bluuebunny/crossref_metadata_2025 huggingface dataset:
One name can change many things
Authors: Kim Jisu
Published: March 2018

As an application study of the network agenda-setting model, this study examines how the media and public network agendas can differ, based on which political candidate was mentioned along with the immigration issue in news coverage and in public tweets. Through network analyses, this study shows that there were differences in the salient attributes of the immigration issue, and that the dominant narrative structure of the issue depended on which political candidate was mentioned.
Serum Cortisol and Cortisone as Potential Biomarkers of Partial 11β-Hydroxysteroid Dehydrogenase Type 2 Deficiency
Authors: Carvajal Cristian A , Tapia-Castillo Alejandra , Valdivia Carolina P , Allende Fidel , Solari Sandra , Lagos Carlos F , Campino Carmen , Martínez-Aguayo Alejandro , Vecchiola Andrea , Pinochet Constanza , Godoy Claudia , Iturrieta Virginia , Baudrand Rene , Fardella Carlos E
Published: March 2018

BACKGROUND

Pathogenic variations in HSD11B2 gene triggers the apparent mineralocorticoid excess syndrome (AME). There is scarce information regarding the phenotypes of subjects carrying heterozygous pathogenic variants in HSD11B2 gene. We investigated if serum cortisol/cortisone (F/E) ratio and cortisone are useful for identifying partial 11βHSD2 deficiency in those heterozygous subjects.

METHODS

We studied two patients diagnosed with AME and their families carrying either D223N or R213C mutation. We also evaluated 32 healthy control subjects (13 children and 19 adults) to obtain normal references ranges for all measured variables. Case 1: A boy carrying D223N mutation in HSD11B2 gene and Case 2: A girl carrying R213C mutation. We assessed serum F/E ratio and cortisone by HPLC-MS/MS, aldosterone, plasma-renin-activity(PRA), electrolytes, and HSD11B2 genetic analyses.

RESULTS

The normal values (median [interquartile range]) in children for serum F/E and cortisone (µg/dl) were 2.56 [2.21–3.69] and 2.54 [2.35–2.88], and in adults were 4.42 [3.70–4.90] and 2.23 [1.92–2.57], respectively. Case 1 showed a very high serum F/E 28.8 and low cortisone 0.46 µg/dl. His mother and sister were normotensives and heterozygous for D223N mutation with high F/E (13.2 and 6.0, respectively) and low cortisone (2.0 and 2.2, respectively). Case 2 showed a very high serum F/E 175 and suppressed cortisone 0.11 µg/dl. Her parents and sister were heterozygous for the R213C mutation with normal phenotype, but high F/E and low cortisone. Heterozygous subjects showed normal aldosterone, PRA, but lower fractional excretion of sodium and urinary Na/K ratio than controls.

CONCLUSION

Serum F/E ratio and cortisone allow to identify partial 11βHSD2 deficiencies, as occurs in heterozygous subjects, who would be susceptible to develop arterial hypertension.
Reactome Pengine: a web-logic API to the Homo sapiens reactome
Authors: Neaves Samuel R , Tsoka Sophia , Millard Louise A C
Published: March 2018

Existing ways of accessing data from the Reactome database are limited. Either a researcher is restricted to particular queries defined by a web application programming interface (API) or they have to download the whole database. Reactome Pengine is a web service providing a logic programming-based API to the human reactome. This gives researchers greater flexibility in data access than existing APIs, as users can send their own small programs (alongside queries) to Reactome Pengine.

Availability and implementation

The server and an example notebook can be found at https://apps.nms.kcl.ac.uk/reactome-pengine. Source code is available at https://github.com/samwalrus/reactome-pengine and a Docker image is available at https://hub.docker.com/r/samneaves/rp4/.

Supplementary information

Supplementary data are available at Bioinformatics online.
Identification and function of FAR protein family genes from a transcriptome analysis of Aphelenchoides besseyi
Authors: Wang Dong-Wei , Xu Chun-Ling , Ding Shan-Wen , Huang Xin , Cheng Xi , Zhang Chao , Chen Chun , Xie Hui
Published: March 2018

Motivation

The rice white tip nematode (RWTN) Aphelenchoides besseyi is a migratory plant parasitic nematode that infects the aboveground parts of plants. Fatty acid- and retinoid-binding (FAR) proteins are nematode-specific proteins that are involved in many important biological processes. Genes encoding FAR proteins have been identified in many species of nematodes, which indicated that nematodes may produce more than one type of FAR protein. The main goal of this study is to find new molecular targets including new far genes that will help control RWTN, and reduce the economic damage caused by RWTN.

Results

Two RWTN populations with different levels of pathogenicity and reproduction were sequenced and analyzed with next-generation sequencing. 17 087 transcripts were annotated using six databases and 1696 differentially expressed genes (DEGs) were identified between the two RWTN populations. Seven new Ab-far genes were identified from the transcriptome data of the two RWTN populations which is the first to identify multiple far genes in plant parasitic nematodes. This study is the first to identify far genes in the nervous system of nematodes and the first to report a transcriptome sequencing analysis of different RWTN populations. The results help elucidate the genes related to parasitism and pathogenicity and also contribute to the identification of new target genes and development of new methods to control RWTN.

Availability and implementation

Our data are publicly available at Sequence Read Archive (SRA) database and GenBank database.

Supplementary information

Supplementary data are available at Bioinformatics online.
Hölder Regularity for Singular Parabolic Obstacle Problems of Porous Medium Type
Authors: Cho Yumi , Scheven Christoph
Published: March 2018

We study the regularity of weak solutions to parabolic obstacle problems related to equations of singular porous medium type that are modeled after the nonlinear equation $$\partial_{t} u - \Delta u^{m} = 0.$$For the range of exponents 0 < m < 1, we prove that locally bounded weak solutions are locally Hölder continuous, provided the obstacle function is. Moreover, in the case $\frac{(n-2)_{+}}{n+2} < m < 1$ we show that every weak solution is locally bounded and therefore Hölder continuous.
Reduction in the Prevalence of Healthcare-Associated Infections in U.S. Acute Care Hospitals, 2015 vs 2011
Authors: Magill Shelley S , Wilson Lucy E , Thompson Deborah L , Ray Susan M , Nadle Joelle , Lynfield Ruth , Janelle Sarah J , Kainer Marion A , Greissman Samantha , Dumyati Ghinwa , Beldavs Zintars G , Edwards Jonathan R ,   Emerging Infections Program Hospital Prevalence Survey Team
Published: March 2018

Background

A 2011 prevalence survey conducted by CDC and the Emerging Infections Program (EIP) showed that 1 in 25 hospital patients had ≥1 healthcare-associated infection (HAI). We repeated the survey in 2015 to assess changes in HAI prevalence.​

Methods

In EIP sites (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) hospitals that participated in the 2011 survey were recruited for the 2015 survey. Hospitals selected 1 day from May–September 2015 on which a random patient sample was identified from the morning census. Trained EIP staff reviewed patient medical records using comparable methods and the same National Healthcare Safety Network HAI definitions used in 2011. Proportions of patients with HAIs were compared using chi-square tests; patient characteristics were compared using chi-square or median tests (OpenEpi 3.01, SAS 9.3).

Results

Data were available from 143 hospitals that participated in both surveys; data from 8954 patients in the 2011 survey were compared with preliminary data from 8833 patients in the 2015 survey. Patient characteristics such as median age, days from admission to survey, and critical care location were similar. Urinary catheter prevalence was lower in 2015 (1,589/8,833, 18.0%) compared with 2011 (2,052/8,954, 22.9%, P < 0.0001), as was central line prevalence (2015: 1,539/8,833, 17.4%, vs. 2011: 1,687/8,954, 18.8%, P = 0.02). The proportion of patients with HAIs was lower in 2015 (284/8,833, 3.2%, 95% confidence interval [CI] 2.9–3.6%) than in 2011 (362/8,954, 4.0%, 95% CI 3.7–4.5%, P = 0.003). Of 309 HAIs in 2015, pneumonia (PNEU) and Clostridium difficileinfections (CDI) were most common (Figure); proportions of patients with PNEU and/or CDI were similar in 2015 (130/8833, 1.5%) and 2011 (133/8954, 1.5%, P = 0.94). A lower proportion of patients had surgical site (SSI) and/or urinary tract infections (UTI) in 2015 (77/8833, 0.9%) vs. 2011 (136/8954, 1.5%, P < 0.001).

Conclusion

HAI prevalence was significantly lower in 2015 compared with 2011. This is partially explained by fewer SSI and UTI, suggesting national efforts to prevent SSI, reduce catheter use and improve UTI diagnosis are succeeding. By contrast, there was no change in the prevalence of the most common HAIs in 2015, PNEU and CDI, indicating a need for increased prevention efforts in hospitals.

Disclosures

All authors: No reported disclosures.
Effect of Macrolide Prophylactic Therapy on AIDS-Defining Conditions and HIV-Related Mortality
Authors: Pasayan Mark Kristoffer , Mationg Mary Lorraine , Boettiger David , Lam Wilson , Zhang Fujie , Ku Wen-Wei , Merati Ketut Tuti , Chaiwarith Romanee , Cuong Do Duy , Yunihastuti Evy , Kiertiburanakul Sasisopin , Van Kinh Nguyen , Avihingsanon Anchalee , Sun Ly Penh , Kamarulzaman Adeeba , Kantipong Pacharee , Kumarasamy Nagalingswaran , Pujari Sanjay , Sim Benedict Lh , Ng Oon Tek , Choi Jun Yong , Tanuma Junko , Ross Jeremy , Ditangco Rossana ,   TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific
Published: March 2018

Background

Mycobacterium avium–intracelllulare complex (MAC) prophylaxis is recommended for patients with CD4 counts of < 50 cells/mm3. With the significant decrease in incidence of disseminated MAC infection and the effective immune recovery due to the availability of combination antiretroviral therapy (ART), the benefits of giving MAC prophylaxis were investigated. This study examined the impact of macrolide prophylaxis on AIDS-defining conditions and HIV-associated mortality in a cohort of HIV-infected patients on ART.

Methods

TREAT Asia HIV Observational Database (TAHOD) patients aged ≥18 years with a CD4 count < 50 cells/mm3 at ART initiation were included. The effect of macrolide prohylaxis on HIV-associated mortality or an AIDS event (as a combined outcome) and HIV-associated mortality alone were evaluated using competing risk regression. Sensitivity analysis was conducted to assess whether results were consistent in patients with a CD4 < 100 cells/mm3 at ART initiation.

Results

Of 1,345 eligible patients (78% male with median age at ART initiation of 34.8 years), 10.6% received macrolide prophylaxis. The rates of the combined outcome and HIV-associated mortality per 100 patient years were 7.35 [95% confidence interval (CI): 6.04–8.95] and 3.14 (95% CI: 2.35–4.19), respectively. After adjusting for possible confounders, macrolide use was associated with a significantly decreased risk of HIV-associated mortality (HR 0.10, 95% CI: 0.01–0.80, P = 0.031) but not the combined outcome (HR 0.86, 95% CI: 0.32–2.229, P = 0.764). Sensitivity analyses showed that, among patients with a CD4 < 100 cells/ mm3 at ART initiation, these results were consistent.

Conclusion

Macrolide prophylaxis is associated with significantly improved survival among Asian HIV-infected patients with very low CD4 cell counts. The benefits of giving macrolide prophylaxis remain despite the availability of effective ART.

Disclosures

All authors: No reported disclosures.
Quantification of Subdural Electrode Shift Between Initial Implantation, Postimplantation Computed Tomography, and Subsequent Resection Surgery
Authors: Fan Xiaoyao , Roberts David W , Kamal Yasmin , Olson Jonathan D , Paulsen Keith D
Published: March 2018

BACKGROUND

Subdural electrodes are often implanted for localization of epileptic regions. Postoperative computed tomography (CT) is typically acquired to locate electrode positions for planning any subsequent surgical resection. Electrodes are assumed to remain stationary between CT acquisition and resection surgery.

OBJECTIVE

To quantify subdural electrode shift that occurred between the times of implantation (Crani 1), postoperative CT acquisition, and resection surgery (Crani 2).

METHODS

Twenty-three patients in this case series undergoing subdural electrode implantation were evaluated. Preoperative magnetic resonance and postoperative CT were acquired and coregistered, and electrode positions were extracted from CT. Intraoperative positions of electrodes and the cortical surface were digitized with a coregistered stereovision system. Movement of the exposed cortical surface was also tracked, and change in electrode positions was calculated relative to both the skull and the cortical surface.

RESULTS

In the 23 cases, average shift of electrode positions was 8.0 ± 3.3 mm between Crani 1 and CT, 9.2 ± 3.7 mm between CT and Crani 2, and 6.2 ± 3.0 mm between Crani 1 and Crani 2. The average cortical shift was 4.7 ± 1.4 mm with 2.9 ± 1.0 mm in the lateral direction. The average shift of electrode positions relative to the cortical surface between Crani 1 and Crani 2 was 5.5 ± 3.7 mm.

CONCLUSION

The results show that electrodes shifted laterally not only relative to the skull, but also relative to the cortical surface, thereby displacing the electrodes from their initial placement on the cortex. This has significant clinical implications for resection based upon seizure activity and functional mapping derived from intracranial electrodes.
The science of addiction
Authors: Murphy Kathryn
Published: March 2018

Furthering our understanding of addiction and exploring treatment possibilities can help us better care for patients with substance use disorders.
Phenotypes/endotypes-driven treatment in asthma
Authors: Braido Fulvio , Tiotiu Angelica , Kowal Krzysztof , Mihaicuta Stefan , Novakova Plamena , Oguzulgen Ipek Kivilcim
Published: March 2018

Purpose of review

Target therapy is the necessary step towards personalized medicine. The definition of asthma phenotypes and underlying mechanisms (endotypes) represent a key point in the development of new asthma treatments. Big data analysis, biomarker research and the availability of monoclonal antibodies, targeting specific cytokines is leading to the rapid evolution of knowledge. In this review, we sought to outline many of the recent advances in the field.

Recent findings

Several attempts have been made to identify asthma phenotypes, sometimes with contrasting results. More success has been obtained concerning the pathogenetic mechanism of specific asthma patterns with the consequent identification of biomarkers and development of effective ad hoc treatment.

We are in the middle of an extraordinary revolution of our mode of thinking about and approaching asthma. All the effort in the identification of clusters of patients with different disease clinical patterns, prognosis and response to treatment is closely linked to the identification of endotypes (Th2-low and Th2-high). This approach has allowed the development of the specific treatments (anti IgE, Anti IL5 and IL5R) that are now available and is leading to new ones.
Occipital condyle fractures in the pediatric population
Authors: Seymour James , Sawyer Jeffrey R. , Warner William C. , Kelly Derek M. , Muhlbauer Michael S.
Published: March 2018

Background:

The purpose of this study was to determine associated injuries and outcomes in children with occiptal condyle fracture (OCF).

Methods:

From review of medical records, children with OCF were identified. Demographics, length of stay, Glasgow Coma Scores (GCS), associated injuries, and outcomes were collected. The Anderson-Montesano classification system was used to define the fracture patterns.

Results:

Of 587 children with a base of the skull fracture, only 13 with OCF were identified (10 type II; three type I). All patients were treated nonoperatively except one patient who had an atlantooccipital dislocation. Associated injuries included scalp contusion, concussion, cerebral edema, neck injury, thoracic trauma, abdominal trauma, and appendicular skeletal fracture. Complications noted within 2 months included tinnitus in three patients and hearing loss in one. One patient had convulsions and syncope 2 years after injury. One patient had difficulties with temperature regulation and bladder control, inability to sweat, headaches, comprehension difficulty, weakness, and tremor 3 years after the accident. One patient was lost to follow-up.

Conclusions:

OCF is rare in children but is associated with head, thoracic, and abdominal trauma. Type I and II fractures predominate. Although operative treatment rarely is necessary, it is required in patients with atlantooccipital dislocation. Ligamentous structures should be assessed with MRI.
The evolving state of acute pediatric septic arthritis and osteomyelitis
Authors: Franklin Don B. , Stephens Byron F. , Sawyer Jeffrey R. , Kelly Derek M. , Beaty James H. , Spence David D. , Smith Richard A. , Warner William C.
Published: March 2018

Background:

A 2006 study from our institution found a 10-fold increase in pediatric community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) osteoarticular infections over a 5-year period and found that these patients had a higher complication rate and required more surgical debridements than those with methicillin-sensitive Staphylococcus aureus (MSSA) infections. Clinical experience since that time has suggested that these trends may have continued. Our investigation sought to evaluate the evolving nature of these infections since the previous publication.

Methods:

The records of all patients treated at our institution for acute hematogenous septic arthritis and osteomyelitis between January 2005 and December 2011 were reviewed for demographic, diagnostic, clinical, and radiographic data.

Results:

Of the 240 patients who met the inclusion criteria, 100 were diagnosed with CA-MRSA infections, 51 had MSSA infections, and 75 had no identifiable pathogen. Group A streptococcus (GAS), group B streptococcus (GBS), Streptococcus pneumoniae, and Salmonella were together responsible for 14 infections. The overall infection incidence was 4.29 cases per 1000 hospital admissions. The mean age of CA-MRSA patients was 6.4 yr, compared to 8.9 yr for MSSA patients (P=0.002). There was no significant difference in admission laboratory values, surgical procedures, or long-term complications for CA-MRSA and MSSA infections. Subperiosteal abscess was evident in 51% and 45% of CA-MRSA and MSSA patients, respectively. Surgical intervention was required in 87% of CA-MRSA patients and 84% of MSSA patients. Deep vein thrombosis was identified in 12 CA-MRSA patients, five of whom subsequently developed septic pulmonary emboli. Eight CA-MRSA patients developed chronic osteomyelitis, as did one MSSA patient. Intramuscular abscesses were seen in nine CA-MRSA patients and four MSSA patients. Empiric antibiotic therapy consisted primarily of clindamycin or vancomycin and was tailored according to microbial sensitivities.

Conclusions:

Contrary to trends identified in an earlier publication, the annual frequency of CA-MRSA infections has stabilized at roughly 40% of all cases. Our data suggest that MSSA infections have become more virulent because these patients now have similar rates of complications and operative interventions to patients with CA-MRSA infections.

Level of Evidence:

Prognostic level II study (retrospective).
Sensitization of recombinant human tumor necrosis factor-related apoptosis-inducing ligand-resistant malignant melanomas by quercetin
Authors: Turner Katherine A. , Manouchehri Jasmine M. , Kalafatis Michael
Published: March 2018

Malignant melanoma is the most commonly diagnosed skin cancer associated with a high rate of metastasis. Low-stage melanoma is easily treated, but metastatic malignant melanoma is an extremely treatment-resistant malignancy with low survival rates. The application of recombinant human tumor necrosis factor-related apoptosis-inducing ligand (rhTRAIL) for the treatment of metastatic malignant melanoma holds considerable promise because of its selective proapoptotic activity towards cancer cells and not nontransformed cells. Unfortunately, the clinical utilization of rhTRAIL has been terminated due to the resistance of many cancer cells to undergo apoptosis in response to rhTRAIL. However, rhTRAIL-resistance can be abrogated through the cotreatment with compounds derived from ‘Mother Nature’ such as quercetin that can modulate cellular components responsible for rhTRAIL-resistance. Here, we show that rhTRAIL-resistant malignant melanomas are sensitized by quercetin. Quercetin action is manifested by the upregulation of rhTRAIL-binding receptors DR4 and DR5 on the surface of cancer cells and by increased rate of the proteasome-mediated degradation of the antiapoptotic protein FLIP. Our data provide for a new efficient and nontoxic treatment of malignant melanoma.
Management of Intracranial Pressure: Part I
Authors: Sacco Tara L. , Delibert Samantha A.
Published: March 2018

Dangerous, sustained elevation in intracranial pressure (ICP) is a risk for any patient following severe brain injury. Intracranial pressure elevations that do not respond to initial management are considered refractory to treatment, or rICP. Patients are at significant risk of secondary brain injury and permanent loss of function resulting from rICP. Both nonpharmacologic and pharmacologic interventions are utilized to intervene when a patient experiences either elevation in ICP or rICP. In part 1 of this 2-part series, pharmacologic interventions are discussed. Opioids, sedatives, osmotic diuretics, hypertonic saline solutions, and barbiturates are drug classes that may be used in an attempt to normalize ICP and prevent secondary injury. Nursing care of these patients includes collaboration with an interprofessional team and is directed toward patient and family comfort. The utilization of an evidence-based guideline for the management of rICP is strongly encouraged to improve patient outcomes.
Increasing Access to Palliative Care Services in the Intensive Care Unit
Authors: McCarroll Caitlin Marie
Published: March 2018

Background

The Institute of Medicine's report, Dying in America, highlights the critical need for the widespread implementation of palliative care to improve end-of-life care.1 Approximately 20% of all deaths in America occur during or shortly after an intensive care unit (ICU) admission2; therefore, it is important for critical care units to have systems in place to facilitate patient access to palliative care services.1,3,4

Objectives

The aim of this quality improvement (QI) project was to develop and implement a palliative care screening tool using evidence-based triggers to help increase the proportion of palliative care consultations in the ICU setting.

Methods

A QI project was designed and implemented in a 14-bed medical-surgical ICU in the southeastern United States using the Plan-Do-Study-Act cycle.5 A palliative care screening tool was developed by an interdisciplinary team of key stakeholders in the ICU using evidence-based triggers, and staff were educated on the intervention. The proportion of ICU patients who received a palliative care consultation was compared preintervention and postintervention to determine whether the QI project contributed to an increased proportion of palliative care consultations.

Results

The proportion of palliative care consultations among patients admitted to the ICU by the pulmonary critical care team increased from 1 of 10 preintervention to 3 of 10 postintervention, resulting in a promising increase in patients receiving palliative care services consistent with evidence-based recommendations.

Conclusion

The use of an evidence-based screening tool to trigger palliative care consultation in the ICU setting can aid in increasing the proportion of critical care patients who receive a palliative care referral. The increase in the proportion of palliative care referrals by the pulmonary critical care service warrants expansion of the intervention to include additional medical subspecialists who frequently admit patients in this ICU setting. Further assessment of the intervention is warranted to determine whether the screening tool can aid in increasing palliative care consultations for more patients admitted to the hospital’s ICU.
Predictors of Postpartum Depression: A Comprehensive Review of the Last Decade of Evidence
Authors: GUINTIVANO JERRY , MANUCK TRACY , MELTZER-BRODY SAMANTHA
Published: March 2018

Postpartum depression (PPD) is one of the most frequent complications of childbirth affecting ~500,000 women annually (prevalence 10% to 15%). Despite the documented adverse outcomes for mother and child, there remains a great need to develop prospective approaches to identify women at risk. This review examines some of the best-characterized molecular and clinical risk factors for PPD. We illustrate that this is a growing literature but there remains a lack of reliable molecular predictors for PPD. Current best predictors are clinical assessments for psychiatric history and adverse life events, highlighting the need for increased depression screening across the perinatal period.
Managing Heavy Menstrual Bleeding in Women at Risk of Thrombosis
Authors: RIVARA ANDREW , JAMES ANDRA H.
Published: March 2018

Management of heavy menstrual bleeding (HMB) in a woman with a history of thrombosis, or who is otherwise at high risk of thrombosis, or who takes medications for anticoagulation can present a challenge to health care providers. The goal of treating HMB is to reduce menstrual blood loss. First-line therapy is typically hormonal, and hormonal therapy can be contraindicated in women with a history of thrombosis unless they are on anticoagulation. As 70% of women on anticoagulation experience HMB, successful management of HMB may involve a modification in the anticoagulation or antiplatelet regimen, hormonal therapy tailored to the patient’s situation, and/or surgical therapy.
Outcomes of Trabeculectomy and Glaucoma Drainage Devices for Elevated Intraocular Pressure After Penetrating Keratoplasty
Authors: Yakin Mehmet , Eksioglu Umit , Yalniz-Akkaya Zuleyha , Uzman Selma , Singar-Ozdemir Evin , Gultekin Kemal , Demirok Gulizar , Yalvac Ilgaz , Ornek Firdevs , Burcu Ayse
Published: March 2018

Purpose:

To assess and compare the outcomes of trabeculectomy with and without antimetabolites (AMs) and glaucoma drainage devices (GDDs) in the management of elevated intraocular pressure (IOP) after penetrating keratoplasty (PK).

Methods:

Data of 84 eyes of 81 patients who underwent trabeculectomy (12 eyes without an AM and 42 eyes with an AM) or GDD implantation (30 eyes) after PK were reviewed retrospectively. The main outcome measures were IOP control, corneal graft survival, and postoperative ocular complications.

Results:

At the final visit, IOP success (<22 mm Hg) was 58.3% in trabeculectomy alone, 64.3% in trabeculectomy with an AM (TrabAM), and 86.7% in GDD groups (P = 0.047). The median time from surgery to IOP failure was 1 month after trabeculectomy alone, 13 months after TrabAM, and 20 months after GDD implantation (P = 0.042). The cumulative probability of IOP success rates at 1 and 3 years postoperatively was as follows: 66.7% and 57.1% in trabeculectomy alone, 80.6% and 64.8% in TrabAM, and 92.3% and 84.6 in GDD groups (P = 0.063). The cumulative probability of corneal graft survival rates at 1 and 3 years postoperatively was as follows: 70.0% and 60.0% in trabeculectomy alone, 76.7% and 67.7% in TrabAM, and 65.8% and 52.6% in GDD groups (P = 0.549).

Conclusions:

GDDs are more successful than trabeculectomy in controlling IOP in eyes that have undergone PK, but they tend to have low corneal graft survival rates. Trabeculectomy without an AM has limited success and may be considered in a limited number of patients with a low risk for bleb failure.
Efficacy and Safety of Echinocandins for the Treatment of Invasive Candidiasis in Children
Authors: Tsekoura Magdalini , Ioannidou Maria , Pana Zoi-Dorothea , Haidich Anna-Bettina , Antachopoulos Charalampos , Iosifidis Elias , Kolios George , Roilides Emmanuel
Published: March 2018

Background:

Echinocandins are recommended for the treatment of suspected or confirmed invasive candidiasis (IC) in adults. Less is known about the use of echinocandins for the management of IC in children. The aim of this study was to investigate the overall efficacy and safety of echinocandin class in neonatal and pediatric patients with IC.

Methods:

PubMed, Cochrane Central, Scopus and Clinical trial registries were searched up to July 27, 2017. Eligible studies were randomized controlled trials that evaluated the efficacy and safety of any echinocandin versus agents of other antifungal classes for the treatment of IC in pediatric patients. The primary outcome was treatment success with resolution of symptoms and signs, and absence of IC. In the meta-analysis a random effects model was used, and the odds ratio (OR) and 95% confidence intervals (CIs) were calculated.

Results:

Four randomized clinical trials (324 patients), 2 confirmed IC (micafungin vs. liposomal amphotericin B (L-AmB) and caspofungin vs. L-AmB) and 2 empirical therapy trials (caspofungin vs. deoxycholate amphotericin B and caspofungin vs. L-AmB) were included. There was no significant difference between echinocandins and comparator in terms of treatment success (OR = 1.61, 95% CI: 0.74–3.50) and incidence of treatment-related adverse events (OR = 0.70, 95% CI: 0.39–1.26). However, fewer children treated with echinocandins discontinued treatment because of adverse events than amphotericin B formulations (OR = 0.26, 95% CI: 0.08–0.82,P= 0.02).

Conclusions:

In the treatment of IC in children, echinocandins show non-inferior efficacy compared with amphotericin B formulations with fewer discontinuations than in comparator arm.
Financial Incentives for Pediatric HIV Testing in Kenya
Authors: Njuguna Irene N. , Wagner Anjuli D. , Omondi Vincent O. , Otieno Verlinda A. , Neary Jillian , Bosire Rose , Babigumira Joseph B. , Levin Carol , Maleche-Obimbo Elizabeth , Wamalwa Dalton C. , John-Stewart Grace , Slyker Jennifer
Published: March 2018

The acceptability of financial incentives for pediatric HIV testing was evaluated in Kenya. Sixty HIV-positive women with children of unknown status were randomized to receive $5, $10 or $15 conditional upon HIV testing. Forty-four (73%) completed child testing, with similar rates across arms. Uptake was significantly higher than a cohort with similar procedures but no incentives (73% vs. 14%, P < 0.001).
Reduction of Inappropriate Antimicrobial Prescriptions in a Tertiary Neonatal Intensive Care Unit After Antimicrobial Stewardship Care Bundle Implementation
Authors: Ting Joseph Y. , Paquette Vanessa , Ng Karen , Lisonkova Sarka , Hait Valoria , Shivanada Sandesh , Tilley Peter , Osiovich Horacio , Roberts Ashley
Published: March 2018

Background:

Our objective was to evaluate the appropriateness of antibiotic prescriptions in the neonatal intensive care unit using standardized criteria and determine the effects of an antimicrobial stewardship program (ASP) on patterns of antibiotic usage.

Methods:

A retrospective audit of antibiotic use from July 2010 to June 2013 was conducted, focusing on prescriptions of vancomycin, cefotaxime, meropenem and linezolid for >3 calendar-days. We evaluated the appropriateness of each course of antibiotic treatment based on the Centers for Disease Control and Prevention 12-Step Guidelines to Prevent Antimicrobial Resistance (steps 4, 6 and 9). An ASP was introduced in August 2014, and the same audit criteria were applied to review antimicrobial use in the subsequent 12 months.

Results:

In the pre-ASP era, 26.3%, 12.1%, 11.4% and 0% of meropenem, cefotaxime, vancomycin and linezolid courses, respectively, were inappropriate. The most common instance of inappropriate utilization included failure to use narrow-spectrum antimicrobials when appropriate. After the introduction of ASP program, 22.2%, 7.5%, 5.4% and 0% of meropenem, cefotaxime, vancomycin and linezolid courses, respectively, were inappropriate. The numbers of inappropriate antibiotic-days/1000 days of therapy with meropenem, cefotaxime and vancomycin changed from 1.89 to 1.96 [rate ratio (RR), 1.04 (0.70–1.52)], 3.56 to 1.73 [RR, 0.49 (0.33–0.71)] and 2.70 to 1.01 [RR, 0.37 (0.22–0.60)], respectively. In subgroup analysis, very low birth weight infants (birth weight, <1500 g) showed no improvement in the rates of inappropriate antibiotic prescriptions.

Conclusions:

In this study, we found that ASP initiatives can be applied in neonatal populations to reduce inappropriate antimicrobial prescriptions, though a different approach may be needed among very low birth weight infants.
Associations between onset of effort-reward imbalance at work and onset of musculoskeletal pain: analyzing observational longitudinal data as pseudo-trials
Authors: Halonen Jaana I. , Virtanen Marianna , Leineweber Constanze , Rod Naja H. , Westerlund Hugo , Magnusson Hanson Linda L.
Published: March 2018

Existing evidence of an association between effort-reward imbalance (ERI) at work and musculoskeletal pain is limited, preventing reliable conclusions about the magnitude and direction of the relation. In a large longitudinal study, we examined whether the onset of ERI is associated with subsequent onset of musculoskeletal pain among those free of pain at baseline, and vice versa, whether onset of pain leads to onset of ERI. Data were from the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. We used responses from 3 consecutive study phases to examine whether exposure onset between the first and second phases predicts onset of the outcome in the third phase (N = 4079). Effort-reward imbalance was assessed with a short form of the ERI model. Having neck-shoulder and low back pain affecting life to some degree in the past 3 months was also assessed in all study phases. As covariates, we included age, sex, marital status, occupational status, and physically strenuous work. In the adjusted models, onset of ERI was associated with onset of neck-shoulder pain (relative risk [RR] 1.51, 95% confidence interval [CI] 1.21-1.89) and low back pain (RR 1.21, 95% CI 0.97-1.50). The opposite was also observed, as onset of neck-shoulder pain increased the risk of subsequent onset of ERI (RR 1.36, 95% CI 1.05-1.74). Our findings suggest that when accounting for the temporal order, the associations between ERI and musculoskeletal pain that affects life are bidirectional, implying that interventions to both ERI and pain may be worthwhile to prevent a vicious cycle.
Design and Rationale of the Cognitive Intervention to Improve Memory in Heart Failure Patients Study
Authors: Pressler Susan J. , Giordani Bruno , Titler Marita , Gradus-Pizlo Irmina , Smith Dean , Dorsey Susan G. , Gao Sujuan , Jung Miyeon
Published: March 2018

Background:

Memory loss is an independent predictor of mortality among heart failure patients. Twenty-three percent to 50% of heart failure patients have comorbid memory loss, but few interventions are available to treat the memory loss. The aims of this 3-arm randomized controlled trial were to (1) evaluate efficacy of computerized cognitive training intervention using BrainHQ to improve primary outcomes of memory and serum brain-derived neurotrophic factor levels and secondary outcomes of working memory, instrumental activities of daily living, and health-related quality of life among heart failure patients; (2) evaluate incremental cost-effectiveness of BrainHQ; and (3) examine depressive symptoms and genomic moderators of BrainHQ effect.

Methods:

A sample of 264 heart failure patients within 4 equal-sized blocks (normal/low baseline cognitive function and gender) will be randomly assigned to (1) BrainHQ, (2) active control computer-based crossword puzzles, and (3) usual care control groups. BrainHQ is an 8-week, 40-hour program individualized to each patient's performance. Data collection will be completed at baseline and at 10 weeks and 4 and 8 months. Descriptive statistics, mixed model analyses, and cost-utility analysis using intent-to-treat approach will be computed.

Conclusions:

This research will provide new knowledge about the efficacy of BrainHQ to improve memory and increase serum brain-derived neurotrophic factor levels in heart failure. If efficacious, the intervention will provide a new therapeutic approach that is easy to disseminate to treat a serious comorbid condition of heart failure.
Associations of Vitamin D Intake and Sleep Quality With Cognitive Dysfunction in Older Adults With Heart Failure
Authors: Song Eun Kyeung , Wu Jia-Rong
Published: March 2018

Background:

Low vitamin D intake and poor sleep quality are independently associated with cognitive dysfunction in healthy older adults. However, the relationships among vitamin D intake, sleep quality, and cognitive dysfunction are unknown in older adults with heart failure (HF).

Purpose:

The aim of this study was to determine the relationships of vitamin D intake and sleep quality with cognitive dysfunction in older adults with HF.

Methods:

A total of 160 older adults with HF completed the Mini-Mental State Examination to assess cognitive function. Vitamin D deficiency was defined as less than 15 mcg/day of average intake determined using a 3-day food diary and use of dietary supplements. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Hierarchical regressions and mediation analysis were used for data analysis.

Results:

Thirty-four patients (21.2%) had severe cognitive dysfunction (total Mini-Mental State Examination score ≤ 19), 88 (55%) had vitamin D deficiency, and 120 (75%) reported poor sleep quality (total PSQI score > 5). Increased daily vitamin D intake (β = 0.305, P < .001) and poorer sleep quality indicated by the total PSQI score (β = −0.312, P < .001) were associated with cognitive function. Vitamin D deficiency was associated with poor sleep quality (odds ratio, 2.22; P = .033). In mediation analysis, the relationship between vitamin D deficiency and cognitive function was mediated by sleep quality among older adults with HF.

Conclusions:

Both vitamin D deficiency and poor sleep quality are associated with cognitive dysfunction in older adults with HF. Interventions should be tested to target patients with poor sleep quality to improve cognitive function, particularly in those with vitamin D deficiency.
Association Between a Physical Activity Vital Sign and Cardiometabolic Disease in High-Risk Patients
Authors: Nelson Vicki R. , Masocol Robert V. , Ewing Joseph A. , Johnston Sheri , Hale Allyson , Wiederman Michael , Asif Irfan M.
Published: March 2018

Objective:

To determine the association between the physical activity vital sign (PAVS) and markers of cardiometabolic disease.

Design:

Patients were assessed through the PAVS, a validated tool self-reporting the frequency and duration of physical activity. Patients were categorized into 3 groups: inactive (0 minutes per week), underactive (1-149 minutes per week), and active (>150 minutes per week). Associations were tested between the PAVS and the cardiometabolic disease biomarkers of body mass index, hemoglobin A1c (A1c), blood pressure, and low-density lipoprotein (LDL) using one-way analyses of variance.

Setting:

High-risk family medicine residency clinic.

Participants:

Two thousand three hundred twenty-one adult patients (age ≥ 18 years).

Results:

Participants reported a mean of 97.87 (SD = 149.35) minutes per week of exercise. Overall, 50.1% reported physical inactivity, 25.7% were underactive, and 24.3% were active. Younger individuals (P < 0.001) and men (P < 0.05) reported more physical activity than older individuals and women. Patients who reported being active were significantly less likely to be overweight (P < 0.05), obese (P < 0.05), or hypertensive (P < 0.05), but there was no association with A1c or LDL levels.

Conclusions:

This is the first investigation to examine the PAVS in a high-risk population. In these patients, reported levels of physical inactivity are 150% higher than other clinical settings, and the PAVS is only associated with improvements in 2 of 4 major cardiometabolic risk factors. For this group, self-reported levels of physical activity may need to be higher for cardiovascular benefits to be realized in all 4 cardiometabolic domains. The PAVS offers health professionals an opportunity to encourage lifestyle-based interventions to reduce cardiovascular risk, but refinements may be necessary to address this population.
Should Emergency Department Attendances be Used With or Instead of Readmission Rates as a Performance Metric?
Authors: Honeyford Kate , Aylin Paul , Bottle Alex
Published: March 2018

Background:

Hospital readmissions are common and are viewed as unfavorable. They are commonly used as a measure of quality of care and, in the United States and England, are associated with financial penalties. Readmissions are not the only possible return-to-acute-care metric; patients may also attend emergency departments (EDs).

Objective:

To assess hospital-level return-to-acute-care metrics using statistical criteria.

Research Design:

Patient readmissions and/or ED attendances were aggregated to produce risk-standardized hospital rates. Return-to-acute-care rates at 7, 30, 90, and 365 days were assessed using key statistical properties: (i) variability between hospitals; (ii) the relative contribution of patient and nonpatient factors to variation; and (iii) the statistical power to detect performance differences.

Subjects:

We had pseudonymized administrative data on all inpatient hospital admissions and ED attendances in National Health Service hospitals in England between April 2009 and March 2011. Patients with an inpatient stay for chronic obstructive pulmonary disorder or heart failure were eligible for inclusion.

Measures:

ED attendances and readmissions for patients discharged from an inpatient stay for chronic obstructive pulmonary disorder or heart failure.

Results:

Interhospital variation was greatest for ED attendance; in addition, readmission was more strongly determined by patient characteristics than was ED attendance or both combined. Because of smaller numbers, the statistical power to detect differences in rates at 7 days for any indicator was limited.

Conclusions:

Despite the current emphasis on readmissions, we found that ED attendance within 30 days has more desirable statistical properties and therefore the potential to be a useful metric when comparing hospitals.
Classical and alternative roles for autophagy in lipid metabolism
Authors: Zhang Xiangyu , Evans Trent D. , Jeong Se-Jin , Razani Babak
Published: March 2018

Purpose of review

Intracellular lipid metabolism is a complex interplay of exogenous lipid handling, trafficking, storage, lipolysis, and export. Recent work has implicated the cellular degradative process called autophagy in several aspects of lipid metabolism. We will discuss both the classical and novel roles of autophagy and the autophagic machinery in this setting.

Recent findings

The delivery of lipid droplets to lysosomes for hydrolysis, named lipophagy, was the first described functional role for autophagy in lipid metabolism. The molecular machinery and regulation of this selective form of macroautophagy is beginning to be discovered and has the potential to shed enormous light on intracellular lipolysis. Yet, the autophagic machinery appears to also be coopted for alternative roles that include interaction with cytosolic lipolysis pathways, supply and expansion of lipid droplets, and lipoprotein trafficking. Additionally, lesser studied forms of autophagy called microautophagy and chaperone-mediated autophagy have distinct roles in lipid handling that also intersect with classical macroautophagy. The integration of current knowledge in these areas into a holistic understanding of intracellular lipid metabolism will be a goal of this review.

As the field of autophagy has evolved and expanded to include functional roles in various aspects of cellular degradation, so has its role in intracellular lipid metabolism. Understanding the mechanisms underlying these classical and alternative roles of autophagy will not only enhance our knowledge in lipid biology but also provide new avenues of translation to human lipid disorders.
Chapter 2. ESPGHAN
Authors: Lentze Michael J. , Auricchio Salvatore , Cadranel Samy , Milla Peter J. , Kelly Deirdre , McNeish Alexander S. , Rey Jean , Schmitz Jacques , Strandvik Birgitta , Taminiau Jan , Visakorpi Jarmo
Published: March 2018

Thirty‐six founding members from Europe were present in 1968, when the European Society of Paediatric Gastroenterology (ESGA) had its first meeting in Paris. The aim was to create a forum for presentations and discussions of research activities in paediatric gastroenterology in Europe. At the second meeting of ESGA 1969 in Interlaken, an important landmark was set for all gastroenterologists in the world. In this conference, the first ever criteria for “the Diagnosis of Coeliac Disease” (CD) were established. In 1990, the revised criteria for the diagnosis of CD were published. After the introduction of new noninvasive techniques, like tissue transglutaminase 2‐antibodies and the HLADQ2/HLADQ8 determinations in blood, “new” criteria for the diagnosis of CD were published in 2012 by the European society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Close collaboration of ESPGHAN and the North American Society of Paediatric Gastroenterology, Hepatology and Nutrition led to mutual meetings. The first combined meeting was 1978 in Paris, followed by meetings in New York, Amsterdam, Houston, and last in Toulouse. The first World Congress of Paediatric Gastroenterology took place in Boston 2000 followed by congresses in Paris, Iguazu, Taipeh, and Toronto. The creation of specialised committees (Nutrition Committees, GI‐Committee, and Hepatology‐Committee) enabled the society to elaborate numerous guidelines for standards in the diagnosis and treatment of diseases within the subspecialties. The Journal of Paediatric Gastroenterology and Nutrition, as organ of ESPGHAN and the North American Society of Paediatric Gastroenterology, Hepatology and Nutrition since 1991, serves as the voice for these worldwide accepted guidelines. Growing educational activities with summer schools, the Young Investigator Forum and the creation of working groups have distributed our current knowledge among the younger generation and led to fruitful reports, guidelines, and syllabus. In 1992, ESPGHAN was 1 of the founding 7 members of the United European Gastroenterology Federation (UEGF), which developed into a successful organisation for gastroenterology in Europe. This year we celebrate the 50th anniversary of ESPGHAN at our annual Meeting in Geneva.
Chapter 4. The Relationship Between the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition
Authors: Lifschitz Carlos H. , Vanderhoof Jon , Winter Harland , Guandalini Stefano , Klish William , Grand Richard , Walker Allan , Perman Jay
Published: March 2018

This chapter is based on the memories of those who shaped the relationship between the European and the North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition. The first joint meeting of the 2 Societies took place in Paris in 1978, followed by 1 in New York in 1985, 1 in Amsterdam in 1990, 1 in Houston in 1994, and the last one in Toulouse in 1998. The formation of the Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN) preceded the First World Congress of all Societies, which took place in Boston in 2000. The success of this meeting was followed by world congresses in Paris in 2004, Iguassu in 2008, Taiwan in 2012, and Montreal in 2016. NASPGHAN and ESPGHAN jointly took on the direction of the Journal of Pediatric Gastroenterology and Nutrition in 1991. Communication between the 2 Societies is extremely active, with members participating in many joint projects.