bluuebunny/crossref_metadata_2025 huggingface dataset:
An Empirical Study on the Driving Path of Optimizing the Resources Allocation of Foreign Trade Enterprises from the Perspective of Energy Supply-side Reform
Authors: You Yu-cong , Yi Lu-xia
Published: November 2017

From the perspective of energy supply-side reform, this paper, by conducting an empirical study on foreign trade enterprises, conducts a research on the cross-role effect of optimizing the resources allocation and enhancing the energy efficiency. Methodologically, this paper creatively introduces the HILE's probabilistic structured property into Granger causality test analysis, forming an HILE–Granger (H-G) model, so as to empirically estimate both the short-term and long-term causal relationship effects between the energy efficiency and resources allocation. Conclusion is drawn that optimization of resources allocation is positively proportional with the energy efficiency enhancement. This paper is to provide a decision-making reference for the supply side reform strategy of foreign trade enterprises under the background of green energy economy.
Improving delivery routes using combined heuristic and optimization in a consumer goods distribution company
Authors: Wibisono E , Santoso A , Sunaryo M A
Published: November 2017

XYZ is a distributor of various consumer goods products. The company plans its delivery routes daily and in order to obtain route construction in a short amount of time, it simplifies the process by assigning drivers based on geographic regions. This approach results in inefficient use of vehicles leading to imbalance workloads. In this paper, we propose a combined method involving heuristic and optimization to obtain better solutions in acceptable computation time. The heuristic is based on a time-oriented, nearest neighbor (TONN) to form clusters if the number of locations is higher than a certain value. The optimization part uses a mathematical modeling formulation based on vehicle routing problem that considers heterogeneous vehicles, time windows, and fixed costs (HVRPTWF) and is used to solve routing problem in clusters. A case study using data from one month of the company’s operations is analyzed, and data from one day of operations are detailed in this paper. The analysis shows that the proposed method results in 24% cost savings on that month, but it can be as high as 54% in a day.
Relationship Between Interrectus Distance and Symptom Severity in Women With Diastasis Recti Abdominis in the Early Postpartum Period
Authors: Keshwani Nadia , Mathur Sunita , McLean Linda
Published: December 2017

Background

Diastasis recti abdominis (DrA) is associated with negative body image, musculoskeletal pain and dysfunction, and perhaps urogynecological complaints. The severity of DrA has traditionally been determined by measuring the interrectus distance (IRD); however, the relationship between IRD and symptoms in women with DrA is unclear.

Objective

The objective of the study was to investigate the relationship between IRD and symptom severity in women with DrA in the early postpartum period.

Design

This study used a cross-sectional design.

Methods

Thirty-two women with DrA were assessed at 3 weeks postpartum. The IRD was measured using ultrasound imaging. Symptom severity was assessed using the Multidimensional Body-Self Relations Questionnaire subscales (body image), visual analog scales (abdominal, low back, and pelvic pain intensity), the Modified Oswestry Index (disability due to low back pain), and the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire (urogynecological dysfunction). Spearman correlation coefficients (ρ) between IRD and each outcome were calculated and tested using 1-tailed significance (adjusted α = .009).

Results

The group median IRD was 2.97 cm (interquartile range = 1.65 cm), with the largest IRD in the sample being 7.97 cm. The IRD was significantly correlated with worst abdominal pain in the last 24 hours (ρ = 0.45, P = .005) and with overall body image (ρ = −0.44, P = .006) but not with the other outcomes.

Limitations

Women in the sample were primiparous, were in the early (3 weeks) postpartum period, had relatively low body mass indexes (mean = 25.0 kg/m2) considering that they had recently given birth, were all breast-feeding, and had a narrow age range (27–35 years old). These factors limited the generalizability of our results to all women with DrA.

Conclusions

This preliminary work suggests that, in the early postpartum period, IRD as a measure of DrA severity is meaningful for body image.
Antifungal Activity of Saponins from the Fruit Pericarp ofSapindus mukorossiagainstVenturia inaequalisandBotrytis cinerea
Authors: Porsche Franziska M. , Molitor Daniel , Beyer Marco , Charton Sophie , André Christelle , Kollar Andreas
Published: November 2017

The antifungal activity of an aqueous extract (AE) and the solid fraction of a chloroform-methanol fruit pericarp extract (CME) of Sapindus mukorossi resolved in water was tested for the first time against Venturia inaequalis and Botrytis cinerea—two important fungal pathogens worldwide. In the greenhouse, a CME (1% vol/vol) spray significantly reduced V. inaequalis symptoms and sporulation (99%) on apple seedling leaves (P ≤ 0.05). In field trials, applications of AE (1% vol/vol) reduced the disease severity of B. cinerea on grape, on average, by 63%. Extracts were fractionated by high-performance liquid chromatography and the bioefficacy of the fractions was tested in vitro. Some components of the most fungicidal fraction were identified by liquid chromatography-high resolution mass spectrometry as saponins: sapindoside B (accounting for ≥98% of the total constituents), hederagenin-pentosylhexoside, and oleanolic acid-hexosyl-deoxyhexosyl-hexoside. This fraction inhibited the mycelial growth of V. inaequalis and B. cinerea by 45 and 43%, respectively.
An Innovative Root Inoculation Method to Study Ralstonia solanacearum Pathogenicity in Tomato Seedlings
Authors: Singh N. , Phukan T. , Sharma P. L. , Kabyashree K. , Barman A. , Kumar R. , Sonti R. V. , Genin S. , Ray S. K.
Published: November 2017

In this study, we report Ralstonia solanacearum pathogenicity in the early stages of tomato seedlings by an innovative root inoculation method. Pathogenicity assays were performed under gnotobiotic conditions in microfuge tubes by employing only 6- to 7-day-old tomato seedlings for root inoculation. Tomato seedlings inoculated by this method exhibited the wilted symptom within 48 h and the virulence assay can be completed in 2 weeks. Colonization of the wilted seedlings by R. solanacearum was confirmed by using gus staining as well as fluorescence microscopy. Using this method, mutants in different virulence genes such as hrpB, phcA, and pilT could be clearly distinguished from wild-type R. solanacearum. The method described here is economic in terms of space, labor, and cost as well as the required quantity of bacterial inoculum. Thus, the newly developed assay is an easy and useful approach for investigating virulence functions of the pathogen at the seedling stage of hosts, and infection under these conditions appears to require pathogenicity mechanisms used by the pathogen for infection of adult plants.
Managing Multiplicity: Conceptualizing Physician Cognition in Multipatient Environments
Authors: Chan Teresa M. , Mercuri Mathew , Van Dewark Kenneth , Sherbino Jonathan , Schwartz Alan , Norman Geoff , Lineberry Matthew
Published: November 2017

Purpose

Emergency physicians (EPs) regularly manage multiple patients simultaneously, often making time-sensitive decisions around priorities for multiple patients. Few studies have explored physician cognition in multipatient scenarios. The authors sought to develop a conceptual framework to describe how EPs think in busy, multipatient environments.

Method

From July 2014 to May 2015, a qualitative study was conducted at McMaster University, using a think-aloud protocol to examine how 10 attending EPs and 10 junior residents made decisions in multipatient environments. Participants engaged in the think-aloud exercise for five different simulated multipatient scenarios. Transcripts from recorded interviews were analyzed inductively, with an iterative process involving two independent coders, and compared between attendings and residents.

Results

The attending EPs and junior residents used similar processes to prioritize patients in these multipatient scenarios. The think-aloud processes demonstrated a similar process used by almost all participants. The cognitive task of patient prioritization consisted of three components: a brief overview of the entire cohort of patients to determine a general strategy; an individual chart review, whereby the participant created a functional patient story from information available in a file (i.e., vitals, brief clinical history); and creation of a relative priority list. Compared with residents, the attendings were better able to construct deeper and more complex patient stories.

Conclusions

The authors propose a conceptual framework for how EPs prioritize care for multiple patients in complex environments. This study may be useful to teachers who train physicians to function more efficiently in busy clinical environments.
Alphaxalone Binds in Inner Transmembrane β+–α− Interfaces of α1β3γ2 γ-Aminobutyric Acid Type A Receptors
Authors: Ziemba Alexis M. , Szabo Andrea , Pierce David W. , Haburcak Marian , Stern Alex T. , Nourmahnad Anahita , Halpin Elizabeth S. , Forman Stuart A.
Published: November 2017

Background

Neurosteroids like alphaxalone are potent anxiolytics, anticonvulsants, amnestics, and sedative-hypnotics, with effects linked to enhancement of γ-aminobutyric acid type A (GABAA) receptor gating in the central nervous system. Data locating neurosteroid binding sites on synaptic αβγ GABAA receptors are sparse and inconsistent. Some evidence points to outer transmembrane β+–α− interfacial pockets, near sites that bind the anesthetics etomidate and propofol. Other evidence suggests that steroids bind more intracellularly in β+–α− interfaces.

Methods

The authors created 12 single-residue β3 cysteine mutations: β3T262C and β3T266C in β3-M2; and β3M283C, β3Y284C, β3M286C, β3G287C, β3F289C, β3V290C, β3F293C, β3L297C, β3E298C, and β3F301C in β3-M3 helices. The authors coexpressed α1 and γ2L with each mutant β3 subunit in Xenopus oocytes and electrophysiologically tested each mutant for covalent sulfhydryl modification by the water-soluble reagent para-chloromercuribenzenesulfonate. Then, the authors assessed whether receptor-bound alphaxalone, etomidate, or propofol blocked cysteine modification, implying steric hindrance.

Results

Eleven mutant β3 subunits, when coexpressed with α1 and γ2L, formed functional channels that displayed varied sensitivities to the three anesthetics. Exposure to para-chloromercuribenzenesulfonate produced irreversible functional changes in ten mutant receptors. Protection by alphaxalone was observed in receptors with β3V290C, β3F293C, β3L297C, or β3F301C mutations. Both etomidate and propofol protected receptors with β3M286C or β3V290C mutations. Etomidate also protected β3F289C. In α1β3γ2L structural homology models, all these protected residues are located in transmembrane β+–α− interfaces.

Conclusions

Alphaxalone binds in transmembrane β+–α− pockets of synaptic GABAA receptors that are adjacent and intracellular to sites for the potent anesthetics etomidate and propofol.
Restoring Perceived Loudness for Listeners With Hearing Loss
Authors: Oetting Dirk , Hohmann Volker , Appell Jens-E. , Kollmeier Birger , Ewert Stephan D.
Published: November 2017

Objectives:

Normalizing perceived loudness is an important rationale for gain adjustments in hearing aids. It has been demonstrated that gains required for restoring normal loudness perception for monaural narrowband signals can lead to higher-than-normal loudness in listeners with hearing loss, particularly for binaural broadband presentation. The present study presents a binaural bandwidth–adaptive dynamic compressor (BBDC) that can apply different gains for narrow- and broadband signals. It was hypothesized that normal perceived loudness for a broad variety of signals could be restored for listeners with mild to moderate high-frequency hearing loss by applying individual signal-dependent gain corrections.

Design:

Gains to normalize perceived loudness for narrowband stimuli were assessed in 15 listeners with mild to moderate high-frequency hearing loss using categorical loudness scaling. Gains for narrowband loudness compensation were calculated and applied in a standard compressor. Aided loudness functions for signals with different bandwidths were assessed. The deviation from the average normal-hearing loudness functions was used for gain correction in the BBDC. Aided loudness functions for narrow- and broadband signals with BBDC were then assessed. Gains for a 65 dB SPL speech-shaped noise of BBDC were compared with gains based on National Acoustic Laboratories’ nonlinear fitting procedure version 2 (NAL-NL2). The perceived loudness for 20 real signals was compared to the average normal-hearing rating.

Results:

The suggested BBDC showed close-to-normal loudness functions for binaural narrow- and broadband signals for the listeners with hearing loss. Normal loudness ratings were observed for the real-world test signals. The proposed gain reduction method resulted on average in similar gains as prescribed by NAL-NL2. However, substantial gain variations compared to NAL-NL2 were observed in the data for individual listeners. Gain corrections after narrowband loudness compensation showed large interindividual differences for binaural broadband signals. Some listeners required no further gain reduction for broadband signals; for others, gains in decibels were more than halved for binaural broadband signals.

Conclusion:

The interindividual differences of the binaural broadband gain corrections indicate that relevant information for normalizing perceived loudness of binaural broadband signals cannot be inferred from monaural narrowband loudness functions. Over-amplification can be avoided if binaural broadband measurements are included in the fitting procedure. For listeners with a high binaural broadband gain correction factor, loudness compensation for narrowband and broadband stimuli cannot be achieved by compression algorithms that disregard the bandwidth of the input signals. The suggested BBDC includes individual binaural broadband corrections in a more appropriate way than threshold-based procedures.
Influence of Comedication on Levetiracetam Pharmacokinetics
Authors: Aldaz Azucena , Alzueta Natalia , Viteri César
Published: November 2017

Background:

To evaluate the effect of concomitant antiepileptic therapy on levetiracetam (LEV) pharmacokinetics.

Methods:

A 6-year retrospective observational study. Patients were grouped according to the antiepileptic drug used as concomitant medication: group A, LEV in monotherapy; group B, LEV + enzyme-inducing antiepileptic drugs (EIAEDs); and group C, LEV + non–enzyme-inducing antiepileptic drugs (NEIAEDs). Apparent oral levetiracetam clearance (LEV CL/F) and basal serum levetiracetam concentrations (LEV C0) were compared among the different groups by analysis of variance.

Results:

A total of 330 LEV C0 corresponding to 205 patients (56% men) were identified. The mean (±SD) of LEV CL/F in group A (n = 180), B (n = 92), and C (n = 58) was 4.41 ± 2.06 L/h, 7.23 ± 3.72 L/h, and 4.87 ± 1.65 L/h, respectively. EIAEDs increased LEV CL/F (L/h) by 64% compared with the monotherapy group and by 48% compared with the NEIAEDs group. The greatest induction in LEV CL/F, compared with the LEV monotherapy group, was observed with carbamazepine, followed by oxcarbazepine and phenobarbital, and was increased by 81%, 64%, and 44%, respectively. LEV C0 values were significantly lower in the EIAEDs group than in the monotherapy group (17.30 ± 7.77 versus 20.08 ± 9.69 mcg/mL; P = 0.038) or indeed the NEIAEDs group (17.30 ± 7.77 versus 20.49 ± 9.46 mcg/mL; P = 0.027).

Conclusions:

Comedication with EIAEDs increased LEV CL/F by more than 40%, whereas carbamazepine had the greatest inducing potency with LEV CL/F being 81% higher than that of the monotherapy group. These data suggest that monitoring LEV serum concentration during polytherapy with EIAEDs is indicated.
Therapeutic Drug Monitoring of Asparaginase Activity—Method Comparison of MAAT and AHA Test Used in the International AIEOP-BFM ALL 2009 Trial
Authors: Lanvers-Kaminsky Claudia , Rüffer Andrea , Würthwein Gudrun , Gerss Joachim , Zucchetti Massimo , Ballerini Andrea , Attarbaschi Andishe , Smisek Petr , Nath Christa , Lee Samiuela , Elitzur Sara , Zimmermann Martin , Möricke Anja , Schrappe Martin , Rizzari Carmelo , Boos Joachim
Published: November 2017

Background:

In the international AIEOP-BFM ALL 2009 trial, asparaginase (ASE) activity was monitored after each dose of pegylated Escherichia coli ASE (PEG-ASE). Two methods were used: the aspartic acid β-hydroxamate (AHA) test and medac asparaginase activity test (MAAT). As the latter method overestimates PEG-ASE activity because it calibrates using E. coli ASE, method comparison was performed using samples from the AIEOP-BFM ALL 2009 trial.

Methods:

PEG-ASE activities were determined using MAAT and AHA test in 2 sets of samples (first set: 630 samples and second set: 91 samples). Bland–Altman analysis was performed on ratios between MAAT and AHA tests. The mean difference between both methods, limits of agreement, and 95% confidence intervals were calculated and compared for all samples and samples grouped according to the calibration ranges of the MAAT and the AHA test.

Results:

PEG-ASE activity determined using the MAAT was significantly higher than when determined using the AHA test (P < 0.001; Wilcoxon signed-rank test). Within the calibration range of the MAAT (30–600 U/L), PEG-ASE activities determined using the MAAT were on average 23% higher than PEG-ASE activities determined using the AHA test. This complies with the mean difference reported in the MAAT manual. With PEG-ASE activities >600 U/L, the discrepancies between MAAT and AHA test increased. Above the calibration range of the MAAT (>600 U/L) and the AHA test (>1000 U/L), a mean difference of 42% was determined. Because more than 70% of samples had PEG-ASE activities >600 U/L and required additional sample dilution, an overall mean difference of 37% was calculated for all samples (37% for the first and 34% for the second set).

Conclusions:

Comparison of the MAAT and AHA test for PEG-ASE activity confirmed a mean difference of 23% between MAAT and AHA test for PEG-ASE activities between 30 and 600 U/L. The discrepancy increased in samples with >600 U/L PEG-ASE activity, which will be especially relevant when evaluating high PEG-ASE activities in relation to toxicity, efficacy, and population pharmacokinetics.
Comparison of the Effects of Benson Muscle Relaxation and Nature Sounds on the Fatigue in Patients With Heart Failure
Authors: Seifi Leila , Najafi Ghezeljeh Tahereh , Haghani Hamid
Published: November 2017

This study was conducted with the aim of comparing the effects of Benson muscle relaxation and nature sounds on fatigue in patients with heart failure. Fatigue and exercise intolerance as prevalent symptoms experienced by patients with heart failure can cause the loss of independence in the activities of daily living. It can also damage self-care and increase dependence to others, which subsequently can reduce the quality of life. This randomized controlled clinical trial was conducted in an urban area of Iran in 2016. Samples were consisted of 105 hospitalized patients with heart failure chosen using a convenience sampling method. They were assigned to relaxation, nature sounds, and control groups using a randomized block design. In addition to routine care, the Benson muscle relaxation and nature sounds groups received interventions in mornings and evenings twice a day for 20 minutes within 3 consecutive days. A 9-item questionnaire was used to collect data regarding fatigue before and after the interventions. Relaxation and nature sounds reduced fatigue in patients with heart failure in comparison to the control group. However, no statistically significant difference was observed between the interventions. Benson muscle relaxation and nature sounds are alternative methods for the reduction of fatigue in patients with heart failure. They are inexpensive and easy to be administered and upon patients' preferences can be used by nurses along with routine nursing interventions.
The Effect of Aromatherapy on Sleep Quality of Elderly People Residing in a Nursing Home
Authors: Faydalı Saide , Çetinkaya Funda
Published: November 2017

Background:

Sleep is important for health and quality of life in the elderly, and sleep disturbances are reported to be associated with many of the adverse medical conditions.

Purpose:

This research was carried out to evaluate the effect of inhalation of lavender oil on sleep quality of nursing home residents.

Methods:

A questionnaire was used to evaluate sociodemographic characteristics and sleeping properties of the 30 volunteers, enrolled. Pittsburgh Sleep Quality Index was applied as a pre- and posttest to measure sleep quality of individuals who inhaled lavender oil drops on the pillows every evening for a week before sleeping.

Results:

Before and after aromatherapy, the mean Pittsburgh Sleep Quality Index score of the nursing home residents was

JOURNAL/honup/04.03/00004650-201801000-00003/3FSM1/v/2023-09-12T063022Z/r/image-gif

= 6.0 ± 5.1 and

JOURNAL/honup/04.03/00004650-201801000-00003/3FSM1/v/2023-09-12T063022Z/r/image-gif

= 2.6 ± 3.4, respectively, whereas statistically significant difference was not observed for independent variables. Cronbach α reliability coefficient of the Pittsburgh Sleep Quality Index scale was found to be 0.816.

Conclusions/Implications for Practice:

The results indicated an improvement of sleep quality of nursing home residents after the application of aromatherapy with lavender oil.
Music Intervention With Reminiscence Therapy and Reality Orientation for Elderly People With Alzheimer Disease Living in a Nursing Home
Authors: Onieva-Zafra María Dolores , Hernández-Garcia Laura , Gonzalez-del-Valle María Teresa , Parra-Fernández María Laura , Fernandez-Martinez Elia
Published: November 2017

The purpose of this study was to investigate the effect of an 8-week nursing intervention consisting of 2 weekly sessions of music and reminiscence therapy together with the application of reality orientation techniques. Our expectation at the onset of the study was that listening to music that was familiar and connected with the memory of past events would, due to the music's emotional impact, stimulate memory associations, leading, in turn, to a positive effect on depression and anxiety in people living with dementia. We carried out a pre-/posttest intervention design with a sample of 19 patients divided into 2 groups—a 10-patient control group and a 9-patient intervention group—in a nursing home in Spain. Goldberg tests for depression and anxiety have been assessed at baseline and postintervention in both groups. Our results confirm the valuable effect of music therapy and reminiscence therapy together with reality orientation techniques on depression in patients with mild Alzheimer disease. Our study may constitute an important starting point for further research on nursing interventions based on the provision of music and/or reminiscence therapy together with reality orientation techniques that is implemented on a daily basis in nursing homes.
COMBINED AUTOLOGOUS TRANSPLANTATION OF NEUROSENSORY RETINA, RETINAL PIGMENT EPITHELIUM, AND CHOROID FREE GRAFTS
Authors: Parolini Barbara , Grewal Dilraj S. , Pinackatt Sajish J. , Baldi Andrea , Di Salvatore Attilio , Besozzi Gianluca , Finzi Alessandro , Cardillo Daniele , Mahmoud Tamer H.
Published: November 2017

Purpose:

To evaluate the feasibility and initial functional and anatomical outcomes of transplanting a full-thickness free graft of choroid and retinal pigment epithelium (RPE), along with neurosensory retina in advanced fibrosis and atrophy associated with end-stage exudative age-related macular degeneration with and without a concurrent refractory macular hole.

Methods:

During vitrectomy, an RPE–choroidal and neurosensory retinal free graft was harvested in nine eyes of nine patients. The RPE–choroidal and neurosensory retinal free graft was either placed subretinally (n = 5), intraretinally to cover the foveal area inside an iatrogenically induced macular hole over the RPE–choroidal graft (n = 3) or preretinally (n = 1) without a retinotomy wherein both free grafts were placed over the concurrent macular hole. Silicone oil endotamponade was used in all cases.

Results:

Mean follow-up was 7 ± 5.5 months (range 3–19). The mean preoperative visual acuity was ∼count fingers (logarithm of the minimum angle of resolution = 2.11, range 2–3), which improved to ∼20/800 (logarithm of the minimum angle of resolution 1.62 ± 0.48, range 0.7–2, P = 0.04). Vision was stable in 5 eyes (55.6%) and improved in 4 eyes (44.4%). Reading ability improved in 5 eyes (55.6%). Postoperative complications were graft atrophy (n = 1), epiretinal membrane (n = 1), and dislocation of neurosensory retina–choroid–RPE free graft (n = 1).

Conclusion:

Combined autologous RPE–choroid and neurosensory retinal free graft is a potential surgical alternative in eyes with end-stage exudative age-related macular degeneration, including concurrent refractory macular hole.
COMPARISON OF 3 MM × 3 MM VERSUS 6 MM × 6 MM OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY SCAN SIZES IN THE EVALUATION OF NON–PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Ho Joseph , Dans Kunny , You Qisheng , Nudleman Eric D. , Freeman William R.
Published: November 2017

Purpose:

To evaluate the utility of different optical coherence tomography angiography scan protocols in evaluating retinal changes in non–proliferative diabetic retinopathy.

Methods:

Patients were imaged with the RTVue XR Avanti OCT 3 mm × 3 mm and 6 mm × 6 mm “Angio Retina” scan protocols. Ability to clearly delineate the foveal avascular zone (FAZ), FAZ remodeling, microaneurysms, capillary nonperfusion, motion, and doubling artifacts were evaluated.

Results:

Forty-six eyes from 27 patients were enrolled. Eighty-nine percent of 3 mm × 3 mm versus 59% of 6 mm × 6 mm scans clearly delineated the FAZ (P = 0.001). Eighty percent of 3 mm × 3 mm versus 43% of 6 mm × 6 mm scans demonstrated FAZ remodeling (P = 0.0002). Microaneurysms were detected by 57% of 6 mm × 6 mm and 35% of 3 mm × 3 mm scans (P = 0.003). Capillary nonperfusion was detected in 87% of 3 mm × 3 mm scans versus 89% of 6 mm × 6 mm scans (P = 0.99). No significant differences were noted in the incidence of artifacts between the scan sizes (motion artifact P = 0.29 and doubling artifact P = 0.29).

Conclusion:

3 mm × 3 mm scan delineated FAZ and remodeling better than 6 mm × 6 mm scan, likely because of its higher scan density. 6 mm × 6 mm scans detected microaneurysms more readily than 3 mm × 3 mm, likely because of its larger scan area. There were utility for both 3 mm × 3 mm and 6 mm × 6 mm scans when evaluating these patients.
APOPTOSIS AND ANGIOFIBROSIS IN DIABETIC TRACTIONAL MEMBRANES AFTER VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITION
Authors: Jiao Chunhua , Eliott Dean , Spee Christine , He Shikun , Wang Kai , Mullins Robert F. , Hinton David R. , Sohn Elliott H.
Published: November 2017

Purpose:

We sought to characterize the angiofibrotic and apoptotic effects of vascular endothelial growth factor (VEGF)-inhibition on fibrovascular epiretinal membranes in eyes with traction retinal detachment because of proliferative diabetic retinopathy.

Methods:

Membranes were excised from 20 eyes of 19 patients (10 randomized to intravitreal bevacizumab, 10 controls) at vitrectomy. Membranes were stained with antibodies targeting connective tissue growth factor (CTGF) or VEGF and colabeled with antibodies directed against endothelial cells (CD31), myofibroblasts, or retinal pigment epithelium markers. Quantitative and colocalization analyses of antibody labeling were obtained through immunofluorescence confocal microscopy. Masson trichrome staining, cell counting of hematoxylin and eosin sections, and terminal dUTP nick-end labeling staining were performed.

Results:

High levels of fibrosis were observed in both groups. Cell apoptosis was higher (P= 0.05) in bevacizumab-treated membranes compared with controls. The bevacizumab group had a nonsignificant reduction in colocalization in CD31–CTGF and cytokeratin–VEGF studies compared with controls. Vascular endothelial growth factor in extracted membranes was positively correlated with vitreous levels of VEGF; CTGF in extracted membranes was negatively correlated with vitreous levels of CTGF.

Conclusion:

Bevacizumab suppresses vitreous VEGF levels, but does not significantly alter VEGF or CTGF in diabetic membranes that may be explained by high baseline levels of fibrosis. Bevacizumab may cause apoptosis within fibrovascular membranes.
INTERNAL LIMITING MEMBRANE PEELING IN MACULAR HOLE SURGERY; WHY, WHEN, AND HOW?
Authors: Chatziralli Irini P. , Theodossiadis Panagiotis G. , Steel David H. W.
Published: November 2017

Purpose:

To review the current rationale for internal limiting membrane (ILM) peeling in macular hole (MH) surgery and to discuss the evidence base behind why, when, and how surgeons peel the ILM.

Methods:

Review of the current literature.

Results:

Pars plana vitrectomy is an effective treatment for idiopathic MH, and peeling of the ILM has been shown to improve closure rates and to prevent postoperative reopening. However, some authors argue against ILM peeling because it results in a number of changes in retinal structure and function and may not be necessary in all cases. Furthermore, the extent of ILM peeling optimally performed and the most favorable techniques to remove the ILM are uncertain. Several technique variations including ILM flaps, ILM scraping, and foveal sparing ILM peeling have been described as alternatives to conventional peeling in specific clinical scenarios.

Conclusion:

Internal limiting membrane peeling improves MH closure rates but can have several consequences on retinal structure and function. Adjuvants to aid peeling, instrumentation, technique, and experience may all alter the outcome. Hole size and other variables are important in assessing the requirement for peeling and potentially its extent. A variety of evolving alternatives to conventional peeling may improve outcomes and need further study.
RETINOBLASTOMA IN INDIA
Authors: Kaliki Swathi , Patel Anamika , Iram Sadiya , Ramappa George , Mohamed Ashik , Palkonda Vijay A. R.
Published: November 2017

Purpose:

To study the clinical presentation, treatment, and outcome of patients with retinoblastoma (RB) in India.

Methods:

Retrospective study of 1,457 patients with RB (2,074 eyes).

Results:

The mean age at presentation of RB was 29 months (median, 24 months; range, <1–370 months). There were 812 (56%) men and 645 (44%) women with unilateral presentation of RB in 57% (n = 834) and bilateral in 43% (n = 623). Familial RB was present in 4% (n = 55). The most common presenting complaints included leukocoria (n = 1,100; 75%), proptosis (n = 91; 6%), strabismus (n = 77; 5%), and red eye (n = 68; 5%). Most (n = 1,889; 91%) tumors were intraocular in location, and 185 (n = 185; 9%) had extraocular tumor extension at presentation. The most common modalities of primary treatment–included systemic chemotherapy (n = 1,171; 60%) and enucleation (n = 674; 35%). At a mean follow-up period of 44 months (median, 30 months; range, 3–234 months), 92% (n = 1,206) were alive, and 108 (8%) patients died because of RB. Based on Kaplan–Meier analysis, the survival at 1, 3, 5, and 10 years was 94%, 91%, 90%, and 89%, respectively.

Conclusion:

The most common presenting signs of RB in Asian Indian population are leukocoria and proptosis. With appropriate treatment, the survival rate is favorable at 92%.
Early Intervention for Families and Children Experiencing Homelessness
Authors: Hurley Jennifer J. , Looby Winnie , Goodrum Ashley R. , Campbell Elizabeth M. , Bonti Gregg K. , Raymon Becca A. , Condon Rebecca , Schwaeber Sami E. , Mauceri Melina E. , Bourne Erin M. , Callahan Elizabeth D. , Hardy Danielle L. , Mathews Pamela
Published: November 2017

Early intervention (EI) services are provided for families and children at risk for or with developmental delays. Early intervention includes services that are provided in the natural environment as mandated by the Individuals with Disabilities Education Act (IDEA; 2004). The natural environment is where children and families would naturally spend their time and for most families, the natural environment is their home (S. A. Raver & D. C. Childress, 2015). There is an upward trend in the number of young children and families who are experiencing homelessness (National Center on Family Homelessness, 2016) and as a result, EI providers are providing services with families who do not have homes. The purpose of this qualitative study was to interview EI providers to highlight the conditions and characteristics of the natural environments where EI services are provided for families that are experiencing homelessness and to gather information about the barriers and beneficial practices for providing EI services with families that are experiencing homelessness. Implications for leaders in the field of EI, service delivery, systems change, and professional development are discussed.
Global burden of neuropathic pain
Authors: Blyth Fiona M.
Published: December 2017

Global burden of disease studies measure the impact of disability and premature death resulting from specific diseases and injuries. Recently, these studies have highlighted the leading contribution of regional pain conditions (low back pain and neck pain in particular) to the global burden of disability. However, to date, there has not been a systematic approach to measuring the global burden of disease attributable to neuropathic pain (NP) conditions. This article gives a brief overview of the concept of burden of disease, the underlying drivers, and dynamics of disease burden at a population level and proposes an agenda in relation to NP for developing the conceptual and empirical evidence base necessary for estimating the global burden of NP.
Prophylactic Use of Haloperidol and Changes in Glucose Levels in Hospitalized Older Patients
Authors: van Keulen Kris , Knol Wilma , Schrijver Edmée J.M. , van Marum Rob J. , van Strien Astrid M. , Nanayakkara Prabath W.B.
Published: November 2017

Background

Treatment with antipsychotic drugs has been associated with glucose dysregulation in older outpatients, especially in the early stage of therapy. The underlying mechanism is, however, unclear. The aim of this study was to investigate changes in glucose levels during haloperidol use compared with the use of placebo among older hospitalized patients.

Methods

This substudy was part of a larger multicenter, randomized, double blind, placebo-controlled clinical trial among hospitalized patients aged 70 years and older who had an increased risk of in-hospital delirium. Patients who were admitted to the Jeroen Bosch Hospital in 's-Hertogenbosch between June 2014 and February 2015 were invited to participate in the study. Participating patients were randomized for treatment and given 1 mg of haloperidol or a placebo twice daily for a maximum of 7 consecutive days (14 doses). Exclusion criteria for this substudy were the use of corticosteroids and changes in diabetes medication. Random blood samples to determine glucose levels were collected before day 1 and on day 6 of the study. Student independent sample t test was used to determine differences in glucose changes between both groups.

Results

Twenty-nine patients were included (haloperidol, n = 14; placebo, n = 15). The mean glucose level for placebo users was 139.3 mg/dL (SD, 50.1) on day 1 and 140.8 mg/dL (SD, 45.7) on day 6, and the mean glucose level for haloperidol users was 139.9 mg/dL (SD, 71.0) on day 1 and 150.2 mg/dL (SD, 39.1) on day 6. The difference was not statistically significant (P = 0.685).

Conclusions

Short-term prophylactic use of haloperidol was not associated with changes in glucose levels in older hospitalized patients compared with those given a placebo in this small study.
Isometric Exercise to Reduce Pain in Patellar Tendinopathy In-Season: Is It Effective “on the Road”?
Authors: Rio Ebonie , Purdam Craig , Girdwood Michael , Cook Jill
Published: November 2017

Objective:

To investigate the effectiveness of an isometric squat exercise using a portable belt, on patellar tendon pain and function, in athletes during their competitive season.

Design:

Case series with no requirements to change any aspect of games or training. The object of this pragmatic study was to investigate this intervention in addition to “usual management.” A control or sham intervention was considered unacceptable to teams.

Setting:

In-season.

Participants:

A total of 25 male and female elite and subelite athletes from 5 sports.

Intervention:

5 × 30-second isometric quadriceps squat exercise using a rigid belt completed over a 4-week period.

Main Outcome Measures:

(1) single-leg decline squat (SLDS)—a pain provocation test for the patellar tendon (numerical rating score of pain between 0 and 10), (2) VISA-P questionnaire assessing patellar tendon pain and function, and (3) self-reported adherence with completing the exercise over a 4-week period.

Results:

Baseline SLDS pain was high for these in-season athletes, median 7.5/10 (range 3.5-9) and was significantly reduced over the 4-week intervention (P < 0.001, ES r = 0.580, median change 3.5). VISA-P scores improved after intervention (P < 0.001, ES r = 0.568, mean change 12.2 ± 8.9, percentage mean change 18.8%, where minimum clinical important difference of relative change for VISA-P is 15.4%-27%). Adherence was high; athletes reported completing the exercise 5 times per week.

Conclusions:

This pragmatic study suggests that a portable isometric squat reduced pain in-season for athletes with patellar tendinopathy (PT). This form of treatment may be effective, but clinical trials with a control group are needed to confirm the results.
Auditory Related Resting State fMRI Functional Connectivity in Tinnitus Patients: Tinnitus Diagnosis Performance
Authors: Minami Shujiro B. , Oishi Naoki , Watabe Takahisa , Uno Kimiichi , Ogawa Kaoru
Published: November 2017

Objective:

The purpose of the present study was to investigate functional connectivity in tinnitus patients with and without hearing loss, and design the tinnitus diagnosis performance by resting state functional magnetic resonance imaging (rs-fMRI).

Subjects and Methods:

Nineteen volunteers with normal hearing without tinnitus, 18 tinnitus patients with hearing loss, and 11 tinnitus patients without hearing loss were enrolled in this study. The subjects were evaluated with rs-fMRI, and region of interests (ROIs) based correlation analyses were performed using the CONN toolbox version 16 and SPM version 8. The correlation coefficients from individual level results were converted into beta values.

Results:

With a beta threshold of more than 0.2, 91% of all possible connections between auditory-related ROIs (Heschl's gyrus, planum temporale, planum polare, operculum, insular cortex, superior temporal gyrus) in the control group remained intact, whereas 83 and 66% of such connections were present in the hearing loss and the normal-hearing tinnitus group. However, between non-auditory-related ROIs, the rates of intact connections at a beta threshold of more than 0.2 were 17% in the control group, and 16 and 15% in the tinnitus groups. When resting state fMRI positive is defined as less than 9% of all possible connections between auditory-related ROIs with a beta threshold of more than 0.7, the sensitivity and specificity of tinnitus diagnosis is 86 and 74%, respectively.

Conclusions:

The associations between auditory-related networks are weakened in tinnitus patients, even if they have normal hearing. It is possible that rs-fMRI can be a tool for objective examination of tinnitus, by focusing the auditory-related areas.
Survey of the American Neurotology Society on Cochlear Implantation: Part 1, Candidacy Assessment and Expanding Indications
Authors: Carlson Matthew L. , Sladen Douglas P. , Gurgel Richard K. , Tombers Nicole M. , Lohse Christine M. , Driscoll Colin L.
Published: November 2017

Objective:

To examine practice variance of cochlear implant candidacy assessment and off-label indications across centers in the United States.

Methods:

Cross-sectional survey of the American Neurotology Society (ANS).

Results:

A total of 81 surveys were returned from ANS members who report regular involvement in cochlear implant care. Overall there was a broad distribution in age and clinical experience, with most respondents reporting ACGME accreditation in neurotology and employment at an academic center. The annual volume of cochlear implant surgeries varied considerably across centers.

Seventy-eight percent of respondents performed cochlear implantation for at least one of the following indications within the last 2 years: profound hearing loss in children less than 12 months of age (35, 43%), children with asymmetrical hearing loss where at least one ear was better than performance cutoff for age (25, 31%), adults with asymmetrical hearing where at least one ear was better than the performance cutoff for adult criteria (49, 61%), single-sided deafness (37, 46%), and ipsilateral vestibular schwannoma (28, 35%). Centers with a higher annual implant volume more frequently performed off-label implantation in all queried populations (all, p≤0.001), and performed surgery on infants with congenital deafness at a younger age (p = 0.013), compared with centers with lower surgical volume.

When surveyed regarding speech perception testing practices for adult candidacy assessment, 75 (100%) respondents who answered this question reported routine use of AzBio sentences, 42 (56%) CNC word scores, and 26 (35%) HINT testing; only 7 (9%) reported using BKB-SIN testing and 6 (8%) reported using CUNY scores. Fifty-one (68%) reported routine use of speech-in-noise testing to determine adult cochlear implant candidacy, 21 (28%) reported selective use only when patient scores were borderline in quiet, and 3 (4%) reported that their center does not currently use testing in noise for candidacy determination. Nineteen (26%) solely used +10 dB signal-to-noise ratio (SNR), 12 (16%) solely used +5 dB SNR, and 41 (55%) used both +10 and +5 dB SNR. Overall, 19% (N = 14) only perform unilateral implantation in the Medicare population, while 81% (N = 58) consider bilateral implantation.

Conclusion:

Significant variation in cochlear implant candidacy assessment and off-label implantation exists across centers and providers in the United States resulting in healthcare inequities. The high percentage of surgeons performing implantations for off-label or nontraditional indications reflects the overly restrictive and dated status of current implant guidelines. With greater adoption of more difficult speech perception testing in noise, careful clinical judgment is needed to maintain a favorable risk–benefit balance for prospective implant candidates.
Clinical Characteristics and Treatment Outcomes for Patients With External Auditory Canal Cholesteatoma
Authors: Morita Shinya , Nakamaru Yuji , Fukuda Atsushi , Fujiwara Keishi , Hoshino Kimiko , Homma Akihiro
Published: November 2017

Objective:

We aimed to evaluate the clinical features and treatment outcomes for patients with idiopathic and secondary external auditory canal cholesteatoma (EACC), and to validate the treatment strategy from the perspective of hearing as well as etiology and staging.

Study Design:

Retrospective case series.

Setting:

Tertiary referral center and affiliated hospitals.

Patients:

Fifty-eight patients with idiopathic EACC and 14 patients with secondary EACC.

Intervention:

Conservative management and surgery.

Main Outcome Measure:

Air conduction (AC) pure-tone averages (PTAs) and mean air-bone gaps (ABGs).

Results:

There were no significant differences between hearing values before and after conservative management for idiopathic EACC patients with stages I–III, indicating that hearing abilities were preserved. For idiopathic EACC patients with stage IV disease treated with surgery, the AC PTA threshold and mean ABG significantly improved from a preoperative value of 60.3 dB HL to a postoperative value of 32.4 dB HL (p = 0.013), and from 34.3 to 9.5 dB HL (p < 0.001), respectively. For secondary EACC, the AC PTA threshold and mean ABG significantly improved from a preoperative value of 49.5 dB HL to a postoperative value of 23.2 dB HL (p < 0.001), and from 31.4 to 6.7 dB HL (p < 0.001), respectively.

Conclusion:

The treatment modalities should be selected based on the perspective of hearing as well as the extent of disease and etiology. The early lesions can be treated conservatively, whereas the advanced lesions or cases refractory to conservative management require complete surgical removal of EACC.
In Vitro Generation of Glucose-Responsive Insulin-Secreting Cells from PDX1–Overexpressing Human-Induced Pluripotent Stem Cell Derived from Diabetic Patient
Authors: Rajaei Bahareh , Shamsara Mehdi , Sanati Mohammad Hossein
Published: November 2017

Pancreatic and duodenal homeobox 1 (PDX1), a member of the homeodomain-containing transcription factor family, is a key transcription factor for pancreas development and mature β-cell function. In this study, induced overexpression of PDX1 resulted in producing susceptible cells for pancreatic differentiation and was well beneficial to enhance β-cell production, maturation, function, and survival. Induced PDX1 overexpression in harmony with a set of signaling molecules involves in guiding the signaling pathways toward pancreas development, leaded to high-efficient in vitro generation of ectopic insulin-producing cells (IPCs) with the effectively reduced number of polyhormonal cells and increased number of insulin (INS) single-positive cells. This strategy yielded 85.61% glucose-responsive insulin-positive cells in vitro, which was seven times higher than the basal level, and electron microscopy images revealed the presence of mature β-cell secretory granules. The generation of glucose-responsive insulin-secreting β-like cells from human-induced pluripotent stem cells (hiPSCs) in vitro would provide a promising approach to produce an unprecedented cell source for cell transplantation therapy in diabetes without the ethical obstacle of embryonic stem cells and would bypass immune rejection. These cells are an invaluable source for disease modeling, drug discovery, and pharmacogenomics studies as well.