bluuebunny/crossref_metadata_2025 huggingface dataset:
Unravelling the nutriproteomics of chickpea (Cicer arietinum) seeds
Authors: Santos Tiago , Marinho Catarina , Freitas Michael , Santos Hugo M. , Oppolzer David , Barros Ana , Carnide Valdemar , Igrejas Gilberto
Published: November 2017

Chickpea (Cicer arietinum L.) is an essential grain for human consumption owing to its high protein content, nutritional quality and energy-efficient production. The aim of this study was to compare the protein extracts of 24 chickpea genotypes by biochemically characterising the storage proteins. The storage protein content was characterised by protein separation with polyacrylamide gel electrophoresis and visualisation of the banding patterns, which revealed considerable genetic variability within and between genotypes in this chickpea collection. High performance liquid chromatography showed that all genotypes had balanced amino acid content and some were rich in seven amino acids. Two chickpea genotypes, Flip97-171C and Elite, representative of the kabuli and desi types, respectively, were chosen for total proteome analysis. Two-dimensional electrophoresis and subsequent mass spectrometry were used to identify 454 protein spots from the Flip97-171C and Elite proteomes. By using Mascot Server software, 37% of the spots were identified as 47 different proteins involved in a large range of metabolic functions. Most proteins from both proteomes were assigned to nutritional storage activity. Chickpea proteome analysis is essential in reaffirming the quality of this grain protein for human nutrition, and will be important in future nutriproteomics and plant-breeding studies.
Decline of the dasyurid marsupial Antechinus minimus maritimus in south-east Australia: implications for recovery and management under a drying climate
Authors: Wilson Barbara A. , Zhuang-Griffin Lily , Garkaklis Mark J.
Published: November 2017

Our understanding of recent extinctions and declines of Australian mammals is poor, particularly where there is a paucity of data to quantify change. The swamp antechinus (A. m. maritimus) has a fragmented, coastal distribution in south-east Australia. Although long-term studies (1975–2007) of this vulnerable species were conducted in the eastern Otways, its current status was unclear. We assessed the success of live trapping and camera trapping (2013–17) at 42 sites, 19 where the species was trapped previously. Between 2013 and 2015 A. m. maritimus was recorded at only 6 sites (n = 8), but at none in 2016–17. Assessment of long-term changes found that high-density populations occurred after above-average rainfall, and both low- and high-density populations collapsed after wildfire, after low rainfall, and in fragmented habitat. The species may now be restricted to very small populations in refuges such as coastal dunes, and predicted low rainfall and increased burning frequency pose major threats to the species’ survival. Recovery is unlikely without targeted management, including predator control and protection from inappropriate fire regimes and habitat fragmentation. If similar declines have been experienced across the species’ range, prevention of extinction of the species will require similar management strategies.
Ideals, practices, and future prospects of stakeholder involvement in sustainability science
Authors: Mielke Jahel , Vermaßen Hannah , Ellenbeck Saskia
Published: November 2017

Significance

Even though stakeholder involvement (SI) is increasingly relevant in scientific research processes, especially in interdisciplinary fields like sustainability science, there is limited academic literature investigating conceptual or methodological questions. Through a survey among researchers from this field, this paper presents an overview of practices and ideals of SI as well as of their divergence. Furthermore, trade-offs between scientific ideals and SI, as well as necessary improvements concerning, for example, methods or funding, are described. To add to the conceptualization of SI, the survey data were related to a typology that differentiates democratic, technocratic, neoliberal-rational, and functionalist views of SI in science. The findings can form one possible basis for development of SI toward a more standardized research approach in sustainability science.
Expansion microscopy of zebrafish for neuroscience and developmental biology studies
Authors: Freifeld Limor , Odstrcil Iris , Förster Dominique , Ramirez Alyson , Gagnon James A. , Randlett Owen , Costa Emma K. , Asano Shoh , Celiker Orhan T. , Gao Ruixuan , Martin-Alarcon Daniel A. , Reginato Paul , Dick Cortni , Chen Linlin , Schoppik David , Engert Florian , Baier Herwig , Boyden Edward S.
Published: November 2017

Significance

We explore the utility of expansion microscopy (ExM) in neuroscience and developmental biology using the zebrafish model. Regarding neuroscience studies, ExM enables the tracing of cellular processes in the zebrafish brain, as well as the imaging of synapses and their biomolecular content and organization. Regarding development, ExM enables the resolving of nuclear compartments, particularly nuclear invaginations and channels, and helps relate such cellular nanostructures to proteins of the cytoskeleton during embryogenesis.
Multiple pathways in pressure-induced phase transition of coesite
Authors: Liu Wei , Wu Xuebang , Liang Yunfeng , Liu Changsong , Miranda Caetano R. , Scandolo Sandro
Published: November 2017

Significance

Coesite is an important geological mineral, yet it presents complicated phase transformations under compression. Earlier reports of pressure-induced amorphization have been later refined showing formation of various crystalline structures, including a high-pressure octahedral phase. Due to the complicated structure nature of coesite, we need to represent the system in a relatively large box. Previous first-principles calculations are limited, as only a small unit cell was employed. Here, we carried out molecular dynamics simulations based on an ab initio parameterized polarizable force field. This approach allows us accurate simulations with relatively large system sizes, which eventually enables us to provide a theoretical identification of multiple transformation pathways that have been discovered so far.
Parallel epigenetic modifications induced by hatchery rearing in a Pacific salmon
Authors: Le Luyer Jérémy , Laporte Martin , Beacham Terry D. , Kaukinen Karia H. , Withler Ruth E. , Leong Jong S. , Rondeau Eric B. , Koop Ben F. , Bernatchez Louis
Published: November 2017

Significance

Captive rearing is known to impact the fitness of individuals released in the wild, but the relative role of genetic vs. nongenetic underlying processes is still debated. We measured genome-wide methylation profiles to document epigenetic differences between Pacific salmon originating from a hatchery and their natural-born congeners in two geographically distant rivers. Our results provide evidence that the epigenetic modifications induced by hatchery rearing provide a potential explanatory mechanism for reduced fitness of hatchery-reared salmon once released in the wild.
An endogenous retroviral envelope syncytin and its cognate receptor identified in the viviparous placental
Mabuya
lizard
Authors: Cornelis Guillaume , Funk Mathis , Vernochet Cécile , Leal Francisca , Tarazona Oscar Alejandro , Meurice Guillaume , Heidmann Odile , Dupressoir Anne , Miralles Aurélien , Ramirez-Pinilla Martha Patricia , Heidmann Thierry
Published: November 2017

Significance

Retroviral envelope gene capture and exaptation for a placental function has been demonstrated in mammals. Remarkably, placental structures have also emerged on rare occasions in nonmammalian vertebrates, resulting in related modes of reproduction. The
Mabuya
lizard, which emerged 25 Mya, possesses a placenta closely related to that of mammals. Here, we identified a specific retroviral envelope gene capture that shows all the characteristic features of a bona fide mammalian syncytin, being conserved in
Mabuya
evolution, expressed in the placenta, and fusogenic. Together with the present identification of its cognate receptor, these results show that syncytin capture is not restricted to mammals and is likely to be a major driving force for placenta emergence.
Lessons Learned in Clinical Trial Communication During an Ebola Outbreak: The Implementation of STRIVE
Authors: Callis Amy , Carter Victoria M , Ramakrishnan Aparna , Albert Alison P , Conteh Lansana , Barrie Alhaji Amadu , Fahnbulleh Lucian , Koroma Mark M , Saidu Samuel , Williams Otis , Samai Mohamed
Published: November 2017

Communication contributed to 4 important aspects of the Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE): recruiting participants, supporting Human Subjects Protection, building trust in the community to support the trial, and mitigating the impact of rumors and misinformation. Communication was particularly important because STRIVE was Sierra Leone’s first vaccine clinical trial and was implemented during a public health emergency. Communication efforts began months prior to trial launch, building awareness and support through sensitization sessions with stakeholders and community leaders. Community engagement activities continued throughout the trial to maintain relationships with leaders and stakeholders and disseminate accurate information, fostering trust in the trial. The communication team led recruitment with hundreds of information sessions for potential participants, facilitating the informed consent process. Communication efforts continued post-enrollment, supporting ongoing voluntary participation in the trial. Informal formative activities during the trial yielded insights on participants’ perceptions and information needs. While Centers for Disease Control and Prevention Institutional Review Board–approved activities and materials did not change, this flexible strategy allowed for responsive interactions with participants. The trial success and its community acceptance illustrated STRIVE’s successful communications efforts, owing in large part to this flexibility and commitment to community engagement.

Clinical Trials Registration

ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].
Long-Term Outcomes After Gamma Knife Radiosurgery for Benign Meningioma: A Single Institution's Experience With 424 Patients
Authors: Seo Youngbeom , Kim Dong Gyu , Kim Jin Wook , Han Jung Ho , Chung Hyun-Tai , Paek Sun-Ha
Published: November 2017

BACKGROUND

Gamma knife radiosurgery (GKRS) is recognized as an important treatment modality for meningioma.

OBJECTIVE

To analyze the long-term outcomes in meningioma patients treated with GKRS to determine the risk factors related to treatment failure and peritumoral edema (PTE) development.

METHODS

Between 1998 and 2010, 770 consecutive patients were treated with GKRS for intracranial meningioma. After the exclusion of patients with follow-up periods of less than 5 yr and those with neurofibromatosis, multiple meningiomas, nonbenign meningioma, or radiotherapy, a total of 424 patients were enrolled in this study. The median follow-up duration was 92 mo. The median tumor volume was 4.35 cm3, and the median marginal dose was 14 Gy.

RESULTS

The overall local tumor control rate was 84%. The actuarial tumor control rates were 91.7% and 78.9% at 5 and 10 yr, respectively. The tumor control rate of a radiologically diagnosed tumor was higher than that of a grade I tumor (82% vs 70.1% at 10 yr, P = .001). In multivariate analysis, factors associated with tumor progression were female sex (hazard ratio: 0.5, P = .025) and a previous history of craniotomy (hazard ratio: 1.9, P = .009). Symptomatic PTE was identified in 36 (8.5%) patients, and the factor associated with poor PTE was the presence of PTE before GKRS (odds ratio: 4.6, P < .001). Permanent complication rate was 4%.

CONCLUSION

GKRS appears to be an effective treatment modality for meningioma with long-term follow-up. However, the identification of delayed tumor progression in our study suggests that extended follow-up data should be collected after GKRS.
Control of Bull’s-Eye Rot of Apple Caused by Neofabraea perennans and Neofabraea kienholzii Using Pre- and Postharvest Fungicides
Authors: Aguilar C. G. , Mazzola M. , Xiao C. L.
Published: November 2017

Bull’s-eye rot is a major postharvest disease of apple caused by several fungi belonging to the Neofabraea and Phlyctema genera. Chemical control of these fungi is a crucial component of disease management for apples that are conventionally grown. The efficacy of several preharvest and postharvest applied fungicides were evaluated to identify effective chemistries that can control bull’s-eye rot incited by Neofabraea perennans and N. kienholzii on apples. In general, the preharvest fungicide thiophanate-methyl was found to be effective at reducing disease caused by N. perennans and N. kienholzii. Two postharvest fungicides, thiabendazole and pyrimethanil, also provided disease control that was far superior to other chemical compounds evaluated in this study. The efficacy of thiabendazole and pyrimethanil was unaffected by application method (fungicide dip compared with thermofog). Despite providing satisfactory control of bull’s-eye rot, integration of these three chemicals into disease management programs should proceed judiciously with consideration of their impact on the development of fungicide resistance and influence on diversity in populations of apple postharvest pathogens.
Integrative Review of Service-Learning Assessment in Nursing Education
Authors: Taylor Susan L. , Leffers Jeanne M.
Published: November 2017

AIM

The aim of the research is to review all qualitative research studies related to service-learning assessment in nursing education.

BACKGROUND

Recent literature reviews have examined quantitative but not qualitative research studies on service-learning assessment in nursing education.

METHOD

An integrative review analyzed the results of published qualitative research of service-learning assessment. Articles included in this review were published in English in peer-reviewed journals from 1997 to 2014 and encompassed information on outcomes, assessment or evaluation, nursing education, and service-learning.

RESULTS

Nine articles containing thematic analysis were included in the final review. Findings were synthesized into a higher order of analysis. Eight categories from that analysis were created: professional competency development, integration of knowledge for the professional nursing role, greater understanding of community strengths and needs, collaboration and teamwork, transformation and personal growth, civic engagement, emotions and adjustment, and culture awareness and competency.

CONCLUSION

The integrative review will aid in the development of measurement categories for further nursing service-learning assessment work.
Effect of Thoracic Epidural Ropivacaine versus Bupivacaine on Lower Urinary Tract Function
Authors: Girsberger Stefan A. , Schneider Marc P. , Löffel Lukas M. , Burkhard Fiona C. , Wuethrich Patrick Y.
Published: November 2017

Background

Thoracic epidural analgesia with bupivacaine resulted in clinically relevant postvoid residuals due to detrusor underactivity. This study aimed to compare the risk of bladder dysfunction with ropivacaine versus bupivacaine using postvoid residuals and maximum flow rates. Our hypothesis was that ropivacaine would result in lower postvoid residuals, because ropivacaine has been shown to have less effect on motor blockade.

Methods

In this single-center, parallel-group, randomized, double-blind superiority trial, 42 patients undergoing open renal surgery were equally allocated to receive epidural bupivacaine 0.125% or ropivacaine 0.2%, and 36 were finally included. Inclusion criterion was normal bladder function. Patients underwent urodynamic investigations preoperatively and during thoracic epidural analgesia. Primary outcome was the difference in postvoid residual preoperatively and during thoracic epidural analgesia postoperatively. Secondary outcomes were changes in maximum flow rate between and within the groups.

Results

Median difference in postvoid residual (ml) from baseline to postoperatively was 300 (range, 30 to 510; P < 0.001) for bupivacaine and 125 (range, −30 to 350; P = 0.011) for ropivacaine, with a significant mean difference between groups (−175; 95% CI, −295 to −40; P = 0.012). Median difference in maximum flow rate (ml/s) was more pronounced with bupivacaine (−12; range, −28 to 3; P < 0.001) than with ropivacaine (−4; range, −16 to 7; P = 0.025) with a significant mean difference between groups (7; 95% CI, 0 to 12; P = 0.028). Pain scores were similar. No adverse events occurred.

Conclusions

Postvoid residuals were significantly lower using ropivacaine compared to bupivacaine for thoracic epidural analgesia reflecting less impairment of detrusor function with ropivacaine.
Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death
Authors: Sessler Daniel I. , Meyhoff Christian S. , Zimmerman Nicole M. , Mao Guangmei , Leslie Kate , Vásquez Skarlet M. , Balaji Packianathaswamy , Alvarez-Garcia Jesús , Cavalcanti Alexandre B. , Parlow Joel L. , Rahate Prashant V. , Seeberger Manfred D. , Gossetti Bruno , Walker S. A. , Premchand Rajendra K. , Dahl Rikke M. , Duceppe Emmanuelle , Rodseth Reitze , Botto Fernando , Devereaux P. J.
Published: November 2017

Background

The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: (1) intraoperative, (2) remaining day of surgery, and (3) during the initial four postoperative days.

Methods

This was a substudy of POISE-2, a 10,010-patient factorial-randomized trial of aspirin and clonidine for prevention of myocardial infarction. Clinically important hypotension was defined as systolic blood pressure less than 90 mmHg requiring treatment. Minutes of hypotension was the exposure variable intraoperatively and for the remaining day of surgery, whereas hypotension status was treated as binary variable for postoperative days 1 to 4. We estimated the average relative effect of hypotension across components of the composite using a distinct effect generalized estimating model, adjusting for hypotension during earlier periods.

Results

Among 9,765 patients, 42% experienced hypotension, 590 (6.0%) had an infarction, and 116 (1.2%) died within 30 days of surgery. Intraoperatively, the estimated average relative effect across myocardial infarction and mortality was 1.08 (98.3% CI, 1.03, 1.12; P < 0.001) per 10-min increase in hypotension duration. For the remaining day of surgery, the odds ratio was 1.03 (98.3% CI, 1.01, 1.05; P < 0.001) per 10-min increase in hypotension duration. The average relative effect odds ratio was 2.83 (98.3% CI, 1.26, 6.35; P = 0.002) in patients with hypotension during the subsequent four days of hospitalization.

Conclusions

Clinically important hypotension—a potentially modifiable exposure—was significantly associated with a composite of myocardial infarction and death during each of three perioperative periods, even after adjustment for previous hypotension.
The South African English Smartphone Digits-in-Noise Hearing Test: Effect of Age, Hearing Loss, and Speaking Competence
Authors: Potgieter Jenni-Marí , Swanepoel De Wet , Myburgh Hermanus Carel , Smits Cas
Published: November 2017

Objectives:

This study determined the effect of hearing loss and English-speaking competency on the South African English digits-in-noise hearing test to evaluate its suitability for use across native (N) and non-native (NN) speakers.

Design:

A prospective cross-sectional cohort study of N and NN English adults with and without sensorineural hearing loss compared pure-tone air conduction thresholds to the speech reception threshold (SRT) recorded with the smartphone digits-in-noise hearing test. A rating scale was used for NN English listeners’ self-reported competence in speaking English. This study consisted of 454 adult listeners (164 male, 290 female; range 16 to 90 years), of whom 337 listeners had a best ear four-frequency pure-tone average (4FPTA; 0.5, 1, 2, and 4 kHz) of ≤25 dB HL.

Results:

A linear regression model identified three predictors of the digits-in-noise SRT, namely, 4FPTA, age, and self-reported English-speaking competence. The NN group with poor self-reported English-speaking competence (≤5/10) performed significantly (p < 0.01) poorer than the N and NN (≥6/10) groups on the digits-in-noise test. Screening characteristics of the test improved with separate cutoff values depending on English-speaking competence for the N and NN groups (≥6/10) and NN group alone (≤5/10). Logistic regression models, which include age in the analysis, showed a further improvement in sensitivity and specificity for both groups (area under the receiver operating characteristic curve, 0.962 and 0.903, respectively).

Conclusions:

Self-reported English-speaking competence had a significant influence on the SRT obtained with the smartphone digits- in-noise test. A logistic regression approach considering SRT, self-reported English-speaking competence, and age as predictors of best ear 4FPTA >25 dB HL showed that the test can be used as an accurate hearing screening tool for N and NN English speakers. The smartphone digits-in-noise test, therefore, allows testing in a multilingual population familiar with English digits using dynamic cutoff values that can be chosen according to self-reported English-speaking competence and age.
Antibiotic Prophylaxis With Cefuroxime: Influence of Duration on Infection Rate With Staphylococcus aureus in a Contaminated Open Fracture Model
Authors: Puetzler Jan , Metsemakers Willem-Jan , Arens Daniel , Zeiter Stephan , Kuehl Richard , Raschke Michael J. , Richards Robert Geoff , Moriarty Thomas Fintan
Published: November 2017

Objectives:

The optimal duration of perioperative antibiotic prophylaxis (PAP) for open fractures remains controversial because of heterogeneous or unclear guidelines and highly variable prophylactic regimens in clinical practice. We aimed at testing different PAP durations under controlled conditions in a contaminated rabbit fracture model.

Methods:

A complete humeral osteotomy in 18 rabbits was fixed with a 7-hole locking compression plate and inoculated with Staphylococcus aureus. Cefuroxime was administered in a weight-adjusted dosage equivalent to human medicine (18.75 mg/kg). PAP was administered as a single shot only; for 24 hours; or for 72 hours in separate groups of rabbits (n = 6 per group). Infection was assessed after 2 weeks by quantitative bacteriological evaluation of the tissues and hardware.

Results:

Postoperative duration of PAP had a significant impact on the success of antibiotic prophylaxis in this model. Whereas the single-shot regimen completely failed to prevent infection, the 24-hour regimen showed a reduced infection rate (1 of 6 rabbits infected), but only the 72-hour course was able to prevent fracture-related infection in all animals in our model.

Conclusions:

When contamination with high bacterial loads is likely (eg, in an open fracture situation), a 72-hour course of intravenous cefuroxime seems to be superior in preventing fracture-related infection in our rabbit model compared with a single-shot or 24-hour antibiotic regimen.
Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery
Authors: Chung Andrew S. , Hustedt Joshua W. , Walker Robert , Jones Clifford , Lowe Jason , Russell George V.
Published: November 2017

Objectives:

Low serum albumin levels (hypoalbuminemia) have classically been used to identify malnutrition. The effect of increasing severity of malnutrition on postoperative outcomes in patients undergoing hip fracture surgery has not been well delineated on a large scale.

Design:

Retrospective.

Setting:

Multicenter.

Patient/Participants:

A total of 12,373 patients undergoing hip fracture surgery from 2006 to 2013 National Surgery Quality Improvement Project data were identified.

Intervention:

Patient demographic, comorbidity, and preoperative laboratory data and complication, reoperation, and readmission data were collected.

Main Outcome Measurements:

Multivariate logistic regression was used to determine the effect of increasing severity of malnutrition on rates of 30-day postoperative complications, readmissions, and reoperations.

Results:

A total of 12,373 hip fractures met inclusion criteria. A total of 6506 (52.6%) patients had normal albumin levels (albumin ≥3.5 g/dL), 3205 (25.9%) patients were mildly malnourished (albumin 3.1–3.49 g/dL), 2265 (18.3%) were moderately malnourished (albumin 2.4–3.1 g/dL), and 397 (3.2%) patients were severely malnourished (albumin <2.4 g/dL). Mean age was similar between the 4 cohorts (P < 0.001). Severe malnutrition was associated with a 2-fold increase in the odds of postoperative complications and mortality when compared with mild malnutrition (P < 0.001). Increasing severity of malnutrition was associated with significantly longer lengths of stay and higher odds of experiencing a related readmission (P < 0.001).

Conclusions:

Increasing severity of hypoalbuminemia is independently associated with poorer outcomes in the 30 days after hip fracture surgery.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Pediatric ACL Reconstruction and Return to the Operating Room: Revision Is Less Than Half of the Story
Authors: DeFrancesco Christopher J. , Storey Eileen P. , Flynn John M. , Ganley Theodore J.
Published: November 2017

Background:

Although there are several causes of unplanned return to the operating room (RTOR) following pediatric anterior cruciate ligament (ACL) reconstruction (ACLR), prior outcomes studies focus primarily on the risk of graft failure. We sought to comprehensively describe indications for RTOR in pediatric primary ACLR patients, estimate associated rates of RTOR, and assess the impact of concomitant meniscal procedures on these rates.

Methods:

This retrospective cohort study considered patients who underwent primary ACLR at an urban, pediatric tertiary care hospital between 2013 and 2015. Cohorts were defined based on the presence or absence of a concomitant surgical meniscal procedure with the index ACLR. The primary outcome was RTOR for an indication pertaining to ACLR or a potential predilection for knee injury. Cases of RTOR were cataloged and classified according to indication. Survival analyses were performed using the Kaplan-Meier estimation and competing-risks regression. Comparisons of any-cause RTOR rates were done using log-rank tests.

Results:

After exclusion criteria were applied, 419 subjects were analyzed. RTOR indications were organized into 5 categories. The overall rate for any RTOR by 3 years after surgery was 16.5%. Graft failure and contralateral ACL tear were the most common indications for RTOR, with predicted rates of 10.3% and 7.1%, respectively. ACL graft failure accounted for less than half of RTOR cases cataloged. Patients who had a concomitant meniscus procedure had lower rates of RTOR.

Conclusions:

Approximately 1 in 6 pediatric ACLR patients underwent ≥1 repeat surgery within 3 postoperative years for indications ranging from wound breakdown to contralateral ACL rupture. While previous studies revealed high rates of complication after pediatric ACLR due primarily to graft failure, we found that re-tear is responsible for less than half of the 3-year RTOR risk. As almost half of re-tears in our sample occurred before clearance to return to full activities, we suspect that the high rate of complication is largely attributable to pediatric patients’ high activity levels and difficulties adhering to postoperative restrictions. Early treatment of meniscus pathology may reduce rates of RTOR.

Level of Evidence:

Level III—therapeutic.
Applicability of the Calcaneal Apophysis Ossification Staging System to the Modern Pediatric Population
Authors: Li Samuel Q. , Nicholson Allen D. , Cooperman Daniel R. , Liu Raymond W.
Published: November 2017

Background:

The calcaneal apophysis ossification staging system is a novel method for assessing skeletal maturity. However, it was created using the same historic patient population that was used to create the Greulich and Pyle atlas of the hand and wrist, predominantly white children. It is unclear if the calcaneal apophysis ossification staging system is still applicable to the modern pediatric population and to children of other races.

Methods:

We retrospectively studied 1327 benign lateral foot x-rays from modern white and black children. Calcaneal stage was determined and age, race, and sex were collected for each patient. A 2-tailed Student t test was used to compare between cohorts the differences in age for each calcaneal stage.

Results:

Mean age was 11.55±4.39 years. Modern white females graded as stage 3 and 4 were significantly delayed in their bone age (stage 3 P<0.002; stage 4 P<0.003) when compared with their historic counterparts. Skeletal maturity was consistent between modern and historic white males for stages 1 to 4. Modern black females graded as stage 1 to 4 were significantly advanced in their skeletal age when compared with modern white females (stage 1 P<0.038; stage 2 P<0.005; stage 3 P<0.002; stage 4 P<0.002). Modern black males graded as stages 1, 3, and 4 were also significantly advanced in their bone age when compared with their modern white counterparts (stage 1 P<0.003; stage 3 P<0.012; stage 4 P<0.029).

Conclusions:

Modern white females mature more slowly in the later stages when compared with their historic counterparts. No significant difference is seen between modern and historic white males. Modern black females and males were skeletally advanced compared with modern white females and males. We have shown that the calcaneal ossification staging system can be used to assess for skeletal maturity in the modern pediatric population with only mild corrections for white females and more significant adjustments for black females and males.

Level of Evidence:

Level III—retrospective chart review.
Kinetics of Urinary Cell Cycle Arrest Markers for Acute Kidney Injury Following Exposure to Potential Renal Insults
Authors: Ostermann Marlies , McCullough Peter A. , Forni Lui G. , Bagshaw Sean M. , Joannidis Michael , Shi Jing , Kashani Kianoush , Honore Patrick M. , Chawla Lakhmir S. , Kellum John A.
Published: November 2017

Objectives:

Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 predict the development of acute kidney injury following renal insults of varied aetiology. To aid clinical interpretation, we describe the kinetics of biomarker elevations around an exposure.

Design:

In an ancillary analysis of the multicenter SAPPHIRE study, we examined the kinetics of the urinary [tissue inhibitor of metalloproteinase-2]•[insulin-like growth factor binding protein 7] in association with exposure to common renal insults (major surgery, IV radiocontrast, vancomycin, nonsteroidal anti-inflammatory drugs, and piperacillin/tazobactam).

Setting:

Thirty-five sites in North America and Europe between September 2010 and June 2012.

Patients:

Seven hundred twenty-three critically ill adult patients admitted to the ICU.

Interventions:

None.

Measurements and Main Results:

We compared the urinary [tissue metalloproteinase-2]•[insulin growth factor binding protein 7] kinetics from the day prior to exposure up to 5 days after exposure in patients developing acute kidney injury stage 2–3, stage 1, or no acute kidney injury by Kidney Disease Improving Global Outcome criteria. Among the 723 patients, 679 (94%) had at least one, 70% had more than one, and 35% had three or more exposures to a known renal insult. There was a significant association between cumulative number of exposures up to study day 3 and risk of acute kidney injury (p = 0.02) but no association between the specific type of exposure and acute kidney injury (p = 0.22). With the exception of radiocontrast, patients who developed acute kidney injury stage 2–3 after one of the five exposures, had a clear rise and fall of urinary [tissue inhibitor of metalloproteinase-2]•[insulin-like growth factor binding protein 7] from the day of exposure to 24–48 hours later. In patients without acute kidney injury, there was no significant elevation in urinary [tissue inhibitor of metalloproteinase-2]•[insulin-like growth factor binding protein 7].

Conclusions:

Exposure to potential renal insults is common. In patients developing acute kidney injury stage 2–3, the kinetics of urinary [tissue inhibitor of metalloproteinase-2]•[insulin-like growth factor binding protein 7] matched the exposure except in the case of radiocontrast.
Initial Antifungal Strategy Reduces Mortality in Critically Ill Patients With Candidemia: A Propensity Score–Adjusted Analysis of a Multicenter Study*
Authors: Garnacho-Montero José , Díaz-Martín Ana , Cantón-Bulnes Luisa , Ramírez Paula , Sierra Rafael , Arias-Verdú Dolores , Rodríguez-Delgado Marina , Loza-Vázquez Ana , Rodriguez-Gomez Jesús , Gordón Mónica , Estella Ángel , García-Garmendia José Luis
Published: November 2017

Objective:

The objective of this study was to evaluate the impact of the empirical therapy with fluconazole or an echinocandin on 30- and 90-day mortality in critically ill patients with candidemia. The outcome of patients in whom the empirical echinocandin was deescalated to fluconazole was also assessed.

Design:

Retrospective, observational multicenter study.

Setting:

Medical and surgical ICUs in nine Spanish hospitals.

Patients:

Adult patients (≥ 18 yr) with an episode of Candida bloodstream infection during ICU admission from January 2011 to April 2016.

Interventions:

Patient characteristics, infection-related variables, therapeutic interventions, and metastatic complications were reviewed. A propensity score–adjusted multivariable analysis was performed to identify the risk factors significantly associated with 30-day and 90-day mortality.

Measurements and Main Results:

A total of 294 patients were diagnosed of candidemia in the participant ICUs. Sixty patients were excluded (other antifungals in the primary therapy or the patient died without empirical antifungal therapy). The study group comprised 115 patients who received fluconazole (30-day mortality, 37.4%) and 119 patients treated empirically with an echinocandin (30-day mortality, 31.9%). The use of an echinocandin in the empirical therapy was a protective factor for 30-day (odds ratio, 0.32; 95% CI, 0.16–0.66; p = 0.002) and 90-day mortality (odds ratio, 0.50; 95% CI, 0.27–0.93; p = 0.014) in the propensity score– adjusted multivariable analysis. Deescalation of the empirical echinocandin to fluconazole was not associated with a higher mortality or the occurrence of long-term complications.

Conclusions:

Empirical use of an echinocandin in critically ill patients with documented candidemia reduces mortality at 30 and 90 days significantly. Deescalation of the empirical echinocandin to fluconazole is safe and effective in fluconazole-susceptible infections.
The history and basic science development of soy isoflavones
Authors: Setchell Kenneth D.R.
Published: November 2017

This review summarizes the 2016 NAMS/Pfizer—Wulf H. Utian Endowed Lecture that focused on the history and basic science of soy isoflavones. Described is a personal perspective of the background and history that led to the current interest in soy and isoflavones with a specific focus on the role that soy isoflavones play in the health of postmenopausal women. This overview covers the metabolism and physiological behavior of isoflavones, their biological properties that are of potential relevance to aging, issues related to the safety of soy isoflavones, and the role of the important intestinally derived metabolite S-(−)equol.
Surgical interventions for the treatment of painful neuroma: a comparative meta-analysis
Authors: Poppler Louis H. , Parikh Rajiv P. , Bichanich Miles J. , Rebehn Kelsey , Bettlach Carrie R. , Mackinnon Susan E. , Moore Amy M.
Published: November 2017

A consensus on the optimal treatment of painful neuromas does not exist. Our objective was to identify available data and to examine the role of surgical technique on outcomes following surgical management of painful neuromas. In accordance with the PRISMA guidelines, we performed a comprehensive literature search to identify studies measuring the efficacy of the surgical treatment of painful neuromas in the extremities (excluding Morton's neuroma and compression neuropathies). Surgical treatments were categorized as excision-only, excision and transposition, excision and cap, excision and repair, or neurolysis and coverage. Data on the proportion of patients with a meaningful reduction in pain were pooled and a random-effects meta-analysis was performed. The effects of confounding, study quality, and publication bias were examined with stratified, meta-regression, and bias analysis. Fifty-four articles met the inclusion criteria, many with multiple treatment groups. Outcomes reporting varied significantly and few studies controlled for confounding. Overall, surgical treatment of neuroma pain was effective in 77% of patients [95% confidence interval: 73-81]. No significant differences were seen between surgical techniques. Among studies with a mean pain duration greater than 24 months, or median number of operations greater than 2 prior to definitive neuroma pain surgery, excision and transposition or neurolysis and coverage were significantly more likely than other operative techniques to result in a meaningful reduction in pain (P < 0.05). Standardization in the reporting of surgical techniques, outcomes, and confounding factors is needed in future studies to enable providers to make comparisons across disparate techniques in the surgical treatment of neuroma pain.
New developments in immunotherapy for pediatric solid tumors
Authors: Schultz Liora M. , Majzner Robbie , Davis Kara L. , Mackall Crystal
Published: November 2017

Purpose of review

Building upon preclinical advances, we are uncovering immunotherapy strategies that are translating into improved outcomes in tumor subsets. Advanced pediatric solid tumors carry poor prognoses and resultant robust efforts to apply immunotherapy advances to pediatric solid tumors are in progress. Here, we discuss recent developments in the field using mAb and mAb-based therapies including checkpoint blockade and chimeric antigen receptors (CARs).

Recent findings

The pediatric solid tumor mAb experience targeting the diganglioside, GD2, for patients with neuroblastoma has been the most compelling to date. GD2 and alternative antigen-specific mAbs are now being incorporated into antibody–drug conjugates, bispecific antibodies and CARs for treatment of solid tumors. CARs in pediatric solid tumors have not yet achieved comparative responses to the hematologic CAR experience; however, novel strategies such as bispecific targeting, intratumoral administration and improved understanding of T-cell biology may yield enhanced CAR-efficacy. Therapeutic effect using single-agent checkpoint blocking antibodies in pediatric solid tumors also remains limited to date. Combinatorial strategies continue to hold promise and the clinical effect in tumor subsets with high antigenic burden is being explored.

Pediatric immunotherapy remains at early stages of translation, yet we anticipate that with advanced technology, we will achieve widespread, efficacious use of immunotherapy for pediatric solid tumors.
Management of Pediatric Isolated Skull Fractures
Authors: Williams Daniel C. , Russell W. Scott , Andrews Annie L. , Simpson Kit N. , Basco William T. , Teufel Ronald J.
Published: November 2017

Objective

Pediatric isolated skull fractures (ISFs) are common injuries that represent challenging disposition decisions for clinicians. The purpose of this study is to use a decision analysis to compare the clinical and cost-effectiveness of 3 emergency department (ED)–based disposition scenarios for a pediatric patient presenting with ISF.

Methods

We conducted a cost-effectiveness analysis comparing ED disposition scenarios that included current practice, increased at-home surveillance, and observation unit utilization. Current rates of admission, deterioration after initial diagnosis, and ED return after discharge, as well as cost of observation-only status, were obtained through literature review. Cost calculations using Healthcare Cost and Utilization Project data included total ED cost, admission without complication, and admission with deterioration.

Results

In current practice, 76% of subjects with ISF are admitted and 2.5% of those develop persistent or new symptoms. No patient diagnosed with ISF required neurosurgical intervention. Of those discharged home from the ED, 2.8% return with a new concern with 7.4% having new findings on imaging leading to admission. Total cost per 100 patients by current practice was US $583,587. Increasing at-home surveillance by 20% resulted in a total cost saving of US $113,176 per 100 patients while increasing returns to the ED from less than 1% to 1.1%. Admitting at the current rate to an observation unit resulted in a US $205,395 cost saving per 100 patients.

Conclusions

Decreased inpatient utilization through home surveillance or observation unit use reduced cost associated with pediatric ISF management without increasing clinical risk owing to the low probability of clinical deterioration after initial diagnosis.
Fast and Sensitive
Authors: Malia Laurie , Strumph Kaitlin , Smith Sharon , Brancato John , Johnson Stephanie T. , Chicaiza Henry
Published: November 2017

Objective

Point-of-care (POC) urine dipstick is a highly used test in the pediatric emergency department (PED) owing to its fast turn-around time and inexpensive cost. Past studies have shown hand-held urine dipsticks and automated urinalysis in children younger than 48 months to be sensitive predictors for urinary tract infection (UTI). It is hypothesized that POC dip testing is as accurate as laboratory urinalysis in the diagnosis of UTI.

Methods

A retrospective chart review was conducted on patients (aged birth through 18 years) presenting to a PED between January 2015 and December 2015. Eligible subjects included those that had a POC dip, laboratory urinalysis (lab UA), and urine culture performed during their PED visit. Subjects were selected, using a random number generator; 334 charts were selected. A positive POC dip was defined as having a positive leukocyte esterase or the presence of nitrites. A positive lab UA was defined as having a positive leukocyte esterase, nitrites, or greater than 10 white blood cells per high-power field. Urine culture was used as the criterion standard for comparison.

Results

A total of 334 subjects' charts were reviewed. Sensitivity and specificity of the POC dip were 91.4% (95% confidence interval [CI], 76.9%–98.2%) and 63.9% (95% CI, 57.2%–69.3%); lab UA, 91.4% (95% CI, 76.9%–98.2%) and 63.9% (95% CI, 58.2%–69.3%); and lab dip, 88.6% (95% CI, 73.3%–96.8%) and 65.6% (95% CI, 59.9%–70.9%).

Conclusions

Point-of-care dips are as sensitive in detecting UTI as the lab UA. A prospective study could allow for further demographic evaluation of POC dip diagnosed UTI.
Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence
Authors: Wilkins Natalie , Myers Lindsey , Kuehl Tomei , Bauman Alice , Hertz Marci
Published: November 2017

Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, “siloed” approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states.
Lactotripeptides Supplementations Alleviate the Decrease in Maximal Isometric Force After High-Intensity Eccentric Exercise
Authors: Tagawa Kaname , Ra Song-Gyu , Choi Youngju , Maeda Seiji
Published: November 2017

Objective

The aim of the study was to investigate whether lactotripeptides supplementations alleviate the decrease in the maximal isometric force, an indirect marker of muscle damage, after eccentric exercise (ECC).

Design

Twenty-two young men performed 50 ECC of the elbow flexors using an isokinetic dynamometer. The subjects were randomly assigned to either the placebo or lactotripeptides group and were each given a 4.5 mg/d placebo or lactotripeptides thrice on the exercise day and the day after. Maximal isometric force and brachial arterial diameter were assessed before and 2 days after the ECC.

Results

The interaction of time and group on maximal isometric force was significant (P< 0.05); maximal isometric force was significantly decreased in both groups after ECC (P< 0.005). The interaction of brachial arterial diameter was significant (P< 0.05); brachial arterial diameter was significantly increased in only the lactotripeptides group (P< 0.005). In addition, the change in maximal isometric force was significantly related to the change in brachial arterial diameter after adjusting for body weight and change in range of motion (P< 0.05).

Conclusions

The present results suggest that lactotripeptides supplementation alleviates the decrease in the maximal isometric force via an increase in brachial arterial diameter after ECC.
Evidence that dry eye is a comorbid pain condition in a U.S. veteran population
Authors: Lee Charity J. , Levitt Roy C. , Felix Elizabeth R. , Sarantopoulos Constantine D. , Galor Anat
Published: November 2017

Introduction:

Recent evidence suggests that dry eye (DE) may be comorbid with other chronic pain conditions.

Objectives:

To evaluate DE as a comorbid condition in the U.S. veteran population.

Methods:

Retrospective review of veterans seen in the Veterans Administration Healthcare System (Veteran Affairs) between January 1, 2010, and December 31, 2014. Dry eye and nonocular pain disorders were ascertained by International Classification of Diseases, Ninth Revision (ICD-9) codes. Dry eye was further separated into ICD-9 codes representing tear film dysfunction or ocular pain. χ2 and logistic regression analyses were used to examine frequency and risk of DE, ocular pain, and tear film dysfunction by pain disorders.

Results:

Of 3,265,894 veterans, 959,881 had a DE diagnosis (29.4%). Dry eye frequency increased with the number of pain conditions reported (P < 0.0005). Ocular pain was most strongly associated with headache (odds ratio [OR] 2.98; 95% confidence interval [CI] 2.95–3.01), tension headache (OR 2.64; 95% CI 2.58–2.71), migraine (OR 2.58; 95% CI 2.54–2.61), temporomandibular joint dysfunction (OR 2.39; 95% CI 2.34–2.44), pelvic pain (OR 2.30; 95% CI 2.24–2.37), central pain syndrome (OR 2.24; 95% CI 1.94–2.60), and fibromyalgia/muscle pain (OR 2.23; 95% CI 2.20–2.26), all P < 0.0005. Tear film dysfunction was most closely associated with osteoarthritis (OR 1.97; 95% CI 1.96–1.98) and postherpetic neuralgia (OR 1.95; 95% CI 1.90–2.00), both P < 0.0005.

Conclusions:

Dry eye, including both ocular pain and tear film dysfunction, is comorbid with pain conditions in this nationwide population, implying common mechanisms.