bluuebunny/crossref_metadata_2025 huggingface dataset:
Text Messaging Promoting Physician-Led Brief Intervention Tobacco Cessation: A Before-And-After Study among Physicians in Three Tertiary Hospitals in Nigeria
Authors: Odukoya Oluwakemi , Faseru Babalola , Uguru Nkolika , Jamda Mustapha , Onigbogi Olanrewaju , James Oluwafunmilola , Leischow Scott , Ayo-Yusuf Olalekan
Published: October 2018

Background: Physician-led smoking cessation services are suboptimal in Nigeria.

Objectives: This study evaluated a text messaging intervention designed to increase the knowledge and practices of physicians in Nigeria to help smokers quit.

Methods: Using a pre-post study design, all physicians ( N = 946) in 3 tertiary care hospitals located in 3 geopolitical zones in Nigeria were sent 2–3 text messages weekly over a 13-week period to create awareness and improve cessation practices using the “Ask, Advise and Refer” (AAR) model. The primary outcomes were the awareness of AAR and the proportion of physicians who offered each of the components of the brief intervention (AAR) to at least half of eligible patients. Secondary outcomes included the attitudes and self-reported effects of the messages on motivation to offer AAR to patients who smoke.

Results: Of the 946 eligible respondents, only 165 responded to both the before and after intervention surveys (17.4% participation rate). Participants were more likely to indicate awareness of the AAR approach after the intervention (60%) than before (21.2%). Overall, physicians’ practice of each component of the AAR changed significantly after the intervention ( P < .001; McNemar test). Of the participants, 71.5% reported reading the messages most/all of the time and 84.8% reported that the frequency of the messages was just adequate.

Conclusions: A brief and low-cost text messaging intervention to physicians increased the awareness and practice of AAR in those who participated in the study. However, the relatively low participation rate highlights the importance of new research to improve and expand text messaging as an intervention among physicians to help them foster tobacco treatment among their patients.
Energy sector of Cameroon
Authors: Marius Lea Laouan , Joel Ndjinang Alex
Published: October 2018

As energy issues are at the top of the national policy agenda, policymakers increasingly need better decision-supporting processes to assist them in fostering a sustainable energy policy. This article aims at supporting the development of energy policy by evaluating the potential, limits and efficiency of energy in Cameroon. The method used is based on the analysis of different forms of energy in Cameroon, through the past trend of energy production and consumption to the current status of Cameroon energetic system. Total energy production and consumption capacity in the country is up to 8.85 Mega tons of oil equivalents (Mtoe) and 5747 kilo tons of oil equivalents (ktoe) respectively. Energy consumption in Cameroon is highly dominated by biomass, followed by petroleum products and electricity; nevertheless, renewable energy is still marginal. Our opinion would be to develop new strategies to shift the energy situation from its present condition to the desired status.
The entrance: how life experience shaped my passion for diversity and inclusion
Authors: Skop Ahna R.
Published: October 2018

I am deeply honored to receive the American Society for Cell Biology (ASCB) Prize for Excellence in Inclusivity made possible through a grant from the Howard Hughes Medical Institute. This generous award of $5000 will go toward travel and registration support for underrepresented students from the University of Wisconsin–Madison to attend the ASCB and SACNAS (Society for Advancement of Chicanos/Hispanics and Native Americans in Science) conferences. In this essay, I have woven together a few stories on how my life experiences have shaped my passion for diversity and inclusion in STEM.
Who mentors whom?
Authors: Nogales Eva
Published: October 2018

This brief write-up describes my personal take on the mentor–mentee relationship as I have lived it while a professor at Berkeley. Ultimately, it is just a shout out to those who passed through my lab and shared with me their early scientific experiences.
Good Laboratory Practice in the Academic Setting: Fundamental Principles for Nonclinical Safety Assessment and GLP-Compliant Pathology Support When Developing Innovative Biomedical Products
Authors: Bolon Brad , Baze Wallace , Shilling Christopher J , Keatley Kendy L , Patrick Daniel J , Schafer Kenneth A
Published: October 2018

Development of new biomedical products necessitates nonclinical safety assessment in animals as a means of assessing potential risk to human patients. Pivotal nonclinical safety studies that support human clinical trials are performed according to Good Laboratory Practice (GLP) guidelines, which are designed to ensure that the study was conducted under carefully controlled conditions using standardized and validated procedures that will yield a reliable, reproducible, and traceable data set. The GLP guidelines established by different regulatory agencies address organizational structure, personnel responsibilities, personnel training practices, quality assurance (ensuring compliance), facilities, equipment, standard operating procedures, study documentation (record keeping), and record and sample retention. Academic institutions engaging in nonclinical safety assessment on-site have multiple options for implementing a GLP quality system. This article outlines the rationale supporting the use of a GLP-compliant or GLP-like quality system in academia and reviews key concepts needed to efficiently and effectively implement GLP in the academic setting. Emphasis is given to provision of GLP-compliant pathology support as (1) pathology data are an essential component of GLP nonclinical safety testing, (2) familiarity with pathology-related GLP procedures typically is gained first outside the academic setting, and (3) microscopic pathology diagnoses and interpretations require special accommodations to ensure that they are undertaken in a GLP-compliant fashion.
A small set of stylometric features differentiates Latin prose and verse
Authors: Chaudhuri Pramit , Dasgupta Tathagata , Dexter Joseph P , Iyer Krithika
Published: October 2018

Identifying the stylistic signatures characteristic of different genres is of central importance to literary theory and criticism. In this article we report a large-scale computational analysis of Latin prose and verse using a combination of quantitative stylistics and supervised machine learning. We train a set of classifiers to differentiate prose and poetry with high accuracy (>97%) based on a set of twenty-six text-based, primarily syntactic features and rank the relative importance of these features to identify a low-dimensional set still sufficient to achieve excellent classifier performance. This analysis demonstrates that Latin prose and verse can be classified effectively using just three top features. From examination of the highly ranked features, we observe that measures of the hypotactic style favored in Latin prose (i.e. subordinating constructions in complex sentences, such as relative clauses) are especially useful for classification.
The management of chronic cough
Authors: Mathur A , Liu-Shiu-Cheong P S K , Currie G P
Published: October 2018

Chronic cough is a common presentation to primary care and constitutes a significant volume of referrals to secondary care. It affects around 10% of the adult population and has a plethora of respiratory and non-respiratory causes. It can have a significant impact on the quality of life of affected individuals. In many patients, minimal baseline investigations lead to an easily identifiable and treatable cause. In others, no cause can be identified even after extensive investigations in specialized cough clinics. This evidence-based review article outlines the approach to the adult patient presenting with chronic cough and focuses upon current management strategies in those with chronic idiopathic cough. It includes results from trials of speech and language therapies, and the emerging concept of chronic idiopathic cough as a neuropathic disorder with its own bespoke approach to management including the use of neuromodulatory agents.
Sweet Orange Fruit Age and Inoculum Concentration Affect the Expression of Citrus Black Spot Symptoms
Authors: Frare Guilherme F. , Silva-Junior Geraldo J. , Lanza Fabrício E. , Bassanezi Renato B. , Ramires Thiago G. , Amorim Lilian
Published: October 2018

Citrus black spot (CBS), caused by Phyllosticta citricarpa, affects different citrus species worldwide. CBS is mainly expressed as false melanose and hard spot symptoms. There is no consensus in the literature about the period when fruit are susceptible to P. citricarpa infection and the length of the CBS incubation period. Therefore, this study aimed to assess the influence of sweet orange variety, fruit age, and inoculum concentration on the incubation period and the expression of different CBS symptoms. Attached fruit of Hamlin, Pera, and Valencia sweet orange at 1.5, 3.0, 5.0, and 7.0 cm diameter were inoculated with suspensions containing 103 and 105 conidia/ml of P. citricarpa. The percent conidial germination was quantified using scanning electron microscopy. The CBS symptoms on fruit were assessed monthly. The four diameters did not significantly affect conidial germination on the inoculated fruit, although CBS incidences were lower when larger fruit were inoculated. Hard spot symptoms on sweet orange fruit did not develop from the false melanose symptoms and vice versa. The incubation periods for false melanose were shorter than those observed for hard spot. False melanose began to appear 44 days after inoculation, but hard spot only formed at 113 days or later. Incubation periods were shorter and incidences of false melanose were higher following inoculation with higher inoculum concentration and smaller fruit diameter. The incubation period of hard spot varied among varieties and fruit diameters. However, there was no relationship between hard spot incidence and variety. This study provides a better understanding of the factors affecting the variation in the CBS incubation period and disease incidence on fruit.
Detection of a Single-Copy Plasmid, pXFSL21, in Xylella fastidiosa Strain Stag’s Leap with Two Toxin-Antitoxin Systems Using Next-Generation Sequencing
Authors: Van Horn Christopher , Wu Fengnian , Zheng Zheng , Dai Zehan , Chen Jianchi
Published: October 2018

Plasmids are important genetic elements contributing to bacterial evolution and environmental adaptation. Xylella fastidiosa is a nutritionally fastidious Gram-negative bacterium causing economically devastating diseases such as Pierce’s disease (PD) of grapevine. In this study, the plasmid status of a highly virulent PD strain, Stag’s Leap, originally isolated from Napa Valley, CA, was studied using sequencing and bioinformatics tools. DNA samples extracted from a pure culture in periwinkle wilt medium (in vitro DNA) and a PD-symptomatic grapevine artificially inoculated in the greenhouse (in planta DNA) were subject to next-generation sequencing (NGS) analyses (Illumina MiSeq or HiSeq). Sequence analyses and polymerase chain reaction experiments revealed the presence of a circular plasmid, pXFSL21, of 21,665 bp. This plasmid existed as a single copy per bacterial genome under both in vitro and in planta conditions. Two toxin-antitoxin (T-A) systems (ydcD-ydcE and higB-higA) were detected in pXFSL21, a possible mechanism for the long-term survival of this single-copy plasmid in the bacterial population. BLAST searches against the GenBank database (version 222) detected homologs of the two T-A systems in chromosomes or plasmids of some X. fastidiosa strains. However, double T-A systems were found only in pXFSL21. pXFSL21 was not found in other known PD strains and, therefore, could serve as a molecular marker for strain Stag’s Leap monitoring and tracking. The NGS-based technique outlined in this article provides an effective tool for identifying single- or low-copy-number plasmids in fastidious prokaryotes.
Timing of Grape Downy Mildew Onset in Bordeaux Vineyards
Authors: Chen Mathilde , Brun François , Raynal Marc , Makowski David
Published: October 2018

Grapevine downy mildew (GDM) is a severe disease of grapevines. Because of the lack of reliable information about the dates of GDM symptom onset, many vine growers begin fungicide treatments early in the season. We evaluate the extent to which such preventive treatments are justified. Observational data for 266 untreated sites for the years between 2010 and 2017 were used to estimate the timing of GDM onset on vines and bunches of grapes in South West France (Bordeaux region) through survival analyses. The onset of GDM was not apparent on vines and bunches before early to mid-May, and the rate of GDM symptom appearance was highly variable across years. Depending on the year, 50% of the plots displayed symptoms between mid-May and late June for vines. For several years, our statistical analysis revealed that the proportion of plots with no symptoms was high in early August on vines (27.5 and 43.7% in 2013 and 2016) and on bunches (between 23 and 79% in 2011, 2013, and 2016). We found a significant effect of the amount of rainfall in spring on the date of symptom appearance. These results indicate that preventive fungicide application is unjustified in many vineyards, and that regional disease surveys should be used to adjust fungicide treatment dates according to local characteristics, in particular according to rainfall conditions in spring.
Risk Factors for Surgical Site Infection in Minor Dermatological Surgery: A Systematic Review
Authors: Delpachitra Meth Ruvinda , Heal Clare , Banks Jennifer , Divakaran Pranav , Pawar Mrinal
Published: October 2018

OBJECTIVE:

To identify patient- and procedure-related risk factors for surgical site infection following minor dermatological surgery.

DATA SOURCES:

The MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Informit, and Scopus databases were searched for relevant literature on patient populations receiving minor surgery, where risk factors for surgical site infection were explicitly stated.

STUDY SELECTION:

Studies involving major dermatological surgery were excluded. The preliminary search yielded 820 studies after removing duplicates; 210 abstracts were screened, and 42 full texts were assessed for eligibility. A total of 13 articles were included. Studies were appraised using the Newcastle-Ottawa Quality Assessment Scale.

DATA EXTRACTION:

An electronic data collection tool was constructed to extract information from the eligible studies, and this information was distributed to participating authors.

DATA SYNTHESIS:

Risk factors identified included age, sex, diabetes mellitus, chronic obstructive pulmonary disease, use of antihypertensive or corticosteroid medications, smoking, surgery on the lower or upper extremities, excision of nonmelanocytic skin cancers, large skin excisions, and complex surgical techniques. No more than two studies agreed on any given risk factor, and there were insufficient studies for meta-analysis.

CONCLUSIONS:

Re-excision of skin cancer, below-knee excisions, and intraoperative hemorrhagic complications were predictive for infection in more than one study. More high-quality studies are required to accurately identify risk factors so they can be reliably used in clinical guidelines.
Adverse childhood experiences and implementing trauma-informed primary care
Authors: Esden Jana L.
Published: October 2018

Adverse childhood experiences (ACEs) include exposures such as abuse and household dysfunction. These exposures are associated with long-term sequelae and unfavorable health outcomes in adulthood. NPs working in primary care can help to reduce the impact of ACEs in adulthood by identifying individuals with these experiences and implementing trauma-informed care strategies.
Unicortical Fixation is Sufficient for Surgical Treatment of Tibial Tubercle Avulsion Fractures in Children
Authors: Arkader Alexandre , Schur Mathew , Refakis Christian , Capraro Anthony , Woon Regina , Choi Paul
Published: October 2018

Background:

Although open reduction and internal fixation are recommended for displaced tibial tubercle avulsion fractures in young athletes, whether to use unicortical or bicortical fixation is debatable. The purpose of this study is to compare the outcomes of unicortical versus bicortical fixation in a series of pediatric tibial tubercle avulsion fractures.

Methods:

We reviewed a consecutive series of patients with tibial tubercle fractures treated surgically at 2 level-1 pediatric tertiary care centers over a 12.5-year period. Patients aged below 18 years of age who received surgical treatment for displaced tibial tubercle fractures with postoperative follow-up were included. Fractures were classified using a modified Ogden classification system. The relative proportion of fracture types treated and incidence of complications were compared.

Results:

The cohort included 90 fractures in 86 patients. There were 82 male and 4 female individuals; average age was 14.7 years (range, 9.0 to 18 y). In total, 87 of 90 were treated with open reduction and internal screw fixation [51 unicortical (59%), 13 mixed (15%), 23 bicortical (26%)] and 3 with percutaneous pinning. All patients were followed-up until healing and postoperative follow-up average was 8 months (range, 3 to 34 mo). There were no significant differences between the 2 groups with regard to patient age (P=0.22), patient weight (P=0.22), and activity clearance times [unicortical: 19.9 wk (range, 10.4 to 42.3 wk); bicortical: 17.7 wk (range, 12.1 to 32 wk); P=0.19]. The mixed cortical group was cleared at an average of 19.9 weeks (range, 10.6 to 29.1 wk). The relative proportion of fracture patterns treated differed negligibly between the unicortical and bicortical groups. Complications were noted in 9 of 90 procedures (10% rate); all subjects showed evidence of full radiographic healing at last follow-up.

Conclusions:

There was no difference in outcome whether unicortical or bicortical fixation was used. All patients exhibited full healing and return to activities with very low-complication rates. The results of this study suggest the adequacy of unicortical fixation for treating tibial tubercle fractures in young athletes.

Level of Evidence:

Level III—retrospective comparative study.
Trochlear Dysplasia and Its Relationship to the Anterior Distal Femoral Physis
Authors: Parikh Shital N. , Rajdev Neil
Published: October 2018

Background:

Trochlear dysplasia is a known risk factor for patellar instability in adolescent patients. A spatial relationship between dysplastic trochlea and anterior distal femoral physis has not been established. The purpose of this study was to investigate this relationship. Our hypothesis was that the position of the dysplastic trochlea and trochlear bump would coincide with the anterior distal femoral physis and that the distance between them would increase with age.

Methods:

In a retrospective study, magnetic resonance images of adolescents with trochlear dysplasia were evaluated. Measurements performed included trochlear depth, trochlear bump size, proximal trochlea-physis distance, and trochlear bump-physis distance. Linear regression analyses were performed to correlate the variables with increasing age.

Results:

In total, 175 knees (160 patients) with trochlear dysplasia were included. The mean trochlea-physis distance was 4.50 mm (SD=1.93) and it increased with age (slope=0.26; P<0.01). The lateral aspect of trochlea was proximal to the physis in 24 (13.7%) knees and was at the level of the physis in 31 (17.7%) knees. The size of trochlear bump increased with age (slope=0.15; P=0.01). The bump-physis distance increased with age (slope=0.41; P<0.01).

Conclusions:

The dysplastic trochlea is closely related to the anterior distal femoral physis. The distance between the dysplastic trochlea and femoral physis increases with age. The close relationship between proximal aspect of trochlea and anterior distal femoral physis should be considered when trochlear surgery is planned in skeletally immature patients.

Level of Evidence:

Level II.
A Bundled Payment Model for Pediatric Distal Radius Fractures: Defining an Episode of Care
Authors: Godfrey Jenna M. , Little Kevin J. , Cornwall Roger , Sitzman Thomas J.
Published: October 2018

Background:

Distal radius fractures are the most common fracture of childhood, occurring in ∼1 per 100 children annually. Given the high incidence of these fractures, we explored feasibility of a bundled payment model. We determined the total treatment costs for each child and identified components of fracture management that contributed to variations in cost.

Methods:

We retrospectively reviewed all hospital and physician costs related to the treatment of closed distal radius fractures at a large academic children’s hospital. We included all children age 2 to 15 years treated by an orthopaedic surgeon for an isolated closed distal radius fracture between 2013 and 2015. We compared total treatment costs by fracture management approach. We then estimated the contribution of each component of fracture management to total treatment costs using linear regression.

Results:

We identified 5640 children meeting the inclusion criteria, of which 4602 (81.6%) received closed treatment without manipulation, 922 (16.3%) underwent closed reduction in the clinic, emergency department, or radiology procedure suite, and 116 (2.1%) underwent treatment in the operating room. The median cost for closed treatment without manipulation was $1390 [interquartile range (IQR) 1029 to 1801], compared with $4263 (IQR, 3740 to 4832) for closed reduction and $9389 (IQR, 8272 to 11,119) for closed reduction and percutaneous pinning (P<0.001). In multivariable regression analysis, fracture management approach and use of the operating room environment were the largest cost drivers (P<0.001, R
2=0.88). Closed reduction in the clinic or emergency department added $894 (95% confidence interval, 819-969) to treatment costs, while closed reduction in the operating room added $5568 (95% confidence interval, 5224-6297). Location of the initial clinical evaluation, number of radiographic imaging series obtained, and number of orthopaedic clinic visits also contributed to total costs.

Conclusions:

Closed pediatric distal radius fractures treated without manipulation show small variations in treatment costs, making them well suited for bundled payment. Bundled payments for these fractures could reduce costs by encouraging adoption of existing evidence-based practices.

Level of Evidence:

Level III—therapeutic.
Sacroiliac Pain
Authors: DePhillipo Nicholas N. , Corenman Donald S. , Strauch Eric L. , Zalepa King Lisa A.
Published: October 2018

Background:

The currently reported incidence of primary sacroiliac joint (SIj) pathology ranges from 15% to 30%. The differential diagnosis of SIj region pain includes pain generated from the lumbar spine, the SIj, and the hip joint. The origins of SIj dysfunctions are controversial and pain generation from this joint has been questioned.

Purpose:

Retrospectively analyze the relative incidence of lumbar spine, SIj, and hip joint etiologies in patients complaining of ≥50% SIj region pain.

Study Design:

This is a retrospective cohort case series.

Methods:

Inclusion criteria: chief complaint SIj pain (≥50% of overall complaint). In total, 124 patients charts were reviewed from a single spine surgeon’s clinic. All patients were evaluated by the same 2 practitioners and all cases were reviewed for clinical examination findings, diagnostic tests performed, final diagnosis, treatment, and clinical follow-up.

Results:

After complete diagnostic workup, 112 (90%) had lumbar spine pain, 5 (4%) had hip pain, 4 (3%) had primary SIj pain, and 3 (3%) had an undetermined source of pain upon initial diagnosis. SIj pain generation was confirmed via fluoroscopy-guided diagnostic injections. Following designated treatment, 11 (9%) patients returned to clinic at an average of 2.4 years complaining of continued/recurrent SIj region pain. Further investigation revealed 6 patients had confirmed pain generation from the lumbar spine, 3 patients had confirmed pain generation from the SIj, and 2 patients had undetermined sources of pain.

Conclusions:

The SIj is a rare pain generator (3%–6%) in patients complaining of ≥50% SIj region pain and is a common site of referral pain from the lumbar spine (88%–90%). Clinicians ought to quantify areas of pain (via percent of overall complaint) when interviewing their patients complaining of low back pain to distinguish potential pain generators. Recommended breakdown of areas of interest include axial low back, SIj region, buttock/leg, groin/anterior thigh.
Race and renal cell carcinoma stage at diagnosis: an analysis of the Surveillance, Epidemiology, and End Results data
Authors: Lin Jie , Kamamia Christine , Shriver Craig D. , Zhu Kangmin
Published: October 2018

To study racial differences in tumor stage at diagnosis among Black and White patients with renal cell carcinoma (RCC) by histologic type and time period. The patients were Black and White patients with RCC from 1999 to 2011 derived from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Multinomial logistic regression was used to assess the associations between cancer stage and race and then stratified by histology and diagnosis year. Compared to Whites, Blacks were less likely to be diagnosed with regional disease [odds ratio (OR)=0.67; 95% confidence interval (CI)=0.60–0.73] or distant disease (OR=0.82; 95% CI=0.74–0.90) after adjusting for age, sex, year of diagnosis, and tumor grade. When stratified by RCC histology, similar results were observed for clear cell (OR=0.71; 95% CI=0.63–0.80), chromophobe (OR=0.51; 95% CI=0.32–0.81), and other histologic type (OR=0.63; 95% CI=0.42–0.96) while the association was not significant for papillary histology. The analyses by time showed a lower likelihood to have regional disease in Black than White in 2003–2006 (OR=0.66; 95% CI=0.55–0.79) and 2007–2011 (OR=0.57; 95% CI=0.49–0.67). Black patients were also less likely to have distant disease in 2007–2011 period (OR=0.76; 95% CI=0.65–0.88). In conclusion, blacks were less likely to be diagnosed at a later stage RCC than Whites regardless of cancer histology. This racial disparity may exist over time during the study period.
Impact of catechol-O-methyltransferase gene variants on methylation status of P16 and MGMT genes and their downregulation in colorectal cancer
Authors: Wani Hilal A. , Majid Sabhiya , Bhat Arif A. , Amin Shajrul , Farooq Rabia , Bhat Showkat A. , Naikoo Nissar A. , Beigh Mushtaq A. , Kadla Showkat A.
Published: October 2018

Globally, colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second most commonly diagnosed cancer in females, with 1.4 million new cases and almost 694 000 deaths estimated to have occurred in 2012. The development and progression of CRC is dictated by a series of alterations in diverse genes mostly proto-oncogenes and tumor suppressor genes. In this dreadful disease disturbances different from mutations called as epigenetic regulations are also taken into consideration and are thoroughly investigated. The present study was designed to analyze the promoter hypermethylation of CpG (cytosine, followed by guanine nucleotide) islands of cyclin-dependent kinase inhibitor 2A (P16) and O6-methylguanine-DNA methyltransferase (MGMT) genes and its subsequent effect on the protein expression in CRC. The impact of the common functional polymorphism of the catechol-O-methyltransferase (COMT) gene, Val158Met, on promoter hypermethylation of P16 and MGMT genes in CRC was also investigated. The study included 200 CRC cases and equal numbers of normal samples. DNA was extracted using the kit method and methylation specific-PCR was performed for analysis of the promoter hypermethylation status. Total protein was isolated form all CRC cases and western blotting was performed for P16 and MGMT proteins. The COMT Val158Met polymorphism was analyzed by a PCR-restriction fragment length polymorphism assay. Epigenetic analysis showed that unlike other high-risk regions, the Kashmiri population has a different promoter hypermethylation profile of both P16 and MGMT genes, with frequent and significant promoter hypermethylation of both in CRC. The frequency of promoter hypermethylation of both genes was significantly higher in males and was insignificantly found to be higher in stage III/IV. The degree of P16 and MGMT promoter hypermethylation increased significantly with increasing severity of the lesion. We also found a significant correlation between P16 and MGMT promoter hypermethylation and loss of protein expression in CRC. A significant association was found between COMT polymorphism (homozygous variant) and P16 methylation status. Similar results were also found for MGMT hypermethylated cases.
Proximal Interruption of the Pulmonary Artery
Authors: Williams Eric A. , Cox Chad , Chung Jonathan H. , Grage Rolf A. , Rojas Carlos A.
Published: October 2018

Proximal interruption of the pulmonary artery (PIPA) is an uncommon developmental anomaly resulting in underdevelopment of the proximal portion of the pulmonary artery with preservation of the intrapulmonary segments. Clinical presentation ranges between an asymptomatic incidental finding to massive hemoptysis. When findings suggestive of PIPA are present radiographically, the diagnosis of PIPA can be definitively diagnosed with computed tomography or magnetic resonance pulmonary angiography. Other imaging modalities, such as nuclear perfusion scan and catheter angiography can help in the diagnosis.
Treatment of the Prominent Ear: A Standardized Approach Without Intraoperative Measurements
Authors: MacIsaac Zoe M. , Zammerilla Lauren , Grunwaldt Lorelei J.
Published: October 2018

Background:

Candidates for otoplasty have variable anatomy that may result in an aesthetically suboptimal appearance. The authors describe an algorithm to obtain ideal aesthetic position of the ear using a standardized suturing only technique.

Methods:

A retrospective review was conducted at a major children's hospital. Pre- and postoperative distances from the mastoid to the posterior lateral helical rim were measured at 3 consistent points (upper helix, mid helix, and lobule). Cosmetic outcomes were determined by visual analog cosmetic score (VACS), assigned by 3 independent reviewers.

Results:

A total of 26 patients underwent otoplasty for prominent ear (average age 8.2 years). Duration of follow-up was an average of 32 weeks postoperatively. Pre- and postoperative VACSs were determined for all patients: overall-appearance, 25.8 versus 71.3; overall-ear appearance, 25.7 versus 70.0; shape, 24.4 versus 72.6; and projection, 23.7 versus 73.9 (P < 0.05 for all). There was no inter-rater difference between scores. There was greater symmetry between ears postoperatively (P < 0.05). Measurements were significantly improved pre- versus postoperatively: upper-helix 2.04 versus 1.20 cm, mid-helix 2.22 versus 1.18 cm, and lobule 1.85 versus 1.49 cm (P < 0.05.) Postoperative measurements are in accordance with established norms for ideal ear position (1.0–1.2 cm upper third of the ear). Two patients recurred, and 1 experienced a spitting suture (11.5%).

Conclusion:

Aesthetic ideal was established on the operating table based on the appearance of the ear. Postoperative measurements fell within aesthetic ideal for a normal ear, suggesting that the use of intraoperative measurements are not needed to obtain an aesthetically acceptable outcome.
Postsurgical Changes in Osseous Dysmorphology of the Midface and Mandible in Unilateral Coronal Craniosynostosis
Authors: Jo Sally , Skolnick Gary B. , Naidoo Sybill D. , Smyth Matthew D. , Patel Kamlesh B.
Published: October 2018

Background:

Early management of unilateral coronal synostosis (UCS) aims to treat the cranial abnormality with the hope of improving middle and lower facial morphology. This study analyzed osseous volume and 3-dimensional distances in the midface and mandible of patients with UCS to assess changes in facial symmetry following a cranial vault procedure.

Methods:

Patients who underwent fronto-orbital advancement for UCS repair between 1981 and 2012 with follow-up of at least 3 years were included. Computed tomography-based 3-dimensional reconstructions of the mandible and LeFort III midface were divided by 3 midline osseous landmarks and measured for volume. Distances between 11 osseous landmarks were measured in the midface and mandible. Ratios between the measurements on synostotic and nonsynostotic sides were calculated. Presurgical to postsurgical changes were evaluated with paired samples t tests. The study was powered to detect differences between preoperative and postoperative ratios of at least 3%.

Results:

Eleven patients were included. Mean age at initial imaging was 4.7 ± 3.2 months (range, 0.4–9.2 months) with postoperative follow-up of 9.0 ± 5.3 years (range, 3.3–17.0 years). Midfacial symmetry of osseous volume improved following surgery (synostotic to nonsynostotic ratio, 94.1% vs 98.9%, P = 0.044). The width (P < 0.001), height (P = 0.039), and anterior–posterior depth of the midface (P = 0.011) also became more symmetric. In the mandible, however, volumetric and linear symmetry did not improve.

Conclusions:

Symmetry of the midface, but not the mandible, improves significantly following the cranial procedure in patients with UCS.
Hemato-oncology and palliative care teams: is it time for an integrated approach to patient care?
Authors: LeBlanc Thomas W. , El-Jawahri Areej
Published: October 2018

Purpose of review

Integrated palliative care for those with advanced solid tumors yields significant benefits in patient and caregiver outcomes. However, most palliative care clinical trials have excluded patients with hematologic malignancies. There is growing interest in whether integrated palliative care may yield similar benefits in hematologic malignancy patients and caregivers, but there has been little direct evidence of benefit in this population. This review summarizes new data on palliative care issues in hematologic malignancies, published in the preceding 12 months.

Recent findings

Most newly published evidence on this topic from the last year is descriptive of unmet needs, poor end-of-life care outcomes or unique differences and issues posed by hematologic malignancies as compared to solid tumors. A few articles describe models of collaborative care in hematologic malignancies, and just one describes the impact of an integrated palliative care intervention on patient and caregiver outcomes. Several studies point to transfusions as a unique and problematic barrier to high-quality end-of-life care in hematologic malignancies.

Recent evidence confirms that hematologic malignancy patients have unique and often unmet palliative care needs, and also have worse end-of-life outcomes. More work is needed to develop and test integrated palliative care interventions in this population.
Precious cargo: Modulation of the mesenteric lymph exosome payload after hemorrhagic shock
Authors: Williams Elliot C. , Coimbra Raul , Chan Theresa W. , Baird Andrew , Eliceiri Brian P. , Costantini Todd W.
Published: October 2018

BACKGROUND

Trauma/hemorrhagic shock (T/HS) causes a release of proinflammatory mediators into the mesenteric lymph (ML) that may trigger a systemic inflammatory response and subsequent organ failure. Recently, we showed that exosomes in postshock ML are biologically active mediators of this inflammation. Because the specific inflammatory mediators in postshock ML exosomes have yet to be characterized, we hypothesized that T/HS would lead to a distinct ML proinflammatory exosome phenotype that could be identified by proteomic analysis. We further hypothesized that their regulation by the neuroenteric axis via the vagus nerve would modify this proinflammatory profile.

METHODS

Male rats underwent an established T/HS model including 60 minutes of HS followed by resuscitation. Mesenteric lymph was collected before HS (preshock) and after resuscitation (postshock). A subset of animals underwent cervical vagus nerve electrical stimulation (VNS) after the HS phase. Liquid chromatography with tandem mass spectroscopy (LC-MS/MS) followed by protein identification, label free quantification, and bioinformatic analysis was performed on exosomes from the pre-shock and post-shock phases in the T/HS and T/HS + vagus nerve electrical stimulation groups. Biological activity of exosomes was evaluated using a monocyte nuclear factor kappa B (NF-κB) activity assay.

RESULTS

ML exosomes express a distinct protein profile after T/HS with enrichment in pathways associated with cell signaling, cell death and survival, and the inflammatory response. Stimulation of the vagus nerve following injury attenuated the transition of ML exosomes to this T/HS-induced inflammatory phenotype with protein expression remaining similar to pre-shock. Monocyte NF-κB activity was increased after exposure to ML exosomes harvested after T/HS, while ML exosomes from preshock had no effect on monocyte NF-κB expression.

CONCLUSION

Postshock ML exosomes carry a distinct, proinflammatory protein cargo. Stimulating the vagus nerve prevents the T/HS-induced changes in ML exosome protein payload and suggests a novel mechanism by which the neuroenteric axis may limit the systemic inflammatory response after injury.
Time course and outcomes associated with transient versus persistent fibrinolytic phenotypes after injury: A nested, prospective, multicenter cohort study
Authors: Roberts Derek J. , Kalkwarf Kyle J. , Moore Hunter B. , Cohen Mitchell J. , Fox Erin E. , Wade Charles E. , Cotton Bryan A.
Published: October 2018

BACKGROUND

Temporal changes in fibrinolytic activity after injury and their impact on outcomes remain poorly defined. We conducted a prospective, multicenter cohort study to determine the incidence of fibrinolytic phenotypes after injury and the trajectories and associated outcomes of these phenotypes over time.

METHODS

We included adults that arrived within 6 hours of injury to three American Level I trauma centers. Clot lysis at 30 minutes (LY-30) was measured at presentation and at 3 hours, 6 hours, 12 hours, 24 hours, 48 hours, 72 hours, 96 hours, and 120 hours. LY-30 was used to categorize patients into the following fibrinolytic phenotypes: fibrinolysis shutdown (SD, LY-30 ≤0.8%), physiologic fibrinolysis (PHYS, LY-30 >0.8% to <3%), or hyperfibrinolysis (HF, LY-30 ≥3%). We used multivariable logistic regression to estimate adjusted odds ratios for mortality.

RESULTS

We included 795 adults (median age, 38 years; median Injury Severity Scale score, 21). In total, 44% presented with SD, 36% with PHYS, and 21% with HF. Mortality was highest among those who presented with HF (20%) followed by SD (10%) and PHYS (7%) (p= 0.001). While mortality within the first 24 hours was highest with admission HF (14% vs. 5% SD vs. 4% PHYS;p= 0.001), both admission HF (7%) and SD (6%) had higher mortality after 24 hours compared with PHYS (3%) (p= 0.04). All patients who presented with HF switched into another phenotype or died within 24 hours. The majority of patients that presented in SD remained in that phenotype, including 71% at 24 hours and 72% at 120 hours. Persistent SD at 24 hours was independently associated with increased mortality after 24 hours (odds ratio, 3.20; 95% confidence interval, 1.51–6.67).

CONCLUSION

Approximately 70% of major trauma patients who present with SD remain in this phenotype up to 120 hours postinjury. In contrast, patients presenting with HF transition into another phenotype or die within 24 hours. While early mortality is highest with the HF phenotype, persistent SD at 24 hours is associated with elevated late mortality.

LEVEL OF EVIDENCE

Prognostic and epidemiological study, level II.
Comparison of diagnostic accuracy for nonocclusive mesenteric ischemia in models with biomarkers including intestinal fatty acid–binding protein in addition to clinical findings
Authors: Matsumoto Shokei , Shiraishi Atsushi , Kojima Mitsuaki , Funaoka Hiroyuki , Funabiki Tomohiro , Saida Takafumi , Kitano Mitsuhide
Published: October 2018

BACKGROUND

Nonocclusive mesenteric ischemia (NOMI) is an acute and life-threatening gastrointestinal disorder, requiring rapid therapeutic intervention for ischemic bowel. However, its rapid detection remains challenging. This retrospective, observational study was aimed at comparing the diagnostic accuracy for NOMI in models of biomarkers, including intestinal fatty acid–binding protein (I-FABP), and clinical findings.

METHODS

All consecutive patients who presented to the emergency department of the study hospital with suspected NOMI were prospectively enrolled. Receiver operating characteristic analysis compared the diagnostic accuracy of I-FABP with traditional biomarkers (white blood cell count, C-reactive protein, lactate, creatine kinase, and D-dimer) alone and in combination with the baseline model established from clinical findings.

RESULTS

Of 96 patients with suspected NOMI, 25 (26.0%) were clinically diagnosed with NOMI. In-hospital mortality was higher in patients with NOMI than those with other conditions (56.0% vs. 4.2%, p < 0.001). Receiver operating characteristic analyses revealed that the I-FABP model had the highest area under the curve (0.805) in the diagnosis of NOMI, compared with other biomarkers. The diagnostic model of clinical findings including age, cardiovascular disease history, undergoing hemodialysis, hypotension, and consciousness disturbance in combination with I-FABP showed the best discrimination (area under the curve, 0.883), compared with other biomarkers. The bootstrap optimism estimate showed the lowest discrimination among the other models with other biomarkers (0.006).

CONCLUSION

The usefulness of I-FABP for final diagnosis of NOMI in patients with clinically suspected NOMI at the emergency department was internally validated. Further external validation study is warranted.

LEVEL OF EVIDENCE

Diagnostic test, level III.
An introduction to patient-reported outcome measures (PROMs) in trauma
Authors: Turner Grace M. , Slade Anita , Retzer Ameeta , McMullan Christel , Kyte Derek , Belli Antonio , Calvert Melanie
Published: October 2018

Increased survival rates from traumatic injury have resulted in more people living with disability and reduced quality of life. To understand how peoples' quality of life is affected following a traumatic injury and the effects of that injury on their health and well-being, it is important to capture patients' perspectives of their own health. Patient-reported outcome measures (PROMs) are questionnaires, completed by patients, which can be used to measure the symptom burden associated with trauma and its treatment, and impact on quality of life. Patient-reported outcome measures have a wide variety of uses that are relevant to trauma. In a research setting, PROMs can be used to assess the effectiveness of treatment and burden of disease. In a clinical setting, PROMs have the potential to inform and guide patient-centered care and clinical decision making. Collected as part of trauma registries, PROMs can be used at an aggregate level to inform improvements and uphold the quality of trauma care. This literature review explores and summarizes the key current and potential future uses of PROMs in trauma research, routine clinical practice, and registries.
Ketamine infusion for pain control in adult patients with multiple rib fractures: Results of a randomized control trial
Authors: Carver Thomas W. , Kugler Nathan W. , Juul Janelle , Peppard William J. , Drescher Karin Madsen , Somberg Lewis B. , Szabo Aniko , Yin Ziyan , Paul Jasmeet S.
Published: October 2018

BACKGROUND

Rib fractures occur in up to 40% of trauma patients and are associated with increased mortality. Opiate-based pain regimens remain the cornerstone of rib fracture management; however, concerns around opioids have fostered interest in alternative analgesics. Ketamine is currently being used in lieu of opioids, but little evidence exists supporting its use within the trauma population.

METHODS

A prospective, randomized, double-blind placebo-controlled trial of adult patients with three or more rib fractures admitted to a Level I trauma center was conducted. Exclusion criteria included age older than 64 years, Glasgow Coma Scale score less than 13, and chronic opiate use. The experimental arm received low-dose ketamine (LDK) at 2.5 μg·kg−1·min−1 while the placebo cohort received an equivalent rate of 0.9% normal saline. All infusions were continued for 48 hours. The primary outcome was reduction in numeric pain score (NPS) during the first 24 hours. Secondary outcomes studied included oral morphine equivalent (OME) utilization, length of stay, epidural rates, pulmonary complications, and adverse events.

RESULTS

Forty-five (49%) of 91 patients were randomized to the experimental arm. Both groups were similar in makeup. Overall, 74.7% were male, had a median age of 49 years, and an Injury Severity Score (ISS) of 14. Low-dose ketamine was not associated with a significant reduction in 24-hour NPS or OME totals. Subgroup analysis of 45 severely injured patients (ISS, >15) demonstrated that LDK was associated with a significant reduction in OME utilization during the first 24 hours (35.7 vs. 68, p = 0.03), 24 hours to 48 hours (64.2 vs. 96, p = 0.03), and overall (152.1 vs. 198, p = 0.048). No difference in other secondary outcomes or adverse events was noted.

CONCLUSION

Low-dose ketamine failed to decrease NPS or OME within the overall cohort, but a decrease in OME was observed among patients with an ISS greater than 15. Confirmatory studies are necessary to determine if LDK is a useful adjunct among severely injured patients.

LEVEL OF EVIDENCE

Therapeutic study, level II.
Antiphospholipid Syndrome and Renal Allograft Thrombosis
Authors: Morales Jose Maria , Serrano Manuel , Martinez-Flores Jose Angel , Perez Dolores , Serrano Antonio
Published: October 2018

Renal allograft thrombosis is the most frequent and devastating complication in the early postrenal transplantation period. Several risk factors to develop graft thrombosis depending on donors and recipients are well known. Antiphospholipid syndrome (APS) is well recognized as an important cause of kidney injury, with specific clinical and histological features that may lead to renal injury caused by thrombosis at any location within the renal vasculature. There are 3 forms of APS, primary (the most common form), associated to other systemic autoimmune diseases (SAD-APS), and catastrophic. Nevertheless, patients with SAD-APS and renal failure only represent 2% to 5% in hemodialysis or transplantation. The presence of pretransplant antiphospholipid antibodies increases risk of graft thrombosis. A new form of APS based on IgA anti–β-2-glycoprotein-I (B2GPI) antibodies, representing up to 30% of patients in end-stage renal disease and renal transplantation, is the main independent risk factor for graft thrombosis and early graft loss after renal transplantation. In addition, B2GP1 bound to IgA aB2GP1 immunocomplexes have been described as a marker to predict thrombosis after renal transplantation in patients with antiphospholipid antibodies. Anticoagulation remains the main treatment to prevent renal allograft thrombosis, although new preventive strategies are coming. Future studies may help to identify better therapeutic targets.