bluuebunny/crossref_metadata_2025 huggingface dataset:
Deleterious effect of proton pump inhibitors on the disease course of cirrhosis
Authors: Janka Tamás , Tornai Tamás , Borbély Brigitta , Tornai Dávid , Altorjay István , Papp Mária , Vitális Zsuzsanna
Published: August 2019

Objectives

Proton pump inhibitors(PPIs) are widely prescribed to patients with liver cirrhosis. We hypothesized that long-standing PPI use is associated with spontaneous bacterial peritonitis(SBP) and accelerated development of disease-specific complications and liver-related death.

Methods

A 5-year follow-up observational cohort study assessed the impact of long-standing PPI use on the clinical course of cirrhosis in a large referral patient cohort. Three hundred fifty patients with cirrhosis (alcohol:69.1%, Child-Pugh stage A/B/C:206/108/36) were assigned to two groups: regular PPI users (n=196) and nonusers (n=154). Occurrence of SBP, decompensation events (ascites, hepatic encephalopathy and variceal bleeding), and liver-related death were assessed.

Results

Regular PPI use was associated with an increased cumulative probability of SBP compared to nonusers [55% vs. 24.8%, hazard ratio(HR):4.25; P=0.05], in patients without previous SBP episode (n=84). A similar association was found between regular PPI use and decompensation events. The risk of the development of a first decompensation was higher in regular PPI users compared with nonusers, in patients with compensated clinical stage at enrollment (HR: 2.81, P= 0.008, n=146). The risk of liver-related death was also significantly increased among regular PPI users (P<0.001). In multivariate Cox-regression analysis, regular PPI use (HR:2.81, P=0.003) and MELD score (HR:1.21, P<0.001) was an independent predictor of mortality.

Conclusion

In the present follow-up cohort study, long-term PPI use was associated with the development of SBP and a progressive disease course in patients with cirrhosis that may have been caused by enhanced pathologic bacterial translocation, accelerated development of bacterial translocation-dependent disease-specific complications, and liver-related death.
Performance of B-mode ratio and 2D shear wave elastography for the detection and quantification of hepatic steatosis and fibrosis after liver transplantation
Authors: Dubois Marine , Ronot Maxime , Houssel-Debry Pauline , Brun Vanessa , Rayar Michel , Auger Magali , Beuzit Luc , Turlin Bruno , Aubé Christophe , Paisant Anita
Published: August 2019

Objectives

To evaluate the diagnostic performance of B-mode ratio and shear wave elastography (SWE) for the assessment of steatosis and liver fibrosis after liver transplantation.

Materials and methods

Patients hospitalized for a systematic check-up after liver transplantation underwent the same day hepatic ultrasound with B-mode ratio and SWE, followed by liver biopsy and biological examinations. Steatosis was measured using hepatorenal sonographic index of B-mode ratio and liver stiffness using SWE. Liver biopsy, used as gold standard, graded steatosis S0(<5%), S1(5–<33%), S2(33–<66%), or S3(≥66%) and liver fibrosis according to the Metavir score. The results were tested against two external validation cohorts.

Results

Fifty-eight patients were included. Mean B-ratio value was significantly higher in patients with steatosis (0.95 ± 0.13 versus 1.39 ± 0.41, P < 0.001). A B-mode ratio cutoff values at least 0.985 was found optimal for steatosis’ detection [area under the receiver operating characteristic curve (AUROC) 0.902 ± 0.05, sensitivity 95%, specificity 79%]. A B-mode ratio value below 0.9 ruled out steatosis and above 1.12 ruled in steatosis. Mean SWE value for patients without significant fibrosis (≤F1) was 15.90 ± 9.2 versus 19.27 ± 7.7 kPa for patients with fibrosis (P = 0.185). A 2D-SWE value below 7.85 kPa ruled out significant fibrosis and above 26.35 kPa ruled it in.

Conclusion

The B-mode ratio is an efficient and accurate tool for the noninvasive diagnostic of steatosis in postliver transplantation patients. Yet, because liver stiffness is higher in postliver transplantation patients, 2D-SWE is not reliable in the diagnosis of significant fibrosis after liver transplantation.
Where Do Oregon Medicaid Enrollees Seek Outpatient Care Post-affordable Care Act Medicaid Expansion?
Authors: Holderness Heather , Angier Heather , Huguet Nathalie , O’Malley Jean , Marino Miguel , Springer Rachel , DeVoe Jennifer
Published: August 2019

Background:

Previous studies suggest the newly Medicaid insured are more likely to use the emergency department (ED) however they did not differentiate between patients established or not established with primary care.

Objectives:

To understand where Oregon Medicaid beneficiaries sought care after the Patient Protection and Affordable Care Act (PPACA) Medicaid expansion (ED, primary care, or specialist) and the interaction between primary care establishment and outpatient care utilization.

Research design:

A retrospective cohort study.

Subjects:

Adults continuously insured from 2014 through 2015 who were either newly, returning, or continuously insured post-PPACA.

Measures:

Site of first and last outpatient visit, established with primary care status, and outpatient care utilization.

Results:

The odds of being established with primary care at their first visit were lower among newly [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.18–0.19] and returning insured (OR, 0.22; 95% CI, 0.22–0.23) than the continuously insured. Continuously insured, new patients with primary care had higher odds of visiting the ED (OR, 2.15; 95% CI, 2.01–2.30) at their first visit than newly or returning insured. Patients established with a single primary care provider in all insurance groups had lower rates of ED visit, whereas those established with multiple primary care providers had the highest ED visit rates.

Conclusions:

Most newly and returning insured Medicaid enrollees sought primary care rather than ED services and most became established with primary care. Our findings suggest that both insurance and primary care continuity play a role in where patients seek health care services.
Understanding and managing intimate partner violence in the pediatric primary care setting: a review
Authors: Wang Amanda Y. , Pannell Melissa
Published: August 2019

Purpose of review

To highlight the impact of intimate partner violence (IPV), also known as domestic violence, on children and families and to provide a framework for pediatricians in managing IPV-affected families.

Recent findings

Children living with a victim of IPV are at a much higher risk of being physically abused themselves. Exposure to IPV places children at high risk for multiple adverse childhood experiences, long-term health morbidity, and increased chance of intergenerational transmission of child abuse and future IPV. Exposure to a violent home environment alone is considered a form of child maltreatment. Furthermore, recent studies have proposed that maternal posttraumatic stress disorder and ineffective parenting styles by a victim of IPV mediate children's negative developmental outcomes, such as aggressive or internalizing behavior, mental health issues, and developmental delays. Trauma-informed care and a better understanding of the child abuse reporting process allow pediatricians to address specific needs of children and families exposed to IPV, to serve as mandated reporters with sensitivity and empathy, and to promote resiliency in families.

IPV is a public health issue that affects children in a variety of ways. Pediatricians can better manage this very serious and personal issue in their offices through an understanding of the unique healthcare needs of children and families impacted by IPV.
Brain-related outcome measures in trials recruiting critically-ill children
Authors: Fink Ericka L. , Tasker Robert C.
Published: August 2019

Purpose of review

Randomized controlled trials leading to innovations that improve outcomes in acute life-threatening illnesses in children are scarce. A key issue is how we refocus research on outcomes that matter and are more relevant to those making emergency decisions, and those involved with managing and living with the late-outcome. We have used information from recent trials in critically ill children – in particular those illnesses without any primary neurologic involvement – to develop an approach to brain-related outcomes that will maximize child and family benefit from research.

Recent findings

Fifteen recent pediatric critical care trials illustrate four types of brain-related outcomes assessment: death or organ-system-failures – as illustrated by studies in systemic illness; neurological and neuropsychological outcomes – as illustrated by the glycemic control studies; cognitive outcomes – as illustrated by a sedative trial; and composite outcomes – as illustrated by the therapeutic hypothermia studies.

The 15 research trials point to five areas that will need to be addressed and incorporated into future trial design, including use of: neurologic monitoring during intensive care unit admission; postdischarge outcomes assessments; strategies to improve retention in long-term follow-up; child and family-centered outcomes; and core outcomes datasets.
A Comparative Study of Blood Sampling From Venipuncture and Short Peripheral Catheters in Pediatric Inpatients
Authors: Twibell K. Renee , Hofstetter Paula , Siela Debra , Brown Dava , Jones Holly M.
Published: August 2019

This prospective, comparative study examined blood test results, hemolysis rates, and patient perceptions related to 2 blood sampling methods in pediatric inpatients (N = 95). Blood specimens were drawn via venipuncture and a short peripheral catheter used for fluid administration. Results revealed no significant differences in potassium and glucose levels. No clinically significant difference in hemoglobin was noted. Hemolysis rates were 4% for venipuncture samples and 15% when drawn from peripheral catheters. One catheter became occluded after a blood draw. Patients/parents rated distress and dissatisfaction with venipuncture as significantly greater compared with short peripheral catheter blood sampling (P< .001).
Complications and Costs of Peripherally Inserted Central Venous Catheters Compared With Implantable Port Catheters for Cancer Patients
Authors: Pu Ya-Lou , Li Zhuang-Shuang , Zhi Xiao-Xu , Shi Yi-An , Meng Ai-Feng , Cheng Fang , Ali Ali , Li Cheng , Fang Hong , Wang Cheng
Published: August 2019

Background

Peripherally inserted central catheters (PICCs) and implantable port catheters (IPCs) are 2 most common central venous access for cancer patients receiving chemotherapy. However, no specific evidence exists to guide practitioners on safety and less cost.

Objective

To compare the differences of complications and costs of PICC and IPC in the treatment of cancer patients with chemotherapy and to provide a basis for better clinical decision making.

Methods

All the cohort studies were searched in the Cochrane Library, JBI, PubMed, Elsevier, Web of Science, CINAHL, CBM, and CNKI from inception to July 2018. Two reviewers screened and selected trials, evaluated quality, and extracted data. Meta-analysis and description of the outcomes were performed by using the RevMan 5.3 software.

Results

A total of 761 articles were retrieved, with 15 articles meeting eligibility criteria. Outcome analysis showed no difference in 1-puncture success rate. Peripherally inserted central catheter use was associated with higher complication rates than IPC, including occlusion, infection, malposition, catheter-related thrombosis, extravasation, phlebitis, and accidental removal rate. The life span of IPC was longer than that of PICC, and the costs of IPC were lower.

Conclusions

Implantable port catheter has advantages over PICC in reducing cancer patients’ complications and less cost in terms of long-term cancer chemotherapy.

Implications for Practice

In terms of safety, the results provide evidence for practitioners to choose which type of central venous catheters is better for cancer chemotherapy patients. In terms of costs, practitioners need to make decisions about which type of central venous catheters has less cost.
Uterine Tumor Resembling Ovarian Sex Cord Tumor (UTROSCT)
Authors: Goebel Emily A. , Hernandez Bonilla Silvia , Dong Fei , Dickson Brendan C. , Hoang Lien N. , Hardisson David , Lacambra Maribel D. , Lu Fang-I , Fletcher Christopher D.M. , Crum Christopher P. , Antonescu Cristina R. , Nucci Marisa R. , Kolin David L.
Published: August 2019

Uterine tumor resembling ovarian sex cord tumor (UTROSCT) is a rare mesenchymal neoplasm, of uncertain biological potential, that was recently reported to exhibit recurrent gene fusions involving NCOA2-3. The purpose of this study was to, using a larger sample size, better characterize the histopathologic and molecular diversity of UTROSCT. Twenty-six cases of UTROSCT from 5 institutions were selected for further study. Fluorescence in situ hybridization for NCOA1, NCOA2, NCOA3, ESR1 and GREB1, and targeted RNA sequencing was performed on 17 and 8 UTROSCTs, respectively. Eight cases underwent massively parallel sequencing to detect single nucleotide variants (SNV), copy number variations, and structural variants using a targeted hybrid-capture based assay. NCOA1-3 rearrangement was identified in 81.8% (18/22) of cases. The most common fusion was ESR1-NCOA3, occurring in 40.9% (9/22). GREB1-NCOA1 (n=4), ESR1-NCOA2 (n=3), and GREB1-NCOA2 (n=1) rearrangements were also identified. No recurrent SNVs were identified and no tumor had SNVs in FOXL2, DICER1, STK11, or AKT1, which can be seen in ovarian sex cord-stromal tumors. Copy number variations were infrequent. Clinical follow-up was available for 11 cases with a mean follow-up interval of 94.4 (range, 1 to 319) months. Only one case had a recurrence 66 months after the initial diagnosis and this was the single case with a GREB1-NCOA2 fusion. This study reports the morphologic spectrum of UTROSCT and confirms the recently reported recurrent NCOA2-3 gene fusions, in addition to identifying novel rearrangements involving NCOA1 in these tumors.
Systematic Selective Sampling of Cholecystectomy Specimens Is Adequate to Detect Incidental Gallbladder Adenocarcinoma
Authors: Akki Ashwin S. , Zhang Wei , Tanaka Kathryn E. , Chung Sun M. , Liu Qiang , Panarelli Nicole C.
Published: August 2019

Many gallbladder adenocarcinomas (ACs) are detected incidentally in routine cholecystectomy specimens, yet sampling practices vary when intestinal metaplasia (IM) or dysplasia are found via routine sampling. Our practice has been to submit 5 additional sections when IM is found, but cases with dysplasia are entirely submitted. We sought to determine an appropriate sampling protocol when encountering these findings. We retrospectively identified cholecystectomy specimens with these features over a 26-month period, yielding 48 of 4059 (1%) cases. Four pathologists independently classified the (2 longitudinal and 1 cystic duct margin) original sections into 1 of 3 categories (IM, low-grade dysplasia [LGD] or high-grade dysplasia [HGD]); initial findings were correlated with final diagnoses. Sixteen (33%) cases had additional findings upon further sampling, including LGD (n=10) or HGD (n=4) and AC (n=2). HGD always accompanied malignancy. We prospectively analyzed 39 of 3133 (1%) additional cholecystectomy specimens, initially submitting the same routine sections. We submitted 5 random sections from cases with IM. Cases with LGD were first examined with 1 additional section per centimeter. All remaining tissue was submitted in all of these cases and separately reviewed. Cases with HGD were entirely submitted as both test cases with HGD in initial sections ultimately showed carcinoma. This protocol detected all cases of HGD and AC. Patients with clear cystic duct margins did not experience neoplastic progression, even if dysplasia was present elsewhere. We conclude gallbladders with HGD should be entirely submitted, LGD may be representatively sampled, and routine sampling is adequate for IM.
How Important Are Parental Age and Educational Level in Nonurgent Admissions to the Pediatric Emergency Department?
Authors: Kurt Funda , Beğde Firat , Oğuz Sinan , Tekin Deniz , Suskan Emine
Published: August 2019

Objective

The aims of the present study were to investigate the reasons parents prefer the pediatric emergency department for nonurgent admissions and to evaluate the effect of parental age and educational level on nonurgent admissions and the relationship between the reasons for nonurgent admissions and child age.

Methods

We conducted a cross-sectional survey at an emergency department of a tertiary care pediatric referral center. A questionnaire that was prepared to understand the reasons underlying nonurgent admissions was administered to the parents of 1033 children who were classified as nonurgent cases using the Pediatric Canadian Triage and Acuity Scale (4–5).

Results

The most common reasons for nonurgent admissions were the concern for progression in child's complaints, the complaints with an onset outside working hours, and the parental perception that more cautious and better care is provided in the emergency department. The most urgent complaints from the parental perspective included fever (23.1%), vomiting (11.0%), and diarrhea (10.5%), respectively. The mean age of the mothers was 31.1 ± 5.9 years (17–51 years), and the mean age of the fathers was 34.94 ± 6.1 years (20–60 years). Parents younger than 30 years were more likely to prefer the emergency department due to convenience and economic reasons. Nonurgent admissions due to confidence in the emergency department were more frequent among parents who were primary school graduate.

Conclusions

It is critically important to examine why parents prefer the emergency department for nonurgent conditions of their children and to develop solution offers in this regard. The improvements to be made in the emergency department would both prioritize patients requiring urgent care and increase the productivity of emergency department staff.
Relationship Between Obesity and Balance in the Community-Dwelling Elderly Population
Authors: Lee Jae Joon , Hong Dong Whan , Lee Seung Ah , Soh Yunsoo , Yang Miryeong , Choi Kwang Min , Won Chang Won , Chon Jinmann
Published: August 2019

Introduction

Although there are similar characteristics between obese individuals and fall-susceptible population, little is known about relationships between body weight and risk factors for fall, particularly in the elderly population. The aim of this study was to determine whether body mass index–based obesity is associated with decreased balance and whether instability has relationships with the main risk factors for falls.

Methods

A total of 317 participants were categorized based on their body mass index. Clinical balance assessments were performed using the Berg Balance Scale, Timed Up and Go test, and Short Physical Performance Battery. The knee extensor strength of each individual was measured using a dynamometer. Total sway distance was calculated on InBody posturography in four conditions.

Results

The results of three clinical balance assessment tools showed significant correlation with body mass index. The obese group showed decreased isokinetic knee extensor muscle strength and had a higher total sway distance than the normal weight group.

Conclusions

The elderly population with obesity exhibits poor balance performing ability, and it is associated with the decreased strength of the lower limbs and impaired postural stability. The logistic regression analysis of our study showed that body mass index–based obesity can be regarded as a fall risk.
Effects of Adding a Neurodynamic Mobilization to Motor Control Training in Patients With Lumbar Radiculopathy Due to Disc Herniation
Authors: Plaza-Manzano Gustavo , Cancela-Cilleruelo Ignacio , Fernández-de-las-Peñas César , Cleland Joshua A. , Arias-Buría José L. , Thoomes-de-Graaf Marloes , Ortega-Santiago Ricardo
Published: August 2019

Objective

The aim of the study was to investigate the effects of the inclusion of neural mobilization into a motor control exercise program on pain, related disability, neuropathic symptoms, straight leg raise, and pressure pain threshold in lumbar radiculopathy.

Design

This is a randomized clinical trial.

Methods

Individuals with low back pain, with confirmed disc herniation, and lumbar radiculopathy were randomly assigned to receive eight sessions of either neurodynamic mobilization plus motor control exercises (n = 16) or motor control exercises alone (n = 16). Outcomes included pain, disability, neuropathic symptoms, straight leg raise, and pressure pain threshold at baseline, after four visits, after eight visits, and after 2 mos.

Results

There were no between-groups differences for pain, related disability, or pressure pain threshold at any follow-up period because both groups get similar and large improvements. Patients assigned to the neurodynamic program group experienced better improvements in neuropathic symptoms and the straight leg raise compared with the motor control exercise group (P < 0.01).

Conclusions

The addition of neurodynamic mobilization to a motor control exercise program leads to reductions in neuropathic symptoms and mechanical sensitivity (straight leg raise) but did not result in greater changes of pain, related disability, or pressure pain threshold over motor control exercises program alone in subjects with lumbar radiculopathy. Future trials are needed to further confirm these findings because between-groups differences did not reach clinically relevance.
Upper Extremity Axon Counts and Clinical Implications for Motor Nerve Transfer
Authors: Cheah Andre , Lee Ellen Y. , Lim Aymeric Y. T.
Published: August 2019

Background:

Nerve transfers are planned based on the following parameters: location, number of branches, and axon count matching of the donor and recipient nerves. The authors have previously defined the former two in upper limb muscles. In the literature, axon counts are obtained from various sources, using different methods of histomorphometry. This study describes the axon counts of the same primary motor nerve branches from the authors’ previous study using a uniform method of manual histomorphometry and completes the authors’ blueprint of upper limb neuromuscular anatomy for reconstructive surgery.

Methods:

The distal ends of the primary nerve branches of 23 upper limb muscles were harvested from 10 fresh frozen cadaveric upper limbs. Manual quantitative histomorphometry was performed by two independent investigators, and the average was reported.

Results:

The primary nerve branches of the arm muscles had higher average axon counts (range, 882 to 1835) compared with those of the forearm muscles (range, 267 to 883). In the forearm, wrist flexor (range, 659 to 746) and extensor (range, 543 to 745) nerve branches had axons counts that were similar to those of potential donors (e.g., supinator, n = 602; pronator teres, n = 625; flexor digitorum superficialis, n = 883; and flexor digitorum profundus, n = 832).

Conclusions:

Apart from describing the axon counts of the upper limb, the authors have found that the forearm axon counts are very comparable. This insight, when combined with information on the location and number of primary nerve branches, will empower surgeons to tailor bespoke nerve transfers for every clinical situation.
Composite Buttock Augmentation: The Next Frontier in Gluteal Aesthetic Surgery
Authors: Aslani Alex , Del Vecchio Daniel A.
Published: August 2019

Background:

Despite rapid growth, gluteal fat transplantation has a dismal safety record and often results in inadequate domal projection. Implants alone for gluteal augmentation have also been reported to be less than ideal, with significant complication rates. The idea of combining both implants and fat, as has been described in the breast, was therefore applied to surgery of the buttocks.

Methods:

One hundred forty-seven consecutive cases of buttock augmentation were reviewed. Average follow-up was 18 months. The technique of composite buttock augmentation used progressive instrument dissection to precisely define the correct intramuscular plane of the implant pocket with a minimum amount of pocket access dissection.

Results:

Operating times averaged 1 hour 55 minutes. The average volume of fat inserted was 380 cc. The average implant volume was 300 cc. Complications included implant displacements and implant pocket infections requiring surgical intervention. There were no cases of pulmonary thromboembolism, fat embolism, or death.

Conclusions:

Taking a lesson from composite breast augmentation, composite buttock augmentation is a new method for gluteal reshaping that seeks to use the best of both worlds: the reliable core projection of an implant combined with the natural appearance and feel of fat. Progressive instrument dissection seeks to minimize unnecessary dissection and to accurately and safely define the intramuscular pocket. The intramuscular placement of implants instead of fat should eliminate the risk of fatal fat pulmonary embolism in these patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Clockwise Rotation of the Occlusal Plane for Aesthetic Purposes by Double Jaw Surgery without Orthodontic Treatment
Authors: Lee Tae Sung , Park Sanghoon
Published: August 2019

The occlusal plane angle is an important factor in lateral facial aesthetics. Low occlusal plane facial profiles appear planar and long-faced, whereas high occlusal plane facial profiles are considered more attractive, especially in Asian regions. Clockwise rotation of the occlusal plane for truly aesthetic purposes can be accomplished with double jaw surgery, without need for orthodontic treatments. Patients with normal occlusion who desired to improve their lateral facial aesthetics were included in this study. A conventional Le Fort I osteotomy was followed by a sagittal split ramus osteotomy under general anesthesia. The movement of the maxillomandibular complex was determined in accord with a preoperative analysis. From 2015 to 2017, 43 patients with normal occlusion underwent double jaw surgery without orthodontic treatment. Whereas all patients were subjectively satisfied with the surgery, two underwent orthodontic treatment to correct mild occlusal discrepancies noticed after surgery. There were no delayed occlusal problems or relapses reported during the study. For patients who desired to improve their lateral facial aesthetics but had normal occlusion, orthognathic surgery without orthodontic treatment can be effective. Clockwise rotation of the occlusal plane by double jaw surgery without orthodontic treatment resulted in satisfactory aesthetic outcomes with stable and reliable long-term results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Non-Midline Frontal Encephalocele Presenting as Disappearing Dermoid
Authors: Khavanin Nima , Steinberg Jordan P.
Published: August 2019

Congenital masses in the lateral brow are most commonly dermoid cysts and can often be excised surgically without additional investigation. These dermoids may rarely develop intracranial extension due to underlying bony erosions and become less prominent over time – a “disappearing dermoid.” However, the authors present an unusual alternative case in which an off-midline frontal encephalocele initially presented as a firm irreducible mass but exhibited changing characteristics over time.
Pituitary Stalk Interruption Syndrome
Authors: Xu Chuanna , Wang Tiejun , Feng Yan
Published: August 2019

Pituitary stalk interruption syndrome is a congenital disease with isolated growth hormone deficiency or multiple anterior pituitary hormone deficiencies. Here, the authors report a 22-year-old female presenting with growth retardation for 13 years. Growth hormone replacement therapy was performed when the patient was young, so her height improved. Besides, she had no secondary sexual characteristics development.
Oculo-Auriculo-Fronto-Nasal Syndrome With Duane Retraction Syndrome and Dysplastic Bony Structure in the Midline of Nose
Authors: Ito Riri , Osawa Masayuki , Yamamoto Yuhei , Murao Naoki , Hayashi Toshihiko , Maeda Taku , Ishikawa Kosuke , Oyama Akihiko , Funayama Emi
Published: August 2019

Oculo-auriculo-fronto-nasal syndrome (OAFNS) is a rare anomaly characterized by features overlapping those of frontonasal dysplasia (FND) and the oculo-auriculo-vertebral spectrum (OAVS).
1
The FND features malformation of frontonasal process-derived structures, characterized by anomalies in the central portion of the face. The OAVS is characterized by developmental anomalies of the first and second pharyngeal arches. The OAFNS is a condition with clinical features of both FND and OAVS.

Here, the authors present the case of a male with OAFNS who not only exhibited typical OAFNS symptoms but also a dysplastic bony structure that bridged the anterior nasal spine and inferior nasal bones, and unilateral type 3 Duane retraction syndrome (absence of right-eye abduction). Abnormal nasal bones are characteristic of OAFNS; such abnormalities are absent from FND and OAVS. The authors reduced the dysplastic nasal bony structure via open external rhinoplasty, followed by lateral nasal osteotomy when he was 16 years of age. The nasal dorsum appeared natural after surgery and he was satisfied with the result.
Elderly adults with isolated hip fractures- orthogeriatric care versus standard care: A practice management guideline from the Eastern Association for the Surgery of Trauma
Authors: Mukherjee Kaushik , Brooks Steven E. , Barraco Robert D. , Como John J. , Hwang Franchesca , Robinson Bryce R. H. , Crandall Marie L.
Published: August 2019

BACKGROUND

Elderly patients commonly suffer isolated hip fractures, causing significant morbidity and mortality. The use of orthogeriatrics (OG) management services, in which geriatric specialists primarily manage or co-manage patients after admission, may improve outcomes. We sought to provide recommendations regarding the role of OG services.

METHODS

Using GRADE methodology with meta-analyses, the Practice Management Guidelines Committee of the Eastern Association for the Surgery of Trauma conducted a systematic review of the literature from January 1, 1900, to August 31, 2017. A single Population, Intervention, Comparator and Outcome (PICO) question was generated with multiple outcomes: Should geriatric trauma patients 65 years or older with isolated hip fracture receive routine OG management, compared with no-routine OG management, to decrease mortality, improve discharge disposition, improve functional outcomes, decrease in-hospital medical complications, and decrease hospital length of stay?

RESULTS

Forty-five articles were evaluated. Six randomized controlled trials and seven retrospective case-control studies met the criteria for quantitative analysis. For critical outcomes, retrospective case-control studies demonstrated a 30-day mortality benefit with OG (OR, 0.78 [0.67, 0.90]), but this was not demonstrated prospectively or at 1 year. Functional outcomes were superior with OG, specifically improved score on the Short Physical Performance Battery at 4 months (mean difference [MD], 0.78 [0.28, 1.29]), and improved score on the Mini Mental Status Examination with OG at 12 months (MD, 1.57 [0.40, 2.73]). Execution of activities of daily living was improved with OG as measured by two separate tests at 4 and 12 months. There was no difference in discharge disposition. Among important outcomes, the OG group had fewer hospital-acquired pressure ulcers (OR, 0.30 [0.15, 0.60]). There was no difference in other complications or length of stay. Overall quality of evidence was low.

CONCLUSION

In geriatric patients with isolated hip fracture, we conditionally recommend an OG care model to improve patient outcomes.

LEVEL OF EVIDENCE

Systematic review/meta-analysis, level III.
Safety profile and impact of low-titer group O whole blood for emergency use in trauma
Authors: Williams James , Merutka Nicholas , Meyer David , Bai Yu , Prater Samuel , Cabrera Rodolfo , Holcomb John B. , Wade Charles E. , Love Joseph D. , Cotton Bryan A.
Published: August 2019

PURPOSE

Following US military implementation of a cold-stored whole blood program, several US trauma centers have begun incorporating uncrossmatched, group O cold-stored whole blood into civilian trauma resuscitation. We set out to evaluate the safety profile, transfusion reactions events, and impact of low-titer group O whole blood (LTO-WB) at our center.

METHODS

In November 2017, we added LTO-WB to each of our helicopters and to our emergency department (ED) refrigerator, alongside that of existing red blood cells and plasma. We collected information on all patients with trauma receiving prehospital or ED transfusion of uncrossed, emergency release blood products between November 2017 and June 2018. Patients were divided into those receiving any LTO-WB and those receiving only red blood cell and or plasma (COMP). Serial hemolysis panels were obtained at 3 hours, 24 hours, and 48 hours. All data were run using STATA 12.1. Statistical significance was set at p < 0.05.

RESULTS

One hundred ninety-eight patients received LTO-WB and 152 patients received COMP. There were no differences in age, sex, or mechanism. The LTO-WB patients had higher chest Abbreviated Injury Scale scores (median, 3 vs. 2; p = 0.027), as well as worse arrival base excess (median, −7 vs. −5; p = 0.014) and lactate (5.1 vs. 3.5; p < 0.001). The LTO-WB patients received less post-ED blood products than the COMP patients (median, 0 vs. 3; p = 0.001). There was no difference in survival (LTO-WB, 73%; COMP, 74%; p = 0.805). There were only two suspected transfusion reactions, both in the COMP group (p = 0.061). There was no difference in hemolysis panel values. Controlling for age, severity of injury, and prehospital physiology, LTO-WB was associated with a 53% reduction in post-ED blood product transfusion (odds ratio, 0.47; 0.23–0.94 95% CI; p = 0.033) and two-fold increase in likelihood of survival (odds ratio, 2.19; 1.01–4.76 95% CI; p = 0.047).

CONCLUSION

Low-titer group O whole blood has similar evidence of laboratory hemolysis, similar transfusion reaction rates, and is associated with a reduction in post-ED transfusions and increase likelihood of survival.

LEVEL OF EVIDENCE

Therapeutic, Level II.
Depressive Symptom Dimensions in Treatment-Resistant Major Depression and Their Modulation With Electroconvulsive Therapy
Authors: Wade Benjamin S.C. , Hellemann Gerhard , Espinoza Randall T. , Woods Roger P. , Joshi Shantanu H. , Redlich Ronny , Jørgensen Anders , Abbott Christopher C. , Oedegaard Ketil J. , McClintock Shawn M. , Oltedal Leif , Narr Katherine L.
Published: August 2019

Objective

Symptom heterogeneity in major depressive disorder obscures diagnostic and treatment-responsive biomarker identification. Whether symptom constellations are differentially changed by electroconvulsive therapy (ECT) remains unknown. We investigate the clustering of depressive symptoms over the ECT index and whether ECT differentially influences symptom clusters.

Methods

The 17-item Hamilton Depression Rating Scale (HDRS-17) was collected from 111 patients with current depressive episode before and after ECT from 4 independent participating sites of the Global ECT-MRI Research Collaboration. Exploratory factor analysis of HDRS-17 items pre- and post-ECT treatment identified depressive symptom dimensions before and after ECT. A 2-way analysis of covariance was used to determine whether baseline symptom clusters were differentially changed by ECT between treatment remitters (defined as patients with posttreatment HDRS-17 total score ≤8) and nonremitters while controlling for pulse width, titration method, concurrent antidepressant treatment, use of benzodiazepine, and demographic variables.

Results

A 3-factor solution grouped pretreatment HDRS-17 items into core mood/anhedonia, somatic, and insomnia dimensions. A 2-factor solution best described the symptoms at posttreatment despite poorer separation of items. Among remitters, core mood/anhedonia symptoms were significantly more reduced than somatic and insomnia dimensions. No differences in symptom dimension trajectories were observed among nonremitting patients.

Conclusions

Electroconvulsive therapy targets the underlying source of depressive symptomatology and may confer differential degrees of improvement in certain core depressive symptoms. Our findings of differential trajectories of symptom clusters over the ECT index might help related predictive biomarker studies to refine their approaches by identifying predictors of change along each latent symptom dimension.
The Neural Basis of Predictive Pursuit
Authors: Yoo Seng Bum Michael , Tu Jiaxin Cindy , Piantadosi Steven T. , Hayden Benjamin Yost
Published: August 2019

It remains unclear how and to what extent non-human animals make demanding on-the-fly predictions during pursuit. We studied this problem in a novel laboratory pursuit task that incentivizes prediction of future prey positions. We trained three macaques to perform joystick-controlled pursuit of prey that followed intelligent escape algorithms. Subjects reliably aimed towards the prey’s likely future positions, indicating that they generate internal predictions and use those predictions to guide behavior. We then developed a generative model that explains real-time pursuit trajectories and showed that our subjects use prey position, velocity, and acceleration to make predictions. We identified neurons in the dorsal anterior cingulate cortex (dACC) whose responses track these three variables. These neurons multiplexed prediction-related variables with a distinct and explicit representation of the prey’s future position. Our results provide a clear demonstration that the brain can explicitly represent future predictions and highlight the critical role of anterior cingulate cortex for future-oriented cognition.

One-sentence summary

In a dynamic pursuit environment, monkeys actively predict future prey positions and dACC neurons encode these future positions.
Transcriptional Dynamics of the Salicylic Acid Response and its Interplay with the Jasmonic Acid Pathway
Authors: Hickman Richard , Mendes Marciel Pereira , Van Verk Marcel C. , Van Dijken Anja J.H. , Di Sora Jacopo , Denby Katherine , Pieterse Corné M.J. , Van Wees Saskia C.M.
Published: August 2019

The phytohormone salicylic acid (SA) is a central regulator of plant immunity. Antagonistic and synergistic actions between SA and other defense-associated hormones like jasmonic acid (JA) play key roles in determining the outcome of the plant immune response. To obtain a deeper understanding of SA-mediated transcriptional reprogramming and SA/JA crosstalk, we generated a high-resolution time series of gene expression from Arabidopsis leaves treated with SA alone and a combination of SA and methyl JA (MeJA), sampled at 14 time points over a 16-h period. We found that approximately one-third of the Arabidopsis genome was differentially expressed in response to SA, and temporal changes in gene expression could be partitioned into 45 distinct clusters of process-specific coregulated genes, linked to specific cis-regulatory elements and binding of transcription factors (TFs). Integration of our expression data with information on TF-DNA binding allowed us to generate a dynamic gene regulatory network model of the SA response, recovering known regulators and identifying novel ones. We found that 12% of SA-responsive genes and 69% of the MeJA-responsive genes exhibited antagonistic or synergistic expression levels in the combination treatment. Multi-condition co-clustering of the single- and combined-hormone expression profiles predicted underlying regulatory mechanisms in signal integration. Finally, we identified the TFs ANAC061 and ANAC090 as negative regulators of SA pathway genes and defense against biotrophic pathogens. Collectively, our data provide an unprecedented level of detail about transcriptional changes during the SA response and SA/JA crosstalk, serving as a valuable resource for systems-level network studies and functional plant defense studies.
Analytical characterization of Parylene-C degradation mechanisms on Utah arrays: evaluation of in vitro Reactive Accelerated Aging model compared to multiyearin vivoimplantation
Authors: Caldwell Ryan , Street Matthew G. , Sharma Rohit , Takmakov Pavel , Baker Brian , Rieth Loren
Published: August 2019

Implantable neural microelectrodes are integral components of neuroprosthetic technologies and can transform treatments for many neural-mediated disorders. However, dielectric material degradation during long-term (> 1 year) indwelling periods restricts device functional lifetimes to a few years. This comprehensive work carefully investigatesin vivomaterial degradation and also explores the ability ofin vitroReactive Accelerated Aging (RAA) to evaluate implant stability. Parylene C-coated Utah electrode arrays (UEAs) implanted in feline peripheral nerve for 3.25 years were explanted and compared to RAA-processed devices, aged in phosphate buffered saline (PBS) + 20 mM H2O2at either 67 or 87 °C (28 or 7 days, respectively). Electron microscopy revealed similar physical damage characteristics between explants and RAA (87° C) devices. Parylene C degradation was overwhelmingly apparent for UEAs from both RAA cohorts. Controls aged in PBS alone displayed almost no damage. Spectroscopic characterization (EDX, XPS, FTIR) found clear indications of oxidation and chlorine abstraction for parylene C agedin vivo. Whilein vitroaging was also accompanied by signs of oxidation, changes in the chemistryin vivoandin vitrowere statistically different. Analysis of RAA- aged devices identified UEA fabrication approaches that may greatly improve device resistance to degradation. This work underscores the need for an improved understanding ofin vivodamage mechanisms, to facilitate the critical need for representativein vitroaccelerated testing paradigms for long-term implants.
CellGPS: Whole-body tracking of single cells by positron emission tomography
Authors: Jung Kyung Oh , Kim Tae Jin , Yu Jung Ho , Rhee Siyeon , Zhao Wei , Ha Byunghang , Red-Horse Kristy , Gambhir Sanjiv Sam , Pratx Guillem
Published: August 2019

In vivo molecular imaging tools are critically important for determining the role played by cell trafficking in biological processes and cellular therapies. However, existing tools measure average cell behavior and not the kinetics and migration routes of individual cells inside the body. Furthermore, efflux and non-specific accumulation of contrast agents are confounding factors, leading to inaccurate estimation of cell distribution in vivo. In view of these challenges, we report the development of a “cellular GPS” capable of tracking single cells inside living subjects with exquisite sensitivity. We use mesoporous silica nanoparticles (MSN) to concentrate 68Ga radioisotope into live cells and inject these cells into live mice. From the pattern of annihilation photons detected by positron emission tomography (PET), we infer, in real time, the position of individual cells with respect to anatomical landmarks derived from X-ray computed tomography (CT). To demonstrate this technique, a single human breast cancer cell was tracked in a mouse model of experimental metastasis. The cell arrested in the lungs 2-3 seconds after tail-vein injection. Its average velocity was estimated at around 50 mm/s, consistent with blood flow rate. Other cells were tracked after injection through other routes, but no motion was detected within 10 min of acquisition. Single-cell tracking could be applied to determine the kinetics of cell trafficking and arrest during the earliest phase of the metastatic cascade, the trafficking of immune cells during cancer immunotherapy, or the distribution of cells after transplantation in regenerative medicine.
Demonstrating and disrupting well-learned habits
Authors: Ceceli Ahmet O. , Myers Catherine E. , Tricomi Elizabeth
Published: August 2019

Researchers have exerted tremendous efforts to empirically study how habits form and dominate at the expense of deliberation, yet we know very little about breaking these rigid habits to restore goal-directed control. In a three-experiment study, we first illustrate a novel approach of studying well-learned habits, in order to effectively demonstrate habit disruption. In Experiment 1, we use a Go/NoGo task with familiar color-response associations to demonstrate outcome-insensitivity when compared to novel, more flexible associations. Specifically, subjects perform more accurately when the required mapping is the familiar association of green–Go/red–NoGo than when it is red–Go/green–NoGo, confirming outcome-insensitive, habitual control. As a control condition, subjects show equivalent performance with unfamiliar color-response mappings (using the colors blue and purple mapped to Go and NoGo responses). Next, in Experiments 2 and 3, we test a motivation-based feedback manipulation in varying magnitudes (i.e., performance feedback with and without monetary incentives) to break the well-established habits elicited by our familiar stimuli. We find that although performance feedback prior to the contingency reversal test is insufficient to disrupt outcome-insensitivity in Experiment 2, a combination of performance feedback and monetary incentive is able to restore goal-directed control in Experiment 3, effectively breaking the habits. As the first successful demonstration of well-learned habit disruption in the laboratory, these findings provide new insights into how we execute and modify habits, while fostering new and translational research avenues that may be applicable to treating habit-based pathologies.
The efficiency for recombineering is dependent on the source of the phage recombinase function unit
Authors: Chang Yizhao , Wang Qian , Su Tianyuan , Qi Qingsheng
Published: August 2019

Phage recombinase function units (PRFUs) such as lambda-Red or Rac RecET have been proven to be powerful genetic tools in the recombineering ofEscherichia coli. Studies have focused on developing such systems in other bacteria as it is believed that these PRFUs have limited efficiency in distant species. However, how the species evolution distance relates to the efficiency of recombineering remains unclear. Here, we present a thorough study of PRFUs to find features that might be related to the efficiency of PRFUs for recombineering. We first identified 59 unique sets of PRFUs in the genusCorynebacteriumand classified them based on their sequence as well as secondary structure similarities. Then both PRFUs from this genus and other bacteria were chosen for experiment based on sequential and secondary structure similarity as well as species distance. These PRFUs were compared for their ability in mediating recombineering with oligo or double-stranded DNA substrates inCorynebacterium glutamicum. We demonstrate that the source of the PRFU is more critical than species distance for the efficiency of recombineering. Our work will provide new ideas for efficient recombineering using PRFUs.

Importance

Recombineering using phage recombinase function units (PRFUs) such as lambda-Red or Rac RecET has gained success inEscherichia coli, while efforts applying these systems in other bacteria were limited by the efficiency. It is believed that the species distance may be a major reason for the low efficiency. In this study, however, we showed that it is the source of PRFU rather than the species distance that matters for the recombineering inCorynebacterium glutamicum. Besides, we also showed that the lower transformation efficiency in other bacteria compared to that ofE. colicould be a major reason for the low performance of heterogeneously expressed RecET. These findings will be helpful for the recombineering using PRFUs.