bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of clinical outcomes between intravascular optical coherence tomography-guided and angiography-guided stent implantation
Authors: Jiang Yu , He Li-Peng , Gong Ren , Lei Guang-Tao , Wu Yan-Qing
Published: February 2019

Objective:

This systematic review was designed to evaluate the overall efficacy of optical coherence tomography (OCT)-guided implantation versus angiography-guided for percutaneous coronary intervention.

Methods:

The following electronic databases, such as CENTRAL, PubMed, Cochrane, and EMBASE were searched for systematic reviews to investigate OCT-guided and angiography-guided implantation. We measured the following 7 parameters in each patient: stent thrombosis, cardiovascular death, myocardial infarction, major adverse cardiac events (MACE), target lesion revascularization (TLR), target vessel revascularization (TVR), all-cause death.

Results:

In all, 11 studies (6 RCTs and 5 observational studies) involving 4026 subjects were included, with 1903 receiving intravascular ultrasound-guided drug-eluting stent (DES) implantation and 2123 using angiography-guided DES implantation. With regard to MACE, MT, TLR, TVR, stent thrombosis and all-cause death, the group of OCT-guided implantation had no significant statistical association with remarkably improved clinical outcomes. However, its effect on cardiovascular death has a significant statistical difference in angiography-guided implantation group.

Conclusion:

In the present pool analysis, OCT-guided DES implantation showed a tendency toward improved clinical outcomes compared to angiography-guided implantation. More eligible randomized clinical trials are warranted to verify the findings and to determine the beneficial effect of OCT-guidance for patients.
In situ revascularization of bilateral complicated giant renal artery aneurysms
Authors: Chen Xiyang , Zhao Jichun , Huang Bin , Yuan Ding , Yang Yi
Published: February 2019

Rationale:

Renal artery aneurysm (RAA) is a rare entity, bilateral multiple RAAs near hilum with a maximum diameter of 7 cm are even rare and bring a great challenge to surgeons. As the technique of vessel reconstruction is quite difficult for the RAAs near hilum, some surgeons choose to resect the involved kidney. We reported a young female patient with the threatened rupture symptoms for further treatment. The details of revascularization methods and procedure design were discussed in the report.

Patient concerns:

A young female patient complained with lumbar and abdominal pain for 1 month. Computed tomography angiography showed bilateral RAAs with the maximum diameter of 6 and 7 cm on the left and right side separately. For the right RAA, apart from a giant aneurysm, there was another small aneurysm with a diameter of 3 cm located on the inferior polar right renal artery. There was a mild tenderness on the left lumbar and lower abdomen, no rebound tenderness was detected.

Diagnosis:

According to the image feature and symptoms, the diagnosis for this patient was bilateral giant RAAs with threatened ruptured.

Interventions:

Dissection of the bilateral giant RAA and in situ revascularization of renal arteries with prosthetic graft was performed.

Outcomes:

The follow-up results showed the satisfactory patency of prosthetic graft and obvious improvement of renal function.

Lessons:

This complicated bilateral giant RAAs was successfully revascularized through in situ renal artery repair with a very difficult procedure process. For the RAA near hilum, vessel reconstruction no matter through in situ or ex vivo are both difficult for surgeons. This extremely rare and difficult case could bring more confidence to surgeons who meet such complicated bilateral RAAs for choosing the vessel reconstruction rather than kidney resection.
MicroRNAs in sputum specimen as noninvasive biomarkers for the diagnosis of nonsmall cell lung cancer
Authors: Zhang Xiaoyun , Wang Qian , Zhang Shijie
Published: February 2019

Background:

Nonsmall cell lung cancer (NSCLC) is a serious leading cause of death worldwide. Recently, multiple researches have identified that microRNA (miRNA) in sputum could be a useful tool for NSCLC diagnosis. The objective of this study was to assess whether aberrant miRNA expression could be regarded as a useful biomarker in sputum specimen for the diagnosis of NSCLC.

Methods:

Eligible studies were searched in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases up to June 2018. We calculated the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) to investigate the diagnostic value of miRNA in sputum for NSCLC. MetaDisc1.4 and STATA12.0 were used to analyze the retrieved data.

Results:

Finally, a total of 14 articles were included in this meta-analysis involving 1009 NSCLC patients and 1006 controls. The results were as followed: the pooled sensitivity, specificity, PLR, NLR, DOR, were 0.75 (95%CI:0.72–0.78), 0.88 (95%CI:0.86–0.90), 5.70 (95%CI:4.82–6.75), 0.30 (95%CI:0.26–0.34), 22.43 (95%CI:17.48–28.79), respectively. The AUC of overall summary receiver operator characteristic curve (SROC) was 0.8917.

Conclusion:

Our comprehensive analysis indicated that miRNAs in sputum specimen may be noninvasive diagnostic biomarkers for NSCLC. However, much more studies should be conducted before clinical application.
Cerebral venous sinus thrombosis due to hyperhomocysteinemia with cystathionine-β-synthase (CBS) gene mutation
Authors: Shang Ke , Li Hui , Luo Xiang
Published: February 2019

Rationale:

Risk factors of cerebral venous sinus thrombosis (CVST) are usually divided into acquired risks (e.g., trauma and pregnancy) and genetic risks (inherited thrombophilia). It is essential but not easy to identify the exact one for each patient.

Patient concerns:

A 14-year-old male patient was admitted in our hospital because of progressively exacerbated severe headache and vomiting for 3 days, accompanied by transient weakness once in his right leg.

Diagnosis:

CVST due to hyperhomocysteinemia with cystathionine-β-synthase (CBS) gene mutation.

Interventions:

Persistent oral anticoagulant therapy.

Outcomes:

Follow-ups at 4 months and 1 year showed that the patient's symptoms alleviated and did not recur, accompanied with improved MRV image; however, the cranial MRV image did not display as a completely normal one.

Lessons:

We recommend that in case of thrombophilic state, serum homocysteine (Hcy), folic acid, and vitamin B12 levels should be routinely screened; when serum Hcy level is extremely high, congenital diseases caused by gene mutations should be considered. We firstly discovered a new mutation of CBS c.949A>G which had not been reported before.
Diffuse large B-cell lymphoma of the central nervous system presenting as “lymphomatosis cerebri” and dementia in elderly man
Authors: Kerbauy Mariana Nassif , Pasqualin Denise da Cunha , Smid Jerusa , Iquizli Rogerio , Kerbauy Lucila Nassif , Nitrini Ricardo , Ribas Guilherme Carvalhal , Neder Luciano , Hamerschlak Nelson
Published: February 2019

Rationale:

Lymphomatosis cerebri is a rare form of PCNSL, characterized by diffuse infiltration of lymphoma cells in cerebral parenchyma, without mass-formation and mild or no contrast enhancement on magnetic resonance (MR) imaging. There are less than 50 cases described in the literature under the term Lymphomatosis cerebri.

Patient concerns:

A 74-year-old man presented to our service with progressive dementia for 12 months and accelerated cognitive decline within the last two months. Brain magnetic resonance imaging showed areas of hyperintensity involving predominantly the white matter of frontal lobes and knee of the corpus callosum, along with areas of blood-brain barrier disruption and areas of restricted diffusion. Stereotaxy brain surgery was indicated into contrasting areas and histologically there was heterogeneous foci of discreet infiltration of rare medium-large lymphoid cells intermingled with inflammatory cells and these atypical lymphoid cells were placed on breakdown neuropil and did not form tumor mass or sheets of cells, but occasionally displayed perivascular distribution. Immunohistochemically, these atypical lymphoid cells expressed CD20, Bcl2, Bcl6 and, heterogeneously, IRF4/MUM1.

Diagnosis:

The diagnosis of a primary CNS diffuse large B-cell lymphoma manifested as lymphomatosis cerebri was performed.

Interventions:

The treatment of choice was: temozolomide 100 mg/m2 (D1 to D5), methotrexate 3 g/m2 (D1, D10, and D20) and rituximab 375 mg/m2.

Outcomes:

The patient evolved with progressive neurological deterioration, regardless of the improvement on neuroimaging.

Lessons:

We described the diagnostic dilemma we faced with an elderly man with rapid cognitive impairment and a myriad of differential diagnoses, diagnosed with primary CNS diffuse large B-cell lymphoma with a lymphomatosis cerebri-like pattern.
Comparison the cost-efficacy of furazolidone-based versus clarithromycin-based quadruple therapy in initial treatment of Helicobacter pylori infection in a variable clarithromycin drug-resistant region, a single-center, prospective, randomized, open-label study
Authors: Yi Dong-Min , Yang Tao-Tao , Chao Shuai-Heng , Li Ya-Xin , Zhou Ying-Lei , Zhang Hai-Hui , Lan Ling , Zhang Yu-Wei , Wang Xue-Mei , Zhang Yan-Rui , Li Jian , Ding Song-Ze
Published: February 2019

Helicobacter pylori (Hp) drug resistant rate to clarithromycin (CLA) has increased to 20% to 50%, which cause concerns regarding its effectiveness in eradicating Hp, we aim to evaluate the cost-effectiveness of CLA-based versus furazolidone (FZD)-based quadruple therapy, and assess factors that affect anti-Hp efficacy.

One hundred eighty-five patients were enrolled in this single-center, prospective, randomized, open-label study. In FZD group, 92 patients were treated with FZD plus esomeprazole, bismuth potassium citrate, and amoxicillin for 14 days. In CLA group, 93 patients were treated with the same regimen except FZD was replaced by CLA. Patients were tested 4 weeks post-treatment to confirm eradication.

Of the 185 enrolled patients, 180 completed the study. On intention-to-treat analysis, Hp eradication rates in FZD and CLA groups were 90.22% and 86.02% (P = .378); in per-protocol analysis, their eradication rates were 93.26% and 87.91%, respectively (P = .220). Overall incidence of total side effects in FZD and CLA groups was 19.57% and 13.98%, and their severe side effects were 3.26% and 2.15%, respectively (P > .05). Cost-effectiveness ratios of FZD and CLA groups were 0.75 and 1.02, and incremental cost-effectiveness ratio of FZD group over CLA group was −3.62. Eradication failures were not associated with factors including gender, age, body mass index, smoking, alcohol consumption, educational level, and urban–rural distribution in this observation (P > .05).

Despite increasing drug resistance to CLA, Hp eradication rates in FZD and CLA groups have no significant difference at present; as FZD-based quadruple therapy is more cost-effective, we recommend this regimen be a first-line choice for Hp eradication.
Imaging findings of intraductal tubulopapillary neoplasm (ITPN) of the pancreas
Authors: Zhang Jingjing , Ren Shuai , Wang Jianhua , Ye Dandan , Zhang Huifeng , Qiu Wenli , Wang Zhongqiu
Published: February 2019

Rationale:

Intraductal tubulopapillary neoplasm (ITPN) is a rare type of pancreatic epithelial neoplasm. We report 2 cases of ITPN and detail the imaging findings.

Patient concerns:

The 1st case was a 36-year-old woman who complained of jaundice, yellow urine and diarrhea. She accepted ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) examination before surgery, which all revealed a mass in the pancreatic head. The 2nd case was a 62-year-old woman who was admitted to our hospital for the treatment of a pancreatic tumor. The MRI showed a mass filled the mian pancreatic duct in the head and neck.

Diagnosis:

The ITPN is an intraductal, grossly visible, tubule-forming epithelial neoplasm with high-grade dysplasia and ductal differentiation without overt mucin production.

Interventions:

The 1st patient received percutaneous transhepatic cholangial drainage procedure, endoscopic ultrasound guided fine needle aspiration, pancreatoduodenectomy, cholecystectomy, and lymphadenectomy successively. The 2nd patient received pancreaticoduodenectomy, cholecystectomy, and partial gastrectomy.

Outcomes:

Two months after surgery, the follow-up MRI revealed hepatic metastasis of the 1st patient. She is still alive now. The 2nd patient was lost to follow-up.

Lessons:

The ITPN is a rare pancreatic neoplasm and its clinical symptoms are atypical. It is difficult to make accurate diagnosis of ITPN before surgery even though various imaging modalities are used in combination. When a solid mass growing in the lumen of the pancreatic duct, ITPN should be taken into consideration.
Prevalence of bullying and perceived happiness in adolescents with learning disability, intellectual disability, ADHD, and autism spectrum disorder
Authors: Lung For-Wey , Shu Bih-Ching , Chiang Tung-Liang , Lin Shio-Jean
Published: February 2019

Children with learning disability (LD), intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) reported higher risk of being bullied compared to their peers. Controlling for the co-morbidity of different diagnosis is important in investigating the frequency of bullying. Therefore, this study aimed to investigate the pathway relationship of adolescents’ psychiatric diagnoses, including LD, ID, ADHD, ASD, with being bullied, their self-perceived psychological well-being (PWB) and social adaptation status (SAS) in 12-years-olds.

The Taiwan Birth Cohort Pilot Study dataset (N = 1561) was used. The Chinese Oxford Happiness Questionnaire was used to measure PWB and SAS.

Adolescent-reported rate of bullying was 25.4%, while only 2.8% of the parents reported knowing their child had been bullied. Boys reported higher rate of being bullied than girls. Adolescents with ADHD were not at higher risk of being bullied compared to their peers, nevertheless, they perceived lower level of SAS. Adolescents diagnosed with ID and ASD reported 63% rate of bullying and those who have been bullied perceived lower level of happiness.

Adolescents with ADHD reported lower level of SAS, for disruption of harmony is even less acceptable in the Asian culture. Adolescents with ID and ASD reported higher rate of bullying than their peers and perceived lower level of happiness. A gap was found between parent and adolescent-reported rate of bullying. Encouraging adolescents to seek adult protection and support to reduce the effect of bullying on the perceived level of happiness is important.
HSV Hepatitis in Pregnancy: A Review of the Literature
Authors: McCormack Ashley Lane , Rabie Nader , Whittemore Brianna , Murphy Trevor , Sitler Collin , Magann Everett
Published: February 2019

Importance

Herpes simplex virus (HSV) hepatitis is a rare condition with a high mortality rate. Immunocompromised individuals, including pregnant women, are the most susceptible. When primary infection occurs during pregnancy, risk for disseminated HSV is greatly increased. Disseminated HSV can manifest in the form of HSV hepatitis.

Objective

We aim to review the literature and summarize what is known about HSV hepatitis in pregnancy to aid in the diagnosis and treatment of this condition.

Evidence Acquisition

A literature search of PubMed and Web of Science was performed. A total of 237 citations were found. All citations were independently reviewed. Thirty-eight full-text articles were identified and included in this review. Additional data from 1 unpublished case from our institution was included.

Results

Fifty-six cases were included with average gestational age at diagnosis of 30 weeks. Patients presented with a wide variety of gastrointestinal, respiratory, neurologic, and urogenital symptoms. The most common examination findings were fever and abdominal tenderness. Only 18.2% of patients had a vesicular rash. All patients had a transaminitis, and 85% had positive viral cultures. A multitude of treatments were used with the majority of favorable outcomes occurring after treatment with acyclovir.

Conclusions and Relevance

Although HSV hepatitis is rare, it carries a mortality rate of up to 39% for mothers and neonates. Therefore, it is crucial that HSV hepatitis be included on the differential diagnosis when a patient presents with fever and transaminitis. When HSV hepatitis is suspected, empiric therapy with acyclovir can be initiated with no additional risk to the fetus.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the participant should be better able to (1) develop a reasonable differential diagnosis for hepatitis in pregnancy, including HSV hepatitis; (2) differentiate these etiologies based on common presentations, physical findings, and laboratory values; (3) value the usage of empiric acyclovir therapy in pregnancy-related hepatitis; and (4) counsel patients on safety measures to protect themselves and their unborn children from infection during pregnancy, including avoidance and vaccination.
Lymphatic Invasion in the Fallopian Tube is a Late Event in the Progression of Pelvic Serous Carcinoma and Correlates With Distant Metastasis
Authors: Seidman Jeffrey D. , Krishnan Jayashree
Published: February 2019

The majority of extrauterine high-grade serous carcinomas are believed to arise in the fallopian tube as serous tubal intraepithelial carcinomas. The primary mode of metastasis is intraperitoneal, and patients usually present with peritoneal carcinomatosis. Although the tubes have a rich lymphatic network, tubal lymphatic invasion is observed in only a minority of cases. Fallopian tube sections from 222 patients with advanced stage high-grade extrauterine serous carcinoma were reviewed and lymphatic invasion within the lamina propria and myosalpinx were assessed. Seventeen patients were FIGO stage II, 162 stage III, and 43 stage IV. Tubal lymphatic invasion was identified in 44 cases (19.7%). Among the cases with lymphatic invasion, nonfimbrial lamina propria, fimbrial lamina propria, and myosalpingeal lymphatic invasion were present in 23 (52%), 21 (48%), and 21 (48%), respectively. Among cases with lymphatic invasion, 16 (36%) were FIGO stage IV, while among cases without lymphatic invasion, 27 (15%) were stage IV (P=0.0014, χ2). In summary, in women with advanced stage high-grade extrauterine serous carcinoma, lymphatic invasion in the fallopian tube is uncommon, and is more than twice as likely to be associated with distant metastases as compared with those without tubal lymphatic invasion.
Clinicopathologic and Immunohistochemical Correlates of CTNNB1 Mutated Endometrial Endometrioid Carcinoma
Authors: Costigan Danielle C. , Dong Fei , Nucci Marisa R. , Howitt Brooke E.
Published: February 2019

Endometrial endometrioid carcinomas (EECs) with exon 3 CTNNB1 mutations characterize a more aggressive subset of tumors in patients with low-grade low-stage disease. Thus, prospectively identifying these cases may be clinically relevant. The aim of this study was to examine the feasibility of β-catenin and Cyclin D1 immunohistochemistry to identify EECs harboring CTNNB1 mutations and to evaluate the clinicopathologic features of EECs with exon 3 CTNNB1 mutations. Thirty-nine CTNNB1 mutated EECs and 40 CTNNB1 wild-type EECs were identified from a cohort of previously sequenced endometrial carcinomas using a targeted next-generation sequencing panel. Immunohistochemistry for β-catenin and Cyclin D1 was performed on all cases. Immunohistochemistry results were correlated with CTNNB1 mutation status and clinicopathologic parameters. Patients with CTNNB1 mutated EECs were younger than those with CTNNB1 wild-type (56.2 vs. 61.5 y; P=0.033). Nuclear β-catenin expression correlated with exon 3 CTNNB1 mutation (P<0.0001) with a sensitivity of 91% and a specificity of 89%. Cyclin D1 expression correlated with CTNNB1 exon 3 mutation with relatively high specificity (90%) but low sensitivity (29%). Recurrence rate in patients with stage IA disease at diagnosis was significantly higher in patients whose tumors were CTNNB1 mutated compared with CTNNB1 wild-type (30% vs. 0%; P=0.025) and included distant metastases; all recurrent tumors in this group harbored exon 3 mutations and were histologically low grade (5 grade 1, 2 grade 2). Nuclear β-catenin expression appears to be an acceptable proxy for CTNNB1 mutation.
Development of an Instrument to Assess Stroke Caregivers’ Readiness for the Transition Home
Authors: Camicia Michelle , Lutz Barbara J. , Harvath Theresa , Kim Katherine K. , Drake Christiana , Joseph Jill G.
Published: February 2019

Purpose

The study purpose was to develop a measure to assess stroke caregivers’ commitment and capacity to assume the caregiving role prior to discharge.

Design

Participants were caregivers of stroke survivors in an inpatient rehabilitation facility.

Methods

A sequential, multimethod approach, which included item generation from qualitative data, review of items by expert clinicians, cognitive interviews to determine response format (n = 22), and item clarity (n = 20), and an analysis of pilot data were utilized.

Findings

Cognitive interviewing provided information to improve item clarity.

Conclusion

This instrument development approach resulted in the Preparedness Assessment for the Transition Home After Stroke (PATH-s), a 26-item self-report instrument. The PATH-s represents the domains of the Model of Caregiver Readiness, upon which the instrument was developed.

Clinical Relevance

The PATH-s, once further validated, may guide healthcare providers in the development of tailored care plans to address identified gaps and better prepare caregivers for the transition home.
Long-term Results of the Side-to-side Isoperistaltic Strictureplasty in Crohn Disease
Authors: Michelassi Fabrizio , Mege Diane , Rubin Michele , Hurst Roger D.
Published: February 2019

Objective:

Review the long-term outcomes of the side-to-side isoperistaltic strictureplasty (SSIS) and its effects on bowel preservation in Crohn disease (CD).

Summary Background Data:

The first SSIS was performed 25 years ago as an alternative to resection in the treatment of extensive fibrostenosing jejuno-ileal CD.

Methods:

Prospective study (January 1992–December 2016) of all patients with a SSIS performed by the authors. Long-term outcomes were evaluated radiographically, endoscopically, and histopathologically.

Results:

Sixty patients [14.4% of patients with jejuno-ileal bowel CD; 31 females; median age 36 (12–69) years] underwent 61 SSIS's for partial intestinal obstruction. Median length of preserved small bowel was 50 (20–148) cm. Associated strictureplasties and bowel resection were performed in 44% and 80%, respectively. Postoperative mortality occurred in 1 (PE on POD#8) and postoperative morbidity in 7 (12%). There were no sutureline dehiscences. SSIS resulted in resolution of preoperative symptoms in all. After a median follow-up of 11 years (range 1 mo–25 yrs), symptomatic recurrence was observed in 61%: 15 patients at the SSIS and 19 away from it (2 cases unclear location; 7 patients with >1 recurrence). Of 15 recurrences at SSIS's, 11 required surgical treatment (revision or strictureplasty in 6, SSIS removal in 5). Fifty-one patients (86%) maintain the original SSIS to date.

Conclusions:

SSIS is a safe, effective, and durable strictureplasty in patients with extensive fibrostenosing CD of the small bowel. Half the surgical recurrences on SSIS can be managed by subsequent revision or strictureplasty. The majority of patients maintain the original SSIS after a median follow-up of 11 years.
Can Minimally Invasive Esophagectomy Replace Open Esophagectomy for Esophageal Cancer? Latest Analysis of 24,233 Esophagectomies From the Japanese National Clinical Database
Authors: Yoshida Naoya , Yamamoto Hiroyuki , Baba Hideo , Miyata Hiroaki , Watanabe Masayuki , Toh Yasushi , Matsubara Hisahiro , Kakeji Yoshihiro , Seto Yasuyuki
Published: February 2019

Objective:

We aimed to elucidate whether minimally invasive esophagectomy (MIE) can be safely performed by reviewing the Japanese National Clinical Database.

Summary of Background Data:

MIE is being increasingly adopted, even for advanced esophageal cancer that requires various preoperative treatments. However, the superiority of MIE's short-term outcomes compared with those of open esophagectomy (OE) has not been definitively established in general clinical practice.

Methods:

This study included 24,233 esophagectomies for esophageal cancer conducted between 2012 and 2016. Esophagectomy for clinical T4 and M1 stages, urgent esophagectomy, 2-stage esophagectomy, and R2 resection were excluded. The effects of preoperative treatment and surgery on short-term outcomes were analyzed using generalized estimating equations logistic regression analysis.

Results:

MIE was superior or equivalent to OE in terms of the incidence of most postoperative morbidities and surgery-related mortality, regardless of the type of preoperative treatment. Notably, MIE performed with no preoperative treatment was associated with significantly less incidence of any pulmonary morbidities, prolonged ventilation ≥48 hours, unplanned intubation, surgical site infection, and sepsis. However, reoperation within 30 days in patients with no preoperative treatment was frequently observed after MIE. The total surgery-related mortality rates of MIE and OE were 1.7% and 2.4%, respectively (P < 0.001). Increasing age, low preoperative activities of daily living, American Society of Anesthesiologists physical status ≥3, diabetes mellitus requiring insulin use, chronic obstructive pulmonary disease, congestive heart failure, creatinine ≥1.2 mg/dL, and lower hospital case volume were identified as independent risk factors for surgery-related mortality.

Conclusions:

The results suggest that MIE can replace OE in various situations from the perspective of short-term outcome.
Survey of Postoperative Activity Guidelines After Minimally Invasive Gynecologic and Pelvic Reconstructive Surgery
Authors: Winkelman William D. , Erlinger Adrienne L. , Haviland Miriam J. , Hacker Michele R. , Rosenblatt Peter L.
Published: February 2019

Objective(s)

Most surgeons recommend restriction of activities after minimally invasive gynecologic and pelvic reconstructive surgery. The goal of this study was to identify and assess the postoperative guidelines gynecologists and urogynecologists provide their patients.

Methods

This was a cross-sectional study of physicians at a national gynecology conference in March 2018. Respondents were asked to answer questions about the typical postoperative recommendations they provide patients after gynecologic surgery as well as their postoperative prescribing habits.

Results

There were 418 attendees, and 135 (32%) eligible physicians completed the survey. Of respondents, 87% were specialists in female pelvic medicine and reconstructive surgery. Most respondents (61%) were in academic practice. Most respondents (82%–86%) recommended specific postoperative lifting restrictions, and 49% to 52% recommended limiting lifting to a maximum of 10 lb after surgery with some variation depending on the surgical procedure performed. Many respondents (42%–56% depending on the surgical procedure) recommended that patients wait at least 2 weeks before returning to sedentary work. Male respondents and those who were in practice for more than 10 years recommended that patients return to work sooner compared with those who were in practice less than 10 years. Male respondents prescribed fewer opioids to patients after vaginal hysterectomy (P = 0.04) and vaginal prolapse repair (P = 0.03) compared with female respondents.

Conclusions

After minimally invasive gynecologic or pelvic reconstructive surgery, providers recommend a wide range of postoperative restrictions and prescribe significantly different quantities of opioids during the postoperative period. This study highlights some of the recommendations with the greatest variability.
An Algorithm to Characterize a Dementia Population by Disease Subtype
Authors: Albrecht Jennifer S. , Hanna Maya , Randall Rhonda L. , Kim Dure , Perfetto Eleanor M.
Published: February 2019

Purpose:

Identification of Alzheimer disease and related dementias (ADRD) subtypes is important for pharmacologic treatment and care planning, yet inaccuracies in dementia diagnoses make ADRD subtypes hard to identify and characterize. The objectives of this study were to (1) develop a method to categorize ADRD cases by subtype and (2) characterize and compare the ADRD subtype populations by demographic and other characteristics.

Methods:

We identified cases of ADRD occurring during 2008 to 2014 from the OptumLabs Database using diagnosis codes and antidementia medication fills. We developed a categorization algorithm that made use of temporal sequencing of diagnoses and provider type.

Results:

We identified 36,838 individuals with ADRD. After application of our algorithm, the largest proportion of cases were nonspecific dementia (41.2%), followed by individuals with antidementia medication but no ADRD diagnosis (15.6%). Individuals with Alzheimer disease formed 10.2% of cases. Individuals with vascular dementia had the greatest burden of comorbid disease. Initial documentation of dementia occurred primarily in the office setting (35.1%).

Discussion:

Our algorithm identified 6 dementia subtypes and three additional categories representing unique diagnostic patterns in the data. Differences and similarities between groups provided support for the approach and offered unique insight into ADRD subtype characteristics.
A semi-automatic dispenser for solid and liquid food in aquatic facilities
Authors: Candelier Raphaël , Bois Alex , Tronche Stéphane , Mahieu Jéremy , Mannioui Abdelkrim
Published: February 2019

We present a novel, low-footprint and low-cost semi-automatic system for delivering solid and liquid food to zebrafish, and more generally to aquatic animals raised in racks of tanks. It is composed of a portable main module equipped with a contactless reader that adjusts the quantity to deliver for each tank, and either a solid food module or a liquid food module. Solid food comprises virtually any kind of dry powder or grains below two millimeters in diameter, and, for liquid-mediated food, brine shrimps (Artemia salina) and rotifers (Rotifera) have been successfully tested. Real-world testing, feedback and validation have been performed in a zebrafish facility for several months. In comparison with manual feeding this system mitigates the appearance of musculoskeletal disorders among regularly-feeding staff, and let operators observe the animals’ behavior instead of being focused on quantities to deliver. We also tested the accuracy of both humans and our dispenser and found that the semi-automatic system is much more reliable, with respectively 7-fold and 84-fold drops in standard deviation for solid and liquid food.
Integrating transcriptomic network reconstruction and QTL analyses reveals mechanistic connections between genomic architecture andBrassica rapadevelopment
Authors: Baker Robert L. , Leong Wen Fung , T. Brock Marcus , Rubin Matthew J. , Markelz R. J. Cody , Welch Stephen , N. Maloof Julin , Weinig Cynthia
Published: February 2019

Plant developmental dynamics can be heritable, genetically correlated with fitness and yield, and undergo selection. Therefore, characterizing the mechanistic connections between the genetic architecture governing plant development and the resulting ontogenetic dynamics of plants in field settings is critically important for agricultural production and evolutionary ecology. We use a hierarchical Bayesian Function-Valued Trait (FVT) approach to estimateBrassica rapagrowth curves throughout ontogeny, across two treatments and in two growing seasons. We find that the shape of growth curves is relatively plastic across environments compared to final height, and that there are trade-offs between growth rate and duration. We determined that combining FVT Quantitative Trait Loci (QTL) and genes/eigengene expression identified via transcriptomic co-expression network reconstructions best characterized phenotypic variation. Further, targeted eQTL analyses identified regulatory hotspots that colocalized with FVT QTL and co-expression network identified genes and mechanistically link FVT QTL with structural trait variation throughout development in agroecologically relevant field settings.
Optical Metabolic Imaging of Heterogeneous Drug Response in Pancreatic Cancer Patient Organoids
Authors: Sharick Joe T , Walsh Christine M , Sprackling Carley M , Pasch Cheri A , Parikh Alexander A , Matkowskyj Kristina A , Deming Dustin A , Skala Melissa C
Published: February 2019

New tools are needed to match pancreatic cancer patients with effective treatments. Patient-derived organoids offer a high-throughput platform to personalize treatments and discover novel therapies. Currently, methods to evaluate drug response in organoids are limited because they cannot be completed in a clinically relevant time frame, only evaluate response at one time point, and most importantly, overlook cellular heterogeneity. In this study, non-invasive optical metabolic imaging (OMI) of cellular heterogeneity in organoids was evaluated as a predictor of clinical treatment response. Organoids were generated from fresh patient tissue samples acquired during surgery and treated with the same drugs as the patient's prescribed adjuvant treatment. OMI measurements of heterogeneity in response to this treatment were compared to later patient response, specifically to the time to recurrence following surgery. OMI was sensitive to patient-specific treatment response in as little as 24 hours. OMI distinguished subpopulations of cells with divergent and dynamic responses to treatment in living organoids without the use of labels or dyes. OMI of organoids agreed with long-term therapeutic response in patients. With these capabilities, OMI could serve as a sensitive high-throughput tool to identify optimal therapies for individual pancreatic cancer patients, and to develop new effective therapies that address cellular heterogeneity in pancreatic cancer.
Mammogram Segmentation using Multi-atlas Deformable Registration
Authors: Sharma Manish Kumar , Jas Mainak , Karale Vikrant , Sadhu Anup , Mukhopadhyay Sudipta
Published: February 2019

Accurate breast region segmentation is an important step in various automated algorithms involving detection of lesions like masses and microcalcifications, and efficient telemammography. Existing segmentation algorithms underperform due to variations in image quality and shape of the breast region. In this paper, we propose to segment breast region by combining data-driven clustering with deformable image registration. In the first phase of the approach, we identify atlas images from a dataset of mammograms using data-driven clustering. Then, we segment these atlas images and use in the next phase of the algorithm. The second phase is atlas-based registration. For a candidate image, we find the most similar atlas image from the set of atlases identified in phase one. We deform the selected atlas image to match the given test image using the Demon's registration algorithm. Then, the segmentation mask of the deformed atlas is transferred to the mammogram in consideration. Finally, we refine the segmentation mask with some morphological operations in order to obtain accurate breast region boundary. We evaluated the performance of our method using ground-truth segmentation masks verified by an expert radiologist. We compared the proposed method with three existing state-of-the-art algorithms for breast region segmentation and the proposed approach outperformed all three in most of the cases.
Lactate and pyruvate promote cellular stress resistance and longevity through ROS signaling
Authors: Tauffenberger Arnaud , Fiumelli Hubert , Almustafa Salam , Magistretti Pierre J.
Published: February 2019

L-lactate, for long considered a glycolytic end-product, is now recognized as an important energy substrate. Moreover, it appears that its role is not limited to energy production but also as a signal for neuroprotection and synaptic plasticity. Using a model of neuroblastoma cells and the nematode C. elegans we investigated the cellular mechanisms underlying this protective role of L-lactate. We found that L-lactate promotes a mild Reactive Oxygen Species (ROS) induction that translates into activation of antioxidant defenses and pro-survival pathways such as PI3K/AKT and Endoplasmic Reticulum (ER) chaperones. This hormetic mechanism provides protection against oxidative stress in both cells and nematodes. Furthermore, a mild ROS induction by lactate also promotes longevity in C. elegans.
Protein appetite drives macronutrient-related differences in ventral tegmental area neural activity
Authors: Chiacchierini Giulia , Naneix Fabien , Peters Kate Zara , Apergis-Schoute John , Simone Snoeren Eelke Mirthe , McCutcheon James Edgar
Published: February 2019

Control of protein intake is essential for numerous biological processes as several amino acids cannot be synthesized de novo, however, its neurobiological substrates are still poorly understood. In the present study, we combined in vivo fiber photometry with nutrient-conditioned flavor in a rat model of protein appetite to record neuronal activity in the ventral tegmental area (VTA), a central brain region for the control of food-related processes. In adult male rats, protein restriction increased preference for casein (protein) over maltodextrin (carbohydrate). Moreover, protein consumption was associated with a greater VTA response relative to carbohydrate. After initial nutrient preference, a switch from a normal balanced diet to protein restriction induced rapid development of protein preference but required extensive exposure to macronutrient solutions to induce greater VTA responses to casein. Furthermore, prior protein restriction induced long-lasting food preference and VTA responses. This study reveals that VTA circuits are involved in protein appetite in times of need, a crucial process for all animals to acquire an adequate amount of protein in their diet.

Significance Statement

Acquiring insufficient protein in one’s diet has severe consequences for health and ultimately will lead to death. In addition, a low level of dietary protein has been proposed as a driver of obesity as it can leverage up intake of fat and carbohydrate. However, much remains unknown about the role of the brain in ensuring adequate intake of protein. Here, we show that in a state of protein restriction a key node in brain reward circuitry, the ventral tegmental area, is activated more strongly during consumption of protein than carbohydrate. Moreover, although rats’ behavior changed to reflect new protein status, patterns of neural activity were more persistent and only loosely linked to protein status.
Senescence-associated metabolomic phenotype in primary and iPSC-derived mesenchymal stromal cells
Authors: Fernandez-Rebollo Eduardo , Franzen Julia , Hollmann Jonathan , Ostrowska Alina , Oliverio Matteo , Sieben Torsten , Rath Bjorn , Kornfeld Jan-Wilhelm , Wagner Wolfgang
Published: February 2019

Long-term culture of primary cells is reflected by functional and secretory changes, which ultimately result in replicative senescence. In contrast, induced pluripotent stem cells (iPSCs) do not reveal any signs of cellular aging while in the pluripotency state, whereas little is known how they senesce upon differentiation. Furthermore, it is largely unclear how the metabolome of cells changes during replicative senescence and if such changes are consistent across different cell types. In this study, we have directly compared culture expansion of primary mesenchymal stromal cells (MSCs) and iPSC-derived MSCs (iMSCs) until they reached growth arrest after a mean of 21 and 17 cumulative population doublings, respectively. Both cell types acquired similar changes in morphology, in vitro differentiation potential, up-regulation of senescence-associated beta-galactosidase, and senescence-associated DNA methylation changes. Furthermore, MSCs and iMSCs revealed overlapping gene expression changes during culture expansion, particularly in functional categories related to metabolic processes. We subsequently compared the metabolome of MSCs and iMSCs at early and senescent passages and observed various significant and overlapping senescence-associated changes in both cell types, including down-regulation of nicotinamide ribonucleotide and up-regulation of orotic acid. Replicative senescence of both cell types was consistently reflected by the metabolic switch from oxidative to glycolytic pathways. Taken together, long-term culture of iPSC-derived MSCs evokes very similar molecular and functional changes as observed in primary MSCs. Replicative senescence is associated with a highly reproducible senescence-associated metabolomics phenotype, which may be used to monitor the state of cellular aging.
Network-specific synchronization of electrical slow-wave oscillations regulates sleep in Drosophila
Authors: Raccuglia Davide , Huang Sheng , Ender Anatoli , Heim Michael-Marcel , Laber Desiree , Liotta Agustin , Sigrist Stephan J , Geiger Joerg R P , Owald David
Published: February 2019

Slow-wave rhythms characteristic of deep sleep oscillate in the delta band (0.5-4 Hz) and can be found across various brain regions in vertebrates. Across systems it is however unclear how oscillations arise and whether they are the causal functional unit steering behavior. Here, for the first time in any invertebrate, we discover sleep-relevant delta oscillations in Drosophila. We find that slow-wave oscillations in the sleep-regulating R2 network increase with sleep need. Optical multi-unit voltage recordings reveal that single R2 neurons get synchronized by sensory and circadian input pathways. We show that this synchronization depends on NMDA receptor (NMDARs) coincidence detector function and on an interplay of cholinergic and glutamatergic inputs setting a resonance frequency. Genetically targeting the coincidence detector function of NMDARs in R2, and thus the uncovered mechanism underlying synchronization, abolished network-specific slow-wave oscillations. It also disrupted sleep and facilitated light-induced wakening, directly establishing a causal role for slow-wave oscillations in regulating sleep and sensory gating. We therefore propose that the synchronization-based increase in oscillatory power likely represents an evolutionarily conserved, potentially optimal, strategy for constructing sleep-regulating sensory gates.
NADPH-oxidase 2 is required for molecular adaptations to high-intensity interval training in skeletal muscle.
Authors: Henriquez-Olguin Carlos , Baghersad Renani Leila , Arab-Ceschia Lyne , Raun Steffen H. , Bhatia Aakash , Li Zhencheng , Knudsen Jonas R. , Holmdahl Rikard , Jensen Thomas
Published: February 2019

Objective: Reactive oxygen species (ROS) have been proposed as signaling molecules mediating exercise training adaptation, but the ROS source has remained unclear. This study aimed to investigate the requirement for NADPH oxidase (NOX)2-dependent redox changes induced by acute and long-term high-intensity interval training (HIIT) in skeletal muscle in a mouse model lacking functional NOX2 complex due to deficient p47phox (Ncf1) subunit expression (ncf1* mutation).
Methods: HIIT was investigated after an acute bout of exercise and after a chronic intervention (3x week for 6 weeks) in wildtype (WT) vs. NOX2 activity-deficient (ncf1*) mice. NOX2 activation during HIIT was measured using a genetically-encoded biosensor. Immunoblotting and single-fiber staining were performed to measure classical exercise-training responsive endpoints in skeletal muscle.
Results: A single bout of HIIT increased NOX2 activity measured using electroporated p47roGFP oxidation immediately after exercise but not 1h after exercise. After a 6-week of HIIT regime, improvements in maximal running capacity and some muscle training-markers responded less to HIIT in the ncf1* mice compared to WT, including superoxide dismutase (SOD)2, catalase, hexokinase II (HK II), pyruvate dehydrogenase (PDH) and protein markers of mitochondrial oxidative phosphorylation complexes. Strikingly, HIIT-training increased mitochondrial network area and decreased fragmentation in WT mice only.
Conclusion: This study provided evidence that HIIT exercise activates NOX2 complex in skeletal muscle and that the presence of functional NOX2 is required for specific skeletal muscle adaptations to HIIT relating to antioxidant defense, glucose metabolism, and mitochondria.
A fronto-temporo-parietal network disambiguates potential objects of joint attention
Authors: Kraemer P. M. , Görner M. , Ramezanpour H. , Dicke P. W. , Thier P.
Published: February 2019

We use the other’s gaze direction to identify her/his object of interest and to shift our attention to the same object, i.e. to establish joint attention. However, gaze direction may not be sufficient to unambiguously identify the object of interest as the other’s gaze may hit more than one object. In this case, the observer must use a priori information to disambiguate the object choice. Using fMRI, we suggest that the disambiguation is based on a 3-component network. A first component, the well-known ‘gaze following patch’ in the posterior STS is activated by gaze following per se. BOLD activity here is determined exclusively by the usage of gaze direction and is independent of the need to disambiguate the relevant object. On the other hand, BOLD activity revealing a priori information for the disambiguation and starting early enough to this end is confined to a patch of cortex at the inferior frontal junction. Finally, BOLD activity reflecting the convergence of both, a priori information and gaze direction, needed to shift attention to a particular object location is confined to the posterior parietal cortex.
Transcriptome Dedifferentiation Observed in Animal Primary Cultures is Essential to Plant Reprogramming
Authors: Ogata Norichika
Published: February 2019

Tissue culture environment liberate cells from ordinary laws of multi-cellular organisms. This liberation enables cells several behaviors, such as growth, dedifferentiation, acquisition of pluripotency, immortalization and reprogramming. Each phenomenon is relating to each other and hardly to determine. Recently, dedifferentiation of animal cell was determined and quantified in increasing information entropy of transcriptome. The increasing information entropy of transcriptome induced by tissue culture may reappear in plant cells too. Here we corroborated it. Measuring information entropies of transcriptomes during reprogramming of plant cells suggested that reprogramming is a combined phenomenon of dedifferentiation and re-differentiation.