bluuebunny/crossref_metadata_2025 huggingface dataset:
A Pilot Study of the Prevalence of Anal Human Papillomavirus and Dysplasia in a Cohort of Patients With IBD
Authors: Cranston Ross D. , Regueiro Miguel , Hashash Jana , Baker Jonathan R. , Richardson-Harman Nicola , Janocko Laura , McGowan Ian
Published: November 2017

BACKGROUND:

Defective cell-mediated immunity increases the risk of human papillomavirus–associated anal dysplasia and cancer. There is limited information on anal canal disease in patients with IBD.

OBJECTIVE:

The purpose of this study was to assess anal/vaginal human papillomavirus and anal dysplasia prevalence in patients with IBD.

DESIGN:

Patients had an anal examination before routine colonoscopy.

SETTINGS:

The study was conducted at a tertiary IBD referral center.

PATIENTS:

We studied a convenience sample of sexually active male and female patients with IBD who were not on biological therapy.

INTERVENTION:

Anal examination, anal and vaginal human papillomavirus testing, anal cytology, and high-resolution anoscopy/biopsy were carried out.

MAIN OUTCOME MEASURES:

Anal and vaginal human papillomavirus types, anal cytology, and biopsy grade were measured.

RESULTS:

Twenty-five male and 21 female evaluable participants, 31 with Crohn’s disease, 14 with ulcerative colitis, and 1 with indeterminate colitis, were predominantly white (91.3%), treatment experienced (76.1%), an average age of 38.1 years (range, 22.0–66.0 y), and had an average length of IBD diagnosis of 9.3 years (range, 1.0–33.0 y). Eighteen (39.1%) had an abnormal perianal examination and 3 (6.5%) had an abnormal digital examination. Forty-one (89.1%) had anal human papillomavirus, 16 with a single type and 25 with multiple types (range, 2–5 types). Human papillomavirus type 16 was most common (65.2%), followed by human papillomavirus types 11 and 45 (37.0% each). Nineteen of 21 (90.5%) women had vaginal human papillomavirus. Overall, 21 (45.7%) had abnormal anal cytology. Thirty three (71.7%) had ≥1 anal biopsy (9 had multiple), with dysplasia diagnosed in 28 (60.9%) and high-grade and low-grade squamous intraepithelial lesions diagnosed in 4 (8.7%) and 24 (43.5%).

LIMITATIONS:

No control group was included, and no detailed sexual history was taken.

CONCLUSIONS:

A high prevalence of anal and vaginal human papillomavirus and anal dysplasia was demonstrated in the study population outcomes. See Video Abstract at http://links.lww.com/DCR/A379.
A Surgical Clostridium-Associated Risk of Death Score Predicts Mortality After Colectomy for Clostridium difficile
Authors: Kulaylat Audrey S. , Kassam Zain , Hollenbeak Christopher S. , Stewart David B.
Published: November 2017

BACKGROUND:

A Clostridium difficile-associated risk of death score was recently developed and validated by using a national cohort of both nonsurgical and surgical patients admitted with C difficile infection. However, risk scores specifically derived from surgical cohorts and designed for patients with C difficile infection are currently unavailable.

OBJECTIVE:

The aim of this study was to develop a risk of death score for patients with C difficile infection who are being considered for total abdominal colectomy because of the failure of medical therapy.

DESIGN:

This is a retrospective cohort study.

SETTINGS:

This study was conducted with the use of a national database.

PATIENTS:

All patients undergoing total colectomy for C difficile infection were identified in the National Surgical Quality Improvement Program database from 2005 to 2014.

MAIN OUTCOME MEASURES:

Variables similar to the original scoring system were used in multivariable analyses to determine the risk of 30-day mortality for patients, and a model was constructed to estimate the predicted probability of mortality after surgery.

RESULTS:

Of 532 patients who underwent surgery, 32.7% experienced 30-day postoperative mortality. Patient covariates associated with significantly increased mortality included age greater than 80 years (OR 5.5, p = 0.003), need for preoperative mechanical ventilation (OR 3.1, p < 0.001), chronic steroid use (OR 2.9, p < 0.001), underlying cardiopulmonary disease (OR 2.0, p = 0.001), and acute renal failure (OR=1.7, p = 0.03). These and other comorbidities, including hepatic disease, a cancer diagnosis, and both insulin- and noninsulin-dependent diabetes mellitus, were used to construct a model to estimate the predicted probability of mortality, which ranged from 8.0% to 96.1% based on individual comorbidity profiles. These estimates differed substantially when compared with those obtained using the National Surgical Quality Improvement Program risk calculator, which estimated the risk of mortality among surgical patients as being consistently lower.

LIMITATIONS:

This study was limited by its retrospective design.

CONCLUSIONS:

Our surgical scoring system allows preoperative risk stratification for patients being evaluated for colectomy for C difficile infection, potentially helping to avoid futile surgery. See Video Abstract at http://links.lww.com/DCR/A434.
Effect of Andrographolide on Gene Expression Profile and Intracellular Calcium in Primary Rat Myocardium Microvascular Endothelial Cells
Authors: Feng Bo , Zhang Qian , Wang Xin , Sun Xiangwan , Mu Xiang , Dong Hong
Published: November 2017

Andrographolide (ANDRO) is a diterpene lactone compound with extensive biological effects, such as antibacterial, antitumor and treatment of cardiovascular diseases. Until now, studies on the pharmacological functions of ANDRO are still in progress. However, little is known about the gene expression profile and calcium response of endothelial cells to ANDRO. In this study, we used a microarray technology to investigate the gene expression responses in primary rat myocardium microvascular endothelial cells treated with 10 μg/mL ANDRO. The expression of caveolin-1 and 1-phosphatidylinositol 4, 5-bisphosphate phosphodiesterase δ3 was verified by RT-PCR and western blot. In addition, we investigated the effect of ANDRO on intracellular calcium induced by exogenous adenosine triphosphate and on inflammatory response induced by lipopolysaccharide. Results showed that ANDRO treatment induced an abundance of differential expressed genes, exhibiting a multitarget regulatory effect. ANDRO significantly decreased caveolin-1 and phosphodiesterase δ3 expression, lipopolysaccharide-induced IL-6 and TNF-α levels and expression of several chemokine genes, which are associated with reducing inflammation response and decreasing calcium release without affecting normal endothelia cell function, suggesting that ANDRO may be a potential candidate to treat cardiovascular diseases with less toxicity.
Androgens Mediate β-adrenergic Vasorelaxation Impairment Using Adenylyl Cyclase
Authors: López-Canales Oscar , Castillo-Hernández Maria del Carmen , Vargas-Robles Hilda , Rios Amelia , López-Canales Jorge , Escalante Bruno
Published: November 2017

Cardiovascular disease development has been associated with sex differences, suggesting that sex hormones are implicated in vascular function and development of hypertension. Vascular tone comparison at different stages of rat growth represents a good model to study testosterone-related vascular response. We explored the role of testosterone in modulation of age-dependent impaired β-adrenergic vasodilation. The 3-week-old male Sprague–Dawley rats were sorted in 3-week-old rats without any manipulation and 3-week-old rats treated with testosterone. The 9-week-old rats were randomly grouped into 9-week-old rats without any manipulation (sham), 9-week-old rats that underwent gonadectomy (9-week-old castrated), and 9-week-old castrated treated with testosterone replacement therapy (9-week-old castrated + testosterone). Vascular relaxation was evaluated in aortic rings. β-adrenergic receptor protein expression, cyclic adenosine monophosphate production, testosterone levels, and adenylyl cyclase (AC) gene expression were assessed. Testosterone levels were low in 3-week-old and 9-week-old castrated rats compared with 9-week-old sham rats. Testosterone replacement raised these levels in 3-week-old and 9-week-old castrated rats similar to those of 9-week-old sham rats. SQ22536, the AC inhibitor, prevented isoproterenol-induced relaxation in aortic rings from 3-week-old and 9-week-old castrated rats. The β-adrenergic receptor protein expression was similar in all experimental groups. AC mRNA and protein expression and cyclic adenosine monophosphate levels were elevated in 3-week-old and 9-week-old castrated rats compared with 3-week-old + testosterone, 9-week-old sham, and 9-week-old castrated + testosterone rats. In conclusion, we demonstrated that age maturation was associated with vascular relaxation impairment. Variations in testosterone levels and reduced AC expression may be responsible for this altered vascular function.
Depression and Anxiety Screening and Triage Protocol for Cardiac Rehabilitation Programs
Authors: Tulloch Heather , Heenan Adam , Cupper Laura , Pelletier Robert , O'Farrell Pat , Pipe Andrew
Published: November 2017

Purpose:

Best practice guidelines for cardiac rehabilitation (CR) suggest routine screening for anxiety and depression, yet many patients are not screened nor do they receive mental health treatment. Protocols are required to identify those in need of care and to ensure that appropriate assistance is provided.

Methods:

Consecutive patients entering CR in our setting from May 4, 2012, to May 3, 2013, completed the Hospital Anxiety and Depression Scale (HADS). As per our Screening and Triage protocol for Anxiety and Depression (STAD), patients with high scores (≥16) were referred to a clinical psychologist; those with low scores (<8 for depression and <11 for anxiety) received information about community resources. Patients with moderate scores were reassessed 4 weeks later before triaging to psychosocial services. High, moderate, and low scores were triaged to a clinical psychologist, social worker, or were guided to community resources, respectively.

Results:

A total of 1504 patients (76% men) completed the HADS at intake; 287 (19%) had elevated depression and/or anxiety scores. Of these, 43 (15%) were referred to psychology services and 244 (85%) patients were referred for HADS readministration at 4 weeks. Scores following reassessment resulted in 6 referrals to psychology services (3%) and 62 to social work (36%), whereas 78 (45%) no longer needed care.

Conclusion:

Many cardiac patients experience symptoms of depression and anxiety. The STAD protocol using the HADS was an efficient method to screen for anxiety and depression and appropriately utilize psychosocial treatment resources in the cardiac rehabilitation setting.
Behavioral Genetics in Criminal and Civil Courts
Authors: Sabatello Maya , Appelbaum Paul S.
Published: November 2017

Although emerging findings in psychiatric and behavioral genetics create hope for improved prevention, diagnosis, and treatment of disorders, the introduction of such data as evidence in criminal and civil proceedings raises a host of ethical, legal, and social issues. Should behavioral and psychiatric genetic data be admissible in judicial proceedings? If so, what are the various means for obtaining such evidence, and for what purposes should its admission be sought and permitted? How could—and should—such evidence affect judicial outcomes in criminal and civil proceedings? And what are the potential implications of using behavioral and psychiatric genetic evidence for individuals and communities, and for societal values of equality and justice? This article provides an overview of the historical and current developments in behavioral genetics. We then explore the extent to which behavioral genetic evidence has—and should—affect determinations of criminal responsibility and sentencing, as well as the possible ramifications of introducing such evidence in civil courts, with a focus on tort litigation and child custody disputes. We also consider two ways in which behavioral genetic evidence may come to court in the future—through genetic theft or the subpoena of a litigant’s biospecimen data that was previously obtained for clinical or research purposes—and the concerns that these possibilities raise. Finally, we highlight the need for caution and for approaches to prevent the misuse of behavioral genetic evidence in courts.
Dementia, Decision Making, and Capacity
Authors: Darby R. Ryan , Dickerson Bradford C.
Published: November 2017

Learning objectives

After participating in this activity, learners should be better able to:

• Assess the neuropsychological literature on decision making and the medical and legal assessment of capacity in patients with dementia

• Identify the limitations of integrating findings from decision-making research into capacity assessments for patients with dementia

Medical and legal professionals face the challenge of assessing capacity and competency to make medical, legal, and financial decisions in dementia patients with impaired decision making. While such assessments have classically focused on the capacity for complex reasoning and executive functions, research in decision making has revealed that motivational and metacognitive processes are also important. We first briefly review the neuropsychological literature on decision making and on the medical and legal assessment of capacity. Next, we discuss the limitations of integrating findings from decision-making research into capacity assessments, including the group-to-individual inference problem, the unclear role of neuroimaging in capacity assessments, and the lack of capacity measures that integrate important facets of decision making. Finally, we present several case examples where we attempt to demonstrate the potential benefits and important limitations of using decision-making research to aid in capacity determinations.
Phacoemulsification in Eyes With Posttrabeculectomy Choroidal Detachment
Authors: Kandarakis Artemios S. , Kontadakis George A. , Kandarakis Stylianos A. , Dimitriou Chrysostomos , Chatziangelidis Iordanis , Karagiannis Dimitrios
Published: November 2017

Four patients developed choroidal detachment within 3 months after trabeculectomy, documented with b-scan ultrasonography (BUS) and ultrasound biomicroscopy (UBM). Intraocular pressure (IOP) of the patients ranged from 3 to 5 mm Hg. Patients were treated with cycloplegia and steroids without complete resolution of detachment. Twelve months later all patients had developed visually significant cataracts and underwent phacoemulsification and intraocular lens implantation. Procedures were uncomplicated. Visual acuity ranged 0.1 to 0 LogMAR in the first postoperative month. IOP demonstrated an increase of 6 to 8 mm Hg, which was maintained up to 1 year postoperatively. BUS and UBM in the first postoperative month demonstrated a complete resolution of choroidal detachment in all our cases. These patients with choroidal detachment underwent safe and effective phacoemulsification procedures. In addition, choroidal detachment resolved in all our patients, possibly because of intraoperative and postoperative IOP spikes, as well as long-term IOP elevation because of effect of cataract surgery on bleb function.
Outcomes of Trabeculectomy and Phacotrabeculectomy With Collagen Matrix Implant (Ologen) and Low-dose Mitomycin C: 2-Year Follow-up
Authors: Castejón Miguel A. , Teus Miguel A. , Bolivar Gema , Paz-Moreno-Arrones Javier , Castaño Beatriz
Published: November 2017

Purpose:

The purpose of this article is to analyze the results achieved in lowering intraocular pressure (IOP) after trabeculectomy or combined surgery (phacotrabeculectomy) with low-dose mitomycin C (MMC) using the Ologen Collagen Matrix (Ologen CM) implant.

Materials and Methods:

This retrospective study included 58 eyes from 47 consecutive patients with glaucoma who underwent filtering surgery alone or combined with cataract surgery. The study group included 29 eyes that underwent trabeculectomy (14 eyes) or phacotrabeculectomy (15 eyes) with low-dose MMC (0.1 mg/mL×1 min) and subconjunctival Ologen CM implant at the end of surgery. The control group included 29 eyes, 12 that underwent trabeculectomy and 17 that underwent phacotrabeculectomy, with the same MMC dose but without the collagen matrix implant. All surgical procedures were performed by the same surgeon. The follow-up period for the patients was 2 years.

Results:

We found statistically significant differences between the 2 groups in the age of the patients (P=0.02). We found no statistically significant differences in the baseline IOP (P=0.37) or preoperative IOP (P=0.5), nor in the visual field damage measured with mean deviation (P=0.2). The number of hypotensive medications used preoperatively was higher in the study group (P=0.0001). At 1 and 2 years after surgery, we only found statistically significant differences in favor of the study group in patients who underwent phacotrabeculectomy (P=0.0008 and 0.02, respectivily).

Conclusion:

The Ologen CM implant can be considered as an adjunct to MMC in patients undergoing filtering surgery combined with phacoemulsification to improve postoperative IOP results over the long term.
Assessing the Methodological Quality of Glaucoma Clinical Practice Guidelines and Their Recommendations on Microinvasive Glaucoma Surgery: A Systematic Review
Authors: Michaelov Evan , Armstrong James J. , Nguyen Mary , Instrum Bridget , Lam Tracey , Denstedt James , Hutnik Cindy M.L.
Published: November 2017

Introduction:

Clinical practice guidelines (CPG) are regarded by many as critical communications providing guidance within specific medical fields. Over a decade ago, the first microinvasive glaucoma surgical (MIGS) procedures were introduced. Since then, a number of these novel intraocular pressure controlling surgical options have been approved worldwide. Governing bodies and health care administration often utilize CPGs when considering funding for newer technologies. This highlights the importance of well-written, accurate, and up-to-date CPGs in the rapidly evolving field of MIGS. If CPGs are unable to fill this role, their use in treatment decision-making is doing a disservice to patients, who will be denied currently available and potentially superior care. To determine the overall value of a CPG, the methodological quality with which it was developed, in addition to the current relevance and appropriateness of its recommendations, should be evaluated. The objective of the present study was to assess the methodological quality of currently available international glaucoma CPGs, as well as their coverage of MIGS as a surrogate marker of relevance and appropriateness to policy-makers and ophthalmologists alike.

Materials and Methods:

To identify potentially relevant CPGs, a predefined search strategy was used to search the following databases: Medline, EMBASE, BIOSIS, and Web of Science. All CPGs related to adult glaucoma and published in English were included. CPG methodological quality was assessed by 3 individuals using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Studies were then assessed for coverage of MIGS devices and procedures.

Results:

Search strategy and subsequent screening identified 11 CPGs for analysis. Eight were of high quality according to the AGREE II criteria. Three included basic information on MIGS, but none provided specific recommendations regarding their indications or which patient populations would benefit most.

Conclusions:

Many international glaucoma CPGs are of high methodological quality. However, coverage of MIGS is sparse, nonspecific and in many instances, absent. This causes CPGs to be a suboptimal source in guiding physicians and health policy-makers in areas characterized by novel and/or rapidly evolving technologies. Mechanisms to incorporate updated evidence in CPGs would have to be considered before they can be used as a source of contemporary clinical decision-making.
Mrgprs activation is required for chronic itch conditions in mice
Authors: Zhu Yuyan , Hanson Claire E. , Liu Qin , Han Liang
Published: November 2017

Introduction:

Chronic itch has been drawing much attention due to its clinical significance and the complexity of its mechanisms. To facilitate the development of anti-itch strategies, it is necessary to investigate the key players in itch sensation under chronic itch conditions. Several members of the Mrgpr family were identified as itch receptors that detect cutaneous pruritogens in primary sensory neurons. However, the role of Mrgprs in chronic itch conditions has not been well described.

Methods:

Scratching behaviors of Wildtype and Mrgpr-clusterΔ

−/−
mice were examined in dry skin model and contact dermatitis model to examine the role of Mrgpr genes in mediating chronic itch sensation. Scratching behaviors of the mice were also examined in allergic itch model. Real-time polymerase chain reaction were performed to examine the expression level of MrgprA3 and MrgprC11 under naive and dry skin conditions. The MrgprA3+ itch-sensing fibers were labeled by tdTomato fluorescence in Mrgpra3

GFP-Cre
; ROSA26

tdTomato
mice, and the morphology and density of those fibers in the epidermis were analyzed under dry skin condition.

Results:

We showed that deleting a cluster of Mrgpr genes in mice reduced scratching behavior severely under 2 chronic itch conditions, namely dry skin and contact dermatitis, and the allergic itch condition. Moreover, the gene expressions of itch receptors MrgprA3 and MrgprC11 in dorsal root ganglia were upregulated significantly under dry skin condition. Consistently, the percentage of MrgprA3+ itch-sensing neurons was increased as well. We also observed hyperinnervation of MrgprA3+ itch-sensing fibers in the epidermis of the skin under dry skin condition.

Discussion:

We demonstrate that Mrgprs play important roles in mediating chronic itch and allergic itch. These findings enrich our knowledge of itch mechanism and may lead to the development of novel therapeutic approach to combat itch.
Repeated Ramp Tests on Stable LVAD Patients Reveal Patient-Specific Hemodynamic Fingerprint
Authors: Imamura Teruhiko , Burkhoff Daniel , Rodgers Daniel , Adatya Sirtaz , Sarswat Nitasha , Kim Gene , Raikhelkar Jayant , Ota Takeyoshi , Song Tae , Juricek Colleen , Jeevanandam Valluvan , Sayer Gabriel , Uriel Nir
Published: November 2017

Hemodynamic speed ramp tests are used in left ventricular assist device (LVAD) patients to guide speed adjustment and medical therapies. However, the reproducibility of these tests is unknown. In this prospective study, clinically stable LVAD patients underwent echocardiography and right heart catheterization ramp tests followed by a repeat test within 2 years as per institutional protocol. Sixteen patients (61.8 ± 10.5 years old, 50% male, eight with HeartMate II and eight with HVAD) underwent repeated ramp testing. The first test was performed 187 (42–1857) days from LVAD implant and the second test was performed 278 (126–560) days from the first test. All hemodynamic variables measured at the baseline speed remained statistically unchanged between the first and second ramp test (p > 0.05 for all). Changes in hemodynamic parameters, as assessed by the slopes of their changes over the range of speeds tested, were also the same at the two timepoints (p > 0.05 for all). Stable LVAD patients had similar hemodynamic profiles over the course of years including similar responses to speed changes. This suggests that ramp tests may represent a hemodynamic fingerprint; deviations from a baseline test can aid diagnosis at times of clinical deterioration or device malfunction.
Impact of Patient Distance From Ventricular Assist Device–Implanting Center on Short- and Long-Term Outcomes
Authors: Ravichandran Ashwin K. , Shah Palak , Singh Ramesh , Aaronson Keith D. , Pagani Francis D. , Stulak John , Dunlay Shannon M. , Dardas Todd F. , Mokadam Nahush A. , Salerno Christopher T. , Cowger Jennifer A.
Published: November 2017

Highly specialized left ventricular assist device care is not readily available in many areas, potentially limiting access to therapy. This retrospective analysis examines the relationship of outcomes by patient distance from implanting left ventricular assist device center within the Mechanical Circulatory Support Research Network. Zip codes were used to calculate patient distance, with the primary outcome of interest being 3-year survival by distance from the surgical center. Secondary outcomes included 90-day survival and incident event rates for the following: gastrointestinal bleeding, infection, cerebral event, and pump thrombosis. Across the four centers, there were 1184 patients supported for a median of 486 days. Overall survival was 91 ± 0.8% at 90 days and 61 ± 1.9% at 3 years, with worse 3-year survival in those living >90 vs. ≤90 miles from the ventricular assist device implant center (55 ± 3.0% vs. 64 ± 2.5, p = 0.019). Patients living >90 miles from an implant center were older, more likely to be implanted for destination therapy support, had a prior sternotomy, and had worse renal function than those living closer (p <0.05 for all). After adjusting for these factors, albumin and center of implant, the hazard ratio did not reach statistical significance (hazard ratio = 1.2; p = 0.14). Except for gastrointestinal bleeding, the event rates for the secondary outcomes were higher for those living closer to the implanting center. Protocols should be designed for more frequent follow-up and increased shared care opportunities to ensure optimal outcomes are achieved in distant patients.
Optimization of Axial Pump Characteristic Dimensions and Induced Hemolysis for Mechanical Circulatory Support Devices
Authors: Korakianitis Theodosios , Rezaienia Mohammad Amin , Paul Gordon , Avital Eldad , Rothman Martin , Mozafari Sahand
Published: November 2017

The application of axial pumps as ventricular assist devices (VADs) requires significant modifications to the size and characteristics of industrial pumps due to the difference in flow fields of industrial and medical pumps. Industrial pumps operate in the region of Reynolds number Re = 108, whereas axial blood pumps operate in Re < 106. The common pump design technique is to rely on the performance of previously designed pumps using the concept of fluid dynamic similarity. Such data are available for industrial pumps as specific speed-specific diameter (n
s–d
s) graphs. The difference between the flow fields of industrial and medical pumps makes the industrial n
s–d
s graphs unsuitable for medical pumps and consequently several clinically available axial blood pumps operate with low efficiencies. In this article, numerical and experimental techniques were used to design 62 axial pump impellers with different design characteristics suitable for VADs and mechanical circulatory support devices (MCSDs). The impellers were manufactured and experimentally tested in various operating conditions of flow, pressure, and rotational speed. The hemocompatibility of the impellers was numerically investigated by modeling shear stress and hemolysis. The highest efficiency of each pump impeller was plotted on an n
s–d
s diagram. The nondimensional results presented in this article enable preliminary design of efficient and hemocompatible axial flow pumps for VADs and MCSDs.
The Role of the Registered Nurse in the Insertion of Nontunneled Central Vascular Access Devices
Authors: Plohal Ann , Dumont Cheryl , Perry Cathy , Biddix Velda , Bird Diedre B. , Darst Teresa , Eisenhart Candee J. , Pugh Melanie
Published: November 2017

As the result of requests from several state boards of nursing, the Infusion Nurses Society (INS) convened a task force to determine whether insertion of central vascular access devices by appropriately trained registered nurses (RNs) should be recommended. The task force consisted of RNs and advanced practice registered nurses with infusion therapy experience in various practice settings. The results are presented in INS' newest position paper, adopted by the INS Board of Directors, September 2017.
Molecular Characterization of Markers Associated With Antimicrobial Resistance in Neisseria gonorrhoeae Identified From Residual Clinical Samples
Authors: Melendez Johan H. , Hardick Justin , Barnes Mathilda , Barnes Perry , Geddes Christopher D. , Gaydos Charlotte A.
Published: November 2017

Background

The emergence and spread of antimicrobial-resistant (AMR) Neisseria gonorrhoeae (NG) is a major public health concern. In the era of nucleic acid amplifications tests, rapid and accurate molecular approaches are needed to help increase surveillance, guide antimicrobial stewardship, and prevent outbreaks.

Methods

Residual urethral swabs, collected prospectively in the Baltimore City Health Department during a 6-month period, were analyzed by real-time polymerase chain reaction assays for NG DNA and AMR determinants to fluoroquinolones, penicillin, and extended-spectrum cephalosporins.

Results

N. gonorrhoeae DNA was detected in 34.8% (73/210) of samples, including 67.3% (68/101) of the swabs that had been previously identified as NG positive by culture. Markers associated with decreased susceptibility to fluoroquinolones were detected in 22.4% of the polymerase chain reaction NG-positive samples. The rate of penicillinase-producing NG was very low (1.6%), and no markers associated with decreased susceptibility to extended-spectrum cephalosporins were detected in this cohort of men using the AMR assays herein described.

Conclusions

Detection of molecular markers associated with AMR in NG can be performed directly from residual clinical samples, although the recovery rate of adequate DNA for molecular testing from these samples can be suboptimal. A high number of samples with mutations associated with decreased susceptibility to fluoroquinolones were identified.
Association Between Sensorimotor Impairments and Functional Brain Changes in Patients With Low Back Pain
Authors: Goossens Nina , Rummens Sofie , Janssens Lotte , Caeyenberghs Karen , Brumagne Simon
Published: November 2017

Low back pain (LBP) coincides with sensorimotor impairments, for example, reduced lumbosacral tactile and proprioceptive acuity and postural control deficits. Recent functional magnetic resonance imaging studies suggest that sensorimotor impairments in LBP may be associated with brain changes. However, no consensus exists regarding the relationship between functional brain changes and sensorimotor behavior in LBP. Therefore, this review critically discusses the available functional magnetic resonance imaging studies on brain activation related to nonnociceptive somatosensory stimulation and motor performance in individuals with LBP. Four electronic databases were searched, yielding nine relevant studies. Patients with LBP showed reduced sensorimotor-related brain activation and a reorganized lumbar spine representation in higher-order (multi)sensory processing and motor regions, including primary and secondary somatosensory cortices, supplementary motor area, and superior temporal gyrus. These results may support behavioral findings of sensorimotor impairments in LBP. In addition, patients with LBP displayed widespread increased sensorimotor-evoked brain activation in regions often associated with abnormal pain processing. Overactivation in these regions could indicate an overresponsiveness to sensory inputs that signal potential harm to the spine, thereby inducing overgeneralized protective responses. Hence, functional brain changes could contribute to the development and recurrence of LBP. However, future studies investigating the causality between sensorimotor-related brain function and LBP are imperative.
The Role of Real-Time Sonoelastography in the Differentiation of Benign From Malignant Parotid Gland Tumors
Authors: Cortcu Sumeyra , Elmali Muzaffer , Tanrivermis Sayit Asli , Terzi Yuksel
Published: November 2017

Objective

The aims of this study are to evaluate the utility of sonoelastography for parotid gland masses and to determine which cutoff strain ratio (SR) would be best for the differentiation between benign and malignant lesions.

Methods

From August 2015 to December 2016, 39 parotid gland masses were examined prospectively by ultrasonography and strain sonoelastography. Elastographic scores were determined by a 4-point scoring method. Interventional procedures were performed on all patients after sonographic examinations. The lesions were divided into groups as benign or malignant according to histopathological findings. The difference in elastographic scores between benign and malignant masses was evaluated.

Results

Among the 39 parotid gland masses, 33 (84.6%) were benign and 6 (15.3%) were malignant tumors with 53.8% (n = 21) of the lesions being on the right side. Pleomorphic adenoma (41%) was the most common neoplasm followed by Warthin tumor (28.2%). The median elastographic score was 2 (range, 1–3) for benign tumors, and it was 3 (range, 2–4) (P = 0.003) for malignant tumors. Median SR was 1.11 (range, 0.26–2.15), and it was 2.75 (range, 1.03–3.54) (P = 0.01) for benign and malignant tumors. In the receiver operating characteristic analysis, the cutoff value of the SR was 2.1, sensitivity was 83.3%, specificity was 97%, positive predictive value was 83.3%, negative predictive value was 97%, and accuracy was 94%.

Conclusions

There was a statistically significant difference between benign lesions and malignant lesions in both elastography score and SR. It is possible that elastography can improve the noninvasive diagnostic accuracy for certain pathological conditions.
Sonographic Features of Cervical Lymph Nodes in Patients With Hashimoto Thyroiditis and the Impacts From the Levothyroxine With Prednisone Therapy
Authors: Lyu Guo-Rong , Zheng Wei-Kun , Lin Wan-Ling , Zheng Li-Ping , Guo Hai-Xin , Li Li-Ya
Published: November 2017

Objective

This study aimed to evaluate the ultrasonographic pattern of cervical lymph nodes (CLNs) and whether levothyroxine with prednisone therapy is effective for lymphadenopathy in patients with Hashimoto thyroiditis (HT).

Methods

This retrospective study was looking at patients with confirmed diagnosis of HT who underwent comprehensive neck ultrasound examination. We reviewed sonographic findings in 127 patients with HT, 234 euthyroid patients with goiter, and 122 healthy subjects. In addition, 30 untreated HT patients with cervical lymphadenopathy were recruited for the levothyroxine with prednisone therapy. We rescanned the patients 9 months after treatment with levothyroxine and prednisone.

Results

Patients with HT had a higher rate of CLN detection on ultrasound than euthyroid patients with goiter and healthy subjects at cervical levels III, IV, and VI (P < 0.01). In addition, patients with HT had a higher rate of detection of CLNs with abnormal sonographic features than the other 2 groups, most notably at cervical levels III, IV, and VI (P < 0.01). After the treatment, the mean thyroid volume, thyroid nodule volume, CLN volume, symptom score, and cosmetic grade of 30 HT patients were remarkably decreased (P < 0.01 or P < 0.001).

Conclusions

Hashimoto thyroiditis seems to be associated with an increased rate of detection of CLNs with abnormal sonographic features, particularly at cervical levels III, IV, and VI. Therapy with levothyroxine with prednisone is effective for cervical lymphadenopathy in patients with HT.
Baroreflex Sensitivity and Blood Pressure Variability can Help in Understanding the Different Response to Therapy During Acute Phase of Septic Shock
Authors: Carrara Marta , Bollen Pinto Bernardo , Baselli Giuseppe , Bendjelid Karim , Ferrario Manuela
Published: November 2017

Background:

Mean values of hemodynamic variables are poorly effective in evaluating an actual recovery of the short-term autonomic mechanisms for blood pressure (BP) and heart rate (HR) regulation. The aim of this work is to analyze the response to therapy in the early phase of septic shock to verify possible associations between BP recovery and BP autonomic control.

Methods:

This is an ancillary study from the multicenter prospective observational trial Shockomics (NCT02141607). A total of 21 septic shock patients were studied at two time points during the acute phase of shock and were classified according to changes in SOFA score. Time series of BP components and HR were analyzed in time and frequency domain. Baroreflex sensitivity (BRS) was assessed, and a mathematical model for the decomposition of diastolic arterial pressure (DAP) oscillations was used to understand the different contributions of BRS and HR on peripheral vascular resistance control.

Results:

Only those patients, who significantly improved organ function (responders, R), showed an increase of mean value and low frequency (LF) power in BP time series. Fluid accumulation was higher in the non-responders (NR). BRS increased in NR and the model of DAP variability showed that the contribution of HR was highly reduced in NR.

Conclusions:

Although patients reached the mean BP target of 65 mmHg, our analyses highlighted important differences in terms of autonomic nervous system control. BP variability, HR variability and baroreflex trends can add information to individual vital sign measure such as mean BP, and can help in understanding the responsiveness to the combination of symphatomimetic drugs and fluid therapy.
Effect of Dexmedetomidine on Lactate Clearance in Patients With Septic Shock: A Subanalysis of a Multicenter Randomized Controlled Trial
Authors: Miyamoto Kyohei , Nakashima Tsuyoshi , Shima Nozomu , Kato Seiya , Ueda Kentaro , Kawazoe Yu , Ohta Yoshinori , Morimoto Takeshi , Yamamura Hitoshi
Published: November 2017

Lactate clearance is useful to guide initial resuscitation of patients with septic shock. We conducted this study to evaluate whether dexmedetomidine increases lactate clearance in patients with septic shock. This was a randomized controlled trial that involved a post hoc subgroup analysis. Adult patients with septic shock under ventilation were randomized to receive sedation strategy with or without dexmedetomidine (60 in the dexmedetomidine and 51 in the nondexmedetomidine groups). The primary outcome was the lactate clearance at 6 h, defined as the percent decrease in lactate from randomization to 6 h after. The median Acute Physiology and Chronic Health Evaluation II score was 25 (interquartile range 19–31). The median serum lactate value at randomization was lower in the dexmedetomidine group than in the nondexmedetomidine group (4.0 mmol/L vs. 4.8 mmol/L; P = 0.053). The lactate clearance at 6 h was higher in the dexmedetomidine group, although this was not statistically significant (23.3 ± 29.8 vs. 11.1 ± 54.4, mean difference 12.2, 95% confidence interval (CI), –4.4 to 28.8). After adjusting for the lactate level at randomization, lactate clearance at 6 h was significantly higher in the dexmedetomidine group (adjusted mean difference 18.5, 95% CI, 2.2–34.9). There was no statistically significant difference in the 28-day mortality between the dexmedetomidine and the nondexmedetomidine groups (13 [22%] vs. 18 [35%] patients, P = 0.11). In conclusion, among mechanically ventilated patients with septic shock, sedation with dexmedetomidine resulted in increased lactate clearance compared with sedation without dexmedetomidine.
Racial/Ethnic Differences in Perineal Lacerations in a Diverse Urban Healthcare System
Authors: Williams Amanda , Gonzalez Beverly , Fitzgerald Colleen , Brincat Cynthia
Published: November 2017

Objectives

The aim of the study was o determine whether variations exist between races/ethnicities in perineal laceration at first vaginal delivery.

Methods

We assessed first vaginal deliveries greater than 35 weeks gestation, for a four-year period, in our diverse urban healthcare system. Predictor variable was race/ethnicity with outcome variable of none, first-, second-, third-, or fourth-degree perineal laceration. Race and ethnicity were self-reported and combined into one variable to facilitate analysis. We also collected data on other known risk factors for laceration to adjust our analysis accordingly.

Results

A total of 1179 charts met criteria. When comparing none, first-, or second-degree lacerations versus third or fourth degrees (obstetric anal sphincter injuries) race was not a significant factor. We also compared lacerations among the following three groups: none or first degree versus second degree versus obstetric anal sphincter injuries. In this case, Asian and white women were associated with an increasing trend of perineal lacerations as degree of severity increased (P < 0.0001), whereas black and Latina women were associated with a decreasing trend as severity increased (P < 0.0001). After adjusting for other significant variables, race was still significant (P = 0.02).

Conclusions

With an urban diverse population, our study demonstrates an association between race/ethnicity and perineal lacerations. As degree of laceration increased, Asian and white women were noted to have more lacerations, and black and Latina women were noted to have fewer. Because perineal lacerations pose a significant risk to future pelvic floor health, the associated factors identified in this study may prove useful in counseling patients on future risk or in identifying the actual risk in underrepresented populations.
The PPARG Pro12Ala Polymorphism and 20-year Cognitive Decline
Authors: West Nancy A. , Tingle Jonathan V. , Simino Jeannette , Selvin Elizabeth , Bressler Jan , Mosley Thomas H.
Published: November 2017

Previous reports suggest race/ethnic and sex heterogeneity in the association between the Pro12Ala polymorphism of the peroxisome proliferator-activated receptor gamma (PPARG) gene and cognitive decline. Tests of verbal memory, processing speed, and verbal fluency and a composite global Z-score were used to assess cognitive performance longitudinally in a large (n=11,620) biracial cohort of older adults in the Atherosclerosis Risk in Communities Neurocognitive Study from midlife to older age. Linear mixed models were used to estimate associations between the Ala12 allele and cognitive performance over 20 years of follow-up. Heterogeneity was present for rate of cognitive decline as measured by the global Z-score by race, sex, and Ala12 allele status (P=0.01 for 4-way interaction term: race×sex×time×Ala12 carrier status). Stratified analysis showed a significantly increased rate of global cognitive decline over the 20-year follow-up for carriers of the Ala12 allele compared with noncarriers among black male individuals (−0.92 SD decline vs. −0.57 SD; P=0.02) but not among black female, white male, or white female individuals. Decline in global cognitive function among black male Ala12 carriers was primarily driven by decline in verbal memory. Our data underscore the context-dependent association between the Pro12Ala polymorphism and cognitive decline, specifically race/ethnic background and sex.
3-Ethyl-5,5-diphenylimidazolidine-2,4-dione
Authors: Guerrab Walid , Akrad Rachida , Ansar Mhammed , Taoufik Jamal , Mague Joel T. , Ramli Youssef
Published: November 2017

In the title molecule, C17H16N2O2, the phenyl rings attached at the 5-position of the imidazolidine-2,4-dione ring are inclined to the five-membered ring by 60.03 (5) and 63.04 (5)°. In the crystal, N—H...O and C—H...O hydrogen bonds form chains along thea-axis direction, which are connected in pairs by additional C—H...O hydrogen bonds. The chains are tied together by C—H...π(ring) interactions.
Learning study is “hard”: case of pre-service biology teachers in British Columbia
Authors: Tan Yuen Sze Michelle
Published: November 2017

Purpose

The purpose of this paper is to describe a pilot learning study (LS) comprising of three biology pre-service teachers (PSTs) in British Columbia, which took place during an initial teacher education (ITE) course and school-based practicum. The study explored PSTs’ learning experiences, and identified conditions that supported and challenged their engagement with the LS discourse.

Design/methodology/approach

Drawing from a variety of methods including teacher semi-structured interviews and reflective entries, the PSTs’ experiences of teaching and reflection were described and themes were constructed; course assignments, classroom materials, meeting notes and fieldnotes served triangulation purposes. Variation theory framed the LS and analysis of this case study.

Findings

Findings highlight how the PSTs developed comfort with the tension of making mistakes that supported their interpretation of classroom pedagogy and refining of instructional strategies. As the study alluded to how LS is “hard,” the PSTs demonstrated how positive experiences in the course-based cycle sustained their pursuit of learning despite challenges faced in the school-based practicum.

Research limitations/implications

This small-scale study has limited generalizability.

Practical implications

Exposing PSTs to a variety of “mistakes” in ITE and to approach them not merely as ontological objects of pedagogical shortcomings are discussed together with factors that promoted teacher learning.

Originality/value

This study contributes to literature exploring the organization of LS within ITE, as situated in educational contexts where LS is unfamiliar and organizational structures are not readily in place to fully support its implementation.
Spreading lesson study in pre-service teacher instruction
Authors: Angelini Maria Laura , Álvarez Neus
Published: November 2017

Purpose

The purpose of this paper is to examine the perceptions of pre-service teachers (PSTs) who used lesson study on a five-week school-based teaching placement. The paper analyses 12 undergraduate PSTs’ perceptions of the way lesson study affected classroom-based teaching of English as a foreign language to pre-school and primary school.

Design/methodology/approach

A qualitative study is carried out from the responses to a semi-structured interview to the PSTs, and written responses to the open-ended question: What are your perceptions of lesson study?

Findings

This paper provides empirical insights about the way lesson study reinforced the PSTs’ classroom management and lesson planning skills. The case-pupils’ responses to the PSTs’ questions post-treatment indicated that games and active techniques in the classroom led to high retention of the taught content. Nevertheless, PSTs’ evaluations of pupils’ learning outcomes require further development. These evaluations often resulted in vague perceptions of overall lesson performance.

Research limitations/implications

This study provides hints of how case-pupils better learned and how PSTs did the observations and performed. However, the results cannot be generalized.

Originality/value

The researchers sustain that the teaching degrees should encourage critical thinking in PSTs’ self-evaluations to reduce the focus on standards and expectations. It is believed that if the pressure of designing perfect lessons is removed from the equation, and instead, sensible and realistic lessons are planned, PSTs will be more inclined to learn and respond resourcefully, creatively, and resolutely to classroom situations.