bluuebunny/crossref_metadata_2025 huggingface dataset:
Epilepsy Surgeries Requiring an Operculoinsular Cortectomy: Operative Technique and Results
Authors: Bouthillier Alain , Nguyen Dang Khoa
Published: February 2017

BACKGROUND

Epilepsy surgeries requiring an operculoinsulectomy pose significant difficulties because the perisylvian area is highly vascular, deep, and functional.

OBJECTIVE

To report the operative technique and results of epilepsy surgeries requiring an operculoinsular cortectomy at our institution.

METHODS

The data of all consecutive patients who had undergone an epilepsy surgery requiring an operculoinsular cortectomy with a minimum follow-up of 1 yr were reviewed. Tumor and vascular malformation cases were excluded. Surgical techniques are described based on findings during surgery.

RESULTS

Twenty-five patients underwent an epilepsy surgery requiring an operculoinsular cortectomy: mean age at surgery was 35 y (9-51), mean duration of epilepsy was 19 y (5-36), 14 were female, and mean duration of follow-up was 4.7 y (1-16). Magnetic resonance imaging of the operculoinsular area was normal or revealed questionable nonspecific findings in 72% of cases. Investigation with intracranial EEG electrodes was done in 17 patients. Surgery was performed on the dominant side for language in 7 patients. An opercular resection was performed in all but 2 patients who only had an insulectomy. Engel class I seizure control was achieved in 80% of patients. Postoperative neurological deficits (paresis, dysphasia, alteration of taste, smell, hearing, pain, and thermal perceptions) were frequent (75%) but always transient except for 1 patient with persistent mild alteration of thermal and pain perception.

CONCLUSION

Surgical treatment of operculoinsular epilepsy is effective in achieving seizure control and is associated with an acceptable long-term complication rate.
Sex Disparity in Cord Blood FoxP3+ CD4 T Regulatory Cells in Infants Exposed to Malaria In Utero
Authors: Prahl Mary , Jagannathan Prasanna , McIntyre Tara I. , Auma Ann , Wamala Samuel , Nalubega Mayimuna , Musinguzi Kenneth , Naluwu Kate , Sikyoma Esther , Budker Rachel , Odorizzi Pamela , Kakuru Abel , Havlir Diane V. , Kamya Moses R. , Dorsey Grant , Feeney Margaret E.
Published: February 2017

Sex differences in the immune response and in infectious disease susceptibility have been well described, although the mechanisms underlying these differences remain incompletely understood. We evaluated the frequency of cord blood CD4 T cell subsets in a highly malaria-exposed birth cohort of mother-infant pairs in Uganda by sex. We found that frequencies of cord blood regulatory T cell ([Treg] CD4+CD25+FoxP3+CD127lo/−) differed by infant sex, with significantly lower frequencies of Tregs in female than in male neonates (P = .006). When stratified by in utero malaria exposure status, this difference was observed in the exposed, but not in the unexposed infants.
Pelvic-Floor Properties in Women Reporting Urinary Incontinence After Surgery and Radiotherapy for Endometrial Cancer
Authors: Bernard Stéphanie , Moffet Hélène , Plante Marie , Ouellet Marie-Pier , Leblond Jean , Dumoulin Chantale
Published: February 2017

Background. Endometrial cancer is the fourth most prevalent cancer in Canadian women. Radiotherapy (RT) is frequently recommended as an adjuvant treatment. There is a high prevalence (>80%) of urinary incontinence (UI) after RT. It is plausible that UI is associated, at least in part, with alterations of the pelvic-floor muscles (PFM).

Objective. The aim of this exploratory study was to compare the PFM functional properties of women reporting UI after hysterectomy and RT for endometrial cancer with those of women with a history of hysterectomy but without UI.

Design. A descriptive cross-sectional study was conducted. Eleven women were recruited for the affected group, and 18 were recruited for the comparison group.

Methods. Urogenital and bowel functions were assessed using International Consultation on Incontinence Questionnaires, and PFM properties were evaluated using a Montreal dynamometer. Nonparametric tests were used for comparison of personal characteristics, functional status, and muscle properties. A correspondence analysis detailed the association between UI severity and PFM properties.

Results. Maximal opening of dynamometer branches, maximal vaginal length, PFM maximum force and rate of force development in a strength test, and number of rapid contractions during a speed test were reduced in the affected group. No significant difference was found for the endurance test. The severity of UI was found to correspond to the rate of force development and the number of rapid contractions in a speed test, endurance, age, and vaginal length.

Limitations. The results are limited to the population studied. The small sample size limited the strength of the conclusions.

Conclusions. Some evidence of alterations in PFM properties were found in women with UI after hysterectomy and RT for endometrial cancer. These alterations appeared to be associated with UI, suggesting a possible role for rehabilitation.
Spatial mismatch and youth unemployment in US cities: public transportation as a labor market institution
Authors: Brandtner Christof , Lunn Anna , Young Cristobal
Published: February 2017

Spatial mismatch between homes and jobs within a city can create unemployment despite the presence of unfilled jobs. This is especially problematic among young people who have limited transportation options and high rates of joblessness. Car ownership is a possible solution to spatial mismatch, but private vehicles are expensive and involve negative externalities. Public transportation provides an alternative infrastructure that reduces structural unemployment by matching supply and demand. Using longitudinal models of public transportation in the 95 largest US cities between 2000 and 2010, we test whether better public transit services reduce youth unemployment. Public transportation systems can serve as a labor market institution, but there are two worlds of public transportation in American cities. Improvements in public transit are mostly beneficial in cities that are already less dependent on private automobiles. Path dependence in transportation design means that some cities see little benefits to incremental investments in public transit.
Modified Orcinol–Ferric Chloride Colorimetric Assay for Water‐Extractable Arabinoxylan in Wheat
Authors: Hu Gongshe , Ellberg Sherry , Burton Charlotte , Evans Chris , Satterfield Kathy
Published: February 2017

Arabinoxylans are an important quality component for which a simple and rapid analysis method useful for plant breeding needs to be developed. Bial's orcinol–ferric chloride colorimetric method was modified to allow simultaneous analysis of at least 24 samples in a single run and in small volumes to measure water‐extractable arabinoxylan (WEAX) in wheat meal. The modified parameters were reduction to 6N HCl, increased concentrations of orcinol and 10% ferric chloride, and a total volume of 500 µL. The sample turbidity was reduced by rapid cooling in an ice water bath followed by addition of 500 µL of 95% ethanol postincubation. The WEAX results from this protocol were compared with GC/MS values. The wheat varieties of Alta Blanca, Eltan, and Hatton were overestimated by 4.3, 1.5, and 0.9%, respectively, whereas the varieties of Eden, Darwin, Finley, and Boundary were underestimated by 14.4, 8.9, 11.3, and 3.6%, respectively. The modified procedure is useful to determine a range of WEAX concentrations in wheat grains.
Investigating Proteome and Transcriptome Defense Response of Apples Induced by Yarrowia lipolytica
Authors: Zhang Hongyin , Chen Liangliang , Sun Yiwen , Zhao Lina , Zheng Xiangfeng , Yang Qiya , Zhang Xiaoyun
Published: February 2017

A better understanding of the mode of action of postharvest biocontrol agents on fruit surfaces is critical for the advancement of successful implementation of postharvest biocontrol products. This is due to the increasing importance of biological control of postharvest diseases over chemical and other control methods. However, most of the mechanisms involved in biological control remain unknown and need to be explored. Yarrowia lipolytica significantly inhibited blue mold decay of apples caused by Penicillium expansum. The findings also demonstrated that Y. lipolytica stimulated the activities of polyphenoloxidase, peroxidase, chitinase, l-phenylalanine ammonia lyase involved in enhancing defense responses in apple fruit tissue. Proteomic and transcriptomic analysis revealed a total of 35 proteins identified as up- and down-regulated in response to the Y. lipolytica inducement. These proteins were related to defense, biotic stimulus, and stress responses, such as pathogenesis-related proteins and dehydrin. The analysis of the transcriptome results proved that the induced resistance was mediated by a crosstalk between salicylic acid (SA) and ethylene/jasmonate (ET/JA) pathways. Y. lipolytica treatment activated the expression of isochorismate synthase gene in the SA pathway, which up-regulates the expression of PR4 in apple. The expression of 1-aminocyclopropane-1-carboxylate oxidase gene and ET-responsive transcription factors 2 and 4, which are involved in the ET pathway, were also activated. In addition, cytochrome oxidase I, which plays an important role in JA signaling for resistance acquisition, was also activated. However, not all of the genes had a positive effect on the SA and ET/JA signal pathways. As transcriptional repressors in JA signaling, TIFY3B and TIFY11B were triggered by the yeast, but the gene expression levels were relatively low. Taken together, Y. lipolytica induced the SA and ET/JA signal mediating the defense pathways by stimulating defense response genes, such as peroxidase, thaumatin-like protein, and chitinase 4-like, which are involved in defense response in apple.

[Formula: see text] Copyright © 2017 The Author(s) This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Clinical Risk Factors for Preeclampsia Determined in Early Pregnancy: Systematic Review and Meta-Analysis of Large Cohort Studies
Authors: Bartsch Emily , Medcalf Karyn E. , Park Alison L. , Ray Joel G.
Published: February 2017

(BMJ.2016;353:i1753)

Earlier studies have reported the effectiveness of aspirin in preventing preeclampsia in women considered to be at moderate to high risk of developing this disorder. This current study was a meta-analysis of cohort studies examining risk factors for preeclampsia with the goal of estimating early in pregnancy (≤16 wk gestation) a woman’s risk of developing preeclampsia based on the presence of absence of various risk factors. Three practical estimates were generated: the absolute risk of developing preeclampsia in the presence or absence of a given risk factor; the relative risk in the presence or absence of a given risk factor, and the population attributable fraction (PAF) for preeclampsia in relation to each risk factor. On the basis of their analysis, the authors aimed to provide a list of risk factors that could be used to identify those women at high risk for developing preeclampsia.
The Validity of Discharge Billing Codes Reflecting Severe Maternal Morbidity
Authors: Sigakis Matthew J.G. , Leffert Lisa R. , Mirzakhani Hooman , Sharawi Nadir , Rajala Baskar , Callaghan William M. , Kuklina Elena V. , Creanga Andreea A. , Mhyre Jill M. , Bateman Brian T.
Published: February 2017

(Anesth Analg. 2016;123:731–738)

International Classification of Diseases (ICD) codes, which are documented in hospital discharge data, are often used to identify cases of severe maternal complications. However, little is known regarding the validity of their use in this manner. Therefore, the authors of the present study defined the positive predictive value (PPV) of ICD codes used to identify maternal morbidity at 2 academic centers: Massachusetts General Hospital (MGH) and the University of Michigan Health System (UMHS).
Vaginal Progesterone Prophylaxis for Preterm Birth (the OPPTIMUM Study): A Multicentre, Randomised, Double-blind Trial
Authors: Norman Jane Elizabeth , Marlow Neil , Messow Claudia-Martina , Shennan Andrew
Published: February 2017

(Lancet. 2016;387:2106–2116)

In a Cochrane meta-analysis, the administration of vaginal progesterone or intramuscular 17α-hydroxyprogesterone caproate reduced preterm birth in women with a short cervix but had no effect on neonatal mortality. For women with a history of prior preterm birth, the meta-analysis found both preterm birth and neonatal mortality were decreased with this treatment. However, data on prolonged benefit of the therapy as well as effects on the child after the neonatal period are lacking. To this end, a double-blind randomized trial, OPPTIMUM (dOes Progesterone Prophylaxis To prevent preterm labour IMprove oUtcoMe?), was performed to determine the effect of vaginal progesterone prophylaxis on neonatal and childhood outcomes.
Increased Pain Relief With Remifentanil Does Not Improve the Success Rate of External Cephalic Version: A Randomized Controlled Trial
Authors: Burgos Jorge , Pijoan José I. , Osuna Carmen , Cobos Patricia , Rodriguez Leire , Del Mar Centeno María , Serna Rosa , Jimenez Antonia , Garcia Eugenia , Fernandez-Llebrez Luis , Melchor Juan C.
Published: February 2017

(Acta Obstet Gynecol Scand. 2016;95:547–554)

One of the high-risk obstetric conditions is breech presentation, and this condition is usually associated with higher cesarean rates. External cephalic version (ECV) is used to decrease the number of breech presentations at delivery with effective results. However, ECV is a painful maneuver and this pain is said to promote reactive maternal abdominal muscle contraction and involuntary abdominal tensing, reducing the likelihood of successful version and causing some women to reject the technique. The objective of this study was to compare the effect of 2 pain relief methods (remifentanil vs. nitrous oxide) on the success rate of ECV.
Catheter Failure Rates and Time Course With Epidural Versus Combined Spinal-Epidural Analgesia in Labor
Authors: Groden J. , Gonzalez-Fiol A. , Aaronson J. , Sachs A. , Smiley R.
Published: February 2017

(IJOA. 2016;26:4–7)

Combined spinal-epidural (CSE) for labor analgesia is preferred over traditional epidural analgesia by many anesthesiologists.
Patient-controlled Oral Analgesia Versus Nurse-controlled Parenteral Analgesia After Caesarean Section: A Randomized Controlled Trial
Authors: Bonnal A. , Dehon A. , Nagot N. , Macioce V. , Nogue E. , Morau E.
Published: February 2017

(Anaesthesia. 2016;71:535–543)

Multimodal strategies are recommended for postcesarean pain management. A common technique is parenteral analgesic administration followed by a transition to oral medication 24 to 48 hours after surgery. However, other oral regimens have been studied as potential alternatives to address limitations in this present strategy. This current randomized study aimed to assess the effectiveness of early multimodal patient-controlled oral analgesia (PCOA) in comparison with multimodal parenteral analgesia using a noninferiority study design.
A Retrospective Analysis of Adverse Events in Hyperbaric Oxygen Therapy (2012-2015): Lessons Learned From 1.5 Million Treatments
Authors: Jokinen-Gordon Hanna , Barry Richard C. , Watson Beckie , Covington D. Scott
Published: February 2017

OBJECTIVE:

To describe the distribution and occurrence of adverse events recorded during hyperbaric oxygen (HBO) therapy from 2012 to 2015. In this analysis, events are defined as otic/sinus barotrauma, confinement anxiety, hypoglycemia, oxygen toxicity, pneumothorax, seizure, and shortness of breath.

DATA AND ANALYSIS:

The data for the analysis were drawn from a proprietary electronic health data system that contained information on 1,529,859 hyperbaric treatments administered during 53,371 treatment courses from 2012 to 2015 in outpatient wound care centers across the United States managed by Healogics, Inc, Jacksonville, Florida.

RESULTS:

Of the 1.5 million treatments included in the analysis, 0.68% were associated with an adverse event. Barotrauma and confinement anxiety were the most frequently reported events. Medically severe events were extremely uncommon, with fewer than 0.05 instances of oxygen toxicity per 1000 treatments and only 1 confirmed case of pneumothorax.

CONCLUSIONS:

Results indicate that the occurrence of adverse events associated with HBO therapy is infrequent and typically not serious. The findings of this study suggest that when administered according to the appropriate therapeutic protocols HBO therapy is a safe and low-risk intervention.
Adjunctive Azithromycin Prophylaxis for Cesarean Delivery
Authors: Tita Alan T. N. , Szychowski Jeff M. , Boggess Kim , Saade George , Longo Sherri , Clark Erin , Esplin Sean , Cleary Kirsten , Wapner Ron , Letson Kellett , Owens Michelle , Abramovici Adi , Ambalavanan Namasivayam , Cutter Gary , Andrews William
Published: February 2017

(Abstracted from N Engl J Med 2016;375:1231–1241)

Pregnancy-associated infections after cesarean delivery are a significant cause of maternal deaths in the United States. Earlier studies proposed that an azithromycin-based extended-spectrum prophylaxis in combination with standard cephalosporin prophylaxis may reduce the risk of infection following cesarean delivery more than standard prophylaxis alone.
International collaboration including patients is essential to develop new therapies for patients with myositis
Authors: Lundberg Ingrid E. , Vencovsky Jiri
Published: February 2017

Purpose of review

To discuss the needs for international collaborations between investigators in different disciplines working with myositis and with patients with myositis.

Recent findings

Recent advances in detection of several myositis-specific autoantibodies that are associated with distinct clinical phenotypes, will enable studies in new well defined clinically homogenous subgroups of myositis This is likely to lead to development of new information on molecular pathogenesis that might be different in different myositis subgroups. Subgrouping patients according to autoantibody profile may also be important to assess outcome, to identify prognostic biomarkers and in clinical trials. As these are rare disorders international collaboration is essential to enrol large enough cohorts of the subgroups. To facilitate such collaboration we have developed a web-based international myositis register, www.euromyositis.eu, which includes validated outcome measures and patient reported outcome measures. This register is to support research but also to support decision-making in the clinic. We welcome investigators to join the Euromyositis register.

Myositis is a heterogeneous disorder with varying treatment response and outcome. There is a high unmet need for new therapies which can only be achieved by increased knowledge on molecular disease mechanisms. Subgrouping patients according to autoantibody profile may be a new way forward to get a better understanding on disease mechanisms and to develop novel therapies.
Reliable Method for Avoiding Malrotation Deformity After Intramedullary Nailing of Comminuted Femur Fractures: Clinical Validation of a Previously Described Technique
Authors: Sathy Ashoke , Barnwell Jonathan C. , Shahrestani Sean N. , Moore Daniel
Published: February 2017

Objectives:

To evaluate a previously described technique using the inherent anteversion of intramedullary nail (IMN) to avoid malrotation in comminuted femur fractures and describe the use of magnetic resonance imaging (MRI) as an alternative method for assessing postoperative femoral version.

Design:

Prospective consecutive cohort study.

Setting:

Level I trauma center.

Patient/Participants:

Twenty-five consecutive patients with comminuted femur fractures (Winquist III/IV, OTA/AO 32-B/32-C) treated by a single surgeon with IMN between September 1, 2011, and February 28, 2015.

Intervention:

IMN on a fracture table with intraoperative femoral version set by the inherent version of the implant. All patients received a postoperative computed tomography (CT) or MRI to assess femoral version.

Main Outcome Measurements:

Mean difference in postoperative femoral anteversion (DFA) between injured limb and uninjured limb as measured by CT or MRI. Mean difference in postoperative femoral version of the injured femur from the inherent version of the implant (12 degrees) was measured with CT or MRI.

Results:

The mean postoperative DFA was 9.1 ± 5.6 degrees. Postoperative DFA greater than 15 degrees was found in 2 (8.0%) patients. Mean difference in postoperative version of the injured femur from the inherent 12 degrees of the implant was 7.1 ± 5.4 degrees. Patients tolerated MRI studies well.

Conclusions:

Our previously described technique using the inherent anteversion of an IMN is effective and leads to a very low rate of malrotation, even in highly comminuted fractures. The technique is particularly useful in treating bilateral femur fractures. MRI can be used safely and effectively to assess anteversion after fixation of femur fractures.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Does Pelvic Embolization Increase Infection Rates in Patients Who Undergo Open Treatment of Acetabular Fractures?
Authors: Firoozabadi Reza , Little Milton , Alton Timothy , Scoloro John , Agel Julie , Kogut Mathew
Published: February 2017

Objective:

Evaluate the impact of pelvic embolization on postoperative infection rate after acetabular fracture fixation.

Design:

Retrospective study of 3 separate cohorts.

Setting:

Level I Trauma Center.

Patients/Participants:

Identified patients who underwent angiography of the pelvis as well as required an open reduction internal fixation (ORIF) of an acetabular fracture. This group was compared to a control group of patients with an acetabular fracture, which did not undergo angiography, and underwent ORIF.

Intervention:

ORIF of an aectabular fracture with angiography ± embolization.

Main Outcome Measurements:

Deep infection rate.

Results:

Seventy-two patients remained for final analysis; 25 patients underwent embolization, 16 patients underwent angiography without embolization, and 31 patients did not undergo angiography. Two out of 25 (8%) patients developed infections in the embolization group, one deep infection and one superficial infection. Five out of 16 (31%) patients developed deep infections in the nonembolization group. Control group of patients who did not undergo angiography had a deep infection rate of 9.6%.

Conclusion:

Despite previous reports of high infection rates after pelvic embolization, the deep infection rate was only 4% after embolization in our cohort. This suggests that concerns for higher rates of infection are not substantiated, and pelvic embolization should be performed when indicated.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Stepwise Percutaneous Leverage Technique to Avoid Posterior Interosseous Nerve Injury in Pediatric Radial Neck Fracture
Authors: Choi Wan-Sun , Han Kyeong-Jin , Lee Doo-Hyung , Lee Ga-Eun , Kweon Heon-Ju , Cho Jae-Ho
Published: February 2017

Objectives:

To introduce a stepwise percutaneous leverage technique to avoid posterior interosseous nerve (PIN) injury in pediatric patients with radial neck fractures and to evaluate the clinical outcome and the predisposing factors affecting the outcome.

Design:

Retrospective case series study.

Setting:

University level 1 trauma center.

Patients:

Thirty-four children with a radial neck fracture, who were treated using a stepwise percutaneous leverage technique, were included in the study.

Intervention:

The radial head fragment was reduced by pulling the first Steinmann pin proximally as a lever. Then, the kinked soft tissue was released by removal of the Steinmann pin with buttressing the radial head by the operator's thumb. The second Steinmann pin was inserted into relaxed soft tissue for fixation of the radial head.

Main Outcome Measurements:

We used the Métaizeau classification as a radiologic result and Mayo Elbow Performance Score (MEPS) as a clinical outcome. Regression analysis was performed to identify the predisposing factors affecting the outcome.

Results:

There was no occurrence of PIN palsy. According to the Métaizeau classification, 23 cases were classified as excellent, 9 as good, 1 as fair, and 1 as poor. The average MEPS was 97.6 points. Based on the regression analysis, only the postoperative Métaizeau classification was confirmed as a risk factor of a relatively poor outcome.

Conclusions:

The stepwise percutaneous leverage technique can be considered a good option in the treatment of pediatric radial neck fractures, because it ensures excellent results by avoiding injury to soft tissues including the PIN.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Sanders II/III Calcaneus Fractures in Laborers: A Cost-Effectiveness Analysis and Call for Effectiveness Research
Authors: Clement R. Carter , Lang Pamela J. , Pettett Brett J. , Overman Robert A. , Ostrum Robert F. , Tennant Joshua N.
Published: February 2017

Objective:

This study compares the cost and cost-effectiveness of treatments options for Sanders II/III displaced intra-articular calcaneus fractures (DIACFs) in laborers.

Methods:

Literature on Sanders type II and III fractures was reviewed to determine complication rates and utility values for each treatment option. Costs were calculated using Medicare reimbursement and implant prices from our institution. Monte Carlo simulations were used to analyze a decision tree to determine the cost and cost-effectiveness of each treatment from a societal perspective. Sensitivity analysis was performed on all variables.

Results:

Minimally invasive open reduction internal fixation (ORIF) (sinus tarsi approach with 4 screws alone) was least expensive ($23,329), followed by nonoperative care ($24,530) and traditional ORIF using extensile lateral approach ($27,963) (P < 0.001); this result was most sensitive to time out of work. Available cost-effectiveness data were limited, but our analysis suggests that minimally invasive ORIF is a dominant strategy, and traditional ORIF is superior to nonoperative care (incremental cost-effectiveness ratio $57,217/quality-adjusted life year).

Conclusions:

Our findings suggest that minimally invasive ORIF (sinus tarsi approach) is the least expensive option for managing Sanders II/III displaced intra-articular calcaneus fractures, followed by nonoperative care. Our cost-effectiveness results favor operative management but are highly sensitive to utility values and are weakened by scarce utility data. We therefore cannot currently recommend a treatment course based on value, and our primary conclusion must be that more extensive effectiveness research (ie, health-related quality of life data, not just functional outcomes) is desperately needed to elucidate the value of treatment options in this field.

Level of Evidence:

Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
Downregulation of circulating insulin-like growth factor 1 contributes to memory impairment in aged mice after sevoflurane anesthesia
Authors: Jiang Jue , Lv Xiang , Wu Xiaoyang , Yang Yaqiong , Jiang Hong
Published: February 2017

Insulin-like growth factor 1 (IGF-1) is a neuroprotective hormone and a decrease in levels of circulating IGF-1 contributes toward cognitive decline. The aim of this study was to investigate the effect of sevoflurane on the level of circulating IGF-1 and cognitive function in aged mice and the role of circulating IGF-1 in the cognitive dysfunction induced by sevoflurane. Aged mice were exposed to 1 or 2 minimal alveolar concentrations of sevoflurane for 4 or 8 h. Before and after the exposure, blood was collected from the tail vein and serum IGF-1 was measured by an enzyme-linked immunosorbent assay. After exposure, spatial learning and memory were tested in the Morris water maze. An intraperitoneal injection of IGF-1 was used to study the role of IGF-1 in the cognitive impairment induced by sevoflurane. Sevoflurane dose dependently decreased the serum IGF-1 concentration, and resulted in aged mice taking significantly longer and traveling significantly further to find the platform. Sevoflurane significantly decreased the times crossing the platform and %time spent in target quadrant relative to the control group. IGF-1 attenuated this effect, but could not completely reverse it. We conclude that downregulation of circulating IGF-1 contributes toward the cognitive impairment induced by sevoflurane.
Maternal risks of fetal therapy
Authors: Al-Refai Alyaa , Ryan Greg , Van Mieghem Tim
Published: February 2017

Purpose of review

Although most fetal disorders can be treated after birth, a few conditions that predictably lead to fetal or neonatal death, or that progress significantly before birth, are ideally treated prenatally. The number of centers offering fetal therapeutic procedures is gradually increasing worldwide. Patients and caregivers should be aware of the potential maternal risks of these interventions.

Recent findings

For transplacental medical therapy (corticosteroids, antiarrhythmics and immunoglobulins), severe maternal adverse events are rare, when done in expert centers. Minimally invasive procedures carry a risk of maternal complications of about 5%, with 1% being severe complications (pulmonary edema or placental abruption). Open fetal surgery carries important risks to the mother, both in the index pregnancy (pulmonary edema, placental abruption, chorioamnionitis and scar dehiscence) and in subsequent pregnancies (uterine rupture), yet some of these risks are decreasing with surgical refinement and increasing experience of the surgical team.

The information in this manuscript provides a base to counsel expectant mothers on risk of fetal therapy.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN ADULT-ONSET FOVEOMACULAR VITELLIFORM DYSTROPHY
Authors: Joshi Komal M. , Nesper Peter L. , Fawzi Amani A. , Mirza Rukhsana G.
Published: February 2017

Purpose:

To determine the ability of optical coherence tomography angiography (OCTA) to detect choroidal neovascularization (CNV) in the pseudohypopyon stage of adult-onset foveomacular vitelliform dystrophy.

Methods:

Prospective case series of eight consecutive patients with adult-onset foveomacular vitelliform dystrophy with at least one eye in the pseudohypopyon stage (a total of 14 eyes). Patients were assessed with spectral domain OCT, flourescein angiography, and OCTA. Main outcome measures were the presence or absence of CNV and any unifying patterns that could be identified on OCTA for adult-onset foveomacular vitelliform dystrophy.

Results:

One (12.5%) of eight eyes in the pseudohypopyon stage had CNV on OCTA, without definitive evidence of CNV on flourescein angiography. Twelve of 14 eyes (86%) had OCTA segmentation errors, giving the false appearance of deep capillary plexus drop out. All 14 eyes (100%) had blockage of flow signal under the vitelliform lesion on OCTA that presented as artifactual loss of flow in the choriocapillaris.

Conclusion:

Optical coherence tomography angiography may be superior to flourescein angiography in detecting CNV in adult-onset foveomacular vitelliform dystrophy, especially in the pseudohypopyon stage. There are common artifacts that must be considered when analyzing vitelliform lesions with OCTA, including segmentation errors and inability to visualize flow under the vitelliform lesion in the choriocapillaris.
Leveraging information from genetic risk scores of coronary atherosclerosis
Authors: Assimes Themistocles L. , Salfati Elias L. , Del Gobbo Liana C.
Published: February 2017

Purpose of review

Genome-wide association studies (GWAS) have identified ∼60 loci for coronary artery disease (CAD). Through genetic risk scores (GRSs), investigators are leveraging this genomic information to gain insights on both the fundamental mechanisms driving these associations as well as their utility in improving risk prediction.

Recent findings

GRSs of CAD track with the earliest atherosclerosis lesions in the coronary including fatty streaks and uncomplicated raised lesions. In multiple cohort studies, they predict incident CAD events independent of all traditional and lifestyle risk factors. The incorporation of SNPs with suggestive but not genome-wide association in GWAS into GRSs often increases the strength of these associations. GRS may also predict recurrent events and identify patients most likely to respond to statins. The effect of the GRS on discrimination metrics remains modest but the minimal degree of improvement needed for clinical utility is unknown.

Most novel loci for CAD identified through GWAS facilitate the formation of coronary atherosclerosis and stratify individuals based on their underlying burden of coronary atherosclerosis. GRSs may one day be routinely used in clinical practice to not only assess the risk of incident events but also to predict who will respond best to established prevention strategies.
F‐calprotectin and Blood Markers Correlate to Quality of Life in Pediatric Inflammatory Bowel Disease
Authors: Carlsen Katrine , Jakobsen Christian , Kallemose Thomas , Paerregaard Anders , Riis Lene B. , Munkholm Pia , Wewer Vibeke
Published: February 2017

Objectives:

Our aim was to investigate predictors of health‐related quality of life (HRQoL) with respect to changes in disease parameters over time in children with inflammatory bowel disease.

Methods:

This was a prospective longitudinal study examining the association between HRQoL (IMPACT III) and symptom scores (Pediatric Crohn Disease Activity Index, abbreviated Pediatric Ulcerative Colitis Activity Index), fecal calprotectin measures and blood analyses (C‐reactive protein, erythrocyte sedimentation rate, orosomucoid, albumin, hemoglobin, and vitamin‐D) in a cohort of 10‐ to 17‐year‐old patients with inflammatory bowel disease. Data were collected prospectively at 3‐month intervals during a 2‐year period. Associations were analyzed using linear mixed‐effect models. Patients were divided into 2 groups, which received nonbiological oral treatment or biological parenteral treatment.

Results:

From 79 patients (39 Crohn disease/40 ulcerative colitis), representing a total of 43,132 days of observation, 572 IMPACT measurements were paired with variables. A decrease in the IMPACT III score was significantly associated with increased ulcerative colitis‐symptom score in the biological group (P = 0.005), and a similar inverse tendency was found in the nonbiological group and for Crohn disease symptoms in both groups. We found in both treatment groups overall a significant (P < 0.05) inverse association between the IMPACT III and the levels of fecal calprotectin, erythrocyte sedimentation rate, and orosomucoid, whereas albumin, hemoglobin, and vitamin‐D were directly significantly associated.

Conclusions:

The IMPACT score, already known to correlate with disease activity, has now been shown to be associated with disease markers in feces and blood. This emphasizes that objective markers of disease activity indirectly can predict the patient's HRQoL.
Travel During Pregnancy: Considerations for the Obstetric Provider
Authors: Antony Kathleen M. , Ehrenthal Deborah , Evensen Ann , Iruretagoyena J. Igor
Published: February 2017

Importance

Travel among US citizens is becoming increasingly common, and travel during pregnancy is also speculated to be increasingly common. During pregnancy, the obstetric provider may be the first or only clinician approached with questions regarding travel.

Objective

In this review, we discuss the reasons women travel during pregnancy, medical considerations for long-haul air travel, destination-specific medical complications, and precautions for pregnant women to take both before travel and while abroad. To improve the quality of pretravel counseling for patients before or during pregnancy, we have created 2 tools: a guide for assessing the pregnant patient’s risk during travel and a pretravel checklist for the obstetric provider.

Evidence Acquisition

A PubMed search for English-language publications about travel during pregnancy was performed using the search terms “travel” and “pregnancy” and was limited to those published since the year 2000. Studies on subtopics were not limited by year of publication.

Results

Eight review articles were identified. Three additional studies that analyzed data from travel clinics were found, and 2 studies reported on the frequency of international travel during pregnancy. Additional publications addressed air travel during pregnancy (10 reviews, 16 studies), high-altitude travel during pregnancy (5 reviews, 5 studies), and destination-specific illnesses in pregnant travelers.

Conclusions and Relevance

Travel during pregnancy including international travel is common. Pregnant travelers have unique travel-related and destination-specific risks. We review those risks and provide tools for obstetric providers to use in counseling pregnant travelers.

Target Audience

Obstetricians and gynecologists, family physicians, and midwives.

Learning Objectives

After completing this activity, the learner should be better able to ask appropriate questions of women who are planning travel during pregnancy; understand the increased risks borne by pregnant women who travel, especially to locations with limited medical resources and/or high rates of foodborne, waterborne, or mosquito-borne illnesses; counsel women about precautions regarding air travel including reducing risk of venous thromboembolism; and counsel women about destination-specific risks or feel empowered to refer women to travel clinics for patients with comorbidities, planning travel to high-risk destinations, or who require immunizations not used for routine vaccination of US patients.
Lateral Asymmetric Decubitus Position for the Rotation of Occipitoposterior Positions: Multicenter Randomized Controlled Trial EVADELA
Authors: Le Ray Camille , Lepleux Flavie , de la Calle Aurélie , Guerin Jessy , Sellam Nathalie , Dreyfus Michel , Chantry Anne A.
Published: February 2017

(Abstracted from Am J Obstet Gynecol 2016;215:511.e1–511.e7)

Approximately 20% of fetal positions during labor and approximately 5% of fetal positions during delivery are occiput posterior (OP), which is associated with high cesarean delivery rates and severe perineal lacerations. The hypothesis of this study was that the maternal lateral asymmetric decubitus (LAD) posture favored fetal head flexion during uterine contractions.
Selfish Drive Can Trump Function When Animal Mitochondrial Genomes Compete
Authors: Ma Hansong , O’Farrell Patrick H.
Published: February 2017

(Abstracted from Nat Genet 2016;48:798–802)

Natural selection favors traits in organisms that enhance fitness and survival. Nuclear genes contain a mixture of both maternal and paternal DNA, whereas mitochondrial genes are inherited unilaterally from the maternal side.
Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy
Authors: Massaro An N. , Campbell Heather E. , Metzler Marina , Al-Shargabi Tareq , Wang Yunfei , du Plessis Adre , Govindan Rathinaswamy B.
Published: February 2017

Objective:

To determine whether measures of heart rate variability are related to changes in temperature during rewarming after therapeutic hypothermia for hypoxic-ischemic encephalopathy.

Design:

Prospective observational study.

Setting:

Level 4 neonatal ICU in a free-standing academic children’s hospital.

Patients:

Forty-four infants with moderate to severe hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.

Interventions:

Continuous electrocardiogram data from 2 hours prior to rewarming through 2 hours after completion of rewarming (up to 10 hr) were analyzed.

Measurements and Main Results:

Median beat-to-beat interval and measures of heart rate variability were quantified including beat-to-beat interval sd, low and high frequency relative spectral power, detrended fluctuation analysis short and long α exponents (αS and αL), and root mean square short and long time scales. The relationships between heart rate variability measures and esophageal/axillary temperatures were evaluated. Heart rate variability measures low frequency, αS, and root mean square short and long time scales were negatively associated, whereas αL was positively associated, with temperature (p < 0.01). These findings signify an overall decrease in heart rate variability as temperature increased toward normothermia.

Conclusions:

Measures of heart rate variability are temperature dependent in the range of therapeutic hypothermia to normothermia. Core body temperature needs to be considered when evaluating heart rate variability metrics as potential physiologic biomarkers of illness severity in hypoxic-ischemic encephalopathy infants undergoing therapeutic hypothermia.
Brief Report: Changes in Levels of Inflammation After Antiretroviral Treatment During Early HIV Infection in AIDS Clinical Trials Group Study A5217
Authors: Macatangay Bernard J. , Yang Ming , Sun Xin , Morton Jessica , De Gruttola Victor , Little Susan , Hogan Christine , Rinaldo Charles R. ,   for the A5217 Team
Published: February 2017

Background:

We evaluated the changes in the levels of soluble biomarkers of inflammation and coagulation and T-cell activation among participants of AIDS Clinical Trials Group Study A5217 who were started on antiretroviral therapy (ART) within the first 6 months of HIV infection.

Methods:

Cryopreserved specimens were obtained pre-ART (week 0), at the time of virologic suppression (week 36), and at 36 weeks after treatment interruption (week 72). Levels of D-dimer, C-reactive protein (CRP), and soluble CD14 (sCD14) were measured in plasma, whereas T-cell activation levels, defined as the frequencies of CD4+ and CD8+ T cells coexpressing HLA-DR and CD38, were measured in peripheral blood mononuclear cells.

Results:

D-dimer levels were significantly lower at viral suppression (P = 0.031), whereas CRP and sCD14 levels remained similar to pre-ART levels. At viral suppression, levels of the soluble markers did not correlate with each other. CD4+ T-cell counts pre-ART tended to modestly correlate with levels of D-dimer (r = 0.35; P = 0.058) and CRP (r = 0.33; P = 0.078). At 36 weeks after treatment interruption (week 72), D-dimer levels returned back to pre-ART levels. However, CD8+ T-cell activation was significantly lower than pre-ART levels (35.8% at week 0 vs 28.9% at week 72; P = 0.004).

Conclusions:

Among the A5217 participants who started ART within the first 6 months of HIV infection, high levels of sCD14 and CRP remain similar to pre-ART levels, suggesting that immune damage occurring in the initial stages of infection persists despite short-term virologic suppression.
Cross-modal recognition of familiar conspecifics in goats
Authors: Pitcher Benjamin J. , Briefer Elodie F. , Baciadonna Luigi , McElligott Alan G.
Published: February 2017

When identifying other individuals, animals may match current cues with stored information about that individual from the same sensory modality. Animals may also be able to combine current information with previously acquired information from other sensory modalities, indicating that they possess complex cognitive templates of individuals that are independent of modality. We investigated whether goats (
Capra hircus
) possess cross-modal representations (auditory–visual) of conspecifics. We presented subjects with recorded conspecific calls broadcast equidistant between two individuals, one of which was the caller. We found that, when presented with a stablemate and another herd member, goats looked towards the caller sooner and for longer than the non-caller, regardless of caller identity. By contrast, when choosing between two herd members, other than their stablemate, goats did not show a preference to look towards the caller. Goats show cross-modal recognition of close social partners, but not of less familiar herd members. Goats may employ inferential reasoning when identifying conspecifics, potentially facilitating individual identification based on incomplete information. Understanding the prevalence of cross-modal recognition and the degree to which different sensory modalities are integrated provides insight into how animals learn about other individuals, and the evolution of animal communication.
Elasticity improves handgrip performance and user experience during visuomotor control
Authors: Mace Michael , Rinne Paul , Liardon Jean-Luc , Uhomoibhi Catherine , Bentley Paul , Burdet Etienne
Published: February 2017

Passive rehabilitation devices, providing motivation and feedback, potentially offer an automated and low-cost therapy method, and can be used as simple human–machine interfaces. Here, we ask whether there is any advantage for a hand-training device to be elastic, as opposed to rigid, in terms of performance and preference. To address this question, we have developed a highly sensitive and portable digital handgrip, promoting independent and repetitive rehabilitation of grasp function based around a novel elastic force and position sensing structure. A usability study was performed on 66 healthy subjects to assess the effect of elastic versus rigid handgrip control during various visuomotor tracking tasks. The results indicate that, for tasks relying either on feedforward or on feedback control, novice users perform significantly better with the elastic handgrip, compared with the rigid equivalent (11% relative improvement, 9–14% mean range;
p
 < 0.01). Furthermore, there was a threefold increase in the number of subjects who preferred elastic compared with rigid handgrip interaction. Our results suggest that device compliance is an important design consideration for grip training devices.
NoRMCorre: An online algorithm for piecewise rigid motion correction of calcium imaging data
Authors: Pnevmatikakis Eftychios A. , Giovannucci Andrea
Published: February 2017

Background

Motion correction is a challenging pre-processing problem that arises early in the analysis pipeline of calcium imaging data sequences. The motion artifacts in two-photon microscopy recordings can be non-rigid, arising from the finite time of raster scanning and non-uniform deformations of the brain medium.

New method

We introduce an algorithm for fast Non-Rigid Motion Correction (NoRMCorre) based on template matching. NoRMCorre operates by splitting the field of view into overlapping spatial patches that are registered at a sub-pixel resolution for rigid translation against a continuously updated template. The estimated alignments are subsequently up-sampled to create a smooth motion field for each frame that can efficiently approximate non-rigid motion in a piecewise-rigid manner.

Existing methods

Existing approaches either do not scale well in terms of computational performance or are targeted to motion artifacts arising from low speed scanning, whereas modern datasets with large field of view are more prone to non-rigid brain deformation issues.

Results

NoRMCorre can be run in an online mode resulting in comparable to or even faster than real time motion registration on streaming data. We evaluate the performance of the proposed method with simple yet intuitive metrics and compare against other non-rigid registration methods on two-photon calcium imaging datasets. Open source Matlab and Python code is also made available.

Conclusions

The proposed method and code provide valuable support to the community for solving large scale image registration problems in calcium imaging, especially when non-rigid deformations are present in the acquired data.