bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhanced Recovery Implementation and Perioperative Outcomes in Posterior Fusion Patients
Authors: Fiasconaro Megan , Wilson Lauren A. , Bekeris Janis , Liu Jiabin , Poeran Jashvant , Soffin Ellen M. , Memtsoudis Stavros G.
Published: March 2020

Study Design.

Retrospective cohort study.

Objective.

We sought to determine if there was an association between enhanced recovery after surgery (ERAS) implementation level and complication risk, length of stay, and cost of hospitalization.

Summary of Background Data.

ERAS protocols aim to minimize the stress response of surgery by promoting early mobilization, oral intake, as well as improvement of analgesia. Implementation of ERAS protocols in spine surgeries has been limited to mostly single-institution studies, and no population-based data exist on the impact of the level of implementation of various ERAS components on outcomes.

Methods.

In this study we identified 265,576 posterior lumbar fusion surgeries from 2006 to 2016. The main effect was the application of eight ERAS-related practices: (1) multimodal analgesia, (2) tranexamic acid, (3) antiemetics, (4) steroids, (5) early physical therapy, (6) avoidance of urinary catheters, (7) avoidance of patient-controlled analgesia, (8) avoidance of wound drains. Patients were classified by levels of ERAS implementation: “High,” “Medium,” and “Low” ERAS implementation if they received more than five, three to five, or less than three ERAS components, respectively. Mixed-effects models measured associations between ERAS implementation categories and complications, length and cost of hospitalization; odds ratios (OR, or average ratios for continuous outcomes), and 99.4% confidence intervals (CI) were reported.

Results.

Overall, 13.3%, 62.8%, and 24.4% of cases were categorized as “High,” “Medium,” and “Low” ERAS implementation, respectively. After adjusting for study variables, “Medium” and “High” (compared with “Low”) ERAS implementation levels were significantly associated with incrementally improved outcomes regarding “any complication” (OR 0.84 CI 0.80–0.88 and OR 0.77 CI 0.71–0.84), cardiopulmonary complications (OR 0.75 CI 0.68–0.73 and OR 0.69 CI 0.59–0.80), length of stay (average ratio 0. 94 CI 0.93–0.94 and average ratio 0.91 CI 0.90–0.91), and hospitalization cost (average ratio 0.99 CI 0.98–0.99 and average ratio OR 0.95 0.95–0.96).

Conclusion.

In a cohort undergoing posterior lumbar spine fusion the level of utilization of ERAS protocol components was independently associated with incrementally improved complication odds as well as reduced length of stay and a small decrease in overall hospitalization cost.

Level of Evidence: 3
Hyperdiluted Calcium Hydroxylapatite 1:2 for Mid and Lower Facial Skin Rejuvenation: Efficacy and Safety
Authors: Rovatti Pier Paolo , Pellacani Giovanni , Guida Stefania
Published: March 2020

BACKGROUND

Diluted/hyperdiluted calcium hydroxylapatite (CaHA) represents an emerging biostimulatory treatment. However, limited data concerning the effects of this agent on the face have been provided so far.

OBJECTIVE

To investigate the efficacy and safety of hyperdiluted CaHA 1:2 treatment for mid and lower face rejuvenation.

PATIENTS AND METHODS

A retrospective study of 40 patients seeking skin rejuvenation for mid and lower face, treated with hyperdiluted CaHA 1:2 technique at baseline (T0), was performed. Patients were classified according to validated scales of aging in the mid to lower face at T0 and efficacy was established with scales calculated again at 4-month post-treatment (T1). In addition, efficacy was assessed by blinded evaluation of T0/T1 clinical pictures, non-invasive skin imaging and patient satisfaction. Safety was assessed through pain scale and minor/major adverse events.

RESULTS

Hyperdiluted CaHA 1:2 successfully decreased aging severity scores of the mid and lower face. Variations of collagen morphology and increased vessel density at T1 were observed with noninvasive skin imaging. Most patients were very satisfied. Mean pain score was low and only minor adverse events were reported.

CONCLUSION

Hyperdiluted CaHA 1:2 technique seems to be effective and safe for mid and lower face skin rejuvenation.
SUPPORT-1 (Subjects Undergoing PCI and Perioperative Reperfusion Treatment): A Prospective, Randomized Trial of CMX-2043 in Patients Undergoing Elective Percutaneous Coronary Intervention
Authors: Tcheng James E. , Gibson Michael , Krucoff Mitchell W. , Patel Manesh R. , Ajit Mullasari , Hiremath Jagdish , Ponde Chandrashekhar , Ramsaran Eddison , Clark Geoffrey , Lader Alan S. , Beeuwkes Reinier ,   on behalf of the SUPPORT-1 Investigators
Published: March 2020

Objective:

The natural molecule α-lipoic acid has been shown to be partially cytoprotective through antioxidant and antiapoptotic mechanisms. To obtain an initial assessment of the safety and potential efficacy of a synthetic derivative, CMX-2043, in preventing ischemic complications of percutaneous coronary intervention (PCI) we conducted the Subjects Undergoing PCI and Perioperative Reperfusion Treatment (SUPPORT-1) trial, the first patient experience with this agent.

Methods and Results:

SUPPORT-1 was a phase 2a, 6-center, international, placebo-controlled, randomized, double-blind trial. A total of 142 patients were randomized to receive a single intravenous bolus dose of drug or placebo administered 15–60 minutes before PCI. Cardiac biomarker assessments included serial measurements of creatine kinase myocardial band (CK-MB) at 6, 12, 18, and 24 hours after PCI and a single measurement of troponin T (TnT) at 24 hours. Peak concentrations of CK-MB and TnT were significantly reduced in the 2.4 mg/kg group compared with placebo (P = 0.05 and 0.03, respectively). No subject administered 2.4 mg/kg of CMX-2043 had an increase of CK-MB to ≥3X upper limit of normal versus 16% for placebo (P = 0.02); 16% of the 2.4-mg/kg dose group developed an elevation of TnT to ≥3X upper limit of normal versus 39% in the placebo group (P = 0.05). No drug-related serious adverse events were observed in any group.

Conclusion:

These data suggest that CMX-2043 may reduce PCI periprocedural myonecrosis and support further clinical evaluation of this novel agent for its potential cytoprotective effects.
Exposure Variability and Target Attainment of Vancomycin: A Systematic Review Comparing Intermittent and Continuous Infusion
Authors: van Maarseveen Erik M. , Gipmans Suzan G. H. , van Zanten Arthur R. H.
Published: March 2020

Background:

Studies comparing the clinical outcomes between vancomycin intermittent infusion (InI) and continuous infusion (CoI) treated patients are generally underpowered. Moreover, due to large differences in the design and efficacy end points in these studies, a meta-analysis of the currently available data is not feasible. Therefore, this systematic review aimed to compare the exposure variability and target attainment with vancomycin during InI and CoI.

Patients and methods:

A literature search was performed, and clinical studies reporting on vancomycin-treated populations were selected. After exclusion of reviews, case reports, and articles not published in the English language, 505 articles were screened for reported data on vancomycin serum concentrations. A total of 34 studies were included in the review. Relative standard deviations reported in the included studies were assessed, and vancomycin serum concentration variability and target attainment were compared between vancomycin InI and CoI.

Results:

The variability in serum concentrations was significantly larger for InI than for CoI (relative standard deviations 46.5% and 32.1%, respectively;P= 0.001). Notably, variability appeared to be independent of the study population or design. Studies directly comparing target attainment between both modes of administration denoted higher and faster target attainment with CoI in all instances.

Conclusions:

In conclusion, CoI was associated with lower variabilities in the serum concentration and favorable target attainment rates compared with InI. These findings are important because vancomycin exposure is considered a major predictor of the patients' clinical outcomes. However, the role of lower serum concentration variability and higher target attainment rates in achieving better clinical outcomes needs to be evaluated in patients treated with vancomycin CoI compared with InI.
Midline catheters: an underutilized means of decreasing central venous catheter use
Authors: Shanja-Grabarz Xhesika , Santoriello Lisa , Ritter Gary , Nicastro Jeffrey , Patel Vihas , Coppa Gene , Barrera Rafael
Published: March 2020

Background:

Central line–associated blood stream infections (CLABSI) remain a substantial source of morbidity and increased health care costs in hospitalized patients. Our aim was to show that by having a dedicated team of physician assistants for the placement of midlines central venous catheters (CVCs), the number of the more typical CVCs placed could be decreased. Patients with difficult peripheral access who were given midlines had a decrease in central line days as well as the number of CVC-associated infections.

Methods:

A retrospective review of data regarding central line days and CLABSI collected from 2009 to 2017 was performed. In that time period, system changes including initiating CVC monitoring and teams who placed these midline venous catheters. Data from January 2016 through December 2017 pertaining to patients in the intensive care unit (ICU) and surgical wards were reviewed, comparing the overall number of CVC and midline catheters placed. Our primary endpoint was decrease in the number of central line days and consequently the number of associated complications in ICU and ward settings.

Results:

Midline catheters were used more often than CVCs and in both the ICU and floor setting. There was a decrease in the number of central-line days and CLABSI that corresponded to hospital system changes, including utilizing a team of trained, designated house staff and physician assistants to monitor central lines and place midline catheters sterilely in patients with difficult peripheral access.

Conclusion:

Our data show that with the implementation of teams to monitor CVCs and to place the midline catheters, the number of midline catheters placed increased, and patients have fewer central line days and fewer central line–associated complications.
A case-based discussion of perioperative care and gender identity: legal, ethical, and philosophical considerations
Authors: Crossley Eleanor J. , Singh Tahwinder
Published: March 2020

Globally estimates suggest 25 million people may identify themselves as transgender, but the literature is scarce regarding the optimal perioperative care of patients who identify as transgender. We discuss the medico-legal issues which were considered during a hospital admission for a 44-year-old transgender patient having day surgery. The issues that arose from this case included whether this patient should be allocated to a male or female postoperative bed, and whom is entitled to make this decision. Pertinent literature and discussions with the patient and health care staff were collated to provide a holistic analysis of the legal and ethical considerations when organizing perioperative care for transgender patients.
Tocol Prophylaxis for Total-body Irradiation: A Proteomic Analysis in Murine Model
Authors: Rosen Elliot , Fatanmi Oluseyi O. , Wise Stephen Y. , Rao V. Ashutosh , Singh Vijay K.
Published: March 2020

The aim of this study was to analyze the changes in mouse jejunum protein expression in response to prophylactic administration of two promising tocols, γ-tocotrienol (GT3) and α-tocopherol succinate (TS), as radiation countermeasures before irradiation to elucidate the molecular mechanism(s) of their radioprotective efficacy. Mice were administered GT3 or TS (200 mg kg−1) subcutaneously 24 h prior to exposure to 11 Gy 60Co γ-radiation, a supralethal dose for mice. Jejunum was harvested 24 h post-irradiation. Results of the two-dimensional differential in-gel electrophoresis (2D-DIGE), coupled with mass spectrometry, and advanced bioinformatics tools suggest that the tocols have a corresponding impact on expression of 13 proteins as identified by mass spectrometry. Ingenuity Pathway Analysis (IPA) reveals a network of associated proteins involved in inflammatory response, organismal injury and abnormalities, and cellular development. Relevant signaling pathways including actin cytoskeleton signaling, RhoA signaling, and Rho family GTPase were identified. This study reveals the major proteins, pathways, and networks involved in preventing the radiation-induced injury in gut that may be contributing to enhanced survival.
Effect of Radiation Dose Rate on Circulatory Disease Mortality among Nuclear Workers: Reanalysis of Hanford Data
Authors: Sasaki Michiya , Kudo Shin’ichi , Furuta Hiroshige
Published: March 2020

The excess relative risk (ERR) of mortality for circulatory disease among nuclear workers was reanalyzed by taking into consideration the annual dose as the dose rate using publicly available epidemiological data of the Hanford site dedicated to the cohort study of nuclear workers in the US, the UK, and Canada. Values of the dose rate (cut-points) were chosen at 2 mSv y−1 intervals from 2 to 40 mSv y−1, and risk estimates were made for 32,988 workers, considering the doses accumulated below and above each cut-point to have different effects. Similarly to that in the previous study for cancer by Sasaki et al., examinations of sensitivity analysis were also carried out for different risk models, lag periods, and impacts of adjusting the monitoring period to find the effect of the dose rate. As a result, emergence of a statistically significant difference between βL1, which is the ERR for the doses accumulated below the specified cut-point, and βH1, which is the ERR for that above the specified cut-point, was observed for cut-point of the dose rate of 4, 6, 34, 36, and 38 mSv y−1. While statistically negative values were estimated for βL1 (4 and 6 mSv y−1) and for βH1 (34, 36, and 38 mSv y−1), the overall relationship between the ERR and the cut-point of the dose rate was found to be similar to that obtained by the analysis of the mortality for all cancers excluding leukemia.
Correlation and Agreement Between Water Drinking Test and Modified Diurnal Tension Curve in Untreated Glaucoma Patients in Nigeria
Authors: Olatunji Olayemi P. , Olawoye Olusola , Ajayi BGK
Published: March 2020

Purpose:

To determine the correlation and agreement between intraocular pressure (IOP) parameters evaluated by the modified diurnal tension curve (mDTC) and the water drinking test (WDT) in primary open-angle glaucoma (POAG) in an indigenous African population.

Materials and Methods:

This was a prospective, interventional, comparative study of 50 newly diagnosed, previously untreated primary open-angle glaucoma patients at the out-patient clinic of the Eleta Eye Institute, Ibadan. A series of IOP measurements were taken 2 hourly (from 7:00 am to 3:00 pm) for the mDTC, using Goldmann applanation tonometer. The WDT was performed thereafter. The patients drank 800 mL of water within 5 minutes, and another series of IOP measurements were taken every 15 minutes for a duration of 1 hour from the moment water was fully ingested. Both the mDTC and the WDT were performed on the same day. IOP peak, mean, and IOP fluctuations were estimated from the data collected. Comparison between the mDTC and the WDT was performed using the paired Student T test for means, Pearson correlation analysis for correlation, and Bland-Altman analysis for agreement.

Results:

Estimated IOP parameters were significantly higher for the WDT than for the mDTC. The average peak IOP was 27.8±4.0 mm Hg during the WDT and 24.9±3.1 mm Hg during the mDTC (P<0.001). The average mean IOP was 25.8±3.6 mm Hg during the WDT and 22.3±2.4 mm Hg during the mDTC (P<0.001). The average IOP fluctuation was higher (6.6±2.9 mm Hg) during the WDT compared with 4.7±2.0 mm Hg during the mDTC. The mean and peak IOPs were strongly correlated between the mDTC (r=0.729, P<0.001) and the WDT (r=0.658, P<0.001). IOP fluctuation, however, showed weak correlation between the mDTC and the WDT (r=0.258, P=0.709).

Conclusions:

There is a strong positive correlation between IOP parameters (peak and mean IOP) estimated from the WDT and the mDTC. The peak and mean IOP can be estimated from the WDT, which is quicker, compared with the mDTC. This is more relevant in low resource settings with limited personnel, time, and resource constraints. In addition, higher IOP values were obtained from the WDT compared with the mDTC, and therefore could serve as a useful practical way to determine target peak in order to optimize IOP control in glaucoma patients.
A Novel Use of Two Prosthetic Concepts for Prosthetic Fitting of a Patient with Charcot-Marie-Tooth-Disease and Multiple Medical Problems
Authors: Baars Erwin C.T. , Olsman Jeroen , Kreulen Anja J.
Published: March 2020

Introduction

This case report describes prosthetic fitting problems in a patient with a short residual limb after a left-sided transtibial amputation as a result of a foot deformity caused by Charcot-Marie-Tooth disease and ipsilateral knee osteoarthrosis.

Materials and Methods

A Kondylen Bettung Munster prosthesis was prescribed with a liner and pin-locking system. Residual limb atrophy and day-to-day volume changes resulted in diminished socket fit, whereas ipsilateral knee osteoarthrosis caused pain during patellar tendon loading resulting in diminished prosthetic use.

Results

A conventional-type prosthesis with thigh corset was prescribed to unload and stabilize the knee. A suction socket system with Seal-In liner and inner slip socket was applied to improve fit and suspension. With this prosthesis, the patient could walk comfortably without walking aids and ride a bicycle.

Conclusion

Prescription of a conventional-type prosthesis with suction socket suspension and inner slip socket demonstrates that combining prosthetic concepts can result in a new prosthetic design fulfilling individual patient needs.
Clinicopathologic Diagnostic Criteria for Vulvar Lichen Planus
Authors: Day Tania , Wilkinson Edward , Rowan Darion , Scurry James
Published: March 2020

Objective

The aim of the study was to describe the clinical and histopathologic features required for a clinicopathologic diagnosis of vulvar lichen planus (LP), which is divided into 3 types: erosive, classic, and hypertrophic.

Materials and Methods

The International Society of the Study of Vulvovaginal Diseases tasked the Difficult Pathologic Diagnoses committee with development of a consensus document for the clinicopathologic diagnosis of vulvar LP, lichen sclerosus, and differentiated vulvar intraepithelial neoplasia. The LP subgroup reviewed the literature and formulated diagnostic criteria, then approved by the International Society of the Study of Vulvovaginal Diseases membership.

Results

The clinicopathologic diagnosis of erosive LP incorporates 5 criteria: (a) a well-demarcated, glazed red macule or patch at labia minora, vestibule, and/or vagina, (b) disease affects hairless skin, mucocutaneous junction, and/or nonkeratinized squamous epithelium, (c) evidence of basal layer damage, categorized as degenerative or regenerative, (d) a closely applied band-like lymphocytic infiltrate, and (e) absent subepithelial sclerosis. The clinicopathologic diagnoses of classic and hypertrophic LP each require a characteristic clinical appearance accompanied by hyperkeratosis, hypergranulosis, acanthosis, basal layer degeneration, a closely applied lymphocytic infiltrate, and absent dermal sclerosis, with hypertrophic LP showing marked epithelial abnormality compared with classic LP.

Conclusions

Clinicopathological correlation yields the most reliable diagnosis of vulvar LP. Disease appearance overlaps with other physiologic, dermatologic, infectious, and neoplastic entities; a low threshold for biopsy at all morphologically distinct areas is recommended. Use of the histopathologic criteria described in this document may reduce the nondiagnostic biopsy rate for clinically diagnosed LP.
Carcinoma in situ of the bladder: why is it underdetected?
Authors: Subiela José D. , Rodríguez Faba Óscar , Guerrero-Ramos Félix , Aumatell Julia , Breda Alberto , Palou Joan
Published: March 2020

Purpose of review

The standard diagnosis of carcinoma in situ (CIS) of the bladder, based on white light cystoscopy and urine cytology, is limited because CIS can vary from normal-appearing mucosa to a lesion indistinguishable from an inflammatory process. Intravesical instillation of Bacillus Calmette–Guerin (BCG) remains first-line therapy; however, a significant proportion of cases persist or recur after BCG treatment. This review summarizes recent improvements in the detection and treatment of CIS.

Recent findings

The new optical technologies improve CIS detection, with a potential positive impact on oncological outcomes. The usefulness of MRI-photodynamic diagnosis fusion transurethral resection in CIS detection is unclear and further studies are needed. BCG instillation remains the first-line therapy in CIS patients and seems to improve recurrence and progression rates, especially with the use of maintenance. Intravesical device-assisted therapies could be effective in both BCG-naïve and BCG-unresponsive CIS patients, but further studies are ongoing to clarify their clinical benefit. A phase II clinical trial with pembrolizumab has shown the potential effectiveness of immune checkpoint inhibitors in BCG-unresponsive CIS patients and further trials are ongoing.

New optical techniques increase the CIS detection rate. BCG instillation remains the first-line treatment. Immune checkpoint inhibitors could be a future alternative in BCG-naïve and BCG-unresponsive CIS patients.
Prevention of Childhood Obesity
Authors: Koletzko Berthold , Fishbein Mark , Lee Way S. , Moreno Luis , Mouane Nezha , Mouzaki Marialena , Verduci Elvira
Published: March 2020

Global childhood obesity increased more than 8‐fold over 40 years, inducing a very large personal, societal, and economic burden. Effects of available treatments are less than satisfactory; therefore, effective prevention is of high priority. In this narrative review, we explore preventive opportunities. The available evidence indicates large benefits of improving nutrition and lifestyle during early life, such as promoting breast‐feeding and improving the quality of infant and early childhood feeding. Promoting healthy eating patterns and limiting sugar‐containing beverage consumption from early childhood onwards are of great benefit. Regular physical activity and limited sedentary lifestyle and screen time alone have limited effects but are valuable elements in effective multicomponent strategies. The home environment is important, particularly for young children, and can be improved by educating and empowering families. School‐ and community‐based interventions can be effective, such as installing water fountains, improving cafeteria menus, and facilitating regular physical activity. Reducing obesogenic risk factors through societal standards is essential for effective prevention and limiting socioeconomic disparity; these may comprise food, drink, and physical activity standards for day cares and schools, general food quality standards, front‐of‐pack food labeling, taxation of unhealthy foods, restriction of food advertisements to children, and others. Effective prevention of childhood obesity is not achieved by single interventions but by integrated multicomponent approaches involving multiple stakeholders that address children, families, and societal standards. Pediatricians and their organizations should be proactive in supporting and empowering families to support their children's health, and in promoting societal measures that protect children.
Refractory and Fatal Presentation of Severe Autoimmune Hemolytic Anemia in a Child With the DNASE1L3 Mutation Complicated With an Additional DOCK8 Variant
Authors: Paç Kisaarslan Aysenur , Witzel Maximilam , Unal Ekrem , Rohlfs Meino , Akyildiz Başaknur , Dogan Muhammet E. , Poyrazoglu Hakan , Klein Christoph , Patiroglu Turkan
Published: March 2020

Various autoimmune diseases may be associated with primary immune deficiencies. We reported a case with a loss-of-function mutation in DNASE1L3, a gene described previously in families with systemic lupus erythematosus. In addition, the patient showed a novel homozygous missense variant in DOCK8, a gene known to be responsible for the hyper-IgE recurrent infection syndrome (HIES). A 3-year-old girl born to consanguine parents presented with chronic urticarial rash, hemolytic anemia, pulmonary hemorrhage, and hypovolemic shock findings. She had a low hemoglobin level, a positive direct antiglobulin test, antinuclear antibody and anti-double stranded DNA, low C3 and C4, third-degree tricuspid regurgitation, and severe enlargement of the right ventricle on echocardiography, suggesting pulmonary embolism. Despite treatment with intravenous immunoglobulin, pulse metilprednisolone, rituximab, and supportive treatment for shock, the patient died on the seventh day. Whole-exome sequencing indicated a homozygous stop variant c.537G>A (p. Trp179Ter) in DNASE1L3. In addition, a possibly pathogenic homozygous missense variant in the HIES gene DOCK8 was detected. The occurrence of potentially clinically relevant, genetic variants in several genes posed various challenges with respect to diagnosis, treatment, and prognosis.
Circulating Tumor DNA Biomarkers for Early Detection of Oligometastasis
Authors: Routman David M. , Chera Bhishamjit S. , Gupta Gaorav P.
Published: March 2020

Oligometastasis represents an intermediate disease stage between localized and widely metastatic cancer. Efficient identification of patients with oligometastasis remains a barrier for accrual on clinical trials of oligometastasis-directed therapy. Here we review the prospect of circulating tumor DNA–based monitoring to promote sensitive, specific, and cost-efficient detection of cancer recurrence during posttreatment surveillance. Thus, an impetus for the development and implementation of clinical-grade circulating tumor DNA assays should be for the positive impact they will have on clinical investigations of oligometastasis-directed therapy.
Prognostic and Predictive Biomarkers in Oligometastatic Disease
Authors: Barnum Kevin J. , Weiss Sarah A.
Published: March 2020

Metastatic lesions are largely responsible for cancer-related deaths and are synonymous with a poor prognosis. However, this is not always true for patients with oligometastases whose disease may be amenable to curative-intent local therapies. It has been proposed that an “intermediate state” (oligometastasis) exists in between locoregional and advanced disease states; however, the clinical definition of oligometastasis varies, and there is limited understanding of how tumor biology differs between oligometastases and polymetastases. There is evidence that local therapies can extend survival in patients with oligometastases, yet patient selection for local intervention and/or systemic therapy remains a challenge. Prognostic and predictive biomarkers of oligometastatic disease are strongly needed to identify patient candidates most likely to gain survival benefit from local therapies and to aid in the incorporation of ablative treatments in the context of existing systemic therapies.
Oligometastatic Disease and Local Therapies
Authors: Hafez Navid , Gettinger Scott
Published: March 2020

Numerous studies in a variety of solid tumor malignancies have demonstrated prolonged progression-free and overall survival with the addition of definitive local therapies to systemic therapies in patients with a limited number of metastases. A subset of patients with oligometastases (1–5 metastases) may experience long-term disease remission or cure after local therapies such as surgery or stereotactic body radiation therapy to metastatic sites. This article reviews the literature in oligometastatic disease and considers a theoretical rationale for a curative approach in a subset of oligometastatic solid tumor patients. In oligometastatic colorectal cancer patients with liver-only metastases and in non–small cell lung cancer patients with disease control after primary therapy and with limited nodal involvement, aggressive local therapies should be considered. Clinical trials and further biomarker validation across disease types are necessary to clarify which subsets of patients may define a theorized “oligometastatic state” and therefore benefit from aggressive local therapies.
Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Active-Duty Service Members Improves Depressive Symptoms
Authors: Roach Alexandra E. , Hines Christopher , Stafford Jane , Mooney Scott
Published: March 2020

Objectives

Current research on the efficacy of repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex as a noninvasive therapy for treatment-resistant depression is largely settled science. However, little is known about its efficacy with active-duty service members (ADSMs) with major depressive disorder. In a retrospective chart review, we examined depressive symptom ratings in ADSMs seeking treatment at the US Army Outpatient Behavioral Health Service Clinic at Eisenhower Army Medical Center, Fort Gordon, Ga.

Methods

We reviewed 121 consecutive outpatient charts, which yielded 61 ADSMs who completed a minimum of 20 rTMS sessions for refractory depression, and for whom both pretreatment and posttreatment depressive symptom ratings were available. Pre– and post–Patient Health Questionnaire 9 (PHQ-9) scores were subjected to a paired t test, and Reliable Change Indices were calculated to determine both reliable and clinical significance.

Results

Average (SD) pretreatment and posttreatment PHQ-9 scores were 15.8 (6.2) and 12.6 (7.6), respectively. Statistically significant reduction in post–PHQ-9 was demonstrated (P < 0.001), with 69% of patients lowering their ratings and 31% demonstrating reliable change (improvement >5.64). Additionally, 20% demonstrated a reliable change that placed them in the nondysfunctional range (post–PHQ-9 <9.6), demonstrating clinical significance.

Conclusions

These data confirm a course of standard rTMS to ADSMs with major depression is promising in reducing depressive symptoms. Given that success and completion rates from this clinic are similar to those reported in civilian populations (80%), rTMS may be an adequate additional treatment or augmentation strategy for refractory depression in ADSMs.
Antioxidant activity and comparative analysis of major functional compounds in liqueur using coffee and coffee-ground
Authors: Kang Jeong Eun , Park Seon Kyeong , Guo Tian Jiao , Kang Jin Yong , Lee Du Sang , Kim Jong Min , Kwon O-Jun , Lee Uk , Heo Ho Jin
Published: March 2020

Sensory evaluation, in vitro antioxidant activities and main compounds of coffee water-extract, coffee liqueur (CL) and coffee-ground liqueur (CGL) were investigated to consider their industrialization. Sensory evaluation showed that all groups of CGL without 25% CGL (3 month) were relatively higher than CL groups. Total phenolic compounds and in vitro antioxidant activities such as 1,1-diphenyl-2picryl-hydrazyl (DPPH) radical scavenging activity and ferric reducing/antioxidant power (FRAP) were also performed. The group of 35% CGL had higher total phenolic compounds than others, and the result of DPPH radical scavenging activity was similar to that of total phenolic compounds. In addition, 35% CGL is comparable to the FRAP of coffee water extract (CE). Qualitative and quantitative analysis using high-performance liquid chromatography (HPLC) were performed, and chlorogenic acid as a ployphenolic compound and caffeine as a nonpolyphenolic compound were detected in all samples. Moreover, the HPLC analysis showed that CGLs contain a larger amounts of chlorogenic acid (difference of 0.3~10.5%) and also greater amounts of caffeine (difference of 10.0~18.2%) more then CE. Consequently, these results suggest that coffee-ground as coffee by-products could be used as commercially available food substances because of its physiological molecules remained.
Effects of low temperature-adapted Saccharomyces cerevisiae Y297 strain and fermentation temperature on the quality characteristics of Yakju
Authors: Seo Dong-Jun , Yeo Soo-Hwan , Mun Ji-Young , Baek Seong Yeol
Published: March 2020

The objective of this study was to evaluate the effects of low temperature-adapted Saccharomyces cerevisiae Y297 and fermentation temperatures on the quality of Yakju brewed. Physicochemical properties of Yakju brewed were compared pH, total acidity, ethanol, free amino acid, organic acid contents, and volatile flavor compounds in S. cerevisiae Y297 with control treatment. Cooked non-glutinous rice and saccharogenic amylase in koji were mixed with ethanol-producing yeasts and then fermented at 15℃, 20℃, and 25℃ for 20 days. Yakju brewed using the Y297 treatment showed the highest ethanol yield (17.9%) at 20℃. Expression of heat shock protein (HSP) 104 was evaluated by immunoblotting as an indication of adaptation to low temperatures (15℃); levels of the HSP104 protein were higher in the Y297 treatment than in the control. Organic acid analysis showed that the lactic acid content of Yakju brewed using the control was the highest at 25℃. Finally, free amino acid analysis showed that the Y297 treatment had a higher proportion of essential amino acids than the control. Overall, these results indicate that S. cerevisiae Y297 could be used as a suitable yeast for Yakju brewed under low temperature (15℃) condition.
Quality characteristics of fermented vinegars using pear
Authors: Park Yeon-Ok
Published: March 2020

Fermented vinegars using pear was compared according to the appled side materials. Quality characteristics of three kinds of the fermented vinegars (pear vinegar, PV; pear black rice vinegar, PBV; pear mint vinegar, PMV) were investigated, which includes pH, total acidity, colors, the contents of sugar, amino acids, total polyphenol, and total flavonoid, ,α‘α-diphenyl-β-pycrylhydrazyl (DPPH) radical scavenging ability, and sensory evaluation. Brown rice vinegar (BRV) was used as a control. The pH and total acidity of the fermented pear vinegars were significantly different showing the range of 3.17~3.43 and 4.01~5.05%, respectively (p<0.05). The sugar contents of PV and PMV were significantly higher than other vinegars (p<0.05). L, a, and b values were the highest in PV, PBV, and PMV, respectively. Among the four vinegars, the essential amino acids were the highest in PV with the order of lysine, isoleucine, valine, and threonine. Besides, the fermented pear vinegars have many non-essential amino acids such as glutamic acid and aspartic acid. The aspartic acid content was the highest in PV while glutamic acid content was the highest in BRV. The total polyphenol content was the highest in PV while total flavonoid content was the highest in PBV. The DPPH radical scavenging ability (%) was the highest in PV. In sensory evaluation, PBV showed the highest color, taste and overall preference scores. These results show that pear would be desirable to prepare high-quality vinegars and functional foods.
Physicochemical and sensory quality characteristics of various rice Jochung products
Authors: Wee Kyung Il , Kang Yoon Han , Lee Keun Taik
Published: March 2020

This study aimed to compare the quality characteristics of developed rice Jochung (E) with those of commercial-rice Jochung (A, B, C, and D). The total soluble solid, reducing sugar, and dextrose equivalent of developed rice Jochung were 80 °Brix, 44.53%, and 56.94%, respectively. The pH and titrable acidity were 6.25 and 0.19%, respectively. The color difference value (ΔE) of developed rice Jochung was 74.42, which was significantly lower than the other samples investigated. The light transmittance and total polyphenol contents of developed rice Jochung were 56.4%T and 108.23 mg GAE/100 g, respectively. The adhesiveness values of various commercial-rice Jochung products were 29.0~66.0 sec, while that of developed-rice Jochung was 61 sec, showing good textural properties for use in manufacturing Hangwa, a Korean traditional cookie. The electron-donating values of various rice Jochung were 20.4~50.3%, among which the developed-rice Jochung showed the highest value. The reducing powers of various rice Jochung products were 0.44~0.72, while that of the developed product was 0.72, which was significantly higher than the other values. Sensory evaluation revealed that the color scores of developed- and commercial-rice Jochung products were 6.70~6.80. Flavor scores of rice Jochung products ranged from 6.00 to 7.00. Taste and mouth feeling scores of developed-rice Jochung did not significantly differ from those of commercial Jochung products. Compared to commercial-rice Jochung products, developed-rice Jochung made with malt extract exhibited high polyphenols content. However, there were no significant differences in the overall acceptability scores between commercial-rice Jochung products and the developed product. The developed-rice Jochung analyzed in this study may be useful as a traditional sweetener for various Hangwa products as a substitute for corn syrup or Jochung.
Effect of fresh chlorella powder on improving qualities and storage condition of organic soybean tofu
Authors: Kim Min-Jeong , Shim Chang-Ki , Kim Yong-Ki , Hong Sung-Jun , Park Jong-Ho , Han Eun-Jung , Kim Seok-Cheol
Published: March 2020

The purpose of this study was to investigate the effect of a fresh chlorella powder on yield, quality and self-life of organic soybean tofu. After added with a fresh chlorella powder, yields, physical properties, color, shelf-life and sensory properties of the organic soybean tofu added with chlorella powder was compared to the properties of soybean tofu. The yield of soybean tofu increased with the addition of more than 1% chlorella powder. Hardness of the organic soybean tofu with chlorella significantly increased compared to that of the soybean tofu. However, Hunter’s color values of L, a, and b decreased by increases in the chlorella powder concentration. Total microbial population of the soybean tofu was higher than that of the organic soybean tofu with chlorella. However, pH of chlorella tofu decreased during storage period at 4℃. After 7 days storage at 4℃, the total microbial population decreased significantly with the addition of 2% chlorella powder. The L and a value of chlorella tofu was increased. On the other hand, the b value of chlorella tofu was decreased during storage. The results revealed that a fresh chlorella powder was a useful material to improve yield, quality and storage condition of the organic soybean tofu.
Physicochemical components of Cynanchi wilfordii Radix fermented with Rhizopus delemar
Authors: Song Bit-Na , Kim Eun-Ju , Jeong Da-Som , Kim So-Young , Cho Yong-Sik , Park Shin-Young
Published: March 2020

This study carried out to determine the physicochemical components of Cynanchi wilfordii Radix (CWR) fermented with Rhizopus delemar. The physicochemical components such as changes on moisture content, pH, total acidity, reducing sugars, and the contents of free sugars, free amino acid, cynandione A were investigated. The moisture content of fermented CWR was increased after 4 days of fermentation. The pH value of fermented CWR was decreased after 4 days of fermentation. The reducing sugars contents were in the range of 1.42-1.69%. The major free sugars were identified as rhamnose, glucose, fructose and sucrose. The content of free sugars was decreased during fermentation process of CWR while the glucose contents in 80% ethanol and water extracts were increased. In addition, the free amino acid increased significantly during fermentation. Finally, The content of cynandion A of the fermented CWR was highest at the level of 14.09 mg/g on the 8th day. These results are indicated that fermentation with Rhizopus strains could be used to increase the bioactivity of CWR and the fermented CWR can be used as a functional material and edible resource in the food industry.
Antioxidant and anti-inflammatory effects of phenolic rich Hylotelephium erythrostictum extracts
Authors: Kim Sang Suk , Park Kyung Jin , Lee Seung Eun , Lee Jeong Hoon , Choi Young Hun
Published: March 2020

Hylotelephium erythrostictum is commonly used as a medicinal herb. In this study, H. erythrostictum leaf (HEL), branch (HEB), root (HER), and above ground (HEAG) extracts were evaluated for their antioxidant properties. The antioxidant activities were assayed by three methods based on scavenging of DPPH, ABTS and superoxide anion radical. HEAG extract showed the highest DPPH, ABTS, superoxide anion radical scavenging activities. HEAG extract also exhibited the highest phenolic content (230 mg/g gallic acid equivalent). In our research for anti-inflammatory ingredients, the extract of HEAG inhibited the generation of nitric oxide (NO) in lipopolysaccharide (LPS)-stimulated RAW264.7 macrophage cells. To test the inhibitory effects of HEAG on pro-inflammatory cytokines, we conducted ELISA assay for the measuring the generation of tumor necrosis factor (TNF)-α, IL (interleukin)-1β, and IL(interleukin)-6 in LPS-stimulated RAW264.7 macrophage cells. In these assays, HEAG ethanol extract showed a dose-dependent decrease in the production of TNF-α, IL-1β, and IL-6. Based on these results, extract of HEAG could be the efficient candidate for anti-inflammatory agents.
Effects of young persimmon fruit powder on rice cookie quality
Authors: Seong Jong-Hwan , Park Han-Sol , Chung Hun-Sik , Kim Dong-Seob , Kim Han-Soo , Lee Young-Guen
Published: March 2020

This study was conducted to develop rice cookies added with young persimmon fruits. Effects of varying amounts (0-12%) of the fruit powder from a young astringent persimmon fruit (picked at July) on the quality characteristics of rice cookies were studied. Ingredients [rice (Oryza sativa subsp. japonica ‘Ilpum’) flours, persimmon (Diospyros kaki Thunb. ‘Cheongdobansi’) powder, sugar, butter, salt, baking powder, egg] were mixed, cut (thickness 3 mm, diameter 35 mm), baked at 170-180°C for 9 min, cooled, and packaged in polyethylene/nylon bags. The loss rate and spread factor after baking of cookies increased and then decreased with an increase in the amount of fruit powder added. The moisture content and color values (L* and a*) of cookies decreased with an increase in the amount of the persimmon powder added. Phenolic compounds content and DPPH radicals scavenging activity increased with an increase in persimmon powder content; in particular, the DPPH activity of the cookies sharply increased after the addition of 3% persimmon powder. These results suggest that the addition of the young persimmon fruit powder affected the quality characteristics of rice cookies and this fruit powder (approximately 3%) can be utilized as an additive during rice cookie processing.
Potential probiotics activity of Bacillus spp. from traditional soybean pastes and fermentation characteristics of Cheonggukjang
Authors: Ryu Myeong Seon , Yang Hee-Jong , Kim Jin Won , Jeong Su-Ji , Jeong Seong-Yeop , Eom Jeong-Seon , Jeong Do-Youn
Published: March 2020

In this study, we tried to screen the Bacillus strain having safety probability by isolation of strains from traditional fermented food, measurement of probiotic properties, and the fermentative characteristics of Cheonggukjang. We isolated 400 Bacillus-like isolates from traditional fermented foods. Selected strains examined on the prevalent characteristic such as extracellular enzyme and antibacterial activities, and their safety probability was confirmed by biogenic amine productivity, hemolytic, and harmful substances and enzyme productivity. We selected the 5 strains by analysis of biogenic amine, antibacterial and B. cereus toxic associated gene. Five selected strains were examined on cell surface hydrophobicity, and bile and acid tolerance, and we selected the SRCM100730 as the final strain. SRCM100730 was confirmed B. amyloliquefaciens by 16S rRNA sequencing, and named the B. amyloloquefaciens SRCM100730 (KCCM11966P). Finally, we manufactured Cheonggukjang using SRCM100730 for confirmation of fermentation properties. Manufactured Cheonggukjang did not contain B. cereus, and showed that γ-PGA and extracellular enzyme activities were superior to commercial Chunggukjang. Amino nitrogen content was 544.02 mg% and 26 free amino acid were detected, and the bitterness-related amino acid content was lower than commercial Cheonggukjang. Especially, the amount of GABA was 3 fold higher than commercial Cheonggukjang. These results suggest that SRCM100730 have high availability in commercial probiotics market and fermented food industry.
Cross-reaction of sera from COVID-19 patients with SARS-CoV assays
Authors: Wan Wei Yee , Seng Eng Hong , Lim Siew Hoon
Published: March 2020

Background

The SARS-CoV-2 shares 74.5% genome identity with SARS-CoV, both exhibiting a similar well conserved structure. Therefore, antibodies produced in COVID-19 and SARS patients should not be that dissimilar. We evaluated SARS-CoV test assays to detect for the presence of antibodies to SARS-CoV-2 and tried to determine the timing of appearance of these antibodies by testing serial sera from these patients.

Methods

Tests were carried out using ELISA (total antibodies) and indirect immunofluorescence (IIFA) (IgM & IgG) methods on serial sera from patients confirmed with SARS-CoV-2 infection.

Results

Cross-reactivity was seen in these two test assays with sera from COVID-19 patients and was detected in 6 out of 7 patients from 7 days after onset of symptoms. Five of the patients had detectable antibodies by the 3rd week into their illness and there was evidence of seroconversion in 4 patients. The IIFA method was marginally more sensitive compared to the ELISA assay, however the IIFA IgM test was not useful in the early phase of the illness with poor sensitivity.

Conclusions

Existing diagnostic assays for SARS-CoV can detect antibodies in patients who were diagnosed with COVID-19. These assays maybe be utilized as an interim measure in epidemiological investigations for contact tracing and to determine the extent of community spread of this new emerging virus pending the availability of specific serology tests for SARS-CoV-2.