bluuebunny/crossref_metadata_2025 huggingface dataset:
Lung transplantation in scleroderma: recent advances and lessons
Authors: Jablonski Renea , Dematte Jane , Bhorade Sangeeta
Published: August 2018

Purpose of review

The purpose of this review is to highlight recent data regarding feasibility and outcomes following lung transplantation for patients with systemic sclerosis related pulmonary disease as well as to emphasize areas of uncertainly in need of further study. We include a description of our centre's approach to lung transplant evaluation and posttransplant management in this complex patient population.

Recent findings

Historical data have demonstrated that patients with scleroderma have an increased risk of complications following lung transplantation owing to the multisystem nature of disease, particularly concurrent gastrointestinal, cardiac and renal involvement. Emerging data support the safety of lung transplant in appropriately selected patients with scleroderma-related interstitial lung disease and pulmonary arterial hypertension.

Accumulating evidence validates that a diagnosis of scleroderma is not a priori a contraindication to lung transplant. In the carefully selected patient, both short-term and long-term outcomes following lung transplantation are comparable to counterparts with fibrotic lung disease or pulmonary arterial hypertension. However, further prospective study to detail how these patients should be evaluated and managed posttransplant is definitely needed. Cardiac disease is an emerging cause of morbidity and mortality in the scleroderma population and deserves particular attention during the pre and posttransplant period.
Impact of Cardiac Resynchronization Therapy on Daily Physical Activity in Heart Failure Patients
Authors: Gad Sandra AbdelGawad , Martin Sylvia , Kimber Shane , Williams Randy , Gulamhusein Sajad , Lockwood Evan , Haennel Robert G.
Published: August 2018

Purpose:

Cardiac resynchronization therapy (CRT) has emerged as a beneficial therapy for heart failure (HF) patients. It has been shown to enhance cardiac pump function and increase exercise capacity in patients with HF who display wide QRS complex on their electrocardiogram. To date, few studies have assessed daily physical activity (PA) in CRT patients. The objective of this pilot study was to assess the impact of CRT on the physical function and daily PA of HF patients who met the standard indications for CRT implantation.

Methods:

The daily PA of 18 CRT patients was measured using a SenseWear Armband for ∼3 d. Daily PA measurements included steps/d and time spent sedentary (≤1.5 metabolic equivalent tasks), in light PA (1.6-2.9 metabolic equivalent tasks), and in moderate-vigorous PA (≥3 metabolic equivalent tasks). To assess exercise capacity, a 6-min walk test was performed pre- and post-CRT.

Results:

There was no significant change in the 6-min walk test distance from pre- to post-CRT (383 ± 99 m at baseline vs 402 ± 104 m post-CRT). There was a decrease in total steps/d from 3405 ± 2334 pre-CRT to 2553 ± 1692 post-CRT (P = .017). Furthermore, no significant changes were observed pre- to post-CRT with regard to the additional PA assessments.

Conclusions:

Our patients exhibited a sedentary lifestyle pre- and post-CRT. These findings underscore the need for a cardiac rehabilitation program that encourages post-CRT patients to decrease sedentary time.
PERSISTENT PLACOID MACULOPATHY IN A PATIENT WITH HIGH MYOPIA
Authors: Kolomeyer Anton M. , Brucker Alexander J.
Published: August 2018

Purpose:

To describe a case of persistent placoid maculopathy in a patient with high myopia.

Methods:

Interventional case report.

Results:

A 59-year-old white man with high myopia presented with blurriness in the left eye. Vision was 20/20 bilaterally. Optical coherence tomography showed subretinal thickening and fluid without definitive leakage on fluorescein angiography after which anti–vascular endothelial growth factor (anti-VEGF) therapy was initiated. The patient was diagnosed with persistent placoid maculopathy based on multimodal imaging and clinical response. His disease course was characterized by multiple bilateral recurrences despite active treatment. At final visit (23 months after presentation), the vision was 20/20 in the right eye and 20/25 in the left eye, and the disease remained quiescent on immunomodulating therapy.

Conclusion:

Prompt initiation of anti-VEGF injections and immunosuppression resulted in disease control and preservation of vision in both eyes for almost 2 years.
The Role of Ocular Response Analyzer in Differentiation of Forme Fruste Keratoconus From Corneal Astigmatism
Authors: Kirgiz Ahmet , Karaman Erdur Sevil , Atalay Kursat , Gurez Ceren
Published: August 2018

Purpose:

To determine the diagnostic accuracy of corneal biomechanical factors in differentiating patients with forme fruste keratoconus (FFKC) from astigmatic and normal cases.

Methods:

A total of 50 eyes with FFKC, 50 with astigmatism and 50 normal eyes, were included in this study. All patients had a detailed ophthalmologic examination including slit-lamp evaluation, Goldmann tonometry, indirect fundoscopy, topography by Scheimpflug imaging biomicroscopic anterior and posterior segment examination, and corneal biomechanical and intraocular pressure evaluation with ocular response analyzer (ORA).

Results:

All topographic findings were statistically significant among the three groups (P>0.05). Although there was no statistically significant difference in the corneal-compensated intraocular pressure (IOPcc) among the three groups, the Goldmann-correlated intraocular pressure (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF) were statistically significantly lower in the FFKC group, compared with the other groups (P<0.001). There were no statistically significant difference in the IOPg, CH, and CRF between astigmatism and control groups (P=0.99, 0.79, and 0.86, respectively). The area under the receiver operating characteristic (AUROC) curve was greater than 0.85 for IOPg (0.80), CH (0.85), and CRF (0.90) for discriminating between FFKC and controls; whereas the AUROC was greater than 0.85 for IOPg (0.80), CH (0.79), and CRF (0.85) for discriminating between FFKC and astigmatism groups.

Conclusion:

Based on our study results, in differentiation of patients with FFKC from normal control cases or astigmatic patients, corneal biomechanical parameters play a role particularly in patients with suspicious results. We suggest using ORA in combination with corneal topography for better and more accurate diagnosis of FFKC.
Multicenter Assessment of Grafts in Coronaries
Authors: Balkhy Husam H. , Patel Nirav C. , Ramshandani Mahesh , Kitahara Hiroto , Subramanian Valavunar A. , Augelli Nicholas V. , Tobler Gareth , Cai Tung H. ,   for the MAGIC Study Investigators
Published: August 2018

Objective

The commercially available C-Port distal anastomotic device (Food and Drug Administration cleared in 2007) is an automated miniature vascular stapler that performs the coronary anastomosis. This prospective multicenter registry sought to evaluate midterm patency using this device compared with hand-sewn grafts.

Methods

Patients receiving at least one C-Port anastomosis during coronary artery bypass grafting surgery were enrolled at eight sites. Of the 117 patients enrolled, 78 patients (67%) with 104 C-Port vein grafts completed the study to patency assessment via computed tomography angiography. Clinical follow-up and index graft patency (Gated 64-slice computed tomography scan) were performed at least 12 months postoperatively. The primary efficacy endpoint was patency compared with the peer-reviewed results from the PRoject of Ex-vivo Vein graft ENgineering via Transfection IV (PREVENT IV) trial.

Results

The patient population was consistent with the PREVENT IV placebo cohort. The mortality at 12 months was 0.85% (1/117). The major cardiac morbidity rate was 3.4% (4/117). The C-Port vein graft occlusion rate was 16.3% (17/104) compared with 26.6% (597/2242) in the PREVENT IV trial ( P = 0.011). Within this study, C-Port graft occlusion rates were not significantly different from the hand-sewn grafts ( P = 0.821).

Conclusions

The C-Port device is safe and effective in creating the distal anastomosis with equivalent patency rates to hand-sewn grafts at 12 months. When compared with hand-sewn anastomoses from a recent large prospective trial, the C-Port device demonstrated a statistically significant reduction in midterm graft occlusion. Further studies are required to evaluate its effect in less invasive coronary surgery.
Outcomes of Impella 5.0 in Cardiogenic Shock
Authors: Batsides George , Massaro Joe , Cheung Anson , Soltesz Edward , Ramzy Danny , Anderson Mark B.
Published: August 2018

Objective

The aim of the study was to comprehensively summarize the survival outcomes and complications of Impella 5.0 (Abiomed Inc, Danvers, MA USA) use in patients with cardiogenic shock (CS).

Methods

We performed a literature review for relevant studies by searching in Medline, Medline In-Process, EMBASE, and the CENTRAL bibliographic databases on April 30, 2017. Nonoverlapping studies with 10 patients or more supported for cardiogenic shock with Impella 5.0 or Impella left direct were included. Data on patient characteristics, indication of support, and outcomes were extracted. A random effect was used to pool the various outcomes.

Results

This meta-analysis included six studies totaling 163 patients (mean ± SD age = 56.3 ± 12.0, male 81%). Indications for support included 88 (54.0%) for acute on chronic decompensated heart failure, 35 (21.5%) for postcardiotomy cardiogenic shock, 27 (16.6%) for acute myocardial infarction complicated by cardiogenic shock, and, 13 (8.0%) for cardiogenic shock due to other reasons. Survival to next therapy was 73.5% in patients supported for acute on chronic decompensated heart failure. The survival to device explant among patients supported for postcardiotomy cardiogenic shock or acute myocardial infarction complicated by cardiogenic shock was 90.2%, and of those, myocardial recovery was achieved in 73.8%. The overall estimated survival to discharge, 30, 180, and 365 days was 73.5%, 72.6%, 62.7%, and 58.4%, respectively. Patients supported for postcardiotomy cardiogenic shock had the highest heart recovery among survivors to explant (92.1%) and highest survival at 30 (89.5%) and 365 days (69.5%).

Conclusions

Impella 5.0/LD is associated with favorable survival outcomes and higher rate of myocardial recovery in patients with cardiogenic shock.
Minimally Invasive versus Full-Sternotomy Septal Myectomy for Hypertrophic Cardiomyopathy
Authors: Musharbash Farah N. , Schill Matthew R. , Hansalia Vivek H. , Schuessler Richard B. , Leidenfrost Jeremy E. , Melby Spencer J. , Damiano Ralph J.
Published: August 2018

Objective

Septal myectomy remains the criterion standard for the treatment of patients with hypertrophic obstructive cardiomyopathy refractory to medical therapy. There have been few reports of minimally invasive approaches. This study compared a minimally invasive septal myectomy performed at our institution with the traditional full-sternotomy approach.

Methods

Patients receiving a stand-alone septal myectomy were retrospectively reviewed from November 1999 to December 2016 (N = 120). Patients were stratified by surgical approach: traditional full sternotomy (n = 34) and ministernotomy (n = 86). Preoperative and perioperative variables were compared as well as follow-up symptomatic and echocardiographic outcomes.

Results

Both groups had a significant decrease in New York Heart Association class heart failure symptoms ( P < 0.001). At a mean ± SD follow-up time of 2.0 ± 3.4 years, postoperative New York Heart Association class distribution was similar between ministernotomy and full sternotomy ( P = 0.684). Follow-up resting left ventricular outflow tract gradient was also similar between ministernotomy and full sternotomy (11 mm Hg ± 15 vs 9 mm Hg ± 13, P = 0.381). Perioperatively, ministernotomy was not significantly different from full sternotomy in median cardiopulmonary bypass time (81 minutes vs 78 minutes, P = 0.101) but had a slightly longer median cross-clamp time (39 minutes vs 35 minutes, P = 0.017). Major complications were similar in the two groups. There was one 30-day mortality in the full-sternotomy group, but no in-hospital deaths.

Conclusions

Septal myectomy performed using a minimally invasive approach has similar outcomes to the criterion standard operation done through a full sternotomy. It represents a feasible option for patients with hypertrophic obstructive cardiomyopathy unresponsive to medications.
Geometric Ring Annuloplasty for Aortic Valve Repair during Aortic Aneurysm Surgery
Authors: Rankin J. Scott , Mazzitelli Domenico , Fischlein Theodor , Choi Yeong-Hoon , Pirk Jan , Pfeiffer Steffen , Wei Lawrence M. , Badhwar Vinay
Published: August 2018

Objective

An aortic annuloplasty ring could be useful for aortic valve repair. This trial evaluated intermediate-term outcomes of internal geometric ring annuloplasty for repair of trileaflet and bicuspid aortic insufficiency associated with ascending aortic and/or aortic root aneurysms.

Methods

Under regulatory supervision, 47 patients with aortic insufficiency and ascending aortic (n = 22) and/or aortic root (n = 25) aneurysms were managed with aortic valve repair and aneurysm resection. Valve repair was performed using trileaflet (n = 40) or bicuspid (n = 7) internal geometric rings, together with leaflet reconstruction. Ascending aortic and/or remodeling root replacements were accomplished with Dacron grafts 5 to 7 mm larger than the rings. An Echo Core Lab provided independent echocardiographic assessments, and changes over time were evaluated by Friedman tests.

Results

Mean ± SD age was 60 ± 14 years, 57% (27/47) were male, 15% (7/47) had bicuspid valves, 87% (41/47) had moderate-to-severe aortic insufficiency, and 13% (6/47) had mild aortic insufficiency. All patients had annular dilatation, with a mean ± SD of 26.5 ± 2.6 mm before repair, and mean ± SD ring sizes were 21.7 ± 1.7 mm. Follow-up was 42 months (mean = 27 months). No operative mortality or valve-related complications occurred. Two patients died beyond 1 year from nonvalve-related causes. One patient required valve replacement for repair failure. Survival free of complications or valve replacement was 94% at 2 years. Significant reduction in aortic insufficiency and New York Heart Association class were observed ( P < 0.0001), and valve gradients remained low. No heart block or direct ring complications occurred.

Conclusions

In preliminary regulatory studies, aortic ring annuloplasty seemed safe and effective during aortic aneurysm surgery. This approach could help standardize aortic valve repair.
Direct Femoral Cannulation in Minimal Invasive Pediatric Cardiac Surgery
Authors: Wadhawa Vivek A. , Patel Kartik G. , Doshi Chirag P. , Shah Jigar K. , Ramani Jaydip A. , Garg Pankaj D. , Adalti Sudhir H. , Rana Yashpal R. , Pandya Himani M. , Gupta Vijay
Published: August 2018

Objective

One of the major challenges faced in minimally invasive pediatric cardiac surgery is cannulation strategy for cardiopulmonary bypass. Central aortic cannulation through the same incision has been the usual strategy, but it has the disadvantage of cluttering of the operative field. We hereby present the results of femoral cannulation in minimally invasive pediatric cardiac surgery in terms of adequacy and safety.

Methods

From January 2013 to June 2016, 200 children (122 males) with mean ± SD age of 9.2 ± 4.51 years (median = 6 years, range = 3–18 years) and weight of 19.22 ± 8.49 kg (median = 15 kg, range = 8–45 kg) were operated for congenital cardiac defects through anterolateral thoracotomy. The most common diagnosis was atrial septal defect (144 patients). In all the patients, femoral artery and femoral vein were cannulated along with direct superior vena cava cannulation for institution of cardiopulmonary bypass.

Results

There were no deaths or any major complications related to femoral cannulation. Femoral artery cannulation provided adequate arterial inflow, whereas femoral vein with direct superior vena cava cannulation provided adequate venous return in all the patients. No patient required vacuum-assisted venous drainage. No patient required conversion to sternotomy or developed vascular, neurological complications. At discharge and at 1-year follow-up, both femoral artery and vein were patent without a significant stenosis on color Doppler ultrasonography in all the patients. At mean ± SD follow-up period of 30.63 ± 10.09 months, all the patients were doing well without any wound-related, neurological, or vascular complications.

Conclusions

Femoral arterial and venous cannulation is a feasible, reliable, and efficient method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery.
Developing a Nursing Practice Framework to Align With Strategy
Authors: Spicer Joan Gygax , Sparacino Patricia S.A. , Larkin Noris E.
Published: August 2018

Clinical and administrative nurse leaders in a safety-net health system in Northern California developed and implemented a nursing practice framework to complement the system’s 5-year strategic initiative (2015-2020). Their contributions have been integral to the health system’s strategic direction and success. This article summarizes highlights of the journey from intellectual curiosity to pragmatic implementation system-wide.
A 5-Year Evaluation of Faculty Use of Practical Within-Course Writing Development Strategies in a DNP Program
Authors: Hampton Michelle DeCoux
Published: August 2018

Background

Nursing students are underprepared for the rigors of graduate writing. The lack of sufficient writing opportunities and skill development in prelicensure nursing education creates barriers that threaten course and program progression.

Approach

This study used a prospective, repeated-measures design to evaluate 5 years of faculty-implemented writing development strategies in a DNP program.

Outcomes

Faculty adopted 12 strategies in 10 courses. The strategies addressed skill building in content, construction, format, plagiarism, and citation use. The most frequently used strategies were rubrics, plagiarism detection software, multistep assignments, and examples of well-written papers, all strategies that increased in use over the 5-year study.

Conclusions

Graduate faculty interact with students and assess writing development outcomes firsthand. Changes in faculty practices over time can indicate the strategies they consider most valuable for writing development.
Mobility Function and Recovery After Stroke: Preliminary Insights From Sympathetic Nervous System Activity
Authors: Chatterjee Sudeshna A. , Daly Janis J. , Porges Eric C. , Fox Emily J. , Rose Dorian K. , McGuirk Theresa E. , Otzel Dana M. , Butera Katie A. , Clark David J.
Published: August 2018

Background and Purpose:

Poststroke hemiparesis increases the perceived challenge of walking. Perceived challenge is commonly measured by self-report, which is susceptible to measurement bias. A promising approach to objectively assess perceived challenge is measuring sympathetic nervous system (SNS) activity with skin conductance to detect the physiological stress response. We investigated the feasibility of using skin conductance measurements to detect task-related differences in the challenge posed by complex walking tasks in adults poststroke.

Methods:

Adults poststroke (n = 31) and healthy young adults (n = 8) performed walking tasks including typical walking, walking in dim lighting, walking over obstacles, and dual-task walking. Measures of skin conductance and spatiotemporal gait parameters were recorded. Continuous decomposition analysis was conducted to assess changes in skin conductance level (ΔSCL) and skin conductance response (ΔSCR). A subset of participants poststroke also underwent a 12-week rehabilitation intervention.

Results:

SNS activity measured by skin conductance (both ΔSCL and ΔSCR) was significantly greater for the obstacles task and dual-task walking than for typical walking in the stroke group. Participants also exhibited “cautious” gait behaviors of slower speed, shorter step length, and wider step width during the challenging tasks. Following the rehabilitation intervention, SNS activity decreased significantly for the obstacles task and dual-task walking.

Discussion and Conclusions:

SNS activity measured by skin conductance is a feasible approach for quantifying task-related differences in the perceived challenge of walking tasks in people poststroke. Furthermore, reduced SNS activity during walking following a rehabilitation intervention suggests a beneficial reduction in the physiological stress response evoked by complex walking tasks.

Video Abstract available for more insights from the authors (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A234).
Feasibility of Aerobic Exercise in the Subacute Phase of Recovery From Traumatic Brain Injury: A Case Series
Authors: Morris Timothy P. , Costa-Miserachs David , Rodriguez-Rajo Pablo , Finestres Jordi , Bernabeu Montserrat , Gomes-Osman Joyce , Pascual-Leone Alvaro , Tormos-Muñoz Jose Maria
Published: August 2018

Background and Purpose:

Aerobic exercise is as important for individuals with traumatic brain injury (TBI) as for the general population; however, the approach to aerobic training may require some adaptation. The objective of the trial program was to examine the feasibility of introducing aerobic physical exercise programs into the subacute phase of multidisciplinary rehabilitation from moderate to severe TBI, which includes computerized cognitive training.

Case Description:

Five individuals undergoing inpatient rehabilitation with moderate or severe TBIs who also have concomitant physical injuries. All of these individuals were in the subacute phase of recovery from TBIs.

Intervention:

An 8-week progressive aerobic physical exercise program. Participants were monitored to ensure that they could both adhere to and tolerate the exercise program. In addition to the physical exercise, individuals were undergoing their standard rehabilitation procedures that included cognitive training. Neuropsychological testing was performed to gain an understanding of each individual's cognitive function.

Outcomes:

Participants adhered to both aerobic exercise and cognitive training. Poor correlations were noted between heart rate reserve and ratings of perceived effort. Two minor adverse events were reported.

Discussion:

Despite concomitant physical injuries and cognitive impairments, progressive aerobic exercise programs seem feasible and well tolerated in subacute rehabilitation from moderate to severe TBI. Findings highlight the difficulty in measuring exercise intensity in this population.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A235)
Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women: A Randomized Clinical Trial
Authors: Huttner Angela , Kowalczyk Anna , Turjeman Adi , Babich Tanya , Brossier Caroline , Eliakim-Raz Noa , Kosiek Katarzyna , Martinez de Tejada Begona , Roux Xavier , Shiber Shachaf , Theuretzbacher Ursula , von Dach Elodie , Yahav Dafna , Leibovici Leonard , Godycki-Ćwirko Maciek , Mouton Johan W. , Harbarth Stephan
Published: August 2018

(Abstracted from JAMA 2018;319:1781–1789)

Guidelines for the treatment of uncomplicated lower urinary tract infections (UTIs) were modified in 2010 because of increasing antimicrobial resistance. The new guidelines recommend nitrofurantoin and fosfomycin as first-line agents.
Fight or Flight: The Role of Staged Approaches to Complex Abdominal Wall Reconstruction
Authors: Petro Clayton C. , Rosen Michael J.
Published: August 2018

Surgeons’ comfort with abdominal wall reconstruction techniques and use of prosthetic reinforcement in contaminated fields has made repair of complex hernias during concomitant procedures an attractive endeavor. Understanding the precarious nature of this practice, tenets of thoughtful patient selection, and principles of repair that mitigate morbidity can allow for an educated thought process when deciding whether or not to pursue concomitant abdominal wall reconstruction.
Optimal Pain Control in Abdominal Wall Reconstruction
Authors: Khansa Ibrahim , Jefferson Ryan , Khansa Lara , Janis Jeffrey E.
Published: August 2018

Lack of physician familiarity with alternative pain control strategies is a major reason why opioids remain the most commonly used first-line treatment for pain after surgery. This is perhaps most problematic in abdominal wall reconstruction, where opioids may delay ambulation and return of bowel function, while negatively affecting mental status. In this article, we discuss multimodal strategies for optimal pain control in abdominal wall reconstruction. These strategies are straightforward and are proven to improve pain control while minimizing opioid-associated side effects.
Prophylactic Mesh for Hernia Prevention: Has the Time Arrived?
Authors: Fox Sarah S. , Johnson Robert , Fischer John P. , Eckhauser Frederick , Hope William W.
Published: August 2018

Incisional and parastomal hernias continue to be vexing problems for patients and surgeons. Risk factors are generally patient-related and/or technical in nature, and in some cases, can be altered, resulting in improved outcomes. Improved fascial closure techniques can only partly reduce the risk of incisional hernia formation. Even under optimal circumstances, using time tested closure techniques and materials, the rate remains high, due primarily to factors that are not modifiable or are unidentifiable. In such cases, there may be a beneficial role for prophylactic mesh augmentation (PMA), wherein mesh is implanted at the time of initial surgery or stoma formation. Several high-risk groups that might benefit from PMA have been identified, including patients undergoing open abdominal aneurysm repair or colorectal procedures, obese patients, and patients requiring creation of permanent gastrointestinal or urological stomas. Although the initial results of PMA are promising, the benefits of this strategy must be weighed against potential risks. Outcome measures to assess efficacy should include not only hernia recurrence but also quality of life, surgical-site occurrences, and cost. Further studies are warranted to predict which specific patient populations might benefit most from PMA and to identify ideal mesh materials as well as preferred implantation sites and methods of mesh fixation.
Prevalence and Clinical Relevance of Extracardiac Findings in Cardiovascular Magnetic Resonance Imaging
Authors: Mantini Cesare , Mastrodicasa Domenico , Bianco Francesco , Bucciarelli Valentina , Scarano Michele , Mannetta Gianluca , Gabrielli Daniela , Gallina Sabina , Petersen Steffen E. , Ricci Fabrizio , Cademartiri Filippo
Published: August 2018

Purpose:

To assess the prevalence of extracardiac findings (ECF) during cardiovascular magnetic resonance (CMR) examinations and their downstream effect on clinical management.

Materials and Methods:

We retrospectively identified 500 consecutive patients. Trans-axial balanced steady-state free precession nongated images acquired from the upper thorax to the upper abdomen were evaluated independently by 2 radiologists. ECF were classified as nonsignificant (benign, with no need for further investigation), significant (mandatory to be reported/monitored), and major (clinically remarkable pathology, mandatory to be reported/investigated/treated). Fifteen-month clinical follow-up information was collected through hospital records.

Results:

Of 500 patients, 108 (21.6%) showed a total of 153 ECF: 59 (11.8% of the entire study population; 38.5% of all ECF) nonsignificant, 76 (15.2%; 49.7%) significant, and 18 (3.6%; 11.8%) major ECF. The most frequent ECF were pleural effusion, hepatic cyst, renal cyst, and ascending aorta dilatation. Of 94 significant and major ECF, 46 were previously unknown and more common in older patients. Newly diagnosed major ECF (n=11, 2.2% of the entire study population, and 7.2% of all ECF)—including 5 tumors (1% of study population)—were confirmed by downstream evaluations and required specific treatment. Patients with major ECF were significantly older than patients without with major ECF. Newly diagnosed clinically significant and major ECF prompted downstream diagnostic tests in 44% and 100% of cases, respectively.

Conclusions:

The detection of significant and major ECF is common during CMR reporting. The knowledge and the correct identification of most frequent ECF enable earlier diagnoses and faster treatment initiation of unknown extracardiac pathologies in patients referred to CMR imaging.
Association of Sex With Clinical Outcome in Critically Ill Sepsis Patients: A Retrospective Analysis of the Large Clinical Database MIMIC-III
Authors: Xu Jinghong , Tong Li , Yao Jiyou , Guo Zilu , Lui Ka Yin , Hu XiaoGuang , Cao Lu , Zhu Yanping , Huang Fa , Guan Xiangdong , Cai Changjie
Published: August 2018

Introduction:

The objective of our study was to explore the association between sex and clinical outcome in sepsis patients in a large, diverse population.

Materials and Methods:

We analyzed 6,134 adult patients with sepsis from the critical care units of Beth Israel Deaconess Medical Center between 2001 and 2012. Study data were retrospectively extracted from Medical Information Mart for Intensive Care-III, a multiparameter intensive care database.

Results:

There were 2,677 (43.6%) female and 3,457 (56.4%) male patients. Compared with female patients, male patients with sepsis had a higher 1-year mortality rate (55.6% vs. 51.4%, P = 0.001), and so did the 90-day mortality rate (45.1% vs. 42.1%, P = 0.018). 33.8% of male and 31.3% of female patients with sepsis died during hospitalization (P = 0.041). The median length of hospitalization and intensive care unit (ICU) stay for male patients was 19.54 and 7.54 days, while that for female patients was 16.49 and 6.75 days (P < 0.001, P = 0.002, respectively). Male patients were more likely to require dialysis therapy (P = 0.109), ventilation support (P = 0.012) and more vasoactive agents (dopamine P = 0.113, norepinephrine P = 0.016, and epinephrine P = 0.093) during the ICU period than female patients. Our Cox proportional hazard regression model confirmed that the risk of death within 1 year of ICU admission in male patients is 1.083 times that in female.

Conclusion:

Female patients with sepsis have better clinical outcomes than male patients in terms of mortality and length of hospitalization and ICU stay.
Perspectives on Quality of Care in Kidney Transplantation: A Semistructured Interview Study
Authors: Brett Kendra E. , Ertel Emily , Grimshaw Jeremy , Knoll Greg A.
Published: August 2018

Background

There is currently no agreement as to what constitutes quality transplant care, and there is a lack of consistency in the approach to assessing transplantation quality. We aimed to ascertain the views of patients, clinicians, and program administrators about quality care for kidney transplant patients.

Methods

Semistructured qualitative interviews were conducted with 20 patients, 17 physicians, and 11 program administrators. Transcripts were analyzed using inductive thematic analysis.

Results

We identified 8 themes: access to treatment (standardized transplant referral, lengthy transplant evaluation process, lengthy living donor evaluation); accessibility of services (alternative access options, flexible appointment availability, appropriate amount of follow-up, barriers for accessing care); program resources (comprehensive multidisciplinary care, knowledgeable staff, peer support groups, educational resources, patient navigators/ advocates); communication of information (taking time to answer questions, clear communication about treatment, communication tailored to patients, health promotion and illness prevention); attitude of care providers (positive and supportive attitude, patient centered care); health outcomes (freedom from dialysis, Long-term health, short-term health, fear of infections); patient satisfaction (returning to normal life, patient satisfaction with care); and safety (reducing infection risk, quick response to complications, patient health status on the waitlist).

Conclusions

There is a need to move beyond basic clinical outcomes and focus on increasing ease of access, the patient-provider relationship, and outcomes that are most important to the patients.
Metagenomic assembly of new (sub)polar Cyanobacteria and their associated microbiome from non-axenic cultures
Authors: Cornet Luc , Bertrand Amandine R. , Hanikenne Marc , Javaux Emmanuelle J. , Wilmotte Annick , Baurain Denis
Published: August 2018

Cyanobacteria form one of the most diversified phyla of Bacteria. They are important ecologically as primary producers, for Earth evolution and biotechnological applications. Yet, Cyanobacteria are notably difficult to purify and grow axenically, and most strains in culture collections contain heterotrophic bacteria that were probably associated with Cyanobacteria in the environment. Obtaining cyanobacterial DNA without contaminant sequences is thus a challenging and time-consuming task. Here, we describe a metagenomic pipeline that enables the easy recovery of genomes from non-axenic cultures. We tested this pipeline on 17 cyanobacterial cultures from the BCCM/ULC public collection and generated novel genome sequences for 12 polar or subpolar strains and three temperate ones, including three early-branching organisms that will be useful for phylogenomics. In parallel, we assembled 31 co-cultivated bacteria (12 nearly complete) from the same cultures and showed that they mostly belong to Bacteroidetes and Proteobacteria, some of them being very closely related in spite of geographically distant sampling sites.
Pericentromeric hypomethylation elicits an interferon response in an animal model of ICF syndrome
Authors: Rajshekar Srivarsha , Yao Jun , Arnold Paige K. , Payne Sara G. , Zhang Yinwen , Bowman Teresa V. , Schmitz Robert J. , Edwards John R. , Goll Mary G.
Published: August 2018

Pericentromeric satellite repeats are enriched in 5-methylcytosine (5mC). Loss of 5mC at these sequences is common in cancer and is a hallmark of Immunodeficiency, Centromere and Facial abnormalities (ICF) syndrome. While the general importance of 5mC is well-established, the specific functions of 5mC at pericentromeres are less clear. To address this deficiency, we generated a viable animal model of pericentromeric hypomethylation through mutation of the ICF-geneZBTB24. Deletion of zebrafishzbtb24caused a progressive loss of 5mC at pericentromeres and ICF-like phenotypes. Hypomethylation of these repeats triggered derepression of pericentromeric transcripts and activation of an interferon-based innate immune response. Injection of pericentromeric RNA is sufficient to elicit this response in wild-type embryos, and mutation of the MDA5-MAVS dsRNA-sensing machinery blocks the response in mutants. These findings identify activation of the innate immune system as an early consequence of pericentromeric hypomethylation, implicating derepression of pericentromeric transcripts as a trigger of autoimmunity.
Swarming bacteria respond to increasing barriers to motility by increasing cell length and modifying colony structure
Authors: Little Kristin , Austerman Jacob L. , Zheng Jenny , Gibbs Karine A.
Published: August 2018

Organisms can alter morphology and behaviors in response to environmental stimuli such as mechanical forces exerted by surface conditions. The bacterium Proteus mirabilis responds to surface-based growth by enhancing cell length and degree of cell-cell interactions. Cells grow as approximately 2-micrometer rigid rods and independently swim in liquid. By contrast on hard agar surfaces, cells elongate up to 40-fold into snake-like cells that move as a collective group across the surface. Here we have elucidated that individual cell size and degree of cell-cell interactions increased across a continuous gradient that correlates with increasing agar density. We further demonstrate that interactions between the lipopolysaccharide (LPS) component of the outer membrane and the immediate local environment modified these responses by reducing agar-associated barriers to motility. Loss of LPS structures corresponded with increased cell elongation on any given surface. These micrometer-scale changes to cell shape and collective interactions corresponded with centimeter-scale changes in the overall visible structure of the swarm colony. It is well-appreciated in eukaryotes that mechanical forces impact cell shape and migration. Here we propose that bacteria can also dynamically respond to the mechanical forces of surface conditions by altering cell shape, individual motility, and collective migration.
Small molecule inhibition of IRE1α kinase/RNase has anti-fibrotic effects in the lung
Authors: Thamsen Maike , Ghosh Rajarshi , Auyeung Vincent C. , Brumwell Alexis , Chapman Harold A. , Backes Bradley J. , Perara Gayani , Maly Dustin J. , Sheppard Dean , Papa Feroz R.
Published: August 2018

Endoplasmic reticulum stress (ER stress) has been implicated in the pathogenesis of idiopathic pulmonary fibrosis (IPF), a disease of progressive fibrosis and respiratory failure. ER stress activates a signaling pathway called the unfolded protein response (UPR) that either restores homeostasis or promotes apoptosis. The bifunctional kinase/RNase IRE1α is a UPR sensor that promotes apoptosis if ER stress remains high (i.e., a “terminal” UPR). Using multiple small molecule inhibitors against IRE1α, we show that ER stress-induced apoptosis of murine alveolar epithelial cells can be mitigated in vitro. In vivo, we show that bleomycin exposure to murine lungs causes early ER stress to activate IRE1α and the terminal UPR prior to development of pulmonary fibrosis. Small-molecule IRE1α kinase-inhibiting RNase attenuators (KIRAs) that we developed were used to evaluate the importance of IRE1α activation in bleomycin-induced pulmonary fibrosis. One such KIRA—KIRA7—provided systemically to mice at the time of bleomycin exposure decreases terminal UPR signaling and prevents lung fibrosis. Administration of KIRA7 14 days after bleomycin exposure even promoted the reversal of established fibrosis. Finally, we show that KIRA8, a nanomolar-potent, monoselective KIRA compound derived from a completely different scaffold than KIRA7, likewise promoted reversal of established fibrosis. These results demonstrate that IRE1α may be a promising target in pulmonary fibrosis and that kinase inhibitors of IRE1α may eventually be developed into efficacious anti-fibrotic drugs.
CA3 place cells that represent a novel waking experience are preferentially reactivated during sharp wave-ripples in subsequent sleep
Authors: Hwaun Ernie , Colgin Laura Lee
Published: August 2018

A popular model of memory consolidation posits that recent memories stored in the hippocampus are reactivated during sleep and thereby transferred to neocortex for long-term storage. This process is thought to occur during sharp wave-ripples (SWRs) in non-rapid eye movement (NREM) sleep. But whether the hippocampus consolidates all recent memories in the same manner remains unclear. An efficient memory system may extract novel information from recent experiences for preferential consolidation. In the hippocampus, memories are thought to be stored initially in CA3. Therefore, CA3 place cells that encode novel experiences may be preferentially reactivated during SWRs in subsequent sleep. To test this hypothesis, we recorded CA3 place cells in rats during exposure to a familiar and a novel environment and during subsequent overnight sleep. We found that cells that preferentially coded a novel environment showed larger firing rate increases during SWRs in NREM sleep than cells that preferentially coded a familiar environment. Moreover, CA3 place cell ensembles replayed trajectories from a novel environment during NREM sleep with higher fidelity than trajectories from a familiar environment. Together, these results suggest that CA3 representations of novel experiences are preferentially processed during subsequent sleep.
Toward a 3D model of phyllotaxis based on a biochemically plausible auxin-transport mechanism
Authors: Hartmann Félix P. , Reuille Pierre Barbier de , Kuhlemeier Cris
Published: August 2018

Polar auxin transport lies at the core of many self-organizing phenomena sustaining continuous plant organogenesis. In angiosperms, the shoot apical meristem is a potentially unique system in which the two main modes of auxin-driven patterning— convergence and canalization—co-occur in a coordinated manner and in a fully three-dimensional geometry. In the epidermal layer, convergence points form, from which auxin is canalized towards inner tissue. Each of these two patterning processes has been extensively investigated separately, but the integration of both in the shoot apical meristem remains poorly understood. We present here a first attempt of a three-dimensional model of auxin-driven patterning during phyllotaxis. We base our simulations on a biochemically plausible mechanism of auxin transport proposed by Cieslak et al. (2015) which generates both convergence and canalization patterns. We are able to reproduce most of the dynamics of PIN1 polarization in the meristem, and we explore how the epidermal and inner cell layers act in concert during phyllotaxis. In addition, we discuss the mechanism by which initiating veins connect to the already existing vascular system.

Author summary

The regularity of leaf arrangement around stems has long puzzled scientists. The key role played by the plant hormone auxin is now well established. On the surface of the tissue responsible for leaf formation, auxin accumulates at several points, from which new leaves eventually emerge. Auxin also guides the progression of new veins from the nascent leaves to the vascular system of the plant. Models of auxin transport have been developed to explain either auxin accumulation or auxin-driven venation. We propose the first three-dimensional model embracing both phenomena using a unifying mechanism of auxin transport. This integrative approach allows an assessment of our present knowledge on how auxin contributes to the early development of leaves. Our model reproduces many observations of auxin dynamics. It highlights how the inner and epidermal tissues act together to position new leaves. We also show that an additional, yet unknown, mechanism is required to attract new developing veins towards the main vasculature of the plant.
Genome-wide Estrogen Receptor-αactivation is sustained, not cyclical
Authors: Holding Andrew N , Cullen Amy E , Markowetz Florian
Published: August 2018

Estrogen Receptor-α(ER) is the key driver of 75% of all breast cancers. Upon stimulation by its ligand estra-2-diol, ER forms a transcriptionally active complex binding chromatin. Previous studies have reported that ER binding follows a cyclical binding pattern with a periodicity of 90 minutes. However, these studies have been limited to individual ER target genes and most were done without replicates. Thus, the robustness and generality of ER cycling are not well understood.

Here we present a comprehensive genome-wide analysis of the time dependence of ER binding affinity up to 90 minutes after activation, based on 6 replicates at 10 time points using our previously reported method for precise quantification of binding, Parallel-Factor ChIP-seq (pfChIP-seq). In contrast to previously described cyclical binding, our approach identifies a unidirectional sustained increase in ER binding affinity, as well as a class of estra-2-diol independent binding sites. Our results are corrob-orated by a quantitative re-analysis of data from multiple independent studies.

Our new model reconciles the results of multiple conflicting studies into the activation of ER at the TFF1 promoter. We provide a detailed understanding of ER’s response to estra-2-diol in the context of the receptor’s fundamental role as both the main driver and therapeutic target of breast cancer.
Neuronal Adaptation to the Value Range in the Macaque Orbitofrontal Cortex
Authors: Conen Katherine E. , Padoa-Schioppa Camillo
Published: August 2018

Economic choice involves computing and comparing the subjective values of different options. The magnitude of these values can vary immensely in different situations. To compensate for this variability, decision-making neural circuits adapt to the current behavioral context. In orbitofrontal cortex (OFC), neurons encode the subjective value of offered and chosen goods in a quasi-linear way. Previous work found that the gain of the encoding is lower when the value range is wider. However, previous studies did not disambiguate between neurons adapting to the value range or to the maximum value. Furthermore, they did not examine changes in baseline activity. Here we investigated how neurons in the macaque OFC adapt to changes in the value distribution. We found that neurons adapt to both the maximum and the minimum value, but only partially. Concurrently, the baseline response is higher when the minimum value is larger. Using a simulated decision circuit, we showed that higher baseline activity increases choice variability, and thus lowers the expected payoff in high value contexts.
Investigation of the Relationship between Markers of Systemic Inflammatory Response and Head and Neck Tumor Characteristics
Authors: Tham Tristan , Costantino Peter
Published: August 2018

Background

Markers of systemic inflammation have been hypothesized to reflect the underlying tumor microenvironment, and have recently been shown to be associated with advanced tumor grade, T and N stages.

Aims/Objective

The objective of this study was to evaluate the relationship between head and neck cancer (HNC) tumor characteristics and routine pretreatment inflammatory markers: the platelet lymphocyte ratio (PLR), the neutrophil to lymphocyte ratio (NLR), and the lymphocyte to monocyte ratio (LMR).

Materials and Methods

This is a retrospective cohort study. The tumor characteristics collected were tumor differentiation, T stage, N stage. The relationship between the inflammatory markers and tumor characteristics was analyzed.

Results

A total of 122 patients were enrolled from 2010-2016. An elevated PLR was found to be significantly associated with advanced T stage (rho=0.191, p=0.00347), and N stage (ANOVA, p=0.005). None of the other inflammatory markers (NLR, LMR) were associated with T stage or N stage. No markers were associated with tumor differentiation.

Conclusion and significance

We found that an PLR is significantly associated with advanced tumor and nodal stage. We were unable to find any tumor associations with the other inflammatory markers (NLR, LMR).
Characterization of Coxsackievirus A20 from a child with acute flaccid paralysis in Nigeria
Authors: Faleye T.O.C. , Adewumi M.O. , Olayinka O.T. , Adeniji J.A.
Published: August 2018

In light of the ongoing cVDPV2 outbreak in Nigeria, we describe the draft genome of a CVA20 strain from a child with AFP. The non-structural region of this genome unambiguously unveiled the source of such regions in recombinant cVDPV2s (JX275140 and KX162716) found in Nigeria in 2008 and 2015, respectively.