing the acetylation of histone H4. Finally, blockade of CXCR4 but not CXCR7 ameliorated the paclitaxel- or vincristine-induced mechanical allodynia. Together, these results suggested that enhanced interaction between STAT3 and p300 mediated the epigenetic upregulation of CXCL12 in dorsal horn neurons, which contributed to the antitubulin chemotherapeutics–induced persistent pain.
Oxytocin alleviates orofacial mechanical hypersensitivity associated with infraorbital nerve injury through vasopressin-1A receptors of the rat trigeminal ganglia
Authors: Kubo Asako , Shinoda Masamichi , Katagiri Ayano , Takeda Mamoru , Suzuki Tatsuro , Asaka Junichi , Yeomans David C. , Iwata Koichi
Published: January 2017

Oxytocin (OXT) is a neuropeptide hormone synthesized and secreted by hypothalamic neurons and has been reported to play a significant role in pain modulation. However, the mechanisms underlying OXT's antinociceptive effect on neuropathic pain are not fully understood. In this study, we examined the peripheral effect of OXT on mechanical hypersensitivity induced by partial ligation of the infraorbital nerve (PNL) in rats. Mechanical hypersensitivity in the whisker pad skin after PNL was attenuated by the direct administration of OXT into the trigeminal ganglion (TG). The proportion of vasopressin-1A receptor (V1A-R)-immunoreactive, but not OXT-receptor–immunoreactive, neurons significantly increased among TG neurons innervating the whisker pad skin after PNL. In a patch-clamp recording from TG neurons isolated from PNL rats, the resting membrane potential of OXT-treated neurons was significantly decreased, and the current thresholds of OXT-treated neurons for spike generation (rheobases) were significantly greater than those of vehicle-treated neurons. In addition, OXT increased voltage-gated K+channel currents in PNL animals. Furthermore, intra-TG administration of a selective V1A-R antagonist reversed the OXT-induced alleviation of mechanical hypersensitivity, and coapplication of the antagonist opposed OXT's effects on the resting membrane potential, rheobase, and K+current. These findings suggest that OXT is effective at suppressing TG neuronal hyperexcitability after nerve injury, likely by modulation of voltage-gated K+channels through V1A-R. This signaling mechanism represents a potential therapeutic target for the treatment of orofacial neuropathic pain.
Long-Term Pulmonary Function and Quality of Life in Children After Acute Respiratory Distress Syndrome: A Feasibility Investigation
Authors: Ward Shan L. , Turpin Autumn , Spicer Aaron C. , Treadwell Marsha J. , Church Gwynne D. , Flori Heidi R.
Published: January 2017

Objectives:

To determine the feasibility of pulmonary function and quality of life evaluations in children after acute respiratory distress syndrome.

Design:

A prospective follow-up feasibility study.

Setting:

A tertiary PICU.

Patients:

Children less than 18 years old with acute respiratory distress syndrome admitted between 2000 and 2005.

Intervention:

Pulmonary function testing and patient and parental quality of life surveys approximately 12-month after acute respiratory distress syndrome.

Measurements and Main Results:

One hundred eighty patients met acute respiratory distress syndrome criteria; 37 (20%) died, 90 (51%) declined participation, 28 (16%) consented but did not return, and 24 (13%) returned for follow-up visit. Twenty-three patients completed quality of life testing and 17 completed pulmonary functions. Clinical characteristics of those who returned were no different from those who did not except for age (median age, 4.9 vs 1.8 yr). One-third had mild to moderate pulmonary function deficits. Quality of life scores were marginal with general health perception, physical functioning, and behavior being areas of concern. These scores were lower than scores in children with chronic asthma. Parental quality of life assessments report lower scores in single-parent homes but no differences were noted by race or parental employment status.

Conclusions:

Valuable information may be discerned from acute respiratory distress syndrome patients who return for follow-up evaluation. In this pilot study, up to one-third of children with acute respiratory distress syndrome exhibit pulmonary function deficits and 12-month postillness quality of life scores are lower than in children with chronic asthma. Parental perceptions of postillness quality of life may be negatively impacted by socioeconomic constraints. Long-term follow of children with acute respiratory distress syndrome is feasible and bears further investigation.
Incorporating a Computerized Cognitive Battery Into the Emergency Department Care of Pediatric Mild Traumatic Brain Injuries—Is It Feasible?
Authors: Khetani Aneesh M. , Brooks Brian L. , Mikrogianakis Angelo , Barlow Karen M.
Published: January 2017

Objectives

The use of computers to test cognitive function acutely after a concussion is becoming increasingly popular, especially after sport-related concussion. Although commonly performed in the community, it is not yet performed routinely in the emergency department (ED), where most injured children present. The challenges of performing computerized cognitive testing (CCT) in a busy ED are considerable. The aim of this study was to evaluate the feasibility of CCT in the pediatric ED after concussion.

Methods

Children, aged 8 to 18 years with mild traumatic brain injury, presenting to the ED were eligible for this prospective study. Exclusion criteria included the use of drugs, alcohol, and/or physical injury, which could affect CCT performance. A 30- or 15-minute CCT battery was performed. Feasibility measures included environmental factors (space, noise, waiting time), testing factors (time, equipment reliability, personnel), and patient factors (age, injury characteristics).

Results

Forty-nine children (28 boys; mean age, 12.6; SD, ± 2.5) participated in the study. All children completed CCT. Mean testing times for the 30- and 15-minute battery were 29.7 and 15.2 minutes, respectively. Noise-cancelling headphones were well tolerated. A shorter CCT was more acceptable to families and was associated with fewer noise disturbances. There was sufficient time to perform testing after triage and before physician assessment in over 90% of children.

Conclusions

Computerized cognitive testing is feasible in the ED. We highlight the unique challenges that should be considered before its implementation, including environmental and testing considerations, as well as personnel training.
Association Between Initial Emergency Department Lactate and Use of Vasoactive Medication in Children With Septic Shock
Authors: Miescier Michael J. , Lane Roni D. , Sheng Xiaoming , Larsen Gitte Y.
Published: January 2017

Objectives

Current guidelines emphasize early recognition of pediatric septic shock using clinical examination findings. Elevated serum lactate has been associated with increased mortality in adult patients with septic shock. Our objective was to determine the association between the initial serum lactate obtained in the pediatric emergency department (PED) from patients treated for septic shock and the use of vasoactive medication within 24 hours.

Methods

This was a retrospective study from 2008 through 2012 of PED patients at a tertiary care children’s hospital. Patients younger than 18 years treated for septic shock were included if they had a serum lactate obtained in the PED.

Results

Eight hundred sixty-four PED encounters met inclusion criteria. Median initial PED lactate was 2.1 mmol/L (interquartile range, 1.4-3.2 mmol/L). Overall, 121 patients (14%) received vasoactive medication within 24 hours of the initial PED lactate. A multivariable logistic regression analysis demonstrated associations between initial lactate levels of 3.1 to 5 mmol/L (odds ratio, 1.82; 95% confidence interval, 1.02-3.26) and 5.1 mmol/L or greater (odds ratio, 5.00; 95% confidence interval, 2.56-9.76) and the use of vasoactive medication within 24 hours. Other factors associated with use of vasoactive medication within 24 hours included hypotension, abnormal pulses, and mental status changes.

Conclusions

Increased initial lactate is associated with use of vasoactive medication within 24 hours in PED patients with septic shock.
Persistent Knee Pain After Falling Off a Bicycle
Authors: Waseem Muhammad , Garrido-Joyce Julissa , Quee Frances , Priovolos Soula
Published: January 2017

We present the case of an 18-year-old young man with severe persistent knee pain secondary to a popliteal artery thrombosis. This occurred as a result of a fall from a bicycle. Acute compartment syndrome refers to the sequelae that can occur because of increased fascial compartment pressures, such as crush injuries, burns, traumatic or spontaneous hemorrhage, or constrictive casts. Increased pressures in nonelastic fascial compartments result in decreased perfusion distally, leading to ischemia of muscles and neurovascular tissue. In addition to highlighting recognition of the classic signs and symptoms of this limb-threatening condition, this case illustrates the importance of obtaining a thorough history; this is necessary in order to have a high index of suspicion for this diagnosis. A significant degree of clinical insight and prompt surgical intervention may save the functions of both the muscles and the nerves. These are at risk of permanent damage due to possible elevated compartment pressures.
Jet Pack Fun that Went Wrong
Authors: Mohite Sharad Arvindrao
Published: January 2017

The water jet pack is a relatively new and very exciting sporting activity for adventure seekers. However, there are some concerns raised in terms of safety, and some sporadic reports have appeared in newspapers about the injuries sustained from this sport. We are presenting an unfortunate case where a teenaged girl fell from a jet pack and sustained serious injuries including the loss of her kidney. This is the first reported serious injury from the Jet pack (Carbon Sports GmbH, Itzehoe, Germany).
A Case of Toxic Breast-feeding?
Authors: Schultz Megan L. , Kostic Mark , Kharasch Sigmund
Published: January 2017

Opiates are frequently prescribed postpartum for pain relief after cesarean delivery, episiotomies, and headaches. It is estimated that greater than 30% of breast-feeding mothers in the United States are prescribed opiates for pain relief associated with childbirth. Many opiates are readily transferred to human milk, although life-threatening events are rare. We report a 6-day-old breast-feeding infant whose mother was taking hydromorphone for pain relief from a cesarean delivery and whose clinical course was suggestive of opiate toxicity. This case emphasizes the importance of thorough medication history taking in postpartum breast-feeding mothers whose infants may present with symptoms of opiate toxicity. Semisynthetic opiates are frequently not detected on emergency department urine toxicology screens. The pertinent literature is reviewed.
Severe community-acquired pneumonia: optimal management
Authors: Leoni Davide , Rello Jordi
Published: January 2017

Purpose of review

Community-acquired pneumonia (CAP) is the leading cause of mortality among infectious diseases. Several efforts have been implemented to achieve better outcomes, but an important proportion of patients continue dying. This review focuses on the newest research on prognostic factors and diagnostics, opening new perspectives in the management of CAP.

Recent findings

CAP survival improved in recent years despite an increasing incidence of severe presentations. Appropriateness of antimicrobial choice, combination therapy and early administration of antibiotics has proved to be decisive. Novel biomarkers, as monocyte human leukocyte antigen-DR, presepsin and proadrenomedullin, have been explored for the prediction of severe CAP; moreover, the application of new techniques in metabolomics, genomics and microbiomics in the field of infections may contribute to predicting clinical instability and worse outcomes, showing that precise individual phenotypes are key factors for survival. CAP with unidentified organism is still an issue of concern, but new rapid molecular tests improve yield rates, revealing an unexpected high prevalence of viral detection and proving their usefulness also in the recognition of bacterial causes.

Precision medicine applied to risk stratification and diagnosis, together with rapid microbiologic molecular testing, may contribute to optimizing the management of CAP, with potential additional reduction of mortality rates.
Effect of Trospium Chloride on Cognitive Function in Women Aged 50 and Older: A Randomized Trial
Authors: Geller Elizabeth J. , Dumond Julie B. , Bowling J. Michael , Khandelwal Christine M. , Wu Jennifer M. , Busby-Whitehead Jan , Kaufer Daniel I.
Published: January 2017

Objectives

This study aimed to investigate the effect of trospium chloride on cognitive function in postmenopausal women treated for overactive bladder (OAB).

Methods

Randomized double-blind placebo-controlled trial conducted from April 2013 to April 2015. Women aged 50 years or older seeking treatment for OAB were randomized to either trospium chloride XR 60 mg daily or placebo. Baseline cognitive function was assessed via Hopkins Verbal Learning Test-Revised (HVLT-R), Mini Mental Status Exam, Mini Mental Status X, Digit Span, Trails A, Trails B, and Epworth Sleepiness Scale. Cognitive function was reassessed at week 1 and week 4. A priori power analysis determined that 21 subjects were needed per group.

Results

Although 59 women were enrolled and randomized (28 trospium and 31 placebo), 45 completed assessment (21 trospium and 24 placebo). Mean age was 68 years, 78% were white, and 44% had previously taken OAB medication. For the primary outcome, there was no difference in HVLT-R total score between trospium and placebo groups at week 4 (P = 0.29). There were also no differences based on the other cognitive tests. There was a correlation between age and the following week-4 tests: HVLT-R total score (r = −0.3, P = 0.02), HVLT-R total recall subscale (r = −0.4, P = 0.007), Trails A (r = 0.4, P = 0.002), and Trails B (r = 0.4, P = 0.004). A linear regression model found that HVLT-R total score decreased by 0.372 points for each increased year of age.

Conclusions

In women aged 50 years and older, there were no changes in cognitive function between those taking trospium and placebo. Cognitive function was correlated with age.
Exposure to Wood Smoke is Associated with Increased Risk of Asthma and Respiratory Symptoms in a Honduran Population
Authors: Cho Bo Hyun , Castellanos Elizabeth , Nguyen Elizabeth , Oh Sam , Thakur Neeta , Tarsi Jaime , Koch Tammy , Flores de Boquin Erika , Valladares Alberto , Balmes John , Burchard Esteban , Castro Mario , Galanter Joshua
Published: January 2017

Background

Exposure to environmental pollutants has been shown to be associated with asthma, but few studies have evaluated the effect of wood smoke on asthma and disease severity in a developing country, where use of stoves powered by solid fuels is a common practice.

Objective

In a population in Olancho, Honduras, we evaluated the association between cooking fuel, stove type and asthma. We also evaluated the effects of these factors on asthma symptoms, lung function, and atopy.

Methods

Participants with physician-diagnosed asthma (n = 597) and controls without asthma (n = 429) were recruited from the Olancho province in Honduras. Participants were interviewed using a questionnaire and their baseline pulmonary function was measured using spirometry.

Results

The prevalence of use of wood as a cooking fuel was 66.9% in the study population, of which 42.1% of participants used wood as their only fuel. Use of wood as a cooking fuel was more prevalent among households with lower income, lower maternal education, and less urbanization. The prevalence of use of an open wood stove as the primary cooking stove among participants with asthma was 6.2% higher (95% CI 0.8 – 11.7%, p = .02) than among healthy controls. In a multiple logistic regression model, we identified a significant association between use of an open wood stove and asthma (OR = 1.80, 95% CI = 1.17 - 2.78, p = 0.007), compared to the referent (electric) stove category. Among participants with asthma, we identified a significant association between use of wood as cooking fuel and increased daytime respiratory symptoms (OR = 1.46, CI: 1.01 – 2.58, p = 0.046) and nocturnal symptoms (OR = 2.51, CI: 1.04 - 2.62, p = 0.04), though not with pulmonary function. Among control participants without asthma, use of wood as cooking fuel was associated with atopy (OR = 1.94, CI = 1.14 – 3.33, p = 0.015) and cough (OR = 2.22, CI = 1.09 – 4.88, p = 0.04).

Conclusions

Use of an open wood stove for cooking in a developing country appears to be a significant risk factor for asthma and respiratory symptoms. Exposure to wood smoke may play a role in atopic sensitization and respiratory symptoms, leading to the development of obstructive lung disease in susceptible individuals.
Molecular and functional variation in iPSC-derived sensory neurons
Authors: Schwartzentruber Jeremy , Foskolou Stefanie , Kilpinen Helena , Rodrigues Julia , Alasoo Kaur , Knights Andrew J , Patel Minal , Goncalves Angela , Ferreira Rita , Benn Caroline Louise , Wilbrey Anna , Bictash Magda , Impey Emma , Cao Lishuang , Lainez Sergio , Loucif Alexandre Julien , Whiting Paul John ,   HIPSCI Consortium (www.hipsci.org), Gutteridge Alex , Gaffney Daniel J
Published: January 2017

Induced pluripotent stem cells (iPSCs), and cells derived from them, have become key tools to model biological processes and disease mechanisms, particularly in cell types such as neurons that are difficult to access from living donors. Here, we present the first map of regulatory variants in an iPSC-derived cell type. To investigate genetic contributions to human sensory function, we performed 123 differentiations of iPSCs from 103 unique donors to a sensory neuronal fate, and measured gene expression, chromatin accessibility, and neuronal excitability. Compared with primary dorsal root ganglion, where sensory nerves collect near the spinal cord, gene expression was more variable across iPSC-derived neuronal cultures, particularly in genes related to differentiation and nervous system development. Single cell RNA-sequencing revealed that although the majority of cells are neuronal and express the expected marker genes, a substantial fraction have a fibroblast-like expression profile. By applying an allele-specific method we identify 3,778 quantitative trait loci influencing gene expression, 6,318 for chromatin accessibility, and 2,097 for RNA splicing at FDR 10%. A number of these overlap with common disease associations, and suggest candidate causal variants and target genes. These include known causal variants atSNCAfor Parkinson’s disease andTNFRSF1Afor multiple sclerosis, as well as new candidates for migraine, Parkinson’s disease, and schizophrenia.
Comparing three types of dietary samples for prey DNA decay in an insect generalist predator
Authors: Kamenova Stefaniya , Mayer Rebecca , Rubbmark Oskar R. , Coissac Eric , Plantegenest Manuel , Traugott Michael
Published: January 2017

The rapidly growing field of molecular diet analysis is becoming increasingly popular among ecologists, especially when investigating methodologically challenging groups such as invertebrate generalist predators. Prey DNA detection success is known to be affected by multiple factors, however the type of dietary sample has rarely been considered. Here, we address this knowledge gap by comparing prey DNA detection success from three types of dietary samples. In a controlled feeding experiment, using the carabid beetlePterostichus melanariusas a model predator, we collected regurgitates, feces and whole consumers (including their gut contents) at different time points post-feeding. All dietary samples were analyzed using multiplex PCR targeting three different length DNA fragments (128 bp, 332 bp and 612 bp). Our results show that both the type of dietary sample and the size of the DNA fragment contribute to a significant part of the variation found in the detectability of prey DNA. Specifically, we observed that in both regurgitates and whole consumers prey DNA was detectable significantly longer for all fragment sizes than for feces. Based on these observations, we conclude that prey DNA detected from regurgitates and whole consumers DNA extracts are comparable, whereas prey DNA detected from feces, though still sufficiently reliable for ecological studies, will not be directly comparable to the former. Therefore, regurgitates and feces constitute an interesting, non-lethal source for dietary information that could be applied to field studies in situations when invertebrate predators should not be killed.
Individual boldness is life stage-dependent and linked to dispersal in a hermaphrodite land snail
Authors: Dahirel Maxime , Vong Alexandre , Ansart Armelle , Madec Luc
Published: January 2017

Both individual variation in dispersal tendency and animal personalities have been shown to be widespread in nature. They are often associated in personality-dependent dispersal, and both have major but underappreciated consequences for ecological and evolutionary dynamics. In addition, personalities are not stable over time and changes can appear through ontogeny, leading to life stage-dependent behaviours. We investigated relationships between dispersal, life stage and boldness in an invertebrate with between- and within-life stages variation in dispersal tendency, the land snailCornu aspersum.Latency to exit the shell following a simulated attack was repeatable, indicating boldness is a personality trait inCornu aspersum. Subadults were bolder and more dispersive than adults. Dispersers were bolder than non-dispersers, independently of boldness changes between life stages. We discuss how these results can be explained in relation with life history strategies in this hermaphrodite species, in particular risk management in the context of reproductive investment.