bluuebunny/crossref_metadata_2025 huggingface dataset:
PARACENTRAL ACUTE MIDDLE MACULOPATHY IN SUSAC SYNDROME
Authors: Haider Ali S. , Viswanathan Deepa , Williams David , Davies Peter
Published: October 2017

Purpose:

To present the first reported case of paracentral acute middle maculopathy in association with Susac syndrome.

Method:

Case report.

Results:

A young female patient presented with unilateral sudden loss of vision of her right eye to count fingers. There were numerous cotton wool spots in a multifocal pattern concentrated around the right macula and optic disk. Clinical examination and spectral domain optical coherence tomography imaging were consistent with paracentral acute middle maculopathy, and fluorescein angiography showed features of retinal arteriole vasculitis. Magnetic resonance imaging demonstrated multiple white matter lesions in a pericallosal distribution. High-dose corticosteroid therapy was commenced, and visual acuity gradually improved to 6/6 corrected. The patient reported hearing impairment and was diagnosed with Susac syndrome for which she has responded extremely well to long-term immunosuppressive therapy.

Conclusion:

Paracentral acute middle maculopathy can occur in association with Susac syndrome. Susac syndrome may present only with multifocal retinal ischemia, and such patients with paracentral acute middle maculopathy should be checked for characteristic magnetic resonance imaging lesions and hearing loss.
TRANSTHYRETIN V30M FAMILIAL AMYLOIDOSIS PRESENTING AS ISOLATED RETINAL ANGIOPATHY
Authors: Chen Judy J. , Kalevar Ananda , Vora Robin A. , Qian Ying , Gorenberg Peter H. , Garcia-Kennedy Richard , Cunningham Emmett T.
Published: October 2017

Purpose:

To describe a patient with confirmed transthyretin V30M form of familial amyloidosis who presented initially with isolated retinal angiopathy.

Methods:

Retrospective chart review.

Results:

A 66-year-old woman presented with bilateral retinal angiopathy. Extensive workup for an infectious, inflammatory, or hypercoagulable cause was unrevealing. The patient subsequently developed bilateral neovascularization of the optic nerve and iris complicated by recurrent vitreous hemorrhages, which were treated with intravitreal bevacizumab and panretinal photocoagulation. The development of cardiac and gastrointestinal symptoms 5 years after presentation led to tissue biopsies that revealed both Congo red staining and apple-green birefringence in polarized light, confirming the diagnosis of systemic amyloidosis. Sequencing of the transthyretin gene confirmed the patient to be heterozygous for the common amyloidogenic V30M mutation.

Conclusion:

The common transthyretin V30M form of familial amyloidotic polyneuropathy can rarely present with retinal angiopathy. Recurrent vitreous hemorrhages were treated successfully with intravitreal bevacizumab and panretinal photocoagulation.
Episcleral Venous Outflow: A Potential Outcome Marker for iStent Surgery
Authors: Bostan Cristina , Harasymowycz Paul
Published: October 2017

Purpose:

(1) To propose the use of episcleral venous outflow (EVO) as an outcome marker of iStent surgery, and an EVO grading scale. (2) To determine the association of EVO with: (a) postoperative intraocular pressure (IOP) and medication burden; (b) iStent patency status.

Patients and Methods:

Retrospective cohort study including 151 glaucomatous eyes having undergone iStent-phacoemulsification surgery. Demographic and preoperative data (IOP, number of antiglaucoma medications, glaucoma type and stage, maximal IOP) were collected. Postoperatively, were recorded: IOP, number of antiglaucoma medications, occurrence of stent malpositioning or obstruction, and EVO scores based on the proposed scale (0: no laminar flow; 1+: faint laminar flow; 2+: marked laminar flow). A Kruskal-Wallis test determined the association between EVO, postoperative IOP, and medication burden. A multivariable-adjusted ordinal logistic regression was used for the association with iStent patency status.

Results:

Patients with marked laminar flow (2+) were more likely to have a lower IOP (P=0.022) and fewer medications (P=0.009) at 1-year postoperatively than those with no laminar flow (0). No difference was found in postoperative IOP and number of medications when comparing patients having faint laminar flow (1+) with patients from the other 2 EVO categories (0 and 2+). iStent patency was associated with greater EVO as opposed to its obstruction (odds ratio, 4.73; 95% confidence interval, 1.74-12.9). No malpositioned stents were noted in our cohort.

Conclusions:

The use of EVO as an outcome marker of iStent surgery is physiologically plausible. The proposed EVO grading scale is simple, comprises few categories, and is easily applicable in an in-office setting. The results of this study suggest this scale could be useful in the assessment of iStent functionality and encourage its further investigation in prospective studies.
Glaucoma Diagnostic Capabilities of Foveal Avascular Zone Parameters Using Optical Coherence Tomography Angiography According to Visual Field Defect Location
Authors: Kwon Junki , Choi Jaewan , Shin Joong Won , Lee Jiyun , Kook Michael S.
Published: October 2017

Purpose:

To assess the diagnostic ability of foveal avascular zone (FAZ) parameters to discriminate glaucomatous eyes with visual field defects (VFDs) in different locations (central vs. peripheral) from normal eyes.

Patients and Methods:

Totally, 125 participants were separated into 3 groups: normal (n=45), glaucoma with peripheral VFD (PVFD, n=45), and glaucoma with central VFD (CVFD, n=35). The FAZ area, perimeter, and circularity and parafoveal vessel density were calculated from optical coherence tomography angiography images. The diagnostic ability of the FAZ parameters and other structural parameters was determined according to glaucomatous VFD location. Associations between the FAZ parameters and central visual function were evaluated.

Results:

A larger FAZ area and longer FAZ perimeter were observed in the CVFD group than in the PVFD and normal groups. The FAZ area, perimeter, and circularity were better in differentiating glaucomatous eyes with CVFDs from normal eyes [areas under the receiver operating characteristic curves (AUC), 0.78 to 0.88] than in differentiating PVFDs from normal eyes (AUC, 0.51 to 0.64). The FAZ perimeter had a similar AUC value to the circumpapillary retinal nerve fiber layer and macular ganglion cell-inner plexiform layer thickness for differentiating eyes with CVFDs from normal eyes (all P>0.05, the DeLong test). The FAZ area was significantly correlated with central visual function (β=−112.7, P=0.035, multivariate linear regression).

Conclusions:

The FAZ perimeter had good diagnostic capability in differentiating glaucomatous eyes with CVFDs from normal eyes, and may be a potential diagnostic biomarker for detecting glaucomatous patients with CVFDs.
Comparison of Del Nido Cardioplegia with Blood Cardioplegia in Adult Combined Surgery
Authors: Hamad Raphael , Nguyen Anthony , Laliberté Éric , Bouchard Denis , Lamarche Yoan , El-Hamamsy Ismail , Demers Philippe
Published: October 2017

Objective

del Nido solution (DNS) is a single-dose cardioplegia designed for pediatric use proposed to offer superior myocardial protection in adults. However, few data support this claim. We hypothesized that DNS and modified blood cardioplegia solution (BS) provide equivalent safety in combined adult valve surgery.

Methods

Between November 2014 and December 2015, 25 patients underwent primary aortic valve replacement and concomitant coronary artery bypass grafting (CABG) with DNS. Outcomes were compared with 25 patients who underwent the same surgery with BS between September 2013 and August 2015.

Results

All preoperative characteristics, comorbidities, and number of CABG performed were similar between groups. One hospital death occurred in the BS group. Postoperative creatine kinase, MB isotype (16.7 ± 5.3 μg/L vs. 22.1 ± 8.9 μg/L, P = 0.011) and troponin T levels (260 ± 105.3 ng/L vs. 370.5 ±218.4 ng/L, P =0.028) were significantly lower in the DNS group. There was no difference in inotropic or vasoactive agent use ( P = 0.512). Cardiopulmonary bypass times (65.5 ± 12.5 min vs. 76.6 ± 19.1 min, P = 0.019) and cross-clamp times (55.6 ± 11.2 min vs. 64.3 ± 18.9 min, P = 0.05) were lower in the DNS group but total operating room times ( P = 0.198) were similar. Peak postoperative creatinine levels were similar in both groups ( P = 0.063). There was no difference in postoperative outcomes including acute renal failure ( P > 0.999), atrial fibrillation ( P = 0.773), acute respiratory failure ( P > 0.999), nor stroke or transient ischemic attack ( P > 0.999). Intensive care unit stay ( P = 0.213) and hospital stay ( P = 0.1) did not differ between groups.

Conclusions

The DNS can be used as an alternative to BS in adult concomitant aortic valve replacement + CABG surgery. This supports our hypothesis that in this specific setting, DNS provides comparable myocardial protection as BS, with possibly shorter cardiopulmonary bypass and cross-clamp times.
The Medical Futility Experience of Nurses in Caring for Critically Ill Patients
Authors: Hsu Ming-Yi , Su Shu-Fen , Chiang Lien-Ying , Shih Sou-Jen , Chen Yu-Chen
Published: October 2017

Background:

Medical futility is a key bioethical concern. In Taiwan, policymakers tend to provide care standards and evaluation guidelines for critically ill and terminal patients whose treatment is medically futile. However, the current status of medical futility for critically ill patients is inadequate, and no consensus currently exists on the definition of medical futility.

Purpose:

The aim of this study was to understand the medical futility experiences of intensive care nurses.

Methods:

This qualitative research adopted a phenomenological perspective and was conducted in a medical center and a regional hospital in Central Taiwan. Eight nurses with at least 1 year of nursing tenure who were serving in the intensive care unit were recruited. Purposive and snowball sampling methods were used to conduct one-on-one in-depth interviews. Each of the tape-recorded interviews was transcribed before data analysis.

Results:

The research results found four themes, including (a) definitions of medical futility and types of patients, (b) considerations of medical futility, (c) the occurrence of medical futility, and (d) nurses’ responses to medical futility. The participants indicated that medical futility refers to the point at which the continued provision of treatment does not evidently ease the disease condition of a patient or improve his or her quality of life or when life-sustaining treatment is provided to patients to facilitate the process of death.

Conclusions:

This study revealed that the major challenge in clinical cases of medical futility is for physicians, nurses, and patients to communicate effectively together during times of rapid and unanticipated change in patient condition. Thus, events of medical futility may be preventable. Past cases of medical futility involving critically ill patients may serve as references for guiding clinical care, education, and related policy formulation.
Perceptions of Diabetes Self-Care Management Among Older Singaporeans With Type 2 Diabetes: A Qualitative Study
Authors: TAN Cherry Chay Lee , CHENG Karis Kin Fong , SUM Chee Fang , SHEW Jasmine Sew Hong , HOLYDARD Eleanor , WANG Wenru
Published: October 2017

Background:

Given the global shift in aging populations and the associated increasing prevalence of diabetes, it is critical to explore new approaches in diabetic self-care management. In Singapore, what has been overlooked to date is an in-depth, contextually based examination of the needs, expectations, and barriers faced in self-care management by older adults with Type 2 diabetes.

Purpose:

This study aimed to explore the experiences of older Singaporeans with Type 2 diabetes in diabetes self-care management to understand their perceived needs, expectations, and barriers associated with their diabetes self-care management.

Methods:

A descriptive qualitative approach using focus group discussions was adopted. Purposive sampling was used to recruit older adults with Type 2 diabetes from Singapore’s three main ethnic groups, namely, Chinese, Malay, and Indian, through the diabetes centers of two hospitals. Four focus groups, including two groups of Chinese, one group of Malays, and one group of Indians, were conducted. Thematic analysis was used to analyze the data set for emerging themes that relate to the experiences of participants with diabetes self-care management.

Results:

The four major themes related to the experiences of participants with diabetes self-care management that emerged were as follows: (a) “Diabetes is genetic, destined, and not serious; complication, let it come”; (b) “Diabetes self-care is difficult”; (c) “I don’t know diabetes”; and (d) “Doctor and nurses are important facilitators of self-care management.”

Conclusions/Implications for Practice:

Findings have important implications in Singapore as well as in other Asian countries where populations are also aging and diabetes prevalence is increasing. The findings provide new culturally focused insights for clinical patient education within the Southeast Asian context to improve diabetes self-care management of older adults.
Information Reception and Expectations Among Hospitalized Elderly Patients in Taiwan: A Pilot Study
Authors: CHEN Kai-Li , CHANG Chia-Ming , CHEN Ching-Huey , HUANG Mei-Chih
Published: October 2017

Background:

Communicating with patients, especially geriatric patients, is a challenge for medical professionals. Medical message receiving and expectations among hospitalized elderly patients have not been studied.

Purpose:

The aim of this study was to explore medical message receiving and expectations concerning medical information among hospitalized elderly patients in Taiwan.

Methods:

A descriptive study design was used. Convenience sampling was applied, and the research was conducted in a geriatric ward in a medical center in southern Taiwan. Patients were recruited who were 65 years or older and capable of verbal communication. Data were collected using a self-developed semistructured questionnaire. For each participant, data were collected in one regular ward round. The messages of the physician were recorded. During the first and fourth hours after the ward round, the researcher collected the medical messages that were conveyed by the physician in the ward round and that could be repeated by the patients. Open-ended questions were used to collect data about patient expectations of medical messages during the first hour after the ward round. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis.

Results:

Thirty patients participated in this study. All of the participants remembered the visit of the physician. Seventeen participants (56.6%), however, could not repeat the messages, and the total message repetition rate was 17.8% at the first hour after the ward round. By the fourth hour, the message repetition rate fell to 8.9%. Furthermore, three participants (10%) reported messages incorrectly. Participants reported the importance and necessity of physicians conveying medical messages. “Desire to know the reasons for discomfort” and “discharge date” were the messages most expected by the participants.

Conclusions:

This study suggests that most hospitalized elderly patients cannot repeat medical messages that are conveyed by their physicians. Written materials and the involvement of principal caregivers in the medical informing process may be necessary. Besides, before providing medical information, medical professionals should be cognizant of the key concerns of their patients.
Analysis of the citation of articles published in the European Journal of Emergency Medicine since its foundation
Authors: Fernández-Guerrero Inés M. , Martín-Sánchez Francisco J. , Burillo-Putze Guillermo , Graham Collin A. , Miró Òscar
Published: October 2017

Objectives

The aim of this study was to evaluate the evolution of the citation of articles from the European Journal of Emergency Medicine (EJEM) from 1994 (EJEM foundation) to 2015 and identify highly cited articles and their principal characteristics and determine a possible correlation between the citations counted in different databases.

Materials and methods

We obtained the articles published in EJEM from 1994 to 2015 in ISI-WoS (main source) and Scopus, Google Scholar, and Medline databases (accessory sources). The citations were quantified and their annual evolution and the bibliometric indices derived (impact factor and SCImago Journal Rank) were evaluated. We identified and analyzed the highly cited EJEM articles and evaluated the possible correlation between the citations counted for these articles in the databases.

Results

Overall, 1705 EJEM articles were cited 9422 times in 8122 different articles. The evolution of the global citation, impact factor, and SCImago Journal Rank from 1994 to 2015 increased significantly. The h-index of EJEM was 30, and 31 articles were considered highly cited (≥30 citations), 16.1% of them being clinical trials. By subjects, 22.5% corresponded to cardiology, 19.3% to emergency department management, and 12.9% to pediatrics; by countries, 81% were from Europe, with Belgian authors publishing four (12.9%) highly cited articles, and French, Spanish, British, and Swedish authors having three (9.7%) each. Two studies in the EJEM achieved the definition of ‘citation classics’ (more than 100 citations). The number of citations in all the databases, except Medline, showed statistically significant correlations.

Conclusion

Citation of EJEM articles has progressively increased and EJEM bibliometric indicators have improved; most highly cited articles are mainly by European authors.
Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes
Authors: Nobel Lisa , Jesdale William M. , Tjia Jennifer , Waring Molly E. , Parish David C. , Ash Arlene S. , Kiefe Catarina I. , Allison Jeroan J.
Published: October 2017

Objective:

To explore the influence of contextual factors on health-related quality of life (HRQoL), which is sometimes used as an indicator of quality of care, we examined the association of neighborhood socioeconomic status (NSES) and trajectories of HRQoL after hospitalization for acute coronary syndromes (ACS).

Methods:

We studied 1481 patients hospitalized with acute coronary syndromes in Massachusetts and Georgia querying HRQoL via the mental and physical components of the 36-item short-form health survey (SF-36) (MCS and PCS) and the physical limitations and angina-related HRQoL subscales of the Seattle Angina Questionnaire (SAQ) during hospitalization and at 1-, 3-, and 6-month postdischarge. We categorized participants by tertiles of the neighborhood deprivation index (a residence-census tract-based measure) to examine the association of NSES with trajectories of HRQoL after adjusting for individual socioeconomic status (SES) and clinical characteristics.

Results:

Participants had mean age 61.3 (SD, 11.4) years; 33% were female; 76%, non-Hispanic white; 11.2% had household income below the federal poverty level. During 6 months postdischarge, living in lower NSES neighborhoods was associated with lower mean PCS scores (1.5 points for intermediate NSES; 1.8 for low) and SAQ scores (2.4 and 4.2 points) versus living in high NSES neighborhoods. NSES was more consequential for patients with lower individual SES. Individuals living below the federal poverty level had lower average MCS and SAQ physical scores (3.7 and 7.7 points, respectively) than those above.

Conclusions:

Neighborhood deprivation was associated with worse health status. Using HRQoL to assess quality of care without accounting for individual SES and NSES may unfairly penalize safety-net hospitals.
Pathogenesis of Neisseria gonorrhoeae in the female reproductive tract: neutrophilic host response, sustained infection, and clinical sequelae
Authors: Stevens Jacqueline S. , Criss Alison K.
Published: October 2017

Purpose of review

Gonorrhea is a major global health concern, caused by the bacterium Neisseria gonorrhoeae. The main clinical feature of acute gonorrhea is neutrophilic influx that is unable to clear infection. Women of reproductive age are predominantly at risk for serious sequelae of gonorrhea, including pelvic inflammatory disease, ectopic pregnancy, and infertility. This review will highlight how neutrophils are recruited to the female reproductive tract (FRT) in response to N. gonorrhoeae, how N. gonorrhoeae resists killing by neutrophils, and the connection between neutrophilic inflammation and cellular damage.

Recent findings

Epithelial cells and immune cells of the FRT recognize and respond to N. gonorrhoeae lipid A and heptose bisphosphate of lipooligosaccharide, porin, lipoproteins, and peptidoglycan fragments. N. gonorrhoeae skews the resulting immune response toward a neutrophilic, Th17-like response. N. gonorrhoeae has multiple, nonredundant mechanisms to survive inside neutrophils and in neutrophil extracellular traps. Infection that ascends to the upper FRT induces the further release of inflammatory cytokines and matrix metalloproteinases, which cause epithelial damage.

N. gonorrhoeae is remarkable in its ability to recruit neutrophils, yet survive in their midst. New models being developed for FRT infection with N. gonorrhoeae will be useful to reveal the mechanisms underlying these observations.
False Lung Metastasis: Concurrent Ewing Sarcoma and Minimally Invasive Adenocarcinoma
Authors: Bechtel Allison S. , Cheek Bradley , Bradfield Scott
Published: October 2017

Pediatric lung cancer is a very rare occurrence, particularly as a primary lesion. A concurrent diagnosis is even more unusual and only reported a handful of times in Ewing sarcoma. Our patient is a 13-year-old boy who had concurrent diagnoses of Ewing sarcoma and minimally invasive adenocarcinoma of the lung, formerly bronchoalveolar carcinoma. To our knowledge this has also been found in at least 1 other case. There are some classic genetic mutations associated with Ewing sarcoma. None have been found to be linked with the concurrent diagnosis. A biological linkage is worth considering.
Prognostications in Health Care
Authors: Powell Suzanne K.
Published: October 2017

There are health care issues that have been around for decades, which may likely continue: rationed health care, rising costs, patient safety, ageing populations, and transitional care techniques. Current issues include these, plus their evolutionary variations such as new technologies, the changing health care landscape, and subsequent emerging ethical issues. Where will it all go? No one knows.
Early Evidence of the Effectiveness of the Human Papillomavirus Vaccination Program Against Anogenital Warts in Manitoba, Canada: A Registry Cohort Study
Authors: Willows Karla , Bozat-Emre Songul , Righolt Christiaan H. , Kliewer Erich V. , Mahmud Salaheddin M.
Published: October 2017

Background

We assessed the effectiveness of the quadrivalent human papillomavirus vaccine (qHPV) vaccination program in Manitoba, Canada, in reducing incident anogenital warts (AGWs) and to what extent effectiveness depends on age at vaccination and number of doses.

Methods

Female participants 9 years or older who received the qHPV in Manitoba between September 2006 and March 2013 (n = 31,464) through the publicly funded school-based program and a high-risk catch-up program were included. They were matched on age and area of residence to unvaccinated female participants. Information on incident AGWs was obtained from provincial administrative databases using validated algorithms. Using stratified Cox regression models, we estimate hazard ratios (HRs) for the association between qHPV and AGWs.

Results

For female participants vaccinated at age 18 years or younger, receipt of qHPV was associated with a 40% reduction in AGW risk (HR, 0.6; 95% confidence interval [CI], 0.4–0.8). Further adjustment for socioeconomic and medical history did not alter this estimate. For women vaccinated at age 19 years or older, we saw an increase in AGW incidence, especially among those who were sexually active (HR, 2.8; 95% CI, 2.1–3.7). Among female participants vaccinated at age 18 years or younger, risk of AGWs was lowest among those who received 3 doses, corresponding to a vaccine effectiveness of 56% (95% CI, 30%–70%). For women vaccinated at older age, risk of AGWs remained increased regardless of the number of doses.

Conclusions

Women vaccinated at an older (≥19 years) age may be less protected against AGWs, particularly if sexually active before vaccine administration. Further efforts should be targeted at increasing vaccine uptake among preadolescents before the initiation of sexual activity.
Gastric Drainage in the Treatment of Near-Fatal Food-Induced Anaphylaxis
Authors: Lazar Isaac , Cavari Yuval , Levitas Aviva , Mandolla Amarilia B. , Broides Arnon
Published: October 2017

Anaphylaxis should be treated with early administration of intramuscular Adrenalin; however, fatalities may still occur even with this therapy. We report a patient with near-fatal anaphylaxis due to milk whose symptoms persisted and were resistant to any therapeutic attempt; however, the patient had a prompt resolution of the anaphylaxis shortly after a nasogastric tube placement with gastric drainage, suggesting that this procedure ended the ongoing absorption of additional allergen from the gastrointestinal tract. We suggest that nasogastric drainage of gastric contents should be considered as part of the therapy in severe food-induced anaphylaxis.
Clinical Decision Rule to Identify Orbital Wall Fracture Among Children
Authors: Paek So Hyun , Jung Jin Hee , Kwak Young Ho , Kim Do Kyun , Lee Jin Hee , Jung Jae Yun , Oh Sohee
Published: October 2017

Objectives

Head and face injuries are leading causes of emergency department visits in children. There is yet no clinical decision rule on face CT such as pediatric head CT rules. The goal was to develop and validate a clinical decision rule for identifying orbital wall fractures in children with periorbital trauma in the emergency department.

Methods

This was a retrospective derivation and validation study. Children younger than 18 years who underwent orbit CT after periorbital trauma were included between January 2011 and December 2013 in 3 emergency centers. Among 16 candidate clinical variables, 13 clinical signs and symptoms were selected as clinical predictors. For the fracture model, these clinical predictors were analyzed by 3-fold cross-validation. Diagnostic performance was assessed using the area under the receiver operating characteristic (AUROC) curve in both cohorts.

Results

Four variables (orbital rim tenderness, periorbital ecchymosis, painful extraocular movement, and nausea/vomiting) had the best predictive model with the highest AUROC value. The AUROC values for fracture prediction were 0.793 (95% confidence interval, 0.741–0.844) and 0.809 (95% confidence interval, 0.742–0.877) in the derivation cohort and validation cohort, respectively. The sensitivity and negative predictive values were 96.4% and 93.4%, respectively, in the derivation cohort, and 97.8% and 98.1%, respectively, in the validation cohort. The sum of these scores ranged from 0 to 4. Patients with a sum of scores of 1 or higher showed significantly increased risk for fracture.

Conclusions

The 4-variable predictive model can be useful for finding clinically important orbital wall fractures in children.
The Peculiar Case of a Large Right Lower Quadrant Solitary Fibrous Tumor With Vasculature Arising from the Splenic Artery and Vein
Authors: Lukaszewicz Andrew Jeremy , Hayes Harold , Maunglay Mary , Muhar Raman , Gerasymchuk Grygori , Menon Shameem
Published: October 2017

We present the interesting case of a patient with peritoneal solitary fibrous tumor (SFT). The patient initially presented with right lower quadrant pain. Computed tomography findings revealed the presence of a large mass near the cecum, with both arterial and venous blood supply arising directly from the splenic artery and vein. The patient ultimately underwent surgical excision of the mass, and pathological examination was consistent with benign SFT. Not only is the location of our patient's tumor exceedingly rare, but also, to our knowledge, it is the first reported case of SFT with such a unique vascular supply.
Cancer Yield of Incidental Breast Lesions Detected on Chest Computed Tomography
Authors: Healey Terrance T. , Agarwal Saurabh , Patel Ronak , Ratanaprasatporn Lisa , Ratanaprasatporn Linda , Lourenco Ana P.
Published: October 2017

Objective

This study aimed to determine the cancer yield for abnormal breast findings initially identified on chest computed tomography (CT).

Materials and Methods

This institutional review board–approved, Health Insurance Portability and Accountability Act–compliant study retrospectively reviewed reports of 41,217 consecutive chest CT examinations done from January 1, 2006, to December 31, 2011, to identify those with breast findings noted in the impression of the report. Examinations done for staging of newly diagnosed breast cancer were excluded. The electronic medical record was searched for any subsequent breast imaging and any corresponding pathology results. Cancer yield was calculated.

Results

A total of 258 chest CT examinations with abnormal breast findings were identified in 218 unique patients. Average patient age was 65.6 years (range, 30–100 years). There were 207 women and 11 men. Of these, 75 patients had follow-up breast imaging in our system. One hundred forty-three patients did not have follow-up in our system and were excluded for purposes of cancer detection rate calculation. Thirteen of 75 patients were found to have lesions that were malignant: infiltrating ductal carcinoma (8), invasive lobular carcinoma (2), lymphoma (2), and intracystic papillary cancer with atypical features (1). Four of 75 patients underwent further workup and were found to have lesions that were benign: fibroadenoma (3) and benign fibrocystic change (1). The remainder of the 58 of 75 patients had dedicated breast imaging that was classified as either Breast Imaging Reporting and Data System score 1 or 2, and no further workup was performed. Cancer yield from CT findings was 17.3%.

Conclusions

Abnormal CT findings in the breast warrant additional evaluation with dedicated breast imaging to evaluate for a possible underlying malignancy. Cancer yield from CT findings in this study was 17.3%.
Heavily Calcified Coronary Arteries
Authors: De Santis Domenico , Jin Kwang Nam , Schoepf U. Joseph , Grant Katharine L. , De Cecco Carlo N. , Nance John W. , Vogl Thomas J. , Laghi Andrea , Albrecht Moritz H.
Published: October 2017

Objectives

The aim of this study was to evaluate a prototype dual-energy computed tomography calcium subtraction algorithm and its impact on luminal visualization in patients with heavily calcified coronary arteries.

Materials and Methods

Twenty-nine patients (62% male; mean age, 64 ± 7 years) who had undergone dual-energy coronary computed tomography angiography were retrospectively included in this institutional review board–approved, Health Insurance Portability and Accountability Act–compliant study. Linearly blended (M_0.6) and calcium-subtracted images were reconstructed. Two independent observers assessed luminal visualization of the coronary arteries in a segment-based analysis, subjective image quality, and diagnostic confidence using 5-point Likert scales. Contrast-to-noise ratios for both data sets were calculated. Wilcoxon testing and Cohen's κ were used for statistical comparisons.

Results

Calcium-subtracted image series showed improved lumen visualization of the coronary arteries (P = 0.008), with excellent interreader agreement (mean score, 3.3; κ = 0.82), compared with M_0.6 series (mean score, 2.9; κ = 0.77). The calcium subtraction algorithm improved diagnostic confidence compared with the M_0.6 reconstructions (mean scores, 4.0 and 3.1, respectively; all P ≤ 0.002). The image quality analysis showed no significant differences between calcium-subtracted and M_0.6 data sets (subjectively: mean scores, 4.1 and 4.2, respectively, P = 0.442; objectively: mean contrast-to-noise ratio, 37.0 and 38.2, respectively, P = 0.733).

Conclusions

A prototype algorithm for calcium subtraction improves coronary lumen visualization and diagnostic confidence in patients with heavy coronary calcifications without differences in conventional subjective and objective measures of image quality.
A Novel Combination of Biomarkers to Herald the Onset of Sepsis Prior to the Manifestation of Symptoms
Authors: Dolin Hallie H. , Papadimos Thomas J. , Stepkowski Stanislaw , Chen Xiaohuan , Pan Zhixing K.
Published: October 2017

Sepsis, which kills over 200,000 patients and costs over $20 billion in the United States alone, presents a constant but preventable challenge in the healthcare system. Among the more challenging problems that it presents is misdiagnosis due to conflation with other inflammatory processes, as its mechanisms are identical to those of other inflammatory states. Unfortunately, current biomarker tests can only assess the severity and mortality risk of each case, whereas no single test exists that can predict sepsis prior to the onset of symptoms for the purpose of pre-emptive care and monitoring. We propose that a single test utilizing three, rather than two, biomarkers that appear most quickly in the blood and are the most specific for sepsis rather than trauma, may improve diagnostic accuracy and lead to lessened patient morbidity and mortality. Such a test would vastly improve patient outcomes and quality of life, prevent complications for sepsis survivors, and prevent hospital readmissions, saving the American healthcare system money. This review summarizes the current use of sepsis biomarkers to prognosticate morbidity and mortality, and rejects the current single-biomarker and even combination biomarker tests as non-specific and inaccurate for current patient needs/pro-inflammatory cytokines, general markers of inflammation, and proteins specific to myeloid cells (and therefore to infection) are discussed. Ultimately, the review suggests a three-biomarker test of procalcitonin (PCT), interleukin-6 (IL-6), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) to diagnose sepsis before the onset of symptoms.
Perioperative and Long-term Outcome of the Warshaw Technique in Laparoscopic Spleen-preserving Distal Pancreatectomy
Authors: Suzumura Kazuhiro , Hatano Etsuro , Okada Toshihiro , Fujimoto Jiro
Published: October 2017

Purpose:

The purpose of this study was to compare the safety and outcomes of laparoscopic splenic vessel preservation (Lap-SVP) to those of laparoscopic Warshaw technique (Lap-WT).

Materials and Methods:

Fourteen patients underwent Lap-SVP and 5 patients underwent Lap-WT. Their clinical data and outcomes of the 2 procedures were compared.

Results:

The operative time, intraoperative blood loss, clinically relevant pancreatic fistula, and the rate of splenic infarction were significantly higher in the patients who underwent Lap-WT than in those who underwent Lap-SVP. In both groups, the platelet count ratio and splenic volume ratio at 1 month after the operation did not differ from the preoperative values. Two patients in the Lap-WT group experienced splenic infarction, and could be observed without any treatment.

Conclusions:

The long-term outcome of Lap-WT was relevant. Therefore, Lap-WT could be a treatment option for patients who may not have undergone Lap-SVP.
Systemic Inflammation in Lewy Body Diseases
Authors: King Eleanor , Thomas Alan
Published: October 2017

Few studies have investigated the role of inflammation in Lewy body dementia (LBD) and variable results have been found. We systematically reviewed the literature for evidence of systemic inflammatory changes in dementia with Lewy bodies and Parkinson disease dementia. Owing to the low number of studies we also included Parkinson disease. Key terms were used to search the relevant databases. Titles and abstracts were screened and potentially relevant articles were reviewed in full. References of included studies and relevant reviews were searched. The database search returned 2166 results, 46 of which were finally included in the systematic review. These studies showed a general increase in inflammatory markers in the peripheral blood, most notably interleukin-1β (IL-1β), tumor necrosis factor-α, IL-6, and IL-10. Studies examining cerebrospinal fluid found IL-1β, IL-6, and transforming growth factor-β1 to be particularly increased, and interferon-γ decreased. C-reactive protein levels were increased, particularly in Parkinson disease dementia. These results provide evidence that LBD is associated with an increased inflammatory response. Furthermore, there may be a stronger general inflammatory response in LBD than in Parkinson disease, while complex changes occur in the individual cytokines.
Flexible clock systems: adjusting the temporal programme
Authors: van der Veen Daan R. , Riede Sjaak J. , Heideman Paul D. , Hau Michaela , van der Vinne Vincent , Hut Roelof A.
Published: October 2017

Under natural conditions, many aspects of the abiotic and biotic environment vary with time of day, season or even era, while these conditions are typically kept constant in laboratory settings. The timing information contained within the environment serves as critical timing cues for the internal biological timing system, but how this system drives daily rhythms in behaviour and physiology may also depend on the internal state of the animal. The disparity between timing of these cues in natural and laboratory conditions can result in substantial differences in the scheduling of behaviour and physiology under these conditions. In nature, temporal coordination of biological processes is critical to maximize fitness because they optimize the balance between reproduction, foraging and predation risk. Here we focus on the role of peripheral circadian clocks, and the rhythms that they drive, in enabling adaptive phenotypes. We discuss how reproduction, endocrine activity and metabolism interact with peripheral clocks, and outline the complex phenotypes arising from changes in this system. We conclude that peripheral timing is critical to adaptive plasticity of circadian organization in the field, and that we must abandon standard laboratory conditions to understand the mechanisms that underlie this plasticity which maximizes fitness under natural conditions.

This article is part of the themed issue ‘Wild clocks: integrating chronobiology and ecology to understand timekeeping in free-living animals’.
CLASP stabilizes microtubule plus ends created by serving to drive cortical array reorientation
Authors: Lindeboom Jelmer J. , Nakamura Masayoshi , Saltini Marco , Hibbel Anneke , Walia Ankit , Ketelaar Tijs , Emons Anne Mie C. , Sedbrook John C. , Kirik Viktor , Mulder Bela M. , Ehrhardt David W.
Published: October 2017

Central to building and reorganizing cytoskeletal arrays is the creation of new polymers. While nucleation has been the major focus of study for new microtubule generation, severing has been proposed as an alternative mechanism to create new polymers, a mechanism recently shown to drive the reorientation of cortical arrays of higher plants in response to blue light perception. As severing produces new plus ends behind the stabilizing GTP-cap, an important and unanswered question is how these are stabilizedin vivoto promote net microtubule generation. Here we identify the conserved protein CLASP as a potent stabilizer of new plus ends created by katanin severing and find that CLASP is required for rapid cortical array reorientation. Inclaspmutants both rescue of shrinking plus ends and the regrowth of plus ends immediately after severing are reduced, computational modeling reveals that it is the specific stabilization of severed ends that explains CLASP’s function in promoting microtubule amplification by severing and cortical array reorientation.
Distress feeding of depredatory birds in Sunflower and Sorghum protected by bioacoustics
Authors: Mahesh S.S. , Vasudeva Rao V. , Surender G. , Kiran kumar D.A. , Swamy K.
Published: October 2017

One of the most ignored aspects of bioacoustic technology employed worldwide is lack of understanding between acclimatisation and distress feeding by depredatory birds. Acclimatisation results in gradual increase in resistance to bioacoustics in comparison to distress feeding, which makes sudden surge in instances of feeding by depredatory birds. Acclimatisation and distress feeding are independent functions of feeding behaviour. Distress feeding in itself is a function of physiological conditions of bird, extent of cropped area, distance traveled to obtain food, population dynamics, other natural habitats and cropping pattern in an area and is greatly influenced by them. There are no studies conducted to understand the distress feeding of birds in agricultural landscape. Experiments proved that bioacoustics could offer protection against distress feeding by birds although at reduced efficiency.
Re-Identification of Individuals in Genomic Data-Sharing Beacons via Allele Inference
Authors: Thenen Nora von , Ayday Erman , Ercument Cicek A.
Published: October 2017

Genomic datasets are often associated with sensitive phenotypes. Therefore, the leak of membership information is a major privacy risk. Genomic beacons aim to provide a secure, easy to implement, and standardized interface for data sharing by only allowing yes/no queries on the presence of specific alleles in the dataset. Previously deemed secure against re-identification attacks, beacons were shown to be vulnerable despite their stringent policy. Recent studies have demonstrated that it is possible to determine whether the victim is in the dataset, by repeatedly querying the beacon for his/her single nucleotide polymorphisms (SNPs). In this work, we propose a novel re-identification attack and show that the privacy risk is more serious than previously thought. Using the proposed attack, even if the victim systematically hides informative SNPs (i.e., SNPs with very low minor allele frequency -MAF-), it is possible to infer the alleles at positions of interest as well as the beacon query results with very high confidence. Our method is based on the fact that alleles at different loci are not necessarily independent. We use the linkage disequilibrium and a high-order Markov chain-based algorithm for the inference. We show that in a simulated beacon with 65 individuals from the CEU population, we can infer membership of individuals with 95% confidence with only 5 queries, even when SNPs with MAF less than 0.05 are hidden. This means, we need less than 0.5% of the number of queries that existing works require, to determine beacon membership under the same conditions. We further show that countermeasures such as hiding certain parts of the genome or setting a query budget for the user would fail to protect the privacy of the participants under our adversary model.
Combined analysis of genome sequencing and RNA-motifs reveals novel damaging non-coding mutations in human tumors
Authors: Singh Babita , Trincado Juan L. , Tatlow PJ , Piccolo Stephen R. , Eyras Eduardo
Published: October 2017

A major challenge in cancer research is to determine the biological and clinical significance of somatic mutations in non-coding regions. This has been studied in terms of recurrence, functional impact, and association to individual regulatory sites, but the combinatorial contribution of mutations to common RNA regulatory motifs has not been explored. We developed a new method, MIRA, to perform the first comprehensive study of significantly mutated regions (SMRs) affecting binding sites for RNA-binding proteins (RBPs) in cancer. Extracting signals related to RNA-related selection processes and using RNA sequencing data from the same samples we identified alterations in RNA expression and splicing linked to mutations on RBP binding sites. We found SRSF10 and MBNL1 motifs in introns, HNRPLL motifs at 5’ UTRs, as well as 5’ and 3’ splice-site motifs, among others, with specific mutational patterns that disrupt the motif and impact RNA processing. MIRA facilitates the integrative analysis of multiple genome sites that operate collectively through common RBPs and can aid in the interpretation of non-coding variants in cancer. MIRA is available athttps://github.com/comprna/mira.
Vagal nerve stimulation triggers widespread responses and alters large-scale functional connectivity in the rat brain
Authors: Cao Jiayue , Lu Kun-Han , Powley Terry L. , Liu Zhongming
Published: October 2017

Vagus nerve stimulation (VNS) is a therapy for epilepsy and depression. However, its efficacy varies and its mechanism remains unclear. Prior studies have used functional magnetic resonance imaging (fMRI) to map brain activations with VNS in human brains, but have reported inconsistent findings. The source of inconsistency is likely attributable to the complex temporal characteristics of VNS-evoked fMRI responses that cannot be fully explained by simplified response models in the conventional model-based analysis for activation mapping. To address this issue, we acquired 7-Tesla blood oxygenation level dependent fMRI data from anesthetized Sprague–Dawley rats receiving electrical stimulation at the left cervical vagus nerve. Using spatially independent component analysis, we identified 20 functional brain networks and detected the network-wise activations with VNS in a data-driven manner. Our results showed that VNS activated 15 out of 20 brain networks, and the activated regions covered >76% of the brain volume. The time course of the evoked response was complex and distinct across regions and networks. In addition, VNS altered the strengths and patterns of correlations among brain networks relative to those in the resting state. The most notable changes in network-network interactions were related to the limbic system. Together, such profound and widespread effects of VNS may underlie its unique potential for a wide range of therapeutics to relieve central or peripheral conditions.
An Early Devonian permineralized rhyniopsid from the Battery Point Formation of Gaspé (Canada)
Authors: Pfeiler Kelly C. , Tomescu Alexandru M.F.
Published: October 2017

The Emsian deposits of the Battery Point Formation (GaspéCanada) host the most diverse Early Devonian flora in North America. While most of this diversity has been described from plant compressions, the permineralized component of the flora is incompletely explored. Based on >15 axes studied in serial sections, we describe a new anatomically preserved rhyniopsid from the Battery Point Formation,Eddianna gaspianagen. & sp. nov..Eddiannaaxes are up to 2 mm in diameter and have a well-developed terete xylem strand with potential centrarch maturation (comprising 80% of the cross sectional surface area) that featuresSennicaulis-type tracheid wall thickenings. A thin layer interpreted as phloem is preserved around the central xylem and an irregular sclerenchymatous cortex forms longitudinal anastomosing ridges on the outside of the axes. The anatomy ofEddiannaaxes suggests that they represent lower portions, specialized in efficient water transfer, of a larger plant whose distal regions have yet to be discovered.Eddianna, the first permineralized rhyniopsid described from the Battery Point Formation, is one of only four anatomically preserved plants reported from this unit. These fossils reiterate the potential for additional discoveries of anatomically preserved plants in the Battery Point Formation.