bluuebunny/crossref_metadata_2025 huggingface dataset:
Noncanonical function of DGCR8 controls mESC exit from pluripotency
Authors: Cirera-Salinas Daniel , Yu Jian , Bodak Maxime , Ngondo Richard P. , Herbert Kristina M. , Ciaudo Constance
Published: January 2017

Mouse embryonic stem cells (mESCs) deficient for DGCR8, a key component of the microprocessor complex, present strong differentiation defects. However, the exact reasons impairing their commitment remain elusive. The analysis of newly generated mutant mESCs revealed that DGCR8 is essential for the exit from the pluripotency state. To dissociate canonical versus noncanonical functions of DGCR8, we complemented the mutant mESCs with a phosphomutant DGCR8, which restored microRNA levels but did not rescue the exit from pluripotency defect. Integration of omics data and RNA immunoprecipitation experiments established DGCR8 as a direct interactor of Tcf7l1 mRNA, a core component of the pluripotency network. Finally, we found that DGCR8 facilitated the splicing of Tcf7l1, an event necessary for the differentiation of mESCs. Our data reveal a new noncanonical function of DGCR8 in the modulation of the alternative splicing of Tcf7l1 mRNA in addition to its established function in microRNA biogenesis.
The epidermal polarity protein Par3 is a non–cell autonomous suppressor of malignant melanoma
Authors: Mescher Melina , Jeong Peter , Knapp Sina K. , Rübsam Matthias , Saynisch Michael , Kranen Marina , Landsberg Jennifer , Schlaak Max , Mauch Cornelia , Tüting Thomas , Niessen Carien M. , Iden Sandra
Published: January 2017

Melanoma, an aggressive skin malignancy with increasing lifetime risk, originates from melanocytes (MCs) that are in close contact with surrounding epidermal keratinocytes (KCs). How the epidermal microenvironment controls melanomagenesis remains poorly understood. In this study, we identify an unexpected non–cell autonomous role of epidermal polarity proteins, molecular determinants of cytoarchitecture, in malignant melanoma. Epidermal Par3 inactivation in mice promotes MC dedifferentiation, motility, and hyperplasia and, in an autochthonous melanoma model, results in increased tumor formation and lung metastasis. KC-specific Par3 loss up-regulates surface P-cadherin that is essential to promote MC proliferation and phenotypic switch toward dedifferentiation. In agreement, low epidermal PAR3 and high P-cadherin expression correlate with human melanoma progression, whereas elevated P-cadherin levels are associated with reduced survival of melanoma patients, implying that this mechanism also drives human disease. Collectively, our data show that reduced KC Par3 function fosters a permissive P-cadherin–dependent niche for MC transformation, invasion, and metastasis. This reveals a previously unrecognized extrinsic tumor-suppressive mechanism, whereby epithelial polarity proteins dictate the cytoarchitecture and fate of other tissue-resident cells to suppress their malignant outgrowth.
Measure rigidity for random dynamics on surfaces and related skew products
Authors: Brown Aaron , Hertz Federico
Published: January 2017

Given a surface

M
M

and a Borel probability measure

ν
\nu

on the group of

C
2

C^2

-diffeomorphisms of

M
M

we study

ν
\nu

-stationary probability measures on

M
M

. We prove for hyperbolic stationary measures the following trichotomy: the stable distributions are non-random, the measure is SRB, or the measure is supported on a finite set and is hence almost-surely invariant. In the proof of the above results, we study skew products with surface fibers over a measure-preserving transformation equipped with a decreasing sub-

σ
\sigma

-algebra

F

^

\hat {\mathcal F}

and derive a related result. A number of applications of our main theorem are presented.
On fewnomials, integral points, and a toric version of Bertini’s theorem
Authors: Fuchs Clemens , Mantova Vincenzo , Zannier Umberto
Published: January 2017

An old conjecture of Erdős and Rényi, proved by Schinzel, predicted a bound for the number of terms of a polynomial

g
(
x
)
∈

C

[
x
]

g(x)\in \mathbb {C}[x]

when its square

g
(
x

)
2

g(x)^2

has a given number of terms. Further conjectures and results arose, but some fundamental questions remained open.

In this paper, with methods which appear to be new, we achieve a final result in this direction for completely general algebraic equations

f
(
x
,
g
(
x
)
)
=
0

f(x,g(x))=0

, where

f
(
x
,
y
)

f(x,y)

is monic of arbitrary degree in

y
y

and has boundedly many terms in

x
x

: we prove that the number of terms of such a

g
(
x
)

g(x)

is necessarily bounded. This includes the previous results as extremely special cases.

We shall interpret polynomials with boundedly many terms as the restrictions to 1-parameter subgroups or cosets of regular functions of bounded degree on a given torus

G

m

l

\mathbb {G}_\textrm {m}^l

. Such a viewpoint shall lead to some best-possible corollaries in the context of finite covers of

G

m

l

\mathbb {G}_\textrm {m}^l

, concerning the structure of their integral points over function fields (in the spirit of conjectures of Vojta) and a Bertini-type irreducibility theorem above algebraic multiplicative cosets. A further natural reading occurs in non-standard arithmetic, where our result translates into an algebraic and integral-closedness statement inside the ring of non-standard polynomials.
Discrete wave equation upscaling
Authors: Fichtner Andreas , Hanasoge Shravan M.
Published: January 2017

We present homogenization technique for the uniformly discretized wave equation, based on the derivation of an effective equation for the low-wavenumber component of the solution. The method produces a down-sampled, effective medium, thus making the solution of the effective equation less computationally expensive. Advantages of the method include its conceptual simplicity and ease of implementation, the applicability to any uniformly discretized wave equation in 1-D, 2-D or 3-D, and the absence of any constraints on the medium properties. We illustrate our method with a numerical example of wave propagation through a 1-D multiscale medium and demonstrate the accurate reproduction of the original wavefield for sufficiently low frequencies.
Survey Results from Canada and Some Latin America Countries: 2016 National Pressure Ulcer Advisory Panel Changes in Terminology and Definitions
Authors: Ayello Elizabeth A. , Lobo Guadalupe Maria , Sibbald R. Gary
Published: January 2017

OBJECTIVE:

Since the National Pressure Ulcer Advisory Panel (NPUAP) held its consensus conference in April 2016, various wound care specialists and professional organizations have been disseminating their response to the revised pressure injury staging definitions. The purpose of this survey was to get an objective perspective of the new NPUAP terminology and staging definitions changes from wound care colleagues outside the United States.

PARTICIPANTS:

In an attempt to obtain the opinions of wound care specialists outside the United States, a convenience sample from some countries in Latin America was invited to complete a survey during the Mexican Association for Integral Care and Wound Healing conference. In addition, students enrolled in the International Interprofessional Wound Care Course conducted in Toronto, Ontario, Canada, were also invited to participate in a revised NPUAP staging definition survey.

RESULTS:

Survey responses reveal strong support for the changes with consensus agreement greater than 80% on all survey items.

CONCLUSIONS:

These survey results can contribute to a universal agreement on terminology and definitions for pressure-related wounds, which may ultimately improve patient care.
Long-term Follow-up of Sexual Function in Women Before and After Tension-Free Vaginal Tape Operation for Stress Urinary Incontinence
Authors: Lindquist Anna Sofie Inger , Glavind Karin
Published: January 2017

(Abstracted from Int Urogynecol J 2016;27:1571–1576)

A number of studies have investigated the effect of incontinence surgery on sexual function in women. Results have been conflicting; some studies have reported improvement, some deterioration, and others no difference.
Evaluation of Gene Expression Patterns in Micrografts Demonstrate Induction of Catagen-Like Processes During Storage
Authors: Krugluger Walter , Stiefsohn Karl , Moser Karl , Moser Claudia , Laciak Katarina
Published: January 2017

BACKGROUND

Alterations of gene expression patterns may contribute to the commonly observed transient reduction of hair shaft elongation in hair restoration surgery.

OBJECTIVE

To elucidate the molecular causes, we evaluated changes in gene expression patterns in hair follicle micrografts during storage.

MATERIALS AND METHODS

Micrografts with different amounts of adjacent connective tissue (regular, skinny, and chubby) were stored for different periods, and the expression of key genes was determined: dermal papilla (DP): FGF7, alkaline phosphatase (ALP), versican; outer root sheath: Krt15; inner root sheath: Krt 25; cuticula: Krt85; Henle layer: filaggrin; genes related to apoptosis and growth/differentiation: Caspase 3, Ovol1, and Foxo1.

RESULTS

A significant decrease in FGF7 (4 × 10−4 fold) was observed after 4 hours, with further decrease after 48 hours. A significant decrease of versican (0.35 fold) and ALP (0.004 fold) was observed after 24 hours of storage. No differences relating to adjacent connective tissue were observed. No changes of different keratins genes or genes related to growth/differentiation and apoptosis were observed.

CONCLUSION

These data clearly demonstrate a reduction in the specific function of cells in the DP, which seem to be the causative for the induction of hair follicle cycling during micrograft preparation and storage.
Early Changes in Facial Profile Following Structured Filler Rhinoplasty: An Anthropometric Analysis Using a 3-Dimensional Imaging System
Authors: Rho Nark Kyoung , Park Je Young , Youn Choon Shik , Lee Soo-Keun , Kim Hei Sung
Published: January 2017

BACKGROUND

Quantitative measurements are important for objective evaluation of postprocedural outcomes. Three-dimensional (3D) imaging is known as an objective, accurate, and reliable system for quantifying the soft tissue dimensions of the face.

OBJECTIVE

To compare the preprocedural and acute postprocedural nasofrontal, nasofacial, nasolabial, and nasomental angles, early changes in the height and length of the nose, and nasal volume using a 3D surface imaging with a light-emitting diode.

METHODS

The 3D imaging analysis of 40 Korean women who underwent structured nonsurgical rhinoplasty was conducted. The 3D assessment was performed before, immediately after, 1 day, and 2 weeks after filler rhinoplasty with a Morpheus 3D scanner (Morpheus Co., Seoul, Korea).

RESULTS

There were significant early changes in facial profile following nonsurgical rhinoplasty with a hyaluronic acid filler. An average increase of 6.03° in the nasofrontal angle, an increase of 3.79° in the nasolabial angle, increase of 0.88° in the nasomental angle, and a reduction of 0.83° in the nasofacial angle was observed at 2 weeks of follow-up. Increment in nasal volume and nose height was also found after 2 weeks. Side effects, such as hematoma, nodules, and skin necrosis, were not observed.

CONCLUSION

The 3D surface imaging quantitatively demonstrated the early changes in facial profile after structured filler rhinoplasty. The study results describe significant acute spatial changes in nose shape following treatment.
Reconstructive Surgery for Bronchopleural Fistula and Empyema: New Application of Free Fascial Patch Graft Combined with Free Flap
Authors: Sakuraba Minoru , Umezawa Hiroki , Miyamoto Shimpei , Fujiki Masahide , Higashino Takuya , Oshima Azusa , Tsuboi Masahiro
Published: January 2017

Background:

Postoperative bronchopleural fistula (BPF) and empyema are not uncommon after lung cancer surgery. Some patients require reconstructive surgery to achieve wound healing. In this report, we describe a novel method of reconstructive surgery for BPF and empyema.

Methods:

From 1996 through 2014, we performed reconstructive surgery for the treatment of BPF and empyema in 13 cases. BPF or a pulmonary fistula was present in 11 patients at the time of reconstruction. Of these, a free fascial patch graft combined with a free soft tissue flap was used to close the fistula in 6 cases. In the other 5 cases, primary fistula closure or direct coverage of the fistula with a transferred flap was performed. Medical records were retrospectively reviewed, and postoperative results were compared for these methods.

Results:

All the flaps were transferred successfully except in 1 case. Although postoperative air leakage was observed in 5 cases, most of these healed with conservative management. Of 11 fistulas, 8 were successfully controlled. Although differences were not statistically significant, a higher success rate of fistula closure was obtained in patients with a fascial patch graft (100% vs 40%). As a result, 9 patients could be discharged from the hospital, but 4 died during their hospital stay.

Conclusion:

Although the incidence of in-hospital mortality was high, fistula closure with a fascial patch graft combined with free flap transfer was effective for the treatment of BPF and empyema, compared with other procedures.
Imaging and the Infertility Evaluation
Authors: JEELANI ROOHI , PUSCHECK ELIZABETH E.
Published: January 2017

Ultrasound (US) has transformed the fertility evaluation. With 1 consultation, blood work and 1 to 2 USs, the female fertility status can be fully evaluated. The initial US is best done early in the follicular cycle to evaluate the pelvic anatomy and ovarian reserve. A three-dimensional US is important to evaluate for uterine anomalies and color Doppler for any masses. A mid-cycle saline infusion sonohysterogram assesses the endometrial cavity better than a hysterosalpingogram as it identifies the cause of any filling defects. By concurrently adding contrast or agitated saline, tubal patency can be tested. This US-based approach reliably, efficiently, and cost-effectively assesses female infertility.
FUNDUS AUTOFLUORESCENCE LIFETIMES AND CENTRAL SEROUS CHORIORETINOPATHY
Authors: Dysli Chantal , Berger Lieselotte , Wolf Sebastian , Zinkernagel Martin S.
Published: January 2017

Purpose:

To quantify retinal fluorescence lifetimes in patients with central serous chorioretinopathy (CSC) and to identify disease specific lifetime characteristics over the course of disease.

Methods:

Forty-seven participants were included in this study. Patients with central serous chorioretinopathy were imaged with fundus photography, fundus autofluorescence, optical coherence tomography, and fluorescence lifetime imaging ophthalmoscopy (FLIO) and compared with age-matched controls. Retinal autofluorescence was excited using a 473-nm blue laser light and emitted fluorescence light was detected in 2 distinct wavelengths channels (498–560 nm and 560–720 nm). Clinical features, mean retinal autofluorescence lifetimes, autofluorescence intensity, and corresponding optical coherence tomography (OCT) images were further analyzed.

Results:

Thirty-five central serous chorioretinopathy patients with a mean visual acuity of 78 ETDRS letters (range, 50–90; mean Snellen equivalent: 20/32) and 12 age-matched controls were included. In the acute stage of central serous chorioretinopathy, retinal fluorescence lifetimes were shortened by 15% and 17% in the respective wavelength channels. Multiple linear regression analysis showed that fluorescence lifetimes were significantly influenced by the disease duration (P < 0.001) and accumulation of photoreceptor outer segments (P = 0.03) but independent of the presence or absence of subretinal fluid. Prolonged central macular autofluorescence lifetimes, particularly in eyes with retinal pigment epithelial atrophy, were associated with poor visual acuity.

Conclusion:

This study establishes that autofluorescence lifetime changes occurring in central serous chorioretinopathy exhibit explicit patterns which can be used to estimate perturbations of the outer retinal layers with a high degree of statistical significance.
LOW ENDOPHTHALMITIS RATES AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS IN AN OPERATION ROOM
Authors: Freiberg Florentina J. , Brynskov Troels , Munk Marion R. , Sørensen Torben L. , Wolf Sebastian , Wirth Magdalena A. , Becker Matthias , Michels Stephan
Published: January 2017

Purpose:

To evaluate the rate of presumed endophthalmitis (EO) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in three European hospitals performed in an operation room (OR) under sterile conditions.

Methods:

A retrospective multicenter study between 2003 and 2016 at three European sites, City Hospital Triemli Zurich, Switzerland (CHT), Zealand University Hospital Roskilde, Denmark (ZUH) and University Clinic Bern, Switzerland (UCB). Intravitreal injection (IVI) database of each department was reviewed. All anti-vascular endothelial growth factor injections were performed using a standardized sterile technique in an operation room. Injection protocols were similar between the three sites. No preinjection antibiotics were given. Postoperative antibiotics varied among sites.

Results:

A total of 134,701 intravitreal injections were performed at the 3 sites between 2003 and 2016. Ten cases of presumed endophthalmitis were documented: 4 in 50,721 at CHT (95% CI: 0.0071–0.0087%), 2 in 44,666 at ZUH (95% CI: 0.0039–0.0051%), and 4 in 39,314 at UCB (95% CI: 0.0092–0.011%). This results in one case in 13,470 intravitreal injections and a combined incidence of 0.0074% per injection (95% CI: 0.0070–0.0078%). Positive cultures were found in 4 out of 10 presumed endophthalmitis cases.

Conclusion:

The standardized sterile technique in an operation room with laminar airflow showed very low rates of endophthalmitis at three European sites.
Totally Endoscopic Robotic Left Atrial Appendage Closure Demonstrates High Success Rate
Authors: Ward Alison F. , Applebaum Robert M. , Toyoda Nana , Fakiha Ans , Neuburger Peter J. , Ngai Jennie , Nampiaparampil Robert G. , Yaffee David W. , Loulmet Didier F. , Grossi Eugene A.
Published: January 2017

Objective

In patients with atrial fibrillation, 90% of embolic strokes originate from the left atrial appendage (LAA). Successful exclusion of the LAA is associated with a lower stroke rate in patients with atrial fibrillation. Surgical oversewing of the LAA is often incomplete when evaluated with transesophageal echocardiogram (TEE). External closure techniques of suturing and stapling have also demonstrated high failure rates with persistent flow and large stumps. We hypothesized that the precise visualization of a robotic LAA closure (RLAAC) would result in superior closure rates.

Methods

Before robotic mitral repair, patients underwent RLAAC; the base of the LAA was oversewn using a running 4–0 polytetrafluoroethylene suture in two layers. Postoperatively, the LAA was interrogated in multiple TEE views. Incomplete closure was defined as any flow across the LAA suture line or a residual stump of greater than 1 cm.

Results

Seventy-nine consecutive patients underwent RLAAC; no injuries occurred. On postrepair TEE, 73 of 79 patients had LAAs visualized well enough to thoroughly evaluate. Successful ligation was confirmed in 64 (87.7%) of 73 patients. Seven patients (9.6%) had small jet flow into the LAA; no residual stumps were noted. Two patients (2.7%) had undetermined flow.

Conclusions

We have demonstrated excellent success with RLAAC; we postulate that this may be due to improved intracardiac visualization. Robotic LAA closure was more successful (87.7%) than previously reported results from the Left Atrial Appendage Occlusion Study for suture exclusion (45.5%) and staple closure (72.7%). With success rates equivalent to transcatheter device closures, RLAAC should be considered for robotic mitral valve surgical patients.
Reliability and Validity of Athletes Disability Index Questionnaire
Authors: Noormohammadpour Pardis , Hosseini Khezri Alireza , Farahbakhsh Farzin , Mansournia Mohammad Ali , Smuck Matthew , Kordi Ramin
Published: January 2017

Objective:

The purpose of this study was to evaluate validity and reliability of a new proposed questionnaire for assessment of functional disability in athletes with low back pain (LBP).

Design:

Validity and reliability study.

Setting:

Elite athletes participating in different fields of sports.

Participants:

Participants were 165 male and female athletes (between 12 and 50 years old) with LBP.

Interventions:

Athlete Disability Index (ADI) Questionnaire which is developed by the authors for assessing LBP-related disability in athletes, Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ).

Main Outcome Measures:

Self-reported responses were collected regarding LBP-related disability through ADI, ODI, and RDQ.

Results:

The test–retest reliability was strong, and intraclass correlation value ranged between 0.74 and 0.94. The Cronbach alpha coefficient value of 0.91 (P < 0.001) demonstrated excellent internal consistency of the questionnaire. The correlation coefficient between ADI and ODI was r = 0.918 (P < 0.0001), between ADI and RDQ was r = 0.669 (P < 0.0001), and between ADI and visual analog scale was r = 0.626 (P < 0.001). According to ODI and RDQ, disability levels were mild in the large majority of subjects (91.5% and 86.0%, respectively). Alternatively, disability assessments by the ADI did not cluster at the mild level and ranged more broadly from mild to very high.

Conclusion:

The ADI is a reliable and valid instrument for assessing disability in athletes with LBP. Compared with the available LBP disability questionnaires used in the general population, ADI can more precisely stratify the disability levels of athletes due to LBP.
The HDL cholesterol/apolipoprotein A-I ratio: an indicator of cardiovascular disease
Authors: Rhee Eun-Jung , Byrne Christopher D. , Sung Ki-Chul
Published: January 2017

Purpose of review

In multiple studies, the HDL cholesterol (HDL-C) concentration has been shown to be inversely associated with cardiovascular disease (CVD) and CVD risk. Based on this observation, increasing the plasma HDL-C concentration is thought to be a desirable strategy, in the 21st century, for decreasing the burden of CVD.

Recent findings

Recent studies have shown that powerful HDL-C concentration-increasing drugs are ineffective for decreasing CVD. Increasing evidence now shows that HDL is an unstable and heterogeneous particle, and that ‘HDL particle functionality’ is far more important in atheroprotection than is the HDL-C level, alone. Apolipoprotein A-I (apoA-I) is the major protein component of HDL, and increasing evidence suggests that the ratio of HDL-C to apoA-I may give additional insight as a risk marker not just for CVD but also for all-cause and cancer mortality.

In this review, we discuss the importance of HDL composition, apoA-I levels, and the HDL-C/apoA-I ratio for predicting CVD and mortality outcomes.
Could high-density lipoprotein cholesterol predict increased cardiovascular risk?
Authors: Chang Tae Ik , Streja Elani , Moradi Hamid
Published: January 2017

Purpose of review

Serum high-density lipoprotein (HDL) is considered to be protective against cardiovascular disease. However, there is emerging evidence that under certain conditions the HDL molecule can become dysfunctional and proinflammatory, paradoxically leading to increased risk of cardiovascular disease. This review will provide a brief outline of the potential mechanisms by which HDL can become atherogenic and summarize some of the clinical evidence on this topic.

Recent findings

HDL metabolism, structure, and function in addition to its level can be profoundly altered under conditions of marked oxidative stress and chronic inflammation. These abnormalities, in turn, lead to impaired reverse cholesterol transport, increased systemic oxidative stress/inflammation, and endothelial dysfunction that subsequently may contribute to atherogenesis and progression of cardiovascular disease.

Association of serum HDL cholesterol level with outcomes is not only dependent on its serum concentration but also on the qualities/properties of this lipoprotein at a given point in time. Hence, it is essential that future studies examining association of HDL with risk of cardiovascular disease take into account the complexities of HDL metabolism and function and address the impact of the HDL particle as a whole (quantity as well as various properties) on atherosclerosis and cardiovascular outcomes.
Is a β cell a β cell?
Authors: Yang Chaoxing , Galivo Feorillo , Dorrell Craig
Published: January 2017

Purpose of review

This report examines recent publications identifying phenotypic and functional heterogeneity among pancreatic β cells and investigating their potential roles in normal and abnormal islet function. The development of new methods and tools for the study of individual islet cells has produced a surge of interest in this topic.

Recent findings

Studies of β cell maturation and pregnancy-induced proliferation have identified changes in serotonin and transcription factors SIX2/3 expression as markers of temporal heterogeneity. Structural and functional heterogeneity in the form of functionally distinct ‘hub’ and ‘follower’ β cells was found in mouse islets. Heterogeneous expression of Fltp (in mouse β cells) and ST8SIA1 and CD9 (in human β cells) were associated with distinct functional potential. Several impressive reports describing the transcriptomes of individual β cells were also published in recent months. Some of these reveal previously unknown β cell subpopulations.

A wealth of information on functional and phenotypic heterogeneity has been collected recently, including the transcriptomes of individual β cells and the identities of functionally distinct β cell subpopulations. Several studies suggest the existence of two broad categories: a more proliferative but less functional and a less proliferative but more functional β cell type. The identification of functionally distinct subpopulations and their association with type 2 diabetes underlines the potential clinical importance of these investigations.
Reliability of the revised Swiss Emergency Triage Scale: a computer simulation study
Authors: Rutschmann Olivier T. , Hugli Olivier W. , Marti Christophe , Grosgurin Olivier , Geissbuhler Antoine , Kossovsky Michel , Simon Josette , Sarasin François P.
Published: January 2017

Background

The Swiss Emergency Triage Scale (SETS) is a four-level emergency scale that previously showed moderate reliability and high rates of undertriage due to a lack of standardization. It was revised to better standardize the measurement and interpretation of vital signs during the triage process.

Objective

The aim of this study was to explore the inter-rater and test–retest reliability, and the rate of correct triage of the revised SETS.

Patients and methods

Thirty clinical scenarios were evaluated twice at a 3-month interval using an interactive computerized triage simulator by 58 triage nurses at an urban teaching emergency department admitting 60 000 patients a year. Inter-rater and test–retest reliabilities were determined using κ statistics. Triage decisions were compared with a gold standard attributed by an expert panel. Rates of correct triage, undertriage, and overtriage were computed. A logistic regression model was used to identify the predictors of correct triage.

Results

A total of 3387 triage situations were analyzed. Inter-rater reliability showed substantial agreement [mean κ: 0.68; 95% confidence interval (CI): 0.60–0.78] and test–retest almost perfect agreement (mean κ: 0.86; 95% CI: 0.84–0.88). The rate of correct triage was 84.1%, and rates of undertriage and overtriage were 7.2 and 8.7%, respectively. Vital sign measurement was an independent predictor of correct triage (odds ratios for correct triage: 1.29 for each additional vital sign measured, 95% CI: 1.20–1.39).

Conclusion

The revised SETS incorporating standardized vital sign measurement and interpretation during the triage process resulted in high reliability and low rates of mistriage.
Can any patients with chronic myeloid leukemia outside of a clinical trial have their tyrosine kinase inhibitor discontinued?
Authors: Mauro Michael J.
Published: January 2017

Purpose of review

This article critically appraises the state of treatment-free remission as a strategy for patients with chronic myeloid leukemia (CML) in deep remission after therapy with tyrosine kinase inhibitors (TKIs).

Recent findings

Approximately half of patients with CML defined fairly narrowly by trial criteria – TKI sensitive, in deep molecular remission for a defined period – can successfully maintain protective levels of response after TKI cessation. Those who cannot appear at very low risk of disease control loss and can promptly regain remission with TKI resumption. Increasing numbers of patients followed longer term in trials have proven as well as a lack of additional late relapse in either group and that ‘functional cure’ of CML is feasible. Both the definition of remission sufficient to attempt treatment-free remission and the trigger to resume treatment have been relaxed somewhat while outcomes have remained the same. Based on repeated confirmatory data, economic pressures, and pragmatism, the question of feasibility and safety of TKI cessation outside of clinical trials is at hand.

TKI cessation outside of clinical trials, if performed under strict guidelines, utilizing optimal monitoring techniques, with counsel available from experts in the field, and after full disclosure of the risks and benefits with the patient, may be safe (see video, supplemental digital content 1, which summarizes the abstract and offers the author's perspective,

http://links.lww.com/COH/A15
).
Successful Treatment of Refractory Langerhans Cell Histiocytosis of the Choroid Plexus in a Child With Pulse Dexamethasone and Lenalidomide
Authors: Uppuluri Ramya , Ramachandrakurup Sreejith , Balaji Ravikanth , Subburaj Divya , Bakane Atish , Raj Revathi
Published: January 2017

Refractory/relapsed Langerhans cell histiocytosis (LCH) has a difficult course with a guarded prognosis. Salvage treatments available are both expensive and highly toxic. On the basis of the pathophysiology of LCH, we used a novel protocol including pulse dexamethasone and lenalidomide in a child with refractory LCH involving the choroid plexus, which resulted in durable remission with minimal toxicity. The protocol was extrapolated from the FIRST trial for patients with multiple myeloma. We present the clinical course, treatment protocol, and outcome in this child, who is at present disease free and in remission 18 months posttreatment.
Anti–Müllerian Hormone Levels in Chinese Women Younger Than 30 Years and 30 Years or Older and Correlated Biochemical Indices
Authors: Zhu Jieping , Wang Jun , Chen Yu , Ji Yuqin , Xiong Miao
Published: January 2017

Importance

Anti–müllerian hormone (AMH) is considered an important marker of ovarian reserve; however, the exact function of AMH has yet to be determined.

Objective

Our purpose was to investigate factors correlated with AMH levels in Chinese women.

Evidence Acquisition

Healthy women were divided into 2 groups: aged younger than 30 years and 30 years or older. Anti–müllerian hormone levels and biochemical indices were compared between the groups.

Results

Eighty women younger than 30 and 29 women 30 years or older were included. The mean AMH level in women younger than 30 years was 8.2 ± 4.4 ng/mL (range, 0.1–17.2 ng/mL), and in those 30 years or older was 5.2 ± 4.3 ng/mL (range, 0.1–13.3 ng/mL). Half of women younger than 30 years had an AMH level above a median of 8.0 ng/mL (interquartile range, 4.9–11.2 ng/mL), whereas the median in those 30 years or older was 4.6 ng/mL (interquartile range, 1.3–8.5 ng/mL). In women younger than 30 years, calcium was positively correlated (P = 0.014) and sex hormone–binding globulin (SHBG) was negatively correlated with AMH (P < 0.001). No correlations of calcium and SHBG with AMH were found in women 30 years or older, but a positive correlation between triglycerides and testosterone and AMH was noted (P = 0.020 and P = 0.007, respectively).

Conclusions and Relevance

Anti–müllerian hormone levels are positively or negatively correlated with testosterone, calcium, SHBG, and triglycerides in Chinese women.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to investigate the factors that affect AMH level in Chinese women, the relation of age and AMH level in Chinese women, and the correlations between AMH level and other biochemical indices.
Utility of Postoperative Voiding Cystourethrogram After Lower Urinary Tract Repair
Authors: Bochenska Katarzyna , Zyczynski Halina M.
Published: January 2017

(Abstracted from Female Pelvic Med Reconstr Surg 2016;22:369–372)

Prolonged use of indwelling catheters in women following lower urinary tract (LUT) surgery is uncomfortable, inhibits postoperative activity, and is the strongest risk factor for catheter-associated urinary tract infection. Voiding cystourethrograms (VCUGs) have been used postoperatively to confirm LUT integrity following surgical repair.
Prognostic Factors for Overall Survival in Elderly Patients With Advanced Ovarian Cancer Treated With Chemotherapy: Results of a Pooled Analysis of Three GINECO Phase II Trials
Authors: Tinquaut Fabien , Freyer Gilles , Chauvin Franck , Gane Nicolas , Pujade-Lauraine Eric , Falandry Claire
Published: January 2017

(Abstracted from Gynecol Oncol 2016;143:22–26)

The high morbidity associated with epithelial ovarian cancer is due to its diagnosis in most patients at advanced stages (International Federation of Gynecology and Obstetrics [FIGO] stages III/IV). Women 75 to 79 years old have the highest reported incidence and mortality from epithelial ovarian cancer.
A Dynamic Quality Assessment Tool for Laparoscopic Hysterectomy to Measure Surgical Outcomes
Authors: Driessen Sara R. C. , van Zwet Erik W. , Haazebroek Pascal , Sandberg Evelien M. , Blikkendaal Mathijs D. , Twijnstra Andries R. H. , Jansen Frank Willem
Published: January 2017

(Abstracted from Am J Obstet Gynecol 2016;215:754.e1–754.e8)

Measuring health outcomes is essential to improve the quality of delivered care. In an attempt to differentiate between high- and low-quality health care, a large number of quality indicators have been developed.
A New Minimally Invasive Treatment for Cesarean Scar Pregnancy and Cervical Pregnancy
Authors: Timor-Tritsch Ilan E. , Monteagudo Ana , Bennett Terri-Ann , Foley Christine , Ramos Joanne , Kaelin Agten Andrea
Published: January 2017

(Abstracted from Am J Obstet Gynecol 2016;215:351.e1–351.e8)

The occurrence of cesarean scar pregnancy and cervical pregnancy, unrelated forms of pathological pregnancies, present significant diagnostic and treatment challenges. A large number of treatments have been used with widely varying effectiveness and complication rates ranging from 10% to 62%.
Prospective Risk of Stillbirth and Neonatal Complications in Twin Pregnancies: Systematic Review and Meta-analysis
Authors: Cheong-See Fiona , Schuit Ewoud , Arroyo-Manzano David , Khalil Asma , Barrett Jon , Joseph K. S. , Asztalos Elizabeth , Hack Karien , Lewi Liesbeth , Lim Arianne , Liem Sophie , Norman Jane E. , Morrison John , Combs C. Andrew , Garite Thomas J. , Maurel Kimberly , Serra Vicente , Perales Alfredo , Rode Line , Worda Katharina , Nassar Anwar , Aboulghar Mona , Rouse Dwight , Thom Elizabeth , Breathnach Fionnuala , Nakayama Soichiro , Russo Francesca Maria , Robinson Julian N. , Dodd Jodie M. , Newman Roger B. , Bhattacharya Sohinee , Tang Selphee , Mol Ben Willem J. , Zamora Javier , Thilaganathan Basky , Thangaratinam Shakila
Published: January 2017

(Abstracted from BMJ 2016;354:i4353)

Twin pregnancies are at increased risk of stillbirth. Uncomplicated twin pregnancies are commonly delivered earlier to prevent stillbirth; however, there is a risk of neonatal complications associated with being born prior to 39 weeks’ gestation.
Noninvasive Prenatal Screening for Fetal Aneuploidy, 2016 Update: A Position Statement of the American College of Medical Genetics and Genomics
Authors: Gregg Anthony R. , Skotko Brian G. , Benkendorf Judith L. , Monaghan Kristin G. , Bajaj Komal , Best Robert G. , Klugman Susan , Watson Michael S.
Published: January 2017

(Abstracted from Genet Med 2016;18(10):1056–1065)

Rapid advancements in genomic technologies led to the introduction in 2011 of noninvasive prenatal screening (NIPS) that used cell-free DNA (cfDNA) derived from the placenta and circulating in maternal blood. Noninvasive prenatal screening is addressed in this American College of Medical Genetics and Genomics (ACMG) guideline to assist patients who are in search of prenatal screening information and health care providers who are responsible for providing precise and up-to-date information to their patients.
fMRI with Central Vision Loss: Effects of Fixation Locus and Stimulus Type
Authors: Plank Tina , Frolo Jozef , Brandl-Rühle Sabine , Renner Agnes B. , Jägle Herbert , Greenlee Mark W.
Published: January 2017

Purpose

In patients with central visual field scotomata, a large part of visual cortex is not adequately stimulated. Patients often use a new eccentric fixation area on intact peripheral retina (“preferred retinal locus”—PRL) that functions as a pseudo-fovea. We used functional magnetic resonance imaging (fMRI) to examine whether stimulating this pseudo-fovea leads to increased activation or altered activation patterns in visual cortex in comparison to stimulating a comparable peripheral area in the opposite hemifield (OppPRL).

Methods

Nineteen patients with binocular central scotomata caused by hereditary retinal dystrophies and an age-matched control group were tested. The center of the visual field, PRL, and OppPRL were stimulated with flickering checkerboard stimuli and object pictures during fMRI measurement.

Results

Results show that stimulation with pictures of everyday objects led to overall larger BOLD (blood oxygen level dependent) responses in visual cortex compared to that evoked by stimulation with flickering checkerboards. Patients showed this enhancement as early as in V1. When the PRL was directly stimulated with object pictures, the central representation area in early visual cortex was coactivated in the patients but not in the controls. In higher visual areas beyond retinotopic cortex, BOLD responses to stimulation of the PRL with object pictures were significantly enhanced in comparison to stimulation of the OppPRL area. Highly stable eccentric fixation with the PRL was associated with a higher BOLD signal in visual cortex in patients, and this effect was most pronounced in the conditions with object picture stimulation.

Conclusions

The observed results suggest that naturalistic images are more likely to trigger top-down processes that regulate activation in early visual cortex in patients with central vision loss.
Sudden Death Due to Unusual Complication of Takayasu Arteritis
Authors: Jedidi Maher , Chkirbene Youssef , Abdessayed Nihed , Masmoudi Tasnim , Mahjoub Mohamed , Mlayeh Souheil , Dhiab Mohamed Ben , Souguir Mohamed Kamel , Yacoubi Mohamed Taher
Published: January 2017

Takayasu arteritis is an uncommon inflammatory disease with usually a good prognosis. However, sometimes, the evolution can be fatal essentially by a coronary arteries involvement. We present a case of a 19-year-old woman who died suddenly from cardiogenic shock complicating an unknown Takayasu arteritis.

At the autopsy, the aorta showed a significant thickening of the wall. The coronary arteries were slightly thickened and did not show any occlusion. Microscopic examination of the aorta showed an abundant granulomatous and a lymphoplasmacytic infiltrate. Microscopic sections of other internal organs showed signs of cardiac hypertrophy and an extensive edema of the lung. Death was attributed to acute heart failure complicating a supravalvular aortic stenosis secondary to unknown Takayasu arteritis.

Takayasu arteritis can be life-threatening by an occlusion of the ascending aorta and its major branches, without any coronary arteries involvement.
Primary Outcome Measures in Pediatric Septic Shock Trials: A Systematic Review*
Authors: Menon Kusum , McNally James Dayre , Zimmerman Jerry J. , Agus Michael S. D. , O’Hearn Katie , Watson R. Scott , Wong Hector R. , Duffett Mark , Wypij David , Choong Karen
Published: January 2017

Objective:

To evaluate all published pediatric randomized controlled trials of patients with septic shock from any cause to examine the outcome measures used, the strengths and limitations of these measurements and whether the trial outcomes met feasibility criteria.

Data Sources:

We used a previously published database of pediatric critical care randomized controlled trials (PICUtrials.net) derived from searches of MEDLINE, EMBASE, LILACS, and CENTRAL.

Study Selection:

We included randomized controlled trials of interventions to children admitted to a PICU with septic or dengue hemorrhagic shock which were published in English.

Data Extraction:

Study characteristics and outcomes were retrieved by two independent reviewers with disagreement being resolved by a third reviewer. We defined feasibility as 1) recruitment of at least 90% of the targeted sample size and agreement of the observed outcome rate in the control group with the rate used for the sample size calculation to within 10% or 2) finding of a statistically significant difference in an interim or final analysis.

Data Synthesis:

Nineteen of 321 identified articles were selected for review. Fourteen of 19 studies (74%) provided an a priori definition of their primary outcome measure in their “Methods section.” Mortality rate was the most commonly reported primary outcome (8/14; 57%), followed by duration of shock (4/14; 29%) followed by organ failure (1/14; 7%). Only three of 19 included trials met feasibility criteria.

Conclusions:

Our review found that use of mortality alone as a primary outcome in pediatric septic shock trials was associated with significant limitations and that long-term patient-centered outcomes were not used in this setting. Composite outcomes incorporating mortality and long-term outcomes should be explored for use in future pediatric septic shock trials.
Examination of Pediatric Radiation Dose Delivered After Cervical Spine Trauma
Authors: Somppi Laura K. , Frenn Kristin A. , Kharbanda Anupam B.
Published: January 2017

Objectives

Pediatric cervical spine injuries (CSIs) are rare but potentially fatal injuries. Plain radiographs (x-rays) and computed tomography (CT) are used to diagnose CSIs. Given concerns related to radiation exposure, the utility of x-rays in diagnosing CSIs compared with other forms of imaging must be examined.

Methods

Patients younger than 19 years presenting with possible CSI to an urban tertiary care hospital who received imaging for possible CSI between January 1, 2011, and December 31, 2013, were included. The dose-length product was abstracted from the PACS system. Test performance for x-ray, CT, and MRI were calculated and effective radiation dose by age group was analyzed using the Kruskal-Wallis Test.

Results

A total of 671 patient charts were reviewed, 574 children were included in the study cohort. Median age of enrolled children was 9.70 (interquartile range, 4.78–13.83) years; 42.5% were female. Test performance of x-ray, CT, and MRI to detect CSI were calculated. Cervical x-rays performed only slightly inferior to CT. Sensitivity was 83% (95% confidence interval [CI], 36−99%), and specificity was 97% (95% CI, 96%–99%) versus 100% (95% CI, 96%–100%) for CT. Median effective dose of radiation for cervical CTs was 4.51 mSv (interquartile range, 3.84–5.59 mSv). Median dose significantly increased with age (2.94–5.10 mSv, P < 0.001).

Conclusions

Plain radiographs were largely sufficient to screen for CSIs, indicating their utility as a screening tool for CSIs. The incidence of CSIs in our sample was similar to prior reports. The effective radiation dose delivered during pediatric head and cervical CTs were lower than previously published estimates.
The Performance of Noncontrast Magnetic Resonance Angiography in Detecting Renal Artery Stenosis as Compared With Contrast Enhanced Magnetic Resonance Angiography Using Conventional Angiography as a Reference
Authors: Liang Keng-Wei , Chen Jhih-Wei , Huang Hsin-Hui , Su Chun-Hung , Tyan Yeu-Sheng , Tsao Teng-Fu
Published: January 2017

Objective

The aims of this study were to evaluate the performance of noncontrast magnetic resonance angiography (NC MRA) for detecting renal artery stenosis (RAS) as compared with contrast-enhanced magnetic resonance angiography (CE MRA) and to evaluate the clinical feasibility, technical success rate, and performance of NC MRA for detecting RAS as compared with CE MRA.

Methods

Thirty-six subjects who underwent NC MRA and/or CE MRA were enrolled. Feasibility, technical success rate, and image quality scores were compared. Diagnostic ability was calculated using conventional angiography as a reference.

Results

Noncontrast MRA had higher feasibility and technical success rates than CE MRA did (100% and 97.2% vs 83.3% and 90%, respectively). Noncontrast MRA yielded significantly better image quality in motion artifact (P = 0.016). The diagnostic ability for detecting RAS is without significant difference between NC MRA and CE MRA.

Conclusion

Although NC MRA and CE MRA demonstrated comparable ability in diagnosing RAS, NC MRA achieved better technical success rates, feasibility, and image quality in motion artifacts than CE MRA did.
Estimation of Uterine Size: How Accurate Are We?
Authors: Hoke Tanya P. , Vakili Babak
Published: January 2017

Objective

To evaluate the accuracy of gynecologic surgeons at estimating uterine dimensions and weight.

Methods

Six model uteri of various sizes were created to simulate the size and consistency of a uterus and displayed at 3 stations. The visual station (VS) comprised 2 specimens placed on an unmarked table. The laparoscopic station (LS) consisted of 2 model uteri, each placed in a separate simulated abdomen with a 0 degree laparoscope and 2 operative trocars with standard instruments. The blind weight station (BWS) consisted of blind palpation of 2 separately weighted models (heavy model [HM] and light model [LM]). Participants visually estimated the dimensions of each VS and LS models and blindly palpated the BWS models to estimate weight.

Results

Participants included 15 residents, 27 attendings, and 6 medical students. There was no difference in estimation accuracy regarding gender and age. For the VS and LS groups, participants underestimated all dimensions (VS variance = −15.0%; P < 0.001 and LS variance = −31.9%; P < 0.0001). Laparoscopic estimation was less accurate than direct vision (P < 0.0001). Attendings and residents equally underestimated the 3 dimensions visually (P = 0.46), but attendings were more accurate at estimating laparoscopic dimensions (−25.8% vs −41.1%; P = 0.0001). All groups overestimated model weights (HM variance, 92.5%; P < 0.001 and LM variance, 132.0%; P < 0.0001), with attendings more accurate than residents (39.7% vs 167.6%; P = 0.015 for HM and 52.0% vs 238.5%; P = 0.035 for LM).

Conclusions

Gynecologic surgeons at all levels of training are inaccurate at estimating dimensions and weights. With surgical decisions often predicated on estimates, education is needed to improve estimation methods.