bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Transbronchial Cryobiopsies Ready for Prime Time?
Authors: Sethi Jaskaran , Ali Muhammad S. , Mohananey Divyanshu , Nanchal Rahul , Maldonado Fabien , Musani Ali
Published: June 2018

Background:

There is a lack of consensus regarding the yield and safety of transbronchial cryobiopsies for diagnosing diffuse parenchymal lung diseases (DPLD). The purpose of this study was to perform a systematic review and meta-analysis assessing the diagnostic yield and safety profile of transbronchial cryobiopsies in DPLD.

Methods:

A literature search of MEDLINE, EMBASE databases, and Google Scholar was performed in August 2017. The quality of included studies was assessed using Quality Assessment, Data Abstraction and Synthesis-2 tool. Meta-analysis was performed using MedCalc (version 17.2). Inverse variance weighting was used to aggregate diagnostic yield proportions across studies, with the number of subjects in each study representing its weight. Random effects model was used when significant heterogeneity was observed (I
2>40%).

Results:

A total of 31 studies were included in the review. Of these, 27 studies with 1443 patients reported data on the performance of cryobiopsies for diagnosing DPLD. The diagnostic yield was 72.9% [95% confidence interval (CI), 67.9%-77.7%]. The pooled mean specimen size obtained by cryobiopsies was 23.4 mm2 (95% CI, 9.6-37.3 mm2). The overall complication rate was 23.1% with bleeding and pneumothoraces being the most commonly reported complications. The incidence of significant bleeding was 14.2% (95% CI, 7.9%-21.9%), whereas pneumothorax was seen in 9.4% (95% CI, 6.7%-12.5%) of patients. Overall reported mortality was 0.3%.

Conclusion:

Our meta-analysis shows that cryobiopsies have a good diagnostic yield but a significant risk for complications. Cryobiopsy outcomes vary markedly among different centers. Further research is needed to standardize the procedure and improve its safety profile.
Use of an Additional 19-G EBUS-TBNA Needle Increases the Diagnostic Yield of EBUS-TBNA
Authors: Garrison Garth , Leclair Timothy , Balla Agnes , Wagner Sarah , Butnor Kelly , Anderson Scott R. , Kinsey C. Matthew
Published: June 2018

Background:

Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has an excellent diagnostic yield, there remain cases where the diagnosis is not obtained. We hypothesized that additional sampling with a 19-G EBUS-TBNA needle may increase diagnostic yield in a subset of cases where additional tissue sampling was required.

Methods:

Indications for use of the 19-G needle following 22-G sampling with rapid on-site cytologic examination were: (1) diagnostic uncertainty of the on-site cytopathologist (eg, nondiagnostic, probable lymphoma, etc.), (2) non–small cell lung cancer with probable need for molecular genetic and/or PD-L1 testing, or (3) need for a larger tissue sample for consideration of inclusion in a research protocol.

Results:

A 19-G EBUS-TBNA needle was utilized following standard sampling with a 22-G needle in 48 patients (50 sites) during the same procedure. Although the diagnostic yield between the needles was equivalent, the concordance rate was only 83%. The 19-G determined a diagnosis in 4 additional patients (8%) and provided additional histopathologic information in 6 other cases (12%). Conversely, in 3 cases (6%) diagnostic information was provided only by the 22-G needle. Compared with 22-G EBUS-TBNA alone, sampling with both the 22- and 19-G EBUS needles resulted in an increase in diagnostic yield from 92% to 99% (P=0.045) and a number needed to sample of 13 patients to provide one additional diagnosis. There were no significant complications.

Conclusion:

In select cases where additional tissue may be needed, sampling with a 19-G EBUS needle following standard aspiration with a 22-G needle results in an increase in diagnostic yield.
Endobronchial Valves Therapy for Advanced Emphysema
Authors: Low See-Wei , Lee Justin Z. , Desai Hem , Hsu Chiu-Hsieh , Sam Afshin R. , Knepler James L.
Published: June 2018

Background:

Trials suggest that bronchoscopic lung volume reduction (BLVR) with endobronchial valve (EBV) implantation may produce similar effects as lung volume reduction surgery, by inducing atelectasis and reducing hyperinflation through a minimally invasive procedure. This study sought to investigate the efficacy and safety of BLVR with EBV for advanced emphysema.

Methods:

We searched PubMed, EMBASE, Web of Science, CINAHL, ClinicalTrials.gov, and Cochrane Library databases for randomized controlled trials comparing EBV implantation versus standard medical treatment or sham bronchoscopy. The main outcome of interest was the percentage change of forced expiratory volume in 1 second.

Results:

Data analyzed from 5 randomized controlled trials with 703 patients revealed improvement in percentage change of forced expiratory volume in 1 second in EBV group compared with control group [weighted mean difference (WMD)=11.43; 95% confidence interval (CI), 6.05-16.80; P<0.0001] and improvement in the St. George’s Respiratory Questionnaire score (WMD=−5.69; 95% CI, −8.67 to −2.70; P=0.0002). There is no difference shown in the 6-minute walking test (WMD=14.12; 95% CI, −4.71 to 32.95; P=0.14). The overall complication rate of EBV was not significantly different except for an increased rate of pneumothorax [relative risk (RR)=8.16; 95% CI, 2.21-30.11; P=0.002), any hemoptysis (RR=5.01; 95% CI, 1.12-22.49; P=0.04)] and valve migration (RR=8.64; 95% CI, 2.01-37.13; P=0.004).

Conclusion:

BLVR using EBV shows short-term improvement in lung function and quality of life, but with increased risk of minor hemoptysis, pneumothorax, and valve migration. Follow-up data on the studies are needed to determine its long-term efficacy.
Refeeding syndrome: relevance for the critically ill patient
Authors: Boot Rianne , Koekkoek Kristine W.A.C. , van Zanten Arthur R.H.
Published: June 2018

Purpose of review

To provide an overview of recent findings concerning refeeding syndrome (RFS) among critically ill patients and recommendations for daily practice.

Recent findings

Recent literature shows that RFS is common among critically ill ventilated patients. Usual risk factors for non-ICU patients addressed on ICU admission do not identify patients developing RFS. A marked drop of phosphate levels (>0.16 mmol/l) from normal levels within 72 h of commencement of feeding, selects patients that benefit from hypocaloric or restricted caloric intake for at least 48 h resulting in lower long-term mortality.

RFS is a potentially life-threatening condition induced by initiation of feeding after a period of starvation. Although a uniform definition is lacking, most definitions comprise a complex constellation of laboratory markers (i.e. hypophosphatemia, hypokalemia, hypomagnesemia) or clinical symptoms, including cardiac and pulmonary failure. Recent studies show that low caloric intake results in lower mortality rates in critically ill RFS patients compared with RFS patients on full nutritional support. Therefore, standard monitoring of RFS-markers (especially serum phosphate) and caloric restriction when RFS is diagnosed should be considered. Furthermore, standard therapy with thiamin and electrolyte supplementation is essential.
Speaking Up and Walking Out
Authors: Martino Steven C. , Elliott Marc N. , Mallett Joshua S. , Orr Nate , Gaillot Sarah , Haviland Amelia M.
Published: June 2018

Background:

Disparities in clinical process-of-care and patient experiences are well documented for Medicare beneficiaries with ≥1 social risk factors. If such patients are less willing to express disagreement with their doctors or change doctors when dissatisfied, these behaviors may play a role in observed disparities.

Objective:

To investigate the association between social risk factors and self-reported likelihood of disagreeing with or changing doctors if dissatisfied among the Medicare fee-for-service population.

Subjects:

Fee-for-service beneficiaries (N=96,317) who responded to the 2014 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Subgroups were defined based on age, education, income, and race/ethnicity.

Methods:

Respondents reported how likely they would be to express disagreement with their doctors and change doctors if dissatisfied (1=very unlikely to 4=very likely; rescaled to 0–100 points). We fit mixed-effect linear regression models predicting these outcomes from social risk factors, controlling for health status and geographic location.

Results:

Beneficiaries who were older, less educated, and had lower incomes were least inclined to express disagreement or change doctors (P<0.001). Compared with non-Hispanic whites, Asian/Pacific Islander (−9.5) and Hispanic (−3.6) beneficiaries said they would be less likely, and black (+2.8) beneficiaries more likely, to express disagreement. Asian/Pacific Islander (−8.7), Hispanic (−5.9), and American Indian/Alaska Native (−3.8) beneficiaries were less inclined than non-Hispanic whites to change doctors (P<0.01).

Discussion:

Reduction in health care disparities may be achieved if doctors and advocates encourage vulnerable patients to express their concerns and perspectives and if communities and caregivers provide support for changing providers when care is poor.
Recurrent Acute Pancreatitis
Authors: Guda Nalini M. , Muddana Venkata , Whitcomb David C. , Levy Philippe , Garg Pramod , Cote Gregory , Uc Aliye , Varadarajulu Shyam , Vege Santhi S. , Chari Suresh T. , Forsmark Chris E. , Yadav Dhiraj , Reddy D. Nageshwar , Tenner Scott , Johnson Colin D. , Akisik Fatih , Saluja Ashok K. , Lerch Markus M. , Mallery J. Shawn , Freeman Martin L.
Published: June 2018

Recurrent acute pancreatitis (RAP) is a clinically significant problem globally. The etiology remains unclear in approximately 10% to 15% of patients despite a thorough workup. Data on natural history and efficacy of treatments are limited. We aimed to establish criteria for diagnosis, evaluate the causative factors, and arrive at a consensus on the appropriate workup and management of patients with RAP. The organizing committee was formed, and a set of questions was developed based on the current evidence, controversies, and topics that needed further research. After a vetting process, these topics were assigned to a group of experts from around the world with special interest in RAP. Data were presented as part of a workshop on RAP organized as a part of the annual meeting of the America Pancreatic Association. Pretest and Posttest questions were administered, and the responses were tabulated by the current Grades of Recommendation Assessment, Development and Evaluation system. The consensus guidelines were established in the format of a diagnostic algorithm. Several deficiencies were identified with respect to data on etiology, treatment efficacies, and areas that need immediate research.
Incidental Neuroendocrine Tumor Discovered After Total Pancreatectomy Intended for Islet Autotransplantation
Authors: Serrano Oscar K. , Peterson Kent J. , Mettler Tetyana , Wilhelm Joshua J. , Bellin Melena D. , Beilman Gregory J. , Trikudanathan Guru , Pruett Timothy L. , Dunn Ty B.
Published: June 2018

Total pancreatectomy (TP) is a treatment option for patients experiencing chronic pancreatitis (CP) refractory to medical management. Patients who are candidates for TP benefit from islet autotransplantation (IAT), which preserves available β-cell mass and thereby reduces the risk of brittle diabetes. Malignancy is an absolute contraindication for IAT to prevent the transplantation of occult malignant cells. We present the case of a patient with CP who was approved to undergo TP with IAT (TPIAT) but was intraoperatively discovered to have a pancreatic neuroendocrine tumor. The case illustrates a number of important surgical decision-making considerations for patients undergoing TPIAT and should help guide surgeons should they be presented with this clinical scenario. We stress the importance of vigilance for possible malignancy and to consider an intraoperative biopsy to further investigate unexpected findings that might represent an occult pancreatic malignancy in patients with CP undergoing TPIAT.
Intestinal Microbial and Metabolic Alterations Following Successful Fecal Microbiota Transplant for D‐Lactic Acidosis
Authors: Bulik‐Sullivan Emily C. , Roy Sayanty , Elliott Ryan J. , Kassam Zain , Lichtman Steven N. , Carroll Ian M. , Gulati Ajay S.
Published: June 2018

Fecal microbiota transplantation (FMT) involves the transfer of stool from a healthy individual into the intestinal tract of a diseased recipient. Although used primarily for recurrent Clostridium difficile infection, FMT is increasingly being attempted as an experimental therapy for other illnesses, including metabolic disorders. D‐lactic acidosis (D‐LA) is a metabolic disorder that may occur in individuals with short bowel syndrome when lactate‐producing bacteria in the colon overproduce D‐lactate. This results in elevated systemic levels of D‐lactate, metabolic acidosis, and encephalopathy. In this study, we report the successful use of FMT for the treatment of recurrent D‐LA in a child who was unresponsive to conventional therapies. Importantly, we also present profiles of the enteric microbiota, as well as fecal D‐/L‐lactic acid metabolites, before and longitudinally after FMT. These data provide valuable insight into the putative mechanisms of D‐LA pathogenesis and its treatment.
Spectrum of Pediatric Autoimmune Liver Disease and Validation of Its Diagnostic Scores in Indian Children
Authors: Sood Vikrant , Lal Bikrant Bihari , Rawat Dinesh , Khanna Rajeev , Rastogi Archana , Bihari Chhagan , Kumar Guresh , Alam Seema
Published: June 2018

Objectives:

There is limited literature on the spectrum of pediatric autoimmune liver disease (AILD, encompassing both autoimmune hepatitis/AIH and autoimmune sclerosing cholangitis [ASC]) in Asian populations and its diagnostic scores similarly require further validation. This work thus aimed to study the clinical characteristics, and to validate available diagnostic criteria in the local pediatric AILD cohort.

Methods:

A review of all pediatric AILD cases, presenting over a 6‐year (2011–2017) period was done, along with comparison of the available diagnostic scores: original (1999), simplified (2008) score, and new proposed (2017) score.

Results:

A total of 85 subjects (AIH = 70 and ASC = 15) were diagnosed as having AILD. Majority of the cases in both groups presented with advanced hepatic disease (portal hypertension and/or hepatic decompensation). Overall 38 (44.7%) subjects had extrahepatic autoimmune disorders. Good outcome (survival with native liver with medically controllable disease), was seen in 80% AIH subjects, while poor outcome (death/need for liver transplantation or LT) was seen in 13% subjects, with similar results in the ASC cohort. All the 3 available scores had area under receiver operating characteristic (AUROC) curves exceeding 0.9 suggestive of excellent discrimination of AILD (to non‐AILD patients), with no statistical difference between them (P >0.05).

Conclusions:

In Indian subcontinent, pediatric AILD subjects usually present with advanced hepatic disease, but may have a good outcome if timely therapy can be instituted. Associated autoimmune disorders should be carefully screened. There is no difference in the predictive value of the available diagnostic scores for pediatric AILD.
Universal Recommendations for the Management of Acute Diarrhea in Nonmalnourished Children
Authors: Guarino Alfredo , Lo Vecchio Andrea , Dias Jorge Amil , Berkley James A. , Boey Chris , Bruzzese Dario , Cohen Mitchell B. , Cruchet Sylvia , Liguoro Ilaria , Salazar‐Lindo Eduardo , Sandhu Bhupinder , Sherman Philip M. , Shimizu Toshiaki
Published: June 2018

Objective:

Despite a substantial consistency in recommendations for the management of children with acute gastroenteritis (AGE), a high variability in clinical practice and a high rate of inappropriate medical interventions persist in both developing and developed countries.

The aim of this study was to develop a set of clinical recommendations for the management of nonseverely malnourished children with AGE to be applied worldwide.

Methods:

The Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition (FISPGHAN) Working Group (WG) selected care protocols on the management of acute diarrhea in infants and children aged between 1 month and 18 years. The WG used a 3‐step approach consisting of: systematic review and comparison of published guidelines, agreement on draft recommendations using Delphi methodology, and external peer‐review and validation of recommendations.

Results:

A core of recommendations including definition, diagnosis, nutritional management, and active treatment of AGE was developed with an overall agreement of 91% (range 80%–96%). A total of 28 world experts in pediatric gastroenterology and emergency medicine successively validated the set of 23 recommendations with an agreement of 87% (range 83%–95%). Recommendations on the use of antidiarrheal drugs and antiemetics received the lowest level of agreement and need to be tailored at local level. Oral rehydration and probiotics were the only treatments recommended.

Conclusions:

Universal recommendations to assist health care practitioners in managing children with AGE may improve practitioners’ compliance with guidelines, reduce inappropriate interventions, and significantly impact clinical outcome and health care‐associated costs.
Can Writing and Storytelling Foster Self-care?
Authors: Bruce Anne , Daudt Helena , Breiddal Susan
Published: June 2018

Research into self-care practices suggests the need for conscientious and systematic support of nurses and other health care providers. The purpose of this study was to explore the impact of an innovative self-care initiative. The goals were to explore the experience of nurses and other health care providers participating in a reflective, creative nonfiction storytelling event called “Dinner and Stories” and the potential benefits and limitations of using an informal, storytelling model for self-care. A qualitative narrative design was used. Twenty-seven participants including nurses, social workers, and hospice volunteers wrote creative nonfiction stories about a lingering experience of providing care. At predefined dates, groups of up to six met for dinner in a home setting. Participants read aloud, listened deeply, and discussed their narrated stories. Four sources of data were collected: creative nonfiction stories, online forum discussions, in-depth interviews, and host facilitator field notes. Researchers identified four themes: (1) needing a self-care culture, (2) storytelling and writing as healing, (3) co-creating layers of connection, and (4) preferring face-to-face contact. Results add to knowledge about the therapeutic benefits of writing and storytelling for nurses and other health care providers including enriched meaning-making, emotional conveyance, and therapeutic connections between storytellers and listeners.
Estimated Impact of Screening on Gonorrhea Epidemiology in the United States: Insights From a Mathematical Model
Authors: Tuite Ashleigh R , Rönn Minttu M , Wolf Emory E , Gift Thomas L , Chesson Harrell W , Berruti Andres , Galer Kara , Menzies Nicolas A , Hsu Katherine , Salomon Joshua A
Published: June 2018

Background

The burden of gonorrhea infections in the United States is high. There are marked disparities by race/ethnicity and sexual orientation. We quantified the impact of screening and treatment on gonorrhea rates in the US population aged 15 to 39 years for the period 2000 to 2015 and estimated the impact that alternative screening strategies might have had over the same period.

Methods

We developed a national-level transmission model that divides the population by race/ethnicity, preferred gender of sex partners, age, gender, and sexual activity level. We compared our fitted model (“base case”) to 4 alternative strategies: (i) no screening, (ii) full adherence to current screening guidelines, (iii) annual universal screening, or (iv) enhanced screening in groups with the highest infection burden. Main outcomes were incidence, infections averted, and incidence rate ratios by race/ethnicity. Mean values and 95% credible intervals were calculated from 1000 draws from parameter posterior distributions.

Results

The calibrated model reproduced observed trends in gonorrhea, including disparities in infection burden by race/ethnicity. We estimated that screening for gonorrhea from 2000 to 2015 averted 30% (95% credible intervals, 18–44%) of total infections that would otherwise have occurred. All alternative active screening strategies were estimated to further reduce, but not eliminate, gonorrhea infections relative to the base case, with differential impacts on the subpopulations of interest.

Conclusions

Our model results suggest that screening has reduced gonorrhea incidence in the US population. Additional reductions in infection burden may have been possible over this period with increased screening, but elimination was unlikely.
Ovarian Carcinoma Histotype: Strengths and Limitations of Integrating Morphology With Immunohistochemical Predictions
Authors: Köbel Martin , Luo Li , Grevers Xin , Lee Sandra , Brooks-Wilson Angela , Gilks C. Blake , Le Nhu D. , Cook Linda S.
Published: June 2018

Ovarian carcinoma histotypes are critical for research and patient management and currently assigned by a combination of histomorphology +/− ancillary immunohistochemistry (IHC). We aimed to validate the previously described IHC algorithm (Calculator of Ovarian carcinoma Subtype/histotype Probability version 3, COSPv3) in an independent population-based cohort, and to identify problem areas for IHC predictions. Histotype was abstracted from cancer registries for eligible ovarian carcinoma cases diagnosed from 2002 to 2011 in Alberta and British Columbia, Canada. Slides were reviewed according to World Health Organization 2014 criteria, tissue microarrays were stained with and scored for the 8 COSPv3 IHC markers, and COSPv3 histotype predictions were calculated. Discordant cases for review and COSPv3 prediction were arbitrated by integrating morphology with IHC results. The integrated histotype (N=880) was then used to identify areas of inferior COSPv3 performance. Review histotype and integrated histotype demonstrated 93% agreement suggesting that IHC information revises expert review in up to 7% of cases. There was also 93% agreement between COSPv3 prediction and integrated histotype. COSPv3 errors predominated in 4 areas: endometrioid carcinoma (EC) versus clear cell (N=23), EC versus low-grade serous (N=15), EC versus high-grade serous (N=11), and high-grade versus low-grade serous (N=6). Most problems were related to Napsin A-negative clear cell, WT1-positive EC, and p53 IHC wild-type high-grade serous carcinomas. Although 93% of COSPv3 prediction accuracy was validated, some histotyping required integration of morphology with ancillary test results. Awareness of these limitations will avoid overreliance on IHC and misclassification of histotypes for research and clinical management.
Evidence of a Monoclonal Origin for Bilateral Serous Tubal Intraepithelial Neoplasia
Authors: Meserve Emily E. , Strickland Kyle C. , Miron Alexander , Soong Thing R. , Campbell Frank , Howitt Brooke E. , Crum Christopher P.
Published: June 2018

Serous tubal intraepithelial carcinoma (STIC) is found in 10% to 60% of cases of tuboovarian high-grade serous carcinoma (HGSC) and is presumed to be the site of origin, linking many HGSCs to the fallopian tube. Bilateral STIC is present in ∼20% of cases. Because clonal Tp53 mutations are a defining feature of HGSC, including their associated STICs, we analyzed 4 cases of bilateral serous tubal intraepithelial neoplasia (STIN), including STIC and Tp53-mutated serous tubal intraepithelial lesions (STILs), associated with HGSC to determine whether they contained the same or different p53 mutations. Extracted DNA from STINs, concurrent HGSCs and control tissues was analyzed for mutations in all exons of Tp53. Sequencing was successful in 3 of the 4 cases, and an identical Tp53 mutation was detected in the HGSC and bilateral STINs in 2 of these 3 cases. One STIN was morphologically a STIL. These findings confirm that a subset of bilateral STINs share the same Tp53 mutation, implying that at least one of the STINs is an intraepithelial metastasis from either the contralateral STIN or HGSC. This study complements others addressing the multiple origins of STIN in the setting of existing HGSC. It further underscores the fact that potential overlap in biologic behavior between STILs and STICs as well as timing and direction of metastatic spread has yet to be resolved.
Functional Impairments Associated With Patient Activation Among Community-Dwelling Older Adults
Authors: Na Ling , Kwong Pui L. , Xie Dawei , Pezzin Liliana E. , Kurichi Jibby E. , Streim Joel E.
Published: June 2018

Objectives

Activity of daily living stages and instrumental activity of daily living stages demonstrated ordered associations with mortality, risk of hospitalization, and receipt of recommended care. This article explores the associations of stages with the following three dimensions of patient activation: self-care efficacy, patient-doctor communication, and health-information seeking. We hypothesized that higher activity of daily living and instrumental activity of daily living stages (greater limitation) are associated with a lower level of patient activation.

Methods

Patient activation factors were derived from the 2004 and 2009 Medicare Current Beneficiary Survey. In this cross-sectional study (N = 8981), the associations of activity limitation stages with patient activation factors were assessed in latent factor models.

Results

Greater activity limitation was in general inversely associated with self-efficacy, patient-doctor communication, and health information seeking, even after adjusting for sociodemographic and clinical characteristics. For instance, the mean of self-care efficacy across activity of daily living stages I–IV (mild, moderate, severe, and complete limitation) compared with stage 0 (no limitation) decreased significantly by 0.17, 0.29, 0.34, and 0.60, respectively. Covariates associated with suboptimal patient activation were also identified.

Discussion

Our study identified multiple opportunities to improve patient activation, including providing support for older adults with physical impairments, at socioeconomic disadvantages, or with psychological or cognitive impairment.
Look-Alike Medication Packages and Patient Safety
Authors: Shao Shih-Chieh , Lai Edward Chia-Cheng , Owang Kok Loon , Chen Hui-Yu , Chan Yuk-Ying
Published: June 2018

Medication errors substantially threaten patient safety, and their prevention requires clinical vigilance. We present a case of taking the wrong drug due to a dispensing error by pharmacists involving medication packaging confusion, and we report how we prevent similar dispensing errors by thorough investigation and intervention. This case emphasizes the need for constant attention by hospital, medical industry, and regulatory authorities to avoid look-alike medication packaging in the interest of medication safety.
Identification of Tracheobronchial Tree Calcifications Using Molecular Imaging Probes
Authors: Al-Zaghal Abdullah , Werner Thomas J. , Høilund-Carlsen Poul F. , Alavi Abass
Published: June 2018

Tracheobronchial calcifications are common in adults and considered as a physiological process of aging with no clinical significance in otherwise asymptomatic, healthy individuals. We are presenting a case of tracheobronchial tree calcifications as detected on 18F-NaF PET/CT in a 75-year-old woman. Many previous publications have reported the accumulation of NaF in extraosseous organs; these observations further set new directions in the evaluation of the metabolic activity of macrocalcification and microcalcification using molecular imaging probes.
Gradenigo Syndrome Induced by Suppurative Otitis Media
Authors: Bozan Nazim , Düzenli Ufuk , Yalinkilic Abdulzaziz , Ayral Abdurrahman , Parlak Mehmet , Turan Mahfuz , Kiroglu Ahmet Faruk
Published: June 2018

Gradenigo syndrome was defined as a clinical triad of otitis media, severe orbito-facial pain, and ipsilateral sixth cranial nerve palsy. It may occur as a complication of either acute or chronic otitis media. Herein, we will report a case of Gradenigo syndrome induced by suppurative chronic otitis media that was promptly diagnosed and aggressively treated.
Investigation of Distances Between the Anterior Nasal Spine and Nasofrontal Beak, Basal Lamella, Skull Base, and Sphenoid Sinus on Paranasal Sinus Computed Tomography
Authors: Alimoglu Yalcin , Topcu Adem
Published: June 2018

Objective:

The aim of this study was to investigate the distances between the anterior nasal spine and basal lamella (BL), skull base, nasofrontal beak (NfB), and the anterior wall of sphenoid sinus on computed tomography (CT) images.

Methods:

A total of 160 patients who were seen at the otolaryngology clinic of our institution were evaluated with the help of the image processing software of the radiology department. Cases in which bony structures could not be seen clearly because of previous surgery or trauma were excluded. The distance between the anterior nasal spine; and NfB, the closest point of the skull base in the frontal recess (SB1), the closest point of the BL, the intersection of the line with which the distance to the BL was measured with the skull base (SB2) and the closest point of the anterior wall of the sphenoid sinus (Sp) were measured using multiplanar reconstruction.

Results:

The images of 140 patients were examined. NfB, SB1, BL, SB2, and Sp were 5.14 ± 0.46 (4.15–6.38) cm, 5.70 ± 0.48 (4.31–7.03) cm, 4.84 ± 0.44 (3.86–5.98) cm, 6.23 ± 0.50 (5.13–7.35) cm, and 6.14 ± 0.46 (5.04–7.36) cm, respectively.

Conclusion:

In our study group, the distances some of which were reported as constant values in the literature were found to have a range of up to 2 cm. Therefore, if distances between structures are to be used for orientation during endoscopic sinus surgery, they should be better measured preoperatively on paranasal sinus CT scan images instead of using predefined constant values.
The Accuracy of Cone-Beam Computed Tomography for Evaluating Bone Density and Cortical Bone Thickness at the Implant Site: Micro-Computed Tomography and Histologic Analysis
Authors: Suttapreyasri Srisurang , Suapear Pradipat , Leepong Narit
Published: June 2018

The aim of this study was to evaluate the accuracy of cone-beam computed tomography (CBCT) for determining cortical thickness and the gray value, investigating its correlation with micro-computed tomography (CT) and histology analysis. Sixty-two bone samples from 4 anatomic regions of the jaw were analyzed. A radiographic surgical stent was used during CBCT and bone sample harvesting. The cortical thickness and gray value of the planned implant were evaluated by CBCT. Bone volumetric fractions, bone mineral density, and % porosity assessed by micro-CT and mineralized material by histology analysis from harvested bone samples were analyzed and assessed for the association with the CBCT using Pearson correlation. A correlation between cortical thickness measured from the CBCT and Micro-CT (r = 0.933, P < 0.01) was identified. There was no difference between gray values measured from the CBCT among regions, while bone density parameters from micro-CT and histologic analysis showed significant difference (P < 0.01) among regions. Bone density parameters from micro-CT and histologic analysis showed correlation with cortical thickness but not with the gray value. In conclusion, CBCT is highly accurate in linear measurements and demonstrated correlation with genuine bone density. However, the gray value could not demonstrate the true bone density according to a low correlation to bone density variable measured from micro-CT and histologic analysis.
One-Year Relapse of Mandibular Distraction for Hemifacial Microsomia Using Masseteric Botulinum Toxin Type A Injections
Authors: Yin Hong-Yu , Wang Chuan , Zhang Zhi-Yong , Shi Lei , Yin Lin , Liu Wei , Feng Shi , Cao Yi-Lin , Tang Xiao-Jun
Published: June 2018

Background:

The relapse of hemifacial microsomia was thought to be highly related to the soft tissue envelope around the mandible angle mainly composed by masseter and medial pterygoid. According to the reason, we tried to apply masseter injection of type A botulinum toxin to weaken the soft envelope tension on the early stage post mandible distraction in adult HFM patients.

Methods:

Eight patients diagnosed with HFM were studied and randomly assigned to an experimental or control group. Patients in the experimental group were treated with DO, orthognathic surgeries, autologous fat grafting, and bilateral masseter muscle injection with type A botulinum toxin. The patients in control group were treated with the same procedures as the patients in experimental group except for masseter muscle injection with type A botulinum toxin. The recurrence rates of both groups were evaluated and analyzed after nearly 1 year of follow-up.

Results:

The mean recurrence rate was 26.30% ± 11.84% (range 7.62%–37.27%) in the 8 patients after 1-year follow-up. The relapse rate was 16.32% ± 7.78% (7.62%–26.22%) in the experimental group and 36.28% ± 1.03% (34.84%–37.27%) in the control group. There was a significant difference (P = 0.002) between the experimental group and the control group.

Conclusions:

The combination of DO, orthognathic surgeries, autologous fat particle transplantation, and masseter muscle type A botulinum toxin injection technique could be a comprehensive treatment plan for adult patients of HFM. Furthermore, masseter injection of type A botulinum toxin might be an alternative method to reduce the early recurrence rate of postoperative adult patients of HFM.
ACTH Gel in Resistant Focal Segmental Glomerulosclerosis After Kidney Transplantation
Authors: Alhamad Tarek , Manllo Dieck John , Younus Usman , Matar Dany , Alasfar Sami , Vujjini Vikas , Wall Devin , Kanawati Bilal , Reiser Jochen , Brennan Daniel C. , Alachkar Nada
Published: June 2018

Background

Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange (TPE) and/or rituximab.

Methods

We performed a retrospective review of cases of de novo or recurrent resistant FSGS at 2 large US transplant centers between April 2012 and December 2016. Proteinuria was measured by urine protein to creatinine ratio.

Results

We identified 20 cases of posttransplant recurrent and de novo FSGS resistant to conventional therapy with TPE and rituximab. Mean ± SD age was 49 ± 15.5 years, 14 (70%) were male, 13 (65%) were whites, and 8 (38%) had previous kidney transplants. Median (interquartile range) of recurrent and de novo FSGS was 3 (0.75-7.5) months posttransplant. The majority of patients, 15 (75%), received TPE as a treatment at the time of diagnosis and 10 (50%) received rituximab, which was started before the use of ACTH gel. There was a significant improvement of urine protein to creatinine ratio from a mean ± SD of 8.6 ± 7.6 g/g before ACTH gel to 3.3 ± 2.3 g/g after the use of ACTH gel (P = 0.004). Ten (50%) patients achieved complete or partial remission.

Conclusions

Although, the response varied among the recipients, ACTH gel might be an effective therapy for posttransplant resistant FSGS cases that fail to respond to TPE and rituximab.
Will the Illinois chorus frog (Pseudacris streckeri illinoensis) survive in Arkansas? A case study of a secretive species In need of protection
Authors: McCallum Malcolm , Trauth Stanley E.
Published: June 2018

The range of the Illinois chorus frog (Pseudacris streckeri illinoensis) in Arkansas is restricted to the eastern quarter of Clay County. Nearly 100% of this species’ native sand-prairie habitat has been converted to agricultural fields. The original range of the Illinois chorus frog encompassed at least 9,982 ha. Although two new localities were identified in 2002, the current range is only 4,399 ha in 2002. This represents a 56% range contraction since 1992. Calling was heard in only 44.5% of its original range. This species may be experiencing a severe range contraction. Decay models predict the extirpation of the Illinois chorus frog in Arkansas within 17.5 to 101 yr. Suggested factors contributing to this range contraction may include drought, pesticide use, changes in surface water hydrology, U.S. E.P.A. Best management practices, and this species’ limited ability to recolonize extirpated sites.
Five Breaks Synchrony While Six Keeps Synchrony: Individual Difference in the Coordinated Pattern of Five- and Six-armed Brittle Stars
Authors: Wakita Daiki , Hayase Yumino , Aonuma Hitoshi
Published: June 2018

Physiological experiments and mathematical models have supported that neuronal activity is crucial for coordinating rhythmic movements in animals. On the other hand, robotics studies have suggested the importance of physical properties made by body structure, i.e. morphology. However, it remains unclear how morphology affects movement coordination in animals, independent of neuronal activity. To begin to understand this issue, our study reports a rhythmic movement in the green brittle star. We found this animal moved five radially symmetric parts in a well-ordered unsynchronized pattern. We built a phenomenological model where internal fluid flows between the five body parts to explain the coordinated pattern without considering neuronal activity. Changing the number of the body parts from five to six, we simulated a synchronized pattern, which was demonstrated also by an individual with six symmetric parts. Our model suggests a different number in morphology makes a different fluid flow, leading to a different synchronization pattern in the animal.
A central component of the N1 event-related brain potential could index the early and automatic inhibition of the actions systematically activated by objects
Authors: Touzel Molly , Snidal Christine , Segal Julia , Renoult Louis , Debruille J. Bruno
Published: June 2018

Stimuli of the environment, like objects, systematically activate the actions they are associated to. These activations occur extremely fast. Nevertheless, behavioural data reveal that, in most cases, these activations are then automatically inhibited, around 100 ms after the occurrence of the stimulus. We thus tested whether this early inhibition could be indexed by a central component of the N1 event-related brain potential (ERP). To achieve that goal, we looked at whether this ERP component is greater in tasks that could increase the inhibition and in trials where reaction times happen to be long. The illumination of a real space bar of a keyboard out of the dark was used as a stimulus. To maximize the modulation of the inhibition, the task participants had to performed was manipulated across blocks. A look-only task and a count task were used to increase inhibition and an immediate press task was used to decrease it. ERPs of the two block-conditions where presses had to be prevented and where the largest central N1s were predicted were compared to those elicited in the press task, differentiating the ERPs to the third of the trials where presses were the slowest from the ERPs to the third of the trials with the fastest presses. Despite larger negativities due to motor potentials and despite greater attention likely in immediate press-trials, central N1s were found to be minimal for the fastest presses, intermediate for the slowest ones and maximal for the two no-press conditions. These results thus provide a strong support for the idea that the central N1 indexes an early and short lasting automatic inhibition of the actions systematically activated by objects. They also confirm that the strength of this automatic inhibition spontaneously fluctuates across trials and tasks. On the other hand, just before N1s, parietal P1s were found greater for fastest presses. They might thus index the initial activation of these actions. Finally, consistent with the idea that N300s index late inhibition processes, that occur preferentially when the task requires them, these ERPs were quasi absent for fast presses trials and much larger in the three other conditions.

Highlights

Event-related brain potentials (ERPs) elicited by a real object

Smaller parietal P1s and greater central N1s for slowest than for fastest motor responses

Even greater central N1s for tasks without such responses

Central N1s may index early inhibition of stimulus-activated actions

N300s could index late inhibition of stimulus-activated actions
Genes associated with neuropsychiatric disease increase vulnerability to abnormal deep grey matter development
Authors: Cullen Harriet , Krishnan Michelle L , Selzam Saskia , Ball Gareth , Visconti Alessia , Saxena Alka , Counsell Serena J , Hajnal Jo , Breen Gerome , Plomin Robert , Edwards A David
Published: June 2018

1.

Background

Neuropsychiatric disease has polygenic determinants but is often precipitated by environmental pressures, including adverse perinatal events. However, the way in which genetic vulnerability and early-life adversity interact remains obscure. Preterm birth is associated with abnormal brain development and psychiatric disease. We hypothesised that the extreme environmental stress of premature extra-uterine life could contribute to neuroanatomic abnormality in genetically vulnerable individuals.

Methods

We combined Magnetic Resonance Imaging (MRI) and genome-wide single nucleotide polymorphism (SNP) data from 194 infants, born before 33 weeks of gestation, to test the prediction that: the characteristic deep grey matter abnormalities seen in preterm infants are associated with polygenic risk for psychiatric illness. Summary statistics from a meta-analysis of SNP data for five psychiatric disorders were used to compute individual polygenic risk scores (PRS). The variance explained by the PRS in the relative volumes of four deep grey matter structures (caudate nucleus, thalamus, subthalamic nucleus and lentiform nucleus) was estimated using linear regression both for the full, mixed-ancestral, cohort and a subsample of European infants.

Results

The PRS was negatively associated with: lentiform volume in the full cohort (β=−0.24, p=8×10−4) and the European subsample (β=−0.24, p=8×10−3); and with subthalamic nuclear volume in the full cohort (β=−0.18, p=0.01) and the European subsample (β=−0.26, p=3×10−3).

Conclusions

Genetic variants associated with neuropsychiatric disease increase vulnerability to abnormal deep grey matter development and are associated with neuroanatomic changes in the perinatal period. This suggests a mechanism by which perinatal adversity leads to later neuropsychiatric disease in genetically predisposed individuals.
Development of environmental DNA surveillance for the threatened crucian carp (Carassius carassius)
Authors: Harper Lynsey R , Griffiths Nathan P , Lawson Handley Lori , Sayer Carl D , Read Daniel S , Harper Kirsten J , Blackman Rosetta C , Li Jianlong , Hänfling Bernd
Published: June 2018

The crucian carp (Carassius carassius) is one of few fish species associated with small ponds in the UK. These populations contain genetic diversity not found in Europe and are important to conservation efforts for the species, which has declined across its range. Detection and monitoring of extant crucian carp populations are crucial for conservation success. Environmental DNA (eDNA) analysis could be very useful in this respect as a rapid, cost-efficient monitoring tool. We developed a species-specific quantitative PCR (qPCR) assay for eDNA surveillance of crucian carp to enable non-invasive, large-scale distribution monitoring. We compared fyke netting and eDNA at ponds with (N = 10) and without (N = 10) crucian carp for presence-absence detection and relative abundance estimation, specifically whether DNA copy number reflected catch-per-unit-effort (CPUE) estimate. We examined biotic and abiotic influences on eDNA detection and quantification, and compared qPCR to standard PCR. Notably, eDNA occurrence and detection probabilities in relation to biotic and abiotic factors were estimated using a hierarchical occupancy model. eDNA analysis achieved 90% detection for crucian carp (N = 10), failing in only one pond where presence was known. We observed an overall positive trend between DNA copy number and CPUE estimate, but this was not significant. Macrophyte cover decreased the probability of eDNA occurrence at ponds, whereas CPUE and conductivity had positive and negative influences on eDNA detection probability in qPCR replicates respectively. Conductivity also had a negative effect on DNA copy number, but copy number increased with temperature and percentage of macrophyte cover. PCR was comparable to qPCR for species detection and may provide semi-quantitative information. Our results demonstrate that eDNA could enable detection of crucian carp populations in ponds and benefit ongoing conservation efforts, but imperfect species detection in relation to biotic and abiotic factors and eDNA workflow requires further investigation. Nonetheless, we have established an eDNA framework for crucian carp and sources of imperfect detection which future investigations can build upon.
Resting state fMRI based target selection for personalized rTMS: stimulation over the left DLPFC temporarily alters the default mode network in healthy subjects
Authors: Singh Aditya , Erwin-Grabner Tracy , Sutcliffe Grant , Antal Andrea , Paulus Walter , Goya-Maldonado Roberto
Published: June 2018

High frequency repetitive TMS (HF-rTMS) to the left dorsolateral prefrontal cortex (DLPFC) is an approved option for the treatment of depression, but there is also much variability in the resulting antidepressant response. This variability is believed to arise from various factors, an important one of which being the method by which rTMS is targeted to the optimal stimulation site in the left DLPFC. To more accurately target HF-rTMS at left DLPFC, we present a new method for target selection based on individual RS-fMRI data. We show in 23 healthy subjects that the new proposed method of target selection is reproducible and yields left DLPFC targets whose functional connectivity correlates more negatively with subgenual anterior cingulate cortex (sgACC) than targets based on standard MNI coordinates. Since previous work has highlighted higher negative connectivity with the sgACC as an important feature of targets for higher antidepressant effect of HF-rTMS, the targets selected by the new method can be expected to lead to a higher therapeutic response. Additionally, the mechanism of action of an entire single session of HF-rTMS (3000 pulses) in healthy subjects has not been reported. We show significant decreases in functional connectivity of the default mode network in sgACC and ventral striatum (vStr) regions, peaking at 27-32 minutes after stimulation. Also, we report a negative correlation between the magnitude of this decrease in the right sgACC and the harm avoidance domain measure from the Temperament and Character Inventory (TCI). This finding points towards the possibility of using the harm avoidance measure as a predictor of HF-rTMS response. In addition, the decreased functional connectivity of the default mode network in right nucleus accumbens (NAcc) correlates with a short-term decrease in self-rated negative emotions from the Positive and Negative Affect Schedule (PANAS) i.e. the lower the functional connectivity of right NAcc with the default mode network, the lower the reported perception of negative mood by the subjects. This suggests a mechanism by which changes induced by rTMS influence the perception of negative mood in recipients.