bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambivalent outcomes of statebuilding: multiplication of brokers and educational expansion in the Democratic Republic of Congo (2004–13)
Authors: Brandt Cyril Owen
Published: September 2017

This empirical article explores how the interaction between two key aspects of statebuilding (democratisation and decentralisation) and existing forms of governance in the Democratic Republic of Congo led to a multiplication in numbers of political and administrative brokers. Furthermore, it investigates how these brokers construct their roles well beyond official mandates. Responding to local demands, they circumvent formal procedures in order to obtain decrees accrediting public primary and secondary schools. As a result, the number of public schools has almost tripled since the early 2000s. Building on qualitative and quantitative empirical data, the article thus reveals that democratisation and decentralisation can reproduce clientelist structures. However, it also uncovers changing socio-spatial dynamics: certain historically neglected and conflict-affected districts have particularly benefited from brokers’ involvement. Despite these positive aspects, the article further illustrates how these outcomes counteract other central administrative and political objectives.
Cancer-associated fibroblasts lead tumor invasion through integrin-β3–dependent fibronectin assembly
Authors: Attieh Youmna , Clark Andrew G. , Grass Carina , Richon Sophie , Pocard Marc , Mariani Pascale , Elkhatib Nadia , Betz Timo , Gurchenkov Basile , Vignjevic Danijela Matic
Published: September 2017

Cancer-associated fibroblasts (CAFs) are the most abundant cells of the tumor stroma. Their capacity to contract the matrix and induce invasion of cancer cells has been well documented. However, it is not clear whether CAFs remodel the matrix by other means, such as degradation, matrix deposition, or stiffening. We now show that CAFs assemble fibronectin (FN) and trigger invasion mainly via integrin-αvβ3. In the absence of FN, contractility of the matrix by CAFs is preserved, but their ability to induce invasion is abrogated. When degradation is impaired, CAFs retain the capacity to induce invasion in an FN-dependent manner. The level of expression of integrins αv and β3 and the amount of assembled FN are directly proportional to the invasion induced by fibroblast populations. Our results highlight FN assembly and integrin-αvβ3 expression as new hallmarks of CAFs that promote tumor invasion.
PML is a ROS sensor activating p53 upon oxidative stress
Authors: Niwa-Kawakita Michiko , Ferhi Omar , Soilihi Hassane , Le Bras Morgane , Lallemand-Breitenbach Valérie , de Thé Hugues
Published: September 2017

Promyelocytic leukemia (PML) nuclear bodies (NBs) recruit partner proteins, including p53 and its regulators, thereby controlling their abundance or function. Investigating arsenic sensitivity of acute promyelocytic leukemia, we proposed that PML oxidation promotes NB biogenesis. However, physiological links between PML and oxidative stress response in vivo remain unexplored. Here, we identify PML as a reactive oxygen species (ROS) sensor. Pml−/− cells accumulate ROS, whereas PML expression decreases ROS levels. Unexpectedly, Pml−/− embryos survive acute glutathione depletion. Moreover, Pml−/− animals are resistant to acetaminophen hepatotoxicity or fasting-induced steatosis. Molecularly, Pml−/− animals fail to properly activate oxidative stress–responsive p53 targets, whereas the NRF2 response is amplified and accelerated. Finally, in an oxidative stress–prone background, Pml−/− animals display a longevity phenotype, likely reflecting decreased basal p53 activation. Thus, similar to p53, PML exerts basal antioxidant properties but also drives oxidative stress–induced changes in cell survival/proliferation or metabolism in vivo. Through NB biogenesis, PML therefore couples ROS sensing to p53 responses, shedding a new light on the role of PML in senescence or stem cell biology.
The first wave of T lymphopoiesis in zebrafish arises from aorta endothelium independent of hematopoietic stem cells
Authors: Tian Ye , Xu Jin , Feng Shachuan , He Sicong , Zhao Shizheng , Zhu Lu , Jin Wan , Dai Yimei , Luo Lingfei , Qu Jianan Y. , Wen Zilong
Published: September 2017

T lymphocytes are key cellular components of the adaptive immune system and play a central role in cell-mediated immunity in vertebrates. Despite their heterogeneities, it is believed that all different types of T lymphocytes are generated exclusively via the differentiation of hematopoietic stem cells (HSCs). Using temporal–spatial resolved fate-mapping analysis and time-lapse imaging, here we show that the ventral endothelium in the zebrafish aorta–gonad–mesonephros and posterior blood island, the hematopoietic tissues previously known to generate HSCs and erythromyeloid progenitors, respectively, gives rise to a transient wave of T lymphopoiesis independent of HSCs. This HSC-independent T lymphopoiesis occurs early and generates predominantly CD4 Tαβ cells in the larval but not juvenile and adult stages, whereas HSC-dependent T lymphopoiesis emerges late and produces various subtypes of T lymphocytes continuously from the larval stage to adulthood. Our study unveils the existence, origin, and ontogeny of HSC-independent T lymphopoiesis in vivo and reveals the complexity of the endothelial-hematopoietic transition of the aorta.
Epithelial transport in The Journal of General Physiology
Authors: Palmer Lawrence G.
Published: September 2017

Epithelia define the boundaries of the body and often transfer solutes and water from outside to inside (absorption) or from inside to outside (secretion). Those processes involve dual plasma membranes with different transport components that interact with each other. Understanding those functions has entailed breaking down the problem to analyze properties of individual membranes (apical vs. basolateral) and individual transport proteins. It also requires understanding of how those components interact and how they are regulated. This article outlines the modern history of this research as reflected by publications in The Journal of General Physiology.
The enduring legacy of the “constant-field equation” in membrane ion transport
Authors: Alvarez Osvaldo , Latorre Ramon
Published: September 2017

In 1943, David Goldman published a seminal paper in The Journal of General Physiology that reported a concise expression for the membrane current as a function of ion concentrations and voltage. This body of work was, and still is, the theoretical pillar used to interpret the relationship between a cell’s membrane potential and its external and/or internal ionic composition. Here, we describe from an historical perspective the theory underlying the constant-field equation and its application to membrane ion transport.
100 years and counting: JGP celebrates its centenary
Authors: Gordon Sharona E.
Published: September 2017

As JGP approaches its 100th year, dissemination of science is more important than ever.
Universal halting times in optimization and machine learning
Authors: Sagun Levent , Trogdon Thomas , LeCun Yann
Published: September 2017

We present empirical evidence that the halting times for a class of optimization algorithms are universal. The algorithms we consider come from quadratic optimization, spin glasses and machine learning. A universality theorem is given in the case of the quadratic gradient descent flow. More precisely, given an algorithm, which we take to be both the optimization routine and the form of the random landscape, the fluctuations of the halting time of the algorithm follow a distribution that, after centering and scaling, appears invariant under changes in the distribution on the landscape — universality is present.
Modified scattering and beating effect for coupled Schrödinger systems on product spaces with small initial data
Authors: Vilaça Da Rocha Victor
Published: September 2017

In this paper, we study a coupled nonlinear Schrödinger system with small initial data in a product space. We establish a modified scattering of the solutions of this system and we construct a modified wave operator. The study of the resonant system, which provides the asymptotic dynamics, allows us to highlight a control of the Sobolev norms and interesting dynamics with the beating effect. The proof uses a recent work of Hani, Pausader, Tzvetkov, and Visciglia for the modified scattering, and a recent work of Grébert, Paturel, and Thomann for the study of the resonant system.
Adhesion force and attachment lifetime of the KIF16B-PX domain interaction with lipid membranes
Authors: Pyrpassopoulos Serapion , Shuman Henry , Ostap E. Michael
Published: September 2017

KIF16B is a highly processive kinesin-3 family member that participates in the trafficking and tubulation of early endosomes along microtubules. KIF16B attaches to lipid cargoes via a PX motif at its C-terminus, which has nanomolar affinity for bilayers containing phosphatidylinositol-3-phosphate (PI[3]P). As the PX domain has been proposed to be a primary mechanical anchor for the KIF16B-cargo attachment, we measured the adhesion forces and detachment kinetics of the PX domain as it interacts with membranes containing 2% PI(3)P and 98% phosphatidylcholine. Using optical tweezers, we found that the adhesion strength of a single PX domain ranged between 19 and 54 pN at loading rates between 80 and 1500 pN/s. These forces are substantially larger than the interaction of the adhesion of a pleckstrin homology domain with phosphatidylinositol 4,5-bisphosphate. This increased adhesion is the result of the membrane insertion of hydrophobic residues adjacent to the PI(3)P binding site, in addition to electrostatic interactions with PI(3)P. Attachment lifetimes under load decrease monotonically with force, indicating slip-bond behavior. However, the lifetime of membrane attachment under load appears to be well matched to the duration of processive motility of the KIF16B motor, indicating the PX domain is a suitable mechanical anchor for intracellular transport.
Taxing stock transfers in the first golden age of financial capitalism: political salience and the limits on the power of finance
Authors: Massoc Elsa
Published: September 2017

The current debate about taxing financial transactions is often presented as a brand new one. It is not. At the turn of the 19th century, a similar tax was debated in France and the US Financial actors fought the tax mightily. Those actors were very powerful. Yet, they lost. A tax on stock transfers (STT) was established. Why? Through a comparative analysis of France and the State of New York, this article argues that the tax was adopted because politicians interested in capitalizing on public discontent endeavored to publicize and frame the STT in simple and antagonizing terms. Strong but heterogeneous public hostility against finance got focused on the explicitly politicized issue of the tax. Political salience disrupted the logics of ‘quiet politics’ and momentarily undermined the privileged position of finance. Despite intense lobbying and threats to relocate from financiers, elected officials chose to vote for the STT.
Time Course of Septic Shock in Immunocompromised and Nonimmunocompromised Patients
Authors: Jamme Matthieu , Daviaud Fabrice , Charpentier Julien , Marin Nathalie , Thy Michaël , Hourmant Yannick , Mira Jean-Paul , Pène Frédéric
Published: September 2017

Objectives:

To address the impact of underlying immune conditions on the course of septic shock with respect to both mortality and the development of acute infectious and noninfectious complications.

Design:

An 8-year (2008–2015) monocenter retrospective study.

Setting:

A medical ICU in a tertiary care center.

Patients:

Patients diagnosed for septic shock within the first 48 hours of ICU admission were included. Patients were classified in four subgroups with respect to their immune status: nonimmunocompromised and immunocompromised distributed into hematologic or solid malignancies and nonmalignant immunosuppression. Outcomes were in-hospital death and the development of ischemic and hemorrhagic complications and ICU-acquired infections. The determinants of death and complications were addressed by multivariate competing risk analysis.

Interventions:

None.

Measurements and Main Results:

Eight hundred one patients were included. Among them, 305 (38%) were immunocompromised, distributed into solid tumors (122), hematologic malignancies (106), and nonmalignant immunosuppression (77). The overall 3-day, in-ICU, and in-hospital mortality rates were 14.1%, 37.3%, and 41.3%, respectively. Patients with solid tumors displayed increased in-hospital mortality (cause-specific hazard, 2.20 [95% CI, 1.64–2.96]; p < 0.001). ICU-acquired infections occurred in 211 of the 3-day survivors (33%). In addition, 95 (11.8%) and 70 (8.7%) patients exhibited severe ischemic or hemorrhagic complications during the ICU stay. There was no association between the immune status and the occurrence of ICU-acquired infections. Nonmalignant immunosuppression and hematologic malignancies were independently associated with increased risks of severe ischemic events (cause-specific hazard, 2.12 [1.14–3.96]; p = 0.02) and hemorrhage (cause-specific hazard, 3.17 [1.41–7.13]; p = 0.005), respectively.

Conclusions:

The underlying immune status impacts on the course of septic shock and on the susceptibility to ICU-acquired complications. This emphasizes the complexity of sepsis syndromes in relation with comorbid conditions and raises the question of the relevant endpoints in clinical studies.
Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type, With Spontaneous Regression After Biopsy
Authors: Marrero-Alemán Gabriel , Montenegro-Dámaso Társila , Peñate Yeray
Published: September 2017

Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) represents approximately 20% of cutaneous B lymphomas with an intermediate prognosis. Spontaneous regression is uncommon; there are only 2 published cases. An 83-year-old woman presented 2 orange erythematous nodules on the back of her right leg with an elastic consistency, infiltrated, painful to the touch, and of an 8-month evolution. A histological examination revealed a dense cellular dermo-hypodermic infiltrate sparing the papillary dermis, composed of large cells with immunoblast and centroblast morphology and frequent mitosis. Immunohistochemical studies showed positivity for CD20, CD79, Bcl2, Bcl6, MUM1, Fox-P1, and IgM with Ki67 >95%. Rearrangement of heavy IgH chains was monoclonal. The extension study was negative, establishing a diagnosis of PCDLBCL-LT, T2aN0M0. Three months after biopsy, the patient's lesions regressed spontaneously. New biopsies were taken that revealed a mild diffused dermo-hypodermic cellular infiltrate compounded by small-sized T lymphocytes, with predominance of CD8. Despite its self-limited character, treatment with radiotherapy was done, remaining asymptomatic after 1 year follow-up. There are 2 published cases of PCDLBCL-LT with spontaneous regression. The cause of this unusual autoinvolutional phenomenon is unknown; it may be an immune response against tumor cells through a traumatic or infectious mechanism.
A Case of Lymphomatoid Papulosis Type E With an Unusual Exacerbated Clinical Course
Authors: Belousova Irena E. , Kyrpychova Liubov , Samtsov Alexey V. , Kazakov Dmitry V.
Published: September 2017

Lymphomatoid papulosis (LyP) type E is a recently delineated variant characterized by the occurrence of large necrotic “eschar”-like lesions displaying microscopically angioinvasive and angiodestructive infiltrates composed of CD30+ lymphocytes, frequently coexpressing CD8. In contrast to other LyP variants where patients develop multiple lesions, most patients with LyP type E present with few lesions (often 1 or 2 at a given time). In this article, we describe a 34-year-old man with LyP type E with an exacerbated clinical course characterized by the occurrence of almost a hundred of lesions. Initially, he presented with a single rapidly growing 2-cm large erythematous nodule on the forearm but after the administration of doxycycline multiple eschar-like lesions developed all over the body. Atypical lymphoid infiltrates with marked angiocentricity and angiotropism of CD30+ medium-sized to large pleomorphic lymphocytes were seen histopathologically. After the withdrawal of the antibiotic, the lesions spontaneously regressed. Awareness of this rare LyP variant and its correct recognition, even if the clinical course is unusual and worrisome, is important to avoid aggressive treatment.
Cutaneous Richter Syndrome Mimicking Primary Cutaneous CD4-Positive Small/Medium T-cell Lymphoma: Case Report and Review of the Literature
Authors: Rito Miguel , Cabeçadas José , Costa Rosa Joaninha , Cravo Mariana , Robson Alistair
Published: September 2017

Richter syndrome represents the transformation of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma into an aggressive large B-cell lymphoma. Skin involvement is exceptionally rare, with <20 cases reported and its presence as the first presentation of CLL/small lymphocytic lymphoma, as an isolated skin lesion has never been described. Primary cutaneous CD4-positive small/medium T-cell lymphoma (CD4+ PCSM-TCL) characteristically presents with a dense dermal infiltrate consisting primarily of small-/medium-sized pleomorphic T-cells and less than 30% large pleomorphic cells. A polymorphous reactive infiltrate composed of B-cells, histiocytes, plasma cells, and eosinophils is also found in differing proportions. Because of these morphological characteristics, the differential diagnosis includes not only other forms of cutaneous T-cell lymphomas but also B-cell lymphomas and reactive lymphoid infiltrates. We report a case of a cutaneous Richter syndrome as the initial manifestation of CLL, mimicking CD4+ PCSM-TCL, in a 65-year-old apparently healthy asymptomatic man who presented with a solitary nodule in his arm. The objective of this study is to draw attention to this potential pitfall and describe this rare presentation.
Langerhans Cell Histiocytosis With Clinical and Histologic Features of Hidradenitis Suppurativa: Brief Report and Review
Authors: Kalen Jessica E. , Shokeen Divya , Mislankar Mona , Wangia Michael , Motaparthi Kiran
Published: September 2017

Langerhans cell histiocytosis (LCH) is an uncommon histiocytic disorder in adults. Clinically, this rare entity can mimic other dermatologic conditions, including hidradenitis suppurativa. A case of LCH is reported with clinical and histologic features of hidradenitis suppurativa, along with a review of these unusual findings. Clinical dermatologists and dermatopathologists benefit from awareness of this unique presentation, which may prompt earlier identification and diagnosis of adult patients with LCH.
Parenting to Reduce Child Screen Time: A Feasibility Pilot Study
Authors: Sanders Wesley , Parent Justin , Forehand Rex
Published: September 2017

Objective:

Excessive screen time has been associated with a multitude of child health problems. This pilot study examined the feasibility and preliminary outcome of a novel 1-session intervention designed to help parents reduce their child's screen time.

Methods:

Thirty-nine parents of 5- to 12-year-old children were randomized to the intervention (a combined didactics and hands-on approach focused on technology-specific parenting) or waitlist control group.

Results:

The findings suggested that a sample could be recruited in a reasonable time (6 wk) at a reasonable cost, randomized, and retained at 6 weeks postintervention. Preliminary evidence suggested the intervention, which was implemented with fidelity, was associated with change in technology-specific parenting and 1 of 2 measures of child screen time. Parents reported satisfaction with the intervention and confidence in managing their child's screen time.

Conclusion:

The results of this pilot study suggest that this 1-session intervention is a promising approach to managing child screen time.
Persistent Encopresis, Enuresis, and Anxiety in a 7-Year-Old Girl
Authors: Nelson Theodora , Chae Heekyung , Anbar Ran D. , Stein Martin T.
Published: September 2017

CASE: Sonia is a 7-year-old old girl who was referred to the Developmental-Behavioral Pediatrics Clinic by the Pediatric Urology Clinic because of persistent wetting and soiling behaviors. Since age 3 years, she has had a history of encopresis (and wetting) for which she has seen gastroenterology and urology specialists. The mother reports that Sonia has accidents almost daily, and she is not upset when sitting in her urine or feces. She dislikes going into the bathroom or sitting on the toilet by herself. She participated in a behavior modification program associated with the pediatric urology clinic, which helps children learn healthy voiding habits and achieve continence.

Sonia also has anxious behaviors. She bites her nails and chews on her hair or shirt. She is afraid of small spaces such as those between the bed and the wall and needs to have stuffed animals cover them. Other instances that trigger her anxious behaviors include loud noises, having a substitute teacher, being separated from her mother, and going to certain bathrooms or new places. She also has severe tantrums, which involve throwing and breaking objects, kicking, and hitting her head against doors.

A cognitive behavioral therapy program was recommended to target anxiety symptoms, in addition to timed toileting after meals and polyethylene glycol. At a clinic visit several months later, symptoms of anxiety, encopresis, and enuresis persisted. Cognitive behavior therapy was continued and sertraline 25 mg was prescribed for anxiety. In addition, she was referred to a pediatrician who specializes in relaxation techniques and hypnotherapy.

Sonia showed modest improvement with these interventions. There were fewer episodes of angry outbursts and a decrease in soiling and wetting, but at times, but she continued to have intermittent periods of wetting and soiling and fear of going to the bathroom by herself persisted.

(This Challenging Case extends observations reviewed in a previous Challenging Case: J Dev Behav Pediatr 2010;531:513–515; DOI: 10.1097/DBP.0b013e3181e5a464.)
Enoxaparin Population Pharmacokinetics in the First Year of Life
Authors: Moffett Brady S. , Galati Marianne , Mahoney Donald , Lee-Kim YoungNa , Teruya Jun , Shah Mona D. , Yee Donald L.
Published: September 2017

Aims:

Enoxaparin dosing requirements in the first year of life can be highly variable. Characterization of pharmacokinetics in this patient population can assist in dosing.

Methods:

Patients less than 1 year postnatal age who received enoxaparin and had an anti–factor Xa activity level drawn as inpatients were identified through the pharmacy database over a 5-year period. Patients on renal replacement therapy or with hyperbilirubinemia were excluded. Data collection included demographic variables, indication for enoxaparin, enoxaparin doses, anti–factor Xa activity levels, serum creatinine, hemoglobin, hematocrit, platelet count, and urine output over the previous 24 hours. Population pharmacokinetic analysis was performed with NONMEM.

Results:

A total of 182 patients [male 50%, median 100 days postnatal age (range: 4–353 days)] met the study criteria. Patients received median 22 doses (range: 1–526) at a mean starting dose of 1.38 ± 0.43 mg/kg with median 5 (range: 1–56) anti–factor Xa activity levels measured. A 1-compartment proportional and additive error model best fits the data. Allometrically scaled weight significantly decreased the objective function value, as did serum creatinine on clearance, and postmenstrual age (PMA) on volume of distribution. When evaluated graphically, dosing based on PMA appeared to have less variability as compared to postnatal age–based dosing.

Conclusions:

Dosing of enoxaparin in infants younger than 1 year should incorporate PMA.
Bilateral Free Flap Breast Reconstruction Outcomes: Do Abdominal Scars Affect Bilateral Flaps?
Authors: Unukovych Dmytro , Caterson Edward J. , Carty Matthew J. , Erdmann-Sager Jessica , Halvorson Eric , Caterson Stephanie A.
Published: September 2017

Background:

The incidence of bilateral mastectomies is increasing along with the rates of breast reconstructions. A substantial number of patients will present with abdominal scars after Cesarean section, laparoscopy, laparotomy, and so on. The aim of this study was to evaluate the impact of prior abdominal scars on complication rates in abdominal bilateral free flap breast reconstruction.

Methods:

All consecutive patients with autologous free flap breast reconstruction between 2007 and 2014 were eligible. The relevant demographic and clinical data were prospectively collected into a study-specific database. Complications and reoperations were prospectively registered after postoperative outpatient visits.

Results:

Overall, 493 patients underwent abdominally based breast reconstruction during the study period: unilateral (n = 250; 50.7%) or bilateral (n = 243; 49.3%). In the bilateral group, the abdominal scar locations were Pfannenstiel (n = 73; 30.1%), midline (n = 16; 6.6%), lower oblique (n = 17; 7.0%), upper oblique (n = 5; 2.1%), and laparoscopic (n = 69; 28.4%). Four (1.7%) flap failures (including 1 converted to a pedicled transverse rectus abdominis flap) were registered, all occurring in patients from the scar group: 3 with Pfannenstiel incision and 1 patient with prior laparoscopy. Pfannenstiel scar was associated with higher risk of hematoma at the recipient site when compared with no scar group (13.7% versus 2.2%; P = 0.006). Partial flap necrosis, infection, and seroma occurred in 14 (5.9%), 8 (3.4%), and 5 (2.1%) patients, respectively, and no differences between the scar groups were identified.

Conclusion:

Surgical outcomes of bilateral reconstructions in patients with abdominal scars are generally comparable with ones in patients without prior surgery; however, some problems have been identified. These procedures might have some intraoperative considerations and often require increased operative times. Apart from the traditional preoperative computed tomography angiography, intraoperative imaging (e.g., fluorescence angiography) may be advocated in patients with abdominal scars.
MORPHOLOGIC FEATURES ASSOCIATED WITH FIBROTIC SCARRING AFTER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Kim Jae Hui , Chang Young Suk , Kim Jong Woo , Kim Chul Gu , Lee Dong Won , Kim Ye Ji
Published: September 2017

Purpose:

To investigate morphologic features associated with fibrotic scarring after anti–vascular endothelial growth factor therapy in polypoidal choroidal vasculopathy (PCV).

Methods:

This retrospective study included 293 patients who had been diagnosed with PCV and treated with anti-vascular endothelial growth factor monotherapy during a 12-month follow-up period. Associations of morphologic features, including type of PCV, location of the polypoidal lesion, greatest linear dimension, largest polyp diameter, choroidal vascular hyperpermeability, pigment epithelial detachment, intraretinal fluid, and subretinal hyperreflective material (SHRM) with fibrotic scar at 12 months were analyzed.

Results:

Fibrotic scars were noted in 15 eyes (5.1%). The incidence of fibrotic scars was higher in Type 1 PCV (8 of 76 eyes) than in Type 2 PCV (7 of 217 eyes, P = 0.028). The incidence was also higher in eyes with SHRM (14 of 124 eyes) than in eyes without SHRM (1 of 169 eyes, P < 0.001). In multivariate analysis, SHRM was associated with fibrotic scar (P = 0.005). Among the SHRM cases, the incidence of the scar was 12.9% in eyes with submacular hemorrhage and 8.5% in eyes without hemorrhage.

Conclusion:

Although fibrotic scar is an infrequent finding in PCV, the possibility of scarring should be considered in eyes with SHRM, particularly in submacular hemorrhage cases.
CHOROIDAL MELANOMA IN PHAKOMATOSIS PIGMENTOVASCULARIS WITH KLIPPEL–TRENAUNAY SYNDROME
Authors: Shields Carol L. , Di Nicola Maura , Pellegrini Marco , Shields Jerry A.
Published: September 2017

Purpose:

To describe the relationship of choroidal melanoma with phakomatosis pigmentovascularis in patients with Klippel–Trenaunay syndrome.

Methods:

Retrospective review of 5 patients.

Results:

In all 5 cases, the patient was white and the cutaneous port-wine stain was congenital. The port-wine stain involved the chin (n = 1), jawline (n = 2), lower cheek (n = 1), thorax (n = 5), abdomen (n = 4), upper (n = 4), and lower (n = 3) limb(s). The ocular melanocytosis involved the sclera (n = 5), iris (n = 2) and choroid (n = 4). At diagnosis of choroidal melanoma, mean patient age was 57 years (median 61, range 17–83 years). The melanoma demonstrated mean basal diameter of 11.6 mm (median 12, range 5–16 mm) and mean thickness of 5.7 mm (median 6.1, range 2–9), revealing intrinsic tumor pigment and subretinal fluid in all cases. Melanoma management included plaque radiotherapy (n = 3), thermotherapy (n = 1), or enucleation (n = 1). At mean follow-up of 4 years, one patient demonstrated melanoma-related metastasis with death.

Conclusion:

Phakomatosis pigmentovascularis represents coexistence of Klippel–Trenaunay syndrome (or Sturge–Weber syndrome) and oculo(dermal) melanocytosis, promoting risk for life-threatening uveal melanoma. The authors suggest that all patients with Klippel–Trenaunay syndrome be evaluated for phakomatosis pigmentovascularis and affected patients have dilated fundus examination once or twice a year.
A Novel Entity of Corneal Diseases with Irregular Posterior Corneal Surfaces: Concept and Clinical Relevance
Authors: Yamaguchi Takefumi , Shimizu Eisuke , Yagi-Yaguchi Yukari , Tomida Daisuke , Satake Yoshiyuki , Shimazaki Jun
Published: September 2017

Various corneal diseases, such as hereditary corneal dystrophies, corneal infection, and bullous keratopathy, cause corneal opacity, scarring, and edema, leading to severely decreased visual acuity and loss of vision. These diseases were regarded as corneal opacity diseases, and the decreased visual acuity was considered to be predominantly caused by corneal opacity. The influence of corneal irregular astigmatism on vision has been poorly understood to date, mainly because accurate quantification of irregular astigmatism has been technically challenging. We have performed detailed analyses of the corneal higher-order aberrations (HOAs) of the anterior and posterior surfaces and total cornea in corneal diseases, using an anterior segment imaging system combined with a ray-tracing method. Subsequently, we conducted correlation analyses between corneal HOAs and visual acuities and characterized the typical HOA patterns in the corneal diseases. Our recent studies demonstrated that corneal HOAs directly degrade visual acuity in eyes with mild-to-moderate corneal opacities, such as corneal dystrophies, corneal scarring, and bullous keratopathy. The findings also suggested that correction of corneal HOAs using rigid gas-permeable contact lenses is effective in eyes with a smooth posterior surface and useful in certain patients with corneal scarring to some extent. Our data will be useful for decision making regarding surgical interventions, based on the amount of corneal HOAs. Our results further indicate the clinical relevance of irregular astigmatism in the posterior surfaces in assessing the visual function of eyes with various corneal diseases.
High levels of cerebrospinal fluid chemokines point to the presence of neuroinflammation in peripheral neuropathic pain: a cross-sectional study of 2 cohorts of patients compared with healthy controls
Authors: Bäckryd Emmanuel , Lind Anne-Li , Thulin Måns , Larsson Anders , Gerdle Björn , Gordh Torsten
Published: September 2017

Animal models suggest that chemokines are important mediators in the pathophysiology of neuropathic pain. Indeed, these substances have been called “gliotransmitters,” a term that illustrates the close interplay between glial cells and neurons in the context of neuroinflammation and pain. However, evidence in humans is scarce. The aim of the study was to determine a comprehensive cerebrospinal fluid (CSF) inflammatory profile of patients with neuropathic pain. Our hypothesis was that we would thereby find indications of a postulated on-going process of central neuroinflammation. Samples of CSF were collected from 2 cohorts of patients with neuropathic pain (n = 11 and n = 16, respectively) and healthy control subjects (n = 11). The samples were analyzed with a multiplex proximity extension assay in which 92 inflammation-related proteins were measured simultaneously (Proseek Multiplex Inflammation I; Olink Bioscience, Uppsala, Sweden). Univariate testing with control of false discovery rate, as well as orthogonal partial least squares discriminant analysis, were used for statistical analyses. Levels of chemokines CXCL6, CXCL10, CCL8, CCL11, CCL23 in CSF, as well as protein LAPTGF-beta-1, were significantly higher in both neuropathic pain cohorts compared with healthy controls, pointing to neuroinflammation in patients. These 6 proteins were also major results in a recent similar study in patients with fibromyalgia. The findings need to be confirmed in larger cohorts, and the question of causality remains to be settled. Because it has been suggested that prevalent comorbidities to chronic pain (eg, depression, anxiety, poor sleep, and tiredness) also are associated with neuroinflammation, it will be important to determine whether neuroinflammation is a common mediator.
Cognitive Skills Training for Homeless Transition-Age Youth
Authors: Medalia Alice , Saperstein Alice M. , Huang Yanlan , Lee Seonjoo , Ronan Elizabeth J.
Published: September 2017

Cognitive impairments are common in homeless youth and negatively impact academic and vocational outcomes. We examined the feasibility and efficacy of cognitive interventions provided to 18- to 22-year-old homeless youth living in urban supportive housing. Ninety-one homeless youth were randomized to receive either targeted cognitive training (cognitive remediation) or general cognitive activation (computer skills training). Cognitive and psychological outcomes were assessed at baseline, after 13 and 26 sessions, and 1 month postintervention. A high dropout rate highlighted the feasibility challenges of treating this population. Intent-to-treat analysis found significant improvements across groups in specific and global measures of cognition and psychological distress, with no significant group differences. Transition-age homeless youth show improvements in cognitive and psychological functioning when engaged in interventions that address their cognitive development. This speaks to the malleability of cognitive skills in this cohort and lays the groundwork for future research to address their cognitive health.
Frequency of Nucleic Acid Amplification Test Positivity Among Men Who Have Sex With Men Returning for a Test-of-Cure Visit 7 to 30 Days After Treatment of Laboratory-Confirmed Neisseria gonorrhoeae Infection at 2 Public Sexual Health Clinics, New York City, 2013 to 2016
Authors: Okah Ebiere , Westheimer Emily F. , Jamison Kelly , Schillinger Julia A.
Published: September 2017

Background

The Centers for Disease Control and Prevention 2015 Sexually Transmitted Disease Treatment Guidelines recommend that clinicians consider cephalosporin treatment failure in patients who deny interval sexual exposure and are nucleic acid amplification test (NAAT) positive for Neisseria gonorrhoeae (NG) at least 7 days after adequate treatment. We evaluate the real-world implications of the interval the Centers for Disease Control and Prevention recommends for a NAAT test-of-cure (TOC), by ascertaining the frequency of NG NAAT positivity at different anatomic sites among men who have sex with men (MSM) at TOC 7 to 30 days after treatment.

Methods

We analyzed data from the medical records of MSM with laboratory-confirmed NG who were presumptively treated for NG during the period from June 2013 to April 2016 and returned for a TOC visit within 30 days. Data examined included symptoms, site of NG specimen collection, treatment regimen, follow-up testing, and intervening sexual activity.

Results

There were 1027 NG-positive specimens obtained from 763 MSM patients at 889 presumptive treatment visits. Of these, 44% (337/763) MSM returned for 1 or more TOC visits, and 413 specimens were collected a median of 10 days after presumptive treatment. Three percent (14/413) of specimens collected were NG NAAT positive at TOC a median of 13 days after treatment: 5% (12/256) of urethral specimens, 1% (1/147) of anorectal specimens (P = 0.037, urethral vs. anorectal), and 10% (1/10) of oropharyngeal specimens (P = 0.40, urethral vs. oropharyngeal).

Conclusions

A small percent of patients were NG NAAT positive at TOC. Compared with anorectal specimens, urethral specimens were more frequently still positive at TOC. A large proportion of MSM will return for a TOC visit as part of standard clinical care.
Optimization of Computed Tomography Coronary Angiography for Improved Plaque Detection
Authors: Kashani Hany , Wright Graham , Ursani Ali , Liu Garry , Hashemi Masoud , Paul Narinder S.
Published: September 2017

Objective

The study aims to optimize visualization of the coronary wall during computed tomography coronary angiography.

Methods

A coronary plaque phantom was scanned on a wide-volume computed tomography scanner. Spatial resolution, contrast resolution, and vessel wall thickness were measured at different x-ray tube currents and voltages.

Results

Spatial resolution ranged from 0.385 to 0.625 mm and was significantly lower at higher currents. Contrast-to-noise ratio was significantly higher at higher currents. The most accurate wall thickness measurements were quantified at 300 and 400 mA for 80 and 100 kVp and 300 mA for 120 and 135 kVp.

Conclusions

Lower spatial resolution at higher currents was due to added blur from increased focal spot size. Contrast-to-noise ratio was higher at higher currents owing to decreased quantum noise. Wall thickness was measured more accurately at intermediate currents with midrange contrast-to-noise ratio but optimal spatial resolution. For accurate coronary wall thickness measurement, contrast-to-noise ratio is compromised to achieve optimal spatial resolution.
Diagnosis of Mesenteric Ectopic Pancreas by Secretin-Enhanced Magnetic Resonance Cholangiopancreatography
Authors: Moreno Pastor Ana , Olalla Muñoz José Ramón , Esteban Delgado Pilar , Soria Aledo Victoriano
Published: September 2017

Ectopic pancreas (EP) is defined as pancreatic tissue found outside its usual anatomical position, with no ductal or vascular communication with the native pancreas.

We report the case of a 59-year-old woman with a mesenteric jejunal EP initially suspected on computed tomography and confirmed by secretin-enhanced magnetic resonance cholangiopancreatography.

Mesenteric EP is a very rare finding with nonspecific clinical presentation, so that, classic radiological findings have not been well described previously.
The Relationship Between Body Mass Index and Fatty Infiltration in the Shoulder Musculature
Authors: Dow David F. , Mehta Kaushal , Xu Yuanfang , England Eric
Published: September 2017

Objective

Fatty infiltration in the rotator cuff muscles has been well studied in the setting of rotator cuff tendon tears to help predict outcomes of surgical repair. Fatty infiltration in the rotator cuff has also been independently correlated to the variables of age and sex. The purpose of our study was to determine if there is a relationship between body mass index and fatty infiltration in patients with no imaging evidence of rotator cuff tendinosis or tear.

Methods

Radiology reports of all magnetic resonance imaging examinations of the shoulder were searched over a 2-year period. Studies with imaging findings of rotator cuff tendinosis, partial tear, or full thickness tear were excluded from the study, resulting in a total of 143 patients with normal rotator cuffs who were included in the study. These studies were reviewed by consensus by 2 fellowship-trained musculoskeletal radiologists who used the Goutallier 5-stage scoring system to grade the supraspinatus, infraspinatus, subscapularis, teres minor, teres major, and deltoid muscles.

Results

Sex was shown not to be significantly associated with fatty infiltration with the exception of the deltoid muscle, which showed a statistically significant increase in fatty infiltration associated with female sex (P = 0.038). Age was shown to be a statistically significant predictor of fatty infiltration for all 6 muscles (P < 0.05). Body mass index was shown to be a statistically significant predictor of fatty infiltration for all of the evaluated shoulder musculature (P < 0.05) with the exception of the teres minor.

Conclusions

Our results suggest that increased body mass index is associated with increased fatty infiltration in the supraspinatus, infraspinatus, subscapularis, teres major, and deltoid muscles. This relationship could help guide the decisions of orthopedic surgeons when considering rotator cuff repair.
Serum Adiponectin Levels in Patients With Systemic Lupus Erythematosus
Authors: Dini Ahmed Ali , Wang Peng , Ye Dong-Qing
Published: September 2017

Background

Higher serum adiponectin in systemic lupus erythematosus (SLE) patients mitigates the inflammatory response. Previous studies investigated serum adiponectin level in SLE patients compared with control subjects, yielding inconsistent results.

Objective

The aim of this meta-analysis was to assess the difference between serum adiponectin levels in SLE patients compared with control subjects.

Methods

MEDLINE, PubMed, EMBASE, and Web of Science were searched from inception to August 31, 2016, to identify all observational studies that examined the relationship between serum adiponectin levels and SLE. The study quality was assessed by the Newcastle-Ottawa Scale. Standard mean difference values and 95% confidence intervals were estimated and pooled using the meta-analysis methodology. The Cochrane Q test and I
2 statistics were used to test heterogeneity. To assess publication bias, visual observations of a funnel plot were used. The Stata software (version 11.0) was used for statistical analysis.

Results

A total of 8 studies including 782 SLE patients and 550 control subjects were eligible for the meta-analysis. In overall random-effects model including all the studies, we found that patients with SLE had higher serum adiponectin levels than control subjects (eight studies; pooled standardized mean difference, 0.502 μg/mL; 95% confidence interval, 0.021–0.984; I
2 = 94.0%; P < 0.001). In subgroup analyses, SLE patients with body mass index of 25 kg/m2 or greater had higher serum adiponectin levels compared with control subjects.

Conclusions

Collectively, our results demonstrate that higher serum adiponectin level is significantly associated with SLE. Furthermore, they suggest that serum adiponectin levels in SLE patients are not correlated with Systemic Lupus Erythematosus Disease Activity Index scores. Imbalanced adiponectin levels might be associated with onset of other chronic diseases.
Management of Peri-Implant Hypertrophic Scarring for an Ear Prosthesis
Authors: Alfenas Elizabeth Rodrigues , Moreno Amália , Tanner Paul Benjamin , Netto Henrique Duque , Fonseca Maria Fernanda Lopes , Rios Fernando Gonçalves
Published: September 2017

The clinical report describes a case of a 14-year-old patient with a traumatic amputation of the left auricle and severe hypertrophic scarring. The management of peri-implant soft tissue was challenging, but successful in the rehabilitation of a patient with auricular prosthesis retained by implants. The prosthesis restored the patient's facial aesthetics and contributed not only to function, but also to psychosocial well-being.
Negative computed tomography can safely rule out clinically significant intra-abdominal injury in the asymptomatic patient after blunt trauma: Prospective evaluation of 1193 patients
Authors: Benjamin Elizabeth , Cho Jayun , Recinos Gustavo , Dilektasli Evren , Lam Lydia , Brunner John , Inaba Kenji , Demetriades Demetrios
Published: September 2017

BACKGROUND

Computed tomography of the abdomen and pelvis (CTAP) is highly specific for injury identification and commonly used in the evaluation of blunt trauma patients. Despite this, there is no consensus on the required clinical observation period after negative imaging, often impacting patient flow and hospital cost. The purpose of this study was to evaluate the use of CTAP after blunt trauma and the need for observation after negative imaging.

METHODS

A prospective analysis at a large Level I trauma center was conducted from November 2014 to May 2015. All blunt trauma patients, older than 14 years with CTAP on admission were included. Symptomatic patients were defined as having abdominal pain or external signs of trauma on admission. The main outcome was missed injury.

RESULTS

Over the study period, there were 1,468 blunt trauma admissions, of which 1,193 patients underwent CTAP. Eight hundred six (67.6%) patients were evaluable on admission (Glasgow Coma Scale score, 15), and of these, 327 (40.6%) were symptomatic, 479 (59.4%) asymptomatic. Among the evaluable asymptomatic patients, there were 65 (13.6%) positive computed tomography scans including 11 patients with grade III, IV, or V solid organ injury and three that required operation. In the 414 evaluable asymptomatic patients with negative imaging, median length of stay was 3 days, and there were zero missed injuries. All images were reviewed by an attending radiologist.

CONCLUSION

Abdominal imaging after trauma is justified in the appropriate clinical setting to evaluate for significant abdominal injury regardless of symptomatology. In asymptomatic, evaluable patients with a negative CTAP, clinically significant abdominal injury is unlikely, and these patients may be considered for early discharge or disposition to another treatment service.

LEVEL OF EVIDENCE

Diagnostic, level III; Therapy, level IV.
Effects of propranolol and clonidine on brain edema, blood-brain barrier permeability, and endothelial glycocalyx disruption after fluid percussion brain injury in the rat
Authors: Genét Gustav Folmer , Bentzer Peter , Hansen Morten Bagge , Ostrowski Sisse Rye , Johansson Pär Ingemar
Published: September 2017

BACKGROUND

Traumatic brain injury causes a disruption of the vascular endothelial glycocalyx layer that is associated with an overactivation of the sympathoadrenal system. We hypothesized that early and unselective beta-blockade with propranolol alone or in combination with the alfa2-agonist clonidine would decrease brain edema, blood-brain barrier permeability, and glycocalyx disruption at 24 hours after trauma.

METHODS

We subjected 53 adult male Sprague-Dawley rats to lateral fluid percussion brain injury and randomized infusion with propranolol (n = 16), propranolol + clonidine (n = 16), vehicle (n = 16), or sham (n = 5) for 24 hours. Primary outcome was brain water content at 24 hours. Secondary outcomes were blood-brain barrier permeability and plasma levels of syndecan-1 (glycocalyx disruption), cell damage (histone-complexed DNA fragments), epinephrine, norepinephrine, and animal motor function.

RESULTS

We found no difference in brain water content (mean ± SD) between propranolol (80.8 ± 0.3%; 95% confidence interval [CI], 80.7–81.0) and vehicle (81.1 ± 0.6%; 95% CI, 80.8–81.4) (p = 0.668) or between propranolol/clonidine (80.8 ± 0.3%; 95% CI, 80.7–81.0) and vehicle (p = 0.555). We found no effect of propranolol and propranolol/clonidine on blood-brain barrier permeability and animal motor scores. Unexpectedly, propranolol and propranolol/clonidine caused an increase in epinephrine and syndecan-1 levels.

CONCLUSION

This study does not provide any support for unselective beta-blockade with propranolol or the combination of propranolol and the alfa2-agonist clonidine on brain water content. The novel finding of an increase in plasma concentrations of epinephrine and syndecan-1 after propranolol treatment in traumatic brain injury is of unclear significance and should be investigated further.