bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregnancy history and cognitive aging among older women: the Rancho Bernardo Study
Authors: Ilango Sindana D. , McEvoy Linda K. , Laughlin Gail A. , Bergstrom Jaclyn , Barrett-Connor Elizabeth , Kritz-Silverstein Donna
Published: March 2019

Objective:

The aim of the study was to examine the association of pregnancy history with trajectories of cognitive function in older women.

Methods:

Participants were 1,025 women (mean age = 73.1 ± 9.6 y) enrolled in the Rancho Bernardo Study who attended a clinic visit between 1988 and 1992, when pregnancy history (ever pregnant, number of pregnancies, ages at first and last pregnancy) was recorded and cognitive function was assessed with a battery of four tests repeated up to 7 times through 2016. Linear mixed-effects regression models were used to examine the association between pregnancy history and longitudinal change in cognitive function.

Results:

Overall, 77% of women had at least one pregnancy; number of pregnancies ranged from 1 to 14 (mean = 2.9 ± 1.7). Ages at first and last pregnancy ranged from 16 to 44 years (mean = 24.9 ± 4.7) and 16 to 49 years (mean = 30.7 ± 5.5), respectively. Of 16 associations tested (4 pregnancy exposures by 4 cognitive tests), one was statistically significant without correction for multiple comparisons. Women who reported ever being pregnant recalled 0.12 fewer words on the Buschke Selective Reminding Test for every year increase in age than women who had never been pregnant (P = 0.05). No other significant associations of pregnancy history with cognitive decline were observed.

Conclusions:

Our results show no clinically meaningful long-term influence of pregnancy history on age-related change in cognitive function. These reassuring findings suggest childbearing decisions and timing will not affect cognitive function in older age.
Safety and feasibility of estrogen receptor-β targeted phytoSERM formulation for menopausal symptoms: phase 1b/2a randomized clinical trial
Authors: Schneider Lon S. , Hernandez Gerson , Zhao Liqin , Franke Adrian A. , Chen Yu-Ling , Pawluczyk Sonia , Mack Wendy J. , Brinton Roberta D.
Published: March 2019

Objective:

PhytoSERM is a formulation of genistein, daidzein, and S-equol that has an 83-fold selective affinity for estrogen receptor-β (ERβ); and may enhance neuron function and estrogenic mechanisms in the brain without having peripheral estrogenic activity.

Methods:

We conducted an overarching, two-stage, dose-ranging, double-blinded, randomized, placebo-controlled trial of 12 weeks duration comparing 50 and 100 mg/d of phytoSERM with placebo for noncognitively impaired, perimenopausal women aged 45 to 60, with intact uteri and ovaries, with at least one cognitive complaint, and one vasomotor-related symptom. Primary objectives were to assess safety and tolerability of a 50 and 100 mg daily dose; and, secondly, to evaluate potential indicators of efficacy on cognition and vasomotor symptoms over 4 and 12 weeks, and using an embedded, 4-week, 2-period, placebo-controlled crossover trial for a subset of participants.

Results:

Seventy-one women were randomized to treatment; 70 were evaluated at 4 weeks; 12 were entered into the crossover study; 5 did not complete 12 weeks. Reasons for discontinuation were withdrawal of consent (n = 1) and lost to follow-up (n = 4). Adverse events occurred in 16.7% (n = 4) placebo, 39.1% (n = 9) 50 mg/d, and 29.2% (n = 7) 100 mg/d treated participants; 85% were mild and none was severe. Vaginal bleeding occurred in 0, placebo; 1, 50 mg; and 3, 100 mg/d participants.

Conclusions:

The phytoSERM formulation was well tolerated at 50 and 100 mg daily doses. Based on safety outcomes, vaginal bleeding at the 100 mg dose, and vasomotor symptoms and cognitive outcomes at 12 weeks, a daily dose of 50 mg was considered preferable for a phase 2 efficacy trial.
RETINAL TELANGIECTASIA ASSOCIATED WITH OPTIC DISK PIT MACULOPATHY
Authors: Padidam Sneha , Burke Marie T. , Mishulin Aleksey , Akhter Mashal , Abrams Gary W.
Published: March 2019

Purpose:

To report a case of optic pit maculopathy with retinoschisis-like edema with a rare finding of retinal telangiectasia.

Methods:

Retrospective case report.

Results:

A 22-year-old white man with a right optic pit presented with blurry vision and was found to have optic pit maculopathy with retinoschisis-like macular edema and retinal telangiectasia along the superior-temporal arcade. The patient underwent pars plana vitrectomy with separation of posterior vitreous and inner retinal fenestration. Upon follow-up, retinal telangiectasia was resolved and retinoschisis-like edema was mostly resolved 2 years after surgery.

Conclusion:

Retinal telangiectasia seen in optic disk maculopathy may be secondary to ischemia induced by the intense stretching of the superficial vascular plexus in the inner retina because of macular edema. In our patient, when traction was relieved following surgical intervention, there was remodeling of the superficial vascular plexus that allowed for resolution of the retinal telangiectasia.
Pain-related functional interference in patients with chronic neuropathic postsurgical pain: an analysis of registry data
Authors: Stamer Ulrike M. , Ehrler Michaela , Lehmann Thomas , Meissner Winfried , Fletcher Dominique
Published: March 2019

Although chronic postsurgical pain (CPSP) is a major health care problem, pain-related functional interference has rarely been investigated. Using the PAIN OUT registry, we evaluated patients' pain-related outcomes on the first postoperative day, and their pain-related interference with daily living (Brief Pain Inventory) and neuropathic symptoms (DN4: douleur neuropathique en 4 questions) at 6 months after surgery. Endpoints were pain interference total scores (PITS) and their association with pain and DN4 scores. Furthermore, possible risk factors associated with impaired function at M6 were analyzed by ordinal regression analysis with PITS groups (no to mild, moderate, and severe interference) as a dependent three-stage factor. Odds ratios with 95% confidence intervals were calculated. Of 2322 patients, 15.3% reported CPSP with an average pain score ≥3 (numeric rating scale 0-10). Risk for a higher PITS group increased by 190% (odds ratio [95% confidence interval]: 2.9 [2.7-3.2]; P < 0.001) in patients with CPSP, compared to without CPSP. A positive DN4 independently increased risk by 29% (1.3 [1.12-1.45]; P < 0.001). Preexisting chronic pain (3.6 [2.6-5.1]; P < 0.001), time spent in severe acute pain (2.9 [1.3-6.4]; P = 0.008), neurosurgical back surgery in males (3.6 [1.7-7.6]; P < 0.001), and orthopedic surgery in females (1.7 [1.0-3.0]; P = 0.036) were the variables with strongest association with PITS. Pain interference total scores might provide more precise information about patients' outcomes than pain scores only. Because neuropathic symptoms increase PITS, a suitable instrument for their routine assessment should be defined.
Evaluating the Effectiveness of Interventions on Increasing Participation in Cervical Cancer Screening
Authors: KURT Gonul , AKYUZ Aygul
Published: March 2019

Background:

Although cervical cancer is highly preventable through regular screenings using Pap smear or human papillomavirus–deoxyribonucleic acid tests, cervical cancer remains a prevalent women's health issue across the world. Therefore, encouraging women to screen for cervical cancer is very important for the early detection of cervical cancer.

Purpose:

The purposes of this study were to (1) assess the effectiveness of three interventions that are typically used to increase the uptake of cervical cancer screening during home visits and (2) determine the participation rate in cervical cancer screenings after invitation, the health promotion perceptions, and the cervical cancer and screening-related knowledge of women. The three interventions noted in Purpose 1 were one-on-one training accompanied by an educational brochure, providing the educational brochure only, and giving an invitation without any relevant information.

Methods:

This interventional study was conducted on women who were between the ages of 30 and 65 years in three Turkish provinces (Ankara, Malatya, and Trabzon). Five hundred twenty home visits were made, and 356 women who did not have a Pap smear test within the previous year were invited for cervical cancer screening. Women were randomized into one of three intervention groups, and the participants in each group were invited to attend a national cervical cancer screening program and to undergo a cervical cancer screening using the related intervention type.

Results:

The results showed that the interventions used during home visits and knowledge were effective in encouraging women to participate in cervical cancer screening. It was determined that the participants who had received one-on-one training accompanied by an educational brochure had a higher cervical cancer screening rate than their peers who were offered a brochure only or a verbal invitation only.

Conclusions:

Invitations to screenings that are made by providing training accompanied with a brochure were found to be effective in increasing the participation of women in cervical cancer screening.
A Randomized Cross-over Trial Comparing a Pressure-free, Adhesive to a Conventional Bone Conduction Hearing Device
Authors: Dahm Valerie , Auinger Alice B. , Liepins Rudolfs , Baumgartner Wolf-Dieter , Riss Dominik , Arnoldner Christoph
Published: March 2019

Objectives:

The main aim of this study was to compare the average daily wearing time of a conventional bone conduction device with a pressure-free, adhesive bone conduction device. Further, audiologic and quality-of-life outcome parameters were evaluated.

Methods:

An academic, prospective, randomized cross-over trial was performed at a single center.

Thirteen subjects between 12 and 63 years with conductive hearing loss were included.

Average daily wearing time and subjective observations were assessed in a diary. Sound field audiometry, Freiburg monosyllables word test, and Oldenburg sentence test in quiet and in noise were carried out after 2 weeks of habituation to each device. AQoL-8D and SSQ-12 questionnaires were completed at baseline and after a 2-week test interval.

Results:

Median wearing time of the devices was 8.1 hours (5.8–10.2 interquartile range) for the adhesive and 4.3 hours (2.7–7.1) for the conventional bone conduction device, the difference was statistically significant (p = 0.033). There were no statistically significant differences in sound field audiometry, Freiburg monosyllables word test, and Oldenburg sentence test when comparing the two devices. AQoL-8D and SSQ-12 showed a significant improvement with the devices in comparison with baseline, with no significant difference between devices in the total scores. Ten subjects reported pain using the conventional device, two subjects reported skin irritations using the adhesive device.

Conclusion:

For patients with mixed or conductive hearing loss, the adhesive device is a valuable alternative with a significantly longer daily wearing time.
A Systematic Review of Preexisting Sepsis and Extracorporeal Membrane Oxygenation
Authors: Sangli Swathi S. , Noronha Shaun F. , Mourad Bashar , Jean Raymonde , Bohman John K. , Seelhammer Troy G.
Published: March 2019

We retrospectively reviewed all pertinent extracorporeal membrane oxygenation (ECMO) studies (January 1995 to September 2017) of adults with sepsis as a primary indication for intervention and its association with morbidity and mortality. Collected data included study type, ECMO configuration, outcomes, effect size, and other features. Advanced age was a risk factor for death. Compared with nonsurvivors, survivors had a lower median Sepsis-Related Organ Failure Assessment score on day 3 (15 vs. 18, p = 0.01). Biomarkers in survivors and nonsurvivors, respectively, were peak lactate (from two studies: 4.5 vs. 15.1 mmol/L, p = 0.03; 3.6 ± 3.7 vs. 3.3 ± 2.4 mmol/L, p = 0.850) and procalcitonin levels (41 vs. 164 ng/ml, p = 0.008). Bacteremia was associated with catheter colonization, and 90.5% of a group without bloodstream infections survived to discharge; ECMO weaning was possible for less than half the bloodstream infection group. Myocarditis portended favorable outcomes for patients with sepsis who received ECMO. Extracorporeal membrane oxygenation was used in immunosuppressed patients with refractory cardiopulmonary insufficiency from severe sepsis with successful weaning from ECMO for most patients. Overall survival varied substantially among studies (15.38–71.43%). Existing studies do not present well-defined patterns supporting use of ECMO in sepsis because of sample sizes and disparate study designs.
Monitoring Hemostasis During Extracorporeal Life Support
Authors: Saifee Nabiha H. , Brogan Thomas V. , McMullan David M. , Yalon Larissa , Matthews Dana C. , Burke Christopher R. , Chandler Wayne L.
Published: March 2019

To balance the risk of bleeding versus circuit thrombosis during extracorporeal life support (ECLS), it is important to monitor anticoagulants and hemostasis. We evaluated the prothrombin time (PT), partial thromboplastin time (PTT), activated clotting time (ACT), and antifactor Xa heparin activity (aXa) correlation with changes in coagulation factor and heparin levels using in vitro and in vivo samples. aXa correlated with heparin (r2 = 0.97) and antithrombin (r2 = 0.98) but was unaffected by other parameters. PT correlated with coagulation factors (r2 = 0.88) but was minimally affected by heparin or other parameters. When single parameters were changed, ACT was insensitive to <0.5 U/ml heparin, correlated with coagulation factors (r2 = 0.99), and was affected by factor XII and platelets. When multiple parameters changed in vitro and in vivo, ACT was not correlated with heparin or coagulation factors. PTT correlated with heparin and coagulation factors individually but had low correlation when multiple parameters changed in vitro and in vivo. In conclusion, aXa is the most specific for heparin levels, and PT is most specific for coagulation factor levels making these assays well suited to monitor anticoagulation and hemostasis for patients on ECLS. PTT is highly variable when multiple parameters are changing in vitro and in vivo, but may be useful when aXa cannot be used because of interference. ACT is too insensitive to heparin, sensitive to too many other factors, and too imprecise to be useful for monitoring hemostasis during ECLS.
A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes
Authors: Lake Eileen T. , Sanders Jordan , Duan Rui , Riman Kathryn A. , Schoenauer Kathryn M. , Chen Yong
Published: March 2019

Background:

The nurse work environment is theorized to influence the quality of nursing care, nurse job outcomes, and patient outcomes.

Objective:

The aim of this meta-analysis was to evaluate quantitatively the association of the work environment with job and health outcomes.

Research Design:

Relevant studies published through September 2018 were identified. Inclusion criteria were use of a nationally endorsed work environment measure and reporting of odds ratios (ORs) and 95% confidence intervals from regression models of 4 outcome classes: nurse job outcomes, safety and quality ratings, patient outcomes, and patient satisfaction. Pooled ORs and confidence intervals were estimated for each outcome using fixed or random effects models.

Subjects:

Of 308 articles reviewed, 40 met inclusion criteria. After excluding 23 due to sample overlap or too few observations to meta-analyze, a set of 17 articles, comprising 21 independent samples, was analyzed. Cumulatively, these articles reported data from 2677 hospitals, 141 nursing units, 165,024 nurses, and 1,368,420 patients, in 22 countries.

Measures:

Practice Environment Scale of the Nursing Work Index, a National Quality Forum nursing care performance standard.

Results:

Consistent, significant associations between the work environment and all outcome classes were identified. Better work environments were associated with lower odds of negative nurse outcomes (average OR of 0.71), poor safety or quality ratings (average OR of 0.65), and negative patient outcomes (average OR of 0.93), but higher odds of patient satisfaction (OR of 1.16).

Conclusions:

The nurse work environment warrants attention to promote health care quality, safety, and patient and clinician well-being.
Senescent cells in the development of cardiometabolic disease
Authors: Postmus Andrea C. , Sturmlechner Ines , Jonker Johan W. , van Deursen Jan M. , van de Sluis Bart , Kruit Janine K.
Published: March 2019

Purpose of review

Senescent cells have recently been identified as key players in the development of metabolic dysfunction. In this review, we will highlight recent developments in this field and discuss the concept of targeting these cells to prevent or treat cardiometabolic diseases.

Recent findings

Evidence is accumulating that cellular senescence contributes to adipose tissue dysfunction, presumably through induction of low-grade inflammation and inhibition of adipogenic differentiation leading to insulin resistance and dyslipidaemia. Senescent cells modulate their surroundings through their bioactive secretome and only a relatively small number of senescent cells is sufficient to cause persistent physical dysfunction even in young mice. Proof-of-principle studies showed that selective elimination of senescent cells can prevent or delay the development of cardiometabolic diseases in mice.

The metabolic consequences of senescent cell accumulation in various tissues are now unravelling and point to new therapeutic opportunities for the treatment of cardiometabolic diseases.
Barriers and Enablers to Implementing a High-Dependency Care Model in Pediatric Care
Authors: Cassidy Christine , MacEachern Lauren , Egar Jeanne , Best Shauna , Foley Laura , Rowe Mary Elizabeth , Curran Janet
Published: March 2019

Background:

As the level of acuity of pediatric hospital admissions continues to increase, additional pressure is being placed on hospital resources and the nursing workforce.

Local Problem:

Currently, there is no formalized approach to care for high-acuity patients on our pediatric inpatient unit.

Methods:

We used a qualitative descriptive design, guided by the Theoretical Domains Framework and Capability, Opportunity, Motivation-Behaviour (COM-B) model, to conduct focus groups and interviews with clinicians and administrators to identify potential barriers and enablers to implementing a high-dependency care (HDC) model. An HDC model focuses on the relationship between adequate nursing staff resources and patient acuity to improve patient health outcomes.

Results:

Participants identified the need for clear guidelines and supportive physical structures to facilitate HDC implementation. Anticipated benefits included enhanced nursing confidence and family-centered care.

Conclusions:

Study findings highlight multilevel factors to consider prior to implementing an HDC model on a pediatric inpatient unit.
Implementing the Serious Illness Care Program in Primary Care
Authors: Massmann Jill A. , Revier Sara S. , Ponto Julie
Published: March 2019

Inadequate communication about serious illness care preferences affects patients, families, health care providers, and health care systems. Many patient and system barriers prevent comprehensive serious illness communication. The purpose of this evidence-based practice project was to provide a structure within a primary care clinic to facilitate conversations with seriously ill individuals about their care preferences that (a) was adaptable to clinic workflow, (b) improved providers’ perception of the care conversation experience, (c) improved documentation of care preferences, and (d) provided a comfortable and helpful experience. The Johns Hopkins Nursing Evidence-Based Practice model and Serious Illness Care Program were used to address provider and system barriers to conversations about care preferences. Program interventions included training providers and staff; identifying patients at risk for high symptom burden and mortality; integrating system interventions; and evaluating outcomes. Providers completed training, after which a 5-week pilot practice change was conducted. Provider perceptions of conversations after implementation were positive. During the pilot, 3 serious illness care conversations were initiated with additional patients prepared for future conversations using an information sheet and introduction to the conversation.
A Mobile Application to Collect Daily Data on Preexposure Prophylaxis Adherence and Sexual Behavior Among Men Who Have Sex With Men: Use Over Time and Comparability With Conventional Data Collection
Authors: Finkenflügel Renee N.N. , Hoornenborg Elske , Achterbergh Roel C.A. , Marra Elske , Davidovich Udi , de Vries Henry J.C. , Prins Maria , Schim van der Loeff Maarten F.
Published: March 2019

Background

We studied the use of a mobile application (app) to measure human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) adherence and sexual behavior, assessed determinants of app use, and we compared data in app and questionnaires.

Methods

Men who have sex with men participating in the Amsterdam PrEP project (AMPrEP) on daily or event-driven PrEP at the Public Health Service of Amsterdam completed the data on sexual risk behavior and PrEP adherence through a standard questionnaire every 3 months and on a daily basis using the project's app. Regression analyses were used to assess factors associated with app use. Among those who reported 90% or greater of data in the app, the number of PrEP pills taken and number of unknown casual sex partners were compared between the app and the questionnaires by Wilcoxon signed-rank test.

Results

Of all participants (n = 374), 94% (352 of 374) reported data in the app at least once; 72% (261 of 362) reported data ≥90% of the days in the sixth month and 62% (222 of 359) in the 12th month following PrEP initiation.

Factors associated with reporting data in the app were using daily PrEP and recent initiation of PrEP. The reported numbers of pills taken and unknown sexual partners were comparable between app and questionnaires.

Conclusions

The AMPrEP app was used frequently, especially by those using a daily PrEP regimen. Data collected by app regarding adherence and sexual risk behavior were consistent with questionnaire data among those who used the app consistently. An app is a promising tool to measure PrEP adherence and sexual risk behavior.
Patterns in On-time, Daily Submission of a Short Web-Based Personal Behavior Survey in a Longitudinal Women's Health Study
Authors: Crowder Hannah R. , Brown Sarah E. , Stennett Christina A. , Johnston Elizabeth , Wnorowski Amelia M. , Mark Katrina S. , Brotman Rebecca M.
Published: March 2019

We evaluated compliance with submitting a short Web-based personal behavior survey daily during a 10-week study (n = 52 women/3419 diaries). Time-stamped forms revealed that 50% of diaries were submitted within 24 hours of the email prompt, and 19% were missing or submitted more than 3 days late. Late submissions may affect data quality.
Case Report: Iridocorneal Endothelial Syndrome Progression Documented by Anterior Segment Optical Coherence Tomography
Authors: Hillard Jacob G.
Published: March 2019

SIGNIFICANCE

Iridocorneal endothelial (ICE) syndrome is characterized by a difficult-to-see membrane of ectopic corneal endothelial cells, called an ICE membrane. This report demonstrates that ICE membranes are detectable by anterior segment optical coherence tomography (AS-OCT) and highlights the benefits of using AS-OCT in ICE syndrome.

PURPOSE

A case of ICE syndrome is reported to highlight the utility of AS-OCT in the characterization and diagnosis of the disease.

CASE REPORT

A 65-year-old African American man was diagnosed as having the Chandler variant of ICE syndrome of the left eye. He was treated topically for corneal edema. Anterior segment optical coherence tomography and anterior segment photography were used to aid in the diagnosis and document an ICE membrane and multiple peripheral anterior synechiae. Further examinations chronicled the progression of a peripheral anterior synechia. At first, only iridocorneal touch (sparing the trabecular meshwork) was present, but later, full apposition to the trabecular meshwork developed. The patient was diagnosed as having pre-perimetric glaucoma in the left eye and is being treated topically to reduce his intraocular pressure. The right eye remains unremarkable.

CONCLUSIONS

Anterior segment optical coherence tomography can support the diagnosis of ICE syndrome by visualizing ICE membranes and differentiating between true peripheral anterior synechiae and iridocorneal touch that does not block the trabecular meshwork. Chronicling ICE membranes longitudinally with AS-OCT will enhance understanding of disease progression. By correlating membranes features (such as location and extent) and patient outcomes, AS-OCT–based ICE membrane classifications can be developed to improve the management and prognosis of ICE syndrome.
Calmer: a robot for managing acute pain effectively in preterm infants in the neonatal intensive care unit
Authors: Holsti Liisa , MacLean Karon , Oberlander Timothy , Synnes Anne , Brant Rollin
Published: March 2019

Introduction:

For preterm infants in the neonatal intensive care unit, early exposure to repeated procedural pain is associated with negative effects on the brain. Skin-to-skin contact with parents has pain-mitigating properties, but parents may not always be available during procedures. Calmer, a robotic device that simulates key pain-reducing components of skin-to-skin contact, including heart beat sounds, breathing motion, and touch, was developed to augment clinical pain management.

Objective:

Our objective was to evaluate the initial efficacy of Calmer for mitigating pain in preterm infants. We hypothesized that, compared to babies who received a human touch–based treatment, facilitated tucking, infants on Calmer would have lower behavioural and physiological pain indices during a single blood test required for clinical care.

Methods:

Forty-nine preterm infants, born between 27 and 36 weeks of gestational age, were randomized either to facilitated tucking or Calmer treatment. Differences between groups in changes across 4 procedure phases (baseline 1, baseline 2, poke, and recovery) were evaluated using (1) the Behavioral Indicators of Infant Pain scored by blind coders from bedside videotape and (2) heart rate and heart rate variability continuously recorded from a single-lead surface ECG (lead II) (Biopac, Canada) sampled at 1000 Hz using a specially adapted portable computer system and processed using Mindware.

Results:

No significant differences were found between groups on any outcome measures.

Conclusion:

Calmer provided similar treatment efficacy to a human touch–based treatment. More research is needed to determine effects of Calmer for stress reduction in preterm infants in the neonatal intensive care unit over longer periods.
The Surface-Volume Coefficient of the Superficial and Deep Facial Fat Compartments: A Cadaveric Three-Dimensional Volumetric Analysis
Authors: Cotofana Sebastian , Koban Konstantin C. , Konstantin Frank , Green Jeremy B. , Etzel Lucas , Giunta Riccardo E. , Schenck Thilo L.
Published: March 2019

Background:

Soft-tissue filler injections for the treatment of facial aging can result in different skin surface effects depending on the targeted facial fat compartment and fascial plane. This work investigates the tissue response of defined amounts of soft-tissue filler material injected into superficial and deep facial fat compartments by means of the calculation of the surface-volume coefficient.

Methods:

Four fresh frozen cephalic specimens obtained from human donors (three female and one male; mean age, 74.96 ± 22.6 years; mean body mass index, 21.82 ± 6.3 kg/m2) were studied. The superficial and deep lateral forehead compartments, deep temporal fat pad, sub–orbicularis oculi fat compartment, and deep medial cheek fat compartment were injected with aliquots of 0.1 cc of contrast-enhanced material and scanned using three-dimensional surface imaging, resulting in a total of 226 injection and scanning procedures.

Results:

The sub–orbicularis oculi fat compartment revealed the highest correlation coefficient (r

p
= 0.992; p < 0.001) and the highest surface-volume coefficient (0.94). The compartment with the lowest tissue response was the deep medial cheek fat compartment (r

p
= 0.745; p < 0.001; surface-volume coefficient = 0.29), followed by the deep lateral forehead compartment (r

p
= 0.814; p < 0.001; surface-volume coefficient = 0.68), superficial lateral forehead compartment (r

p
= 0.824; p < 0.001; surface-volume coefficient = 0.74), and deep temporal fat pad (r

p
= 0.947; p < 0.001; overall surface-volume coefficient = 0.64).

Conclusions:

These results, confirmatory in their nature to current injection strategies, provide evidence for the validity and reliability of the surface-volume coefficient. Injection procedures should be targeted in terms of facial fat compartments and fascial planes for a desired aesthetic outcome, as each fat compartment and fascial plane has unique tissue responses to injected soft-tissue fillers.
Synergistic Effect of Adipose-Derived Stem Cells and Fat Graft on Wrinkles in Aged Mice
Authors: Kim Kikap , Fan Yingfang , Lin Guang , Park Yoon Kyung , Pak Chang Sik , Jeong Jae Hoon , Kim Sukwha
Published: March 2019

Background:

The authors investigated the synergistic effects of adipose-derived stem cells and fat graft on skin wrinkles in a nude mouse model of chronologic aging.

Methods:

After 50 weeks of chronologic aging, 44 female BALB/c nude mice were classified into four groups: (1) negative control, (2) mice injected subcutaneously with fat on the back skin (0.5 cm3), (3) mice injected with adipose-derived stem cells (1 × 105 cells in 0.5 cm3 Hanks balanced salt solution), and (4) mice injected with both fat (0.5 cm3) and adipose-derived stem cells (1 × 105 cells in 0.5 cm3 Hanks balanced salt solution). The degree of wrinkling was evaluated using replica analysis, and skin biopsies were performed after 4 weeks. The dermal thickness and density of collagen were determined. Type I procollagen and matrix metalloproteinase levels were determined using real-time polymerase chain reaction and Western blot analysis. Tropoelastin, fibrillin-1, and CD31 levels were evaluated using immunohistochemistry.

Results:

Based on the total wrinkle area, there was significant wrinkle reduction in the fat-treated and adipose-derived stem cell with fat–treated groups. Type I procollagen mRNA and collagen levels were significantly higher in the adipose-derived stem cell with fat–treated group than in the adipose-derived stem cell–treated and the fat-treated groups. In addition, the adipose-derived stem cells with fat graft group exhibited significantly higher CD31 expression level than the adipose-derived stem cell–treated and the fat-treated groups.

Conclusion:

Both adipose-derived stem cells and fat graft have a wrinkle-reducing effect and synergistically affect collagen synthesis and neovascularization.
The Role of Deferoxamine in Irradiated Breast Reconstruction: A Study of Oncologic Safety
Authors: Lynn Jeremy V. , Urlaub Kevin M. , Ranganathan Kavitha , Donneys Alexis , Nelson Noah S. , Subramanian Chitra , Cohen Mark S. , Buchman Steven R.
Published: March 2019

Background:

Radiotherapy plays an essential role in the oncologic management of breast cancer. However, patients who undergo radiotherapy experience significantly more wound complications during the reconstructive process. Deferoxamine has immense potential to up-regulate angiogenesis and improve reconstructive outcomes. The purpose of this study was to determine the impact of deferoxamine on breast cancer cell proliferation in vitro, to delineate oncologic safety concerns regarding the use of deferoxamine as a regenerative therapeutic.

Methods:

The dose-dependent effect of radiation and deferoxamine on two triple-negative breast cancer cell lines (MDA-MB-231 and MDA-MB-468) was determined by means of MTS (percentage cell viability) and tumorsphere (sphere number) analysis. Radiation therapy and deferoxamine were delivered both individually and in combination, and all experiments were completed in triplicate. Intracellular iron, nuclear factor-κB localization, and apoptosis/necrosis assays were performed to delineate mechanism. Analysis of variance statistical analysis was performed using SPSS (p< 0.05).

Results:

For both cell lines, percentage viability and sphere number significantly decreased following exposure to 10 Gy of radiation. Surprisingly, the administration of 25 µM deferoxamine also significantly decreased each metric. The administration of deferoxamine (100 µM) in combination with radiation (10 Gy) resulted in significantly reduced percentage viability and sphere number compared with the administration of radiation alone. Deferoxamine treatment decreased intracellular iron, suppressed nuclear factor-κB activation, and induced apoptosis.

Conclusion:

Radiation and deferoxamine significantly decrease breast cancer proliferation when delivered independently and in combination, suggesting deferoxamine may be safely used to facilitate improved reconstructive outcomes among triple-negative breast cancer survivors.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Managing Missing Data in the Hospital Survey on Patient Safety Culture: A Simulation Study
Authors: Boussat Bastien , François Olivier , Viotti Julien , Seigneurin Arnaud , Giai Joris , François Patrice , Labarère José
Published: March 2019

Background

Case-wise analysis is advocated for the Hospital Survey on Patient Safety culture (HSOPS).

Objectives

Through a computer-intensive simulation study, we aimed to evaluate the accuracy of various imputation methods in managing missing data in the HSOPS.

Methods

Using the original data from a cross-sectional survey of 5064 employees at a single university hospital in France, we produced simulation data on two levels. First, we resampled 1000 completed data based on the original 3045 complete responses using a bootstrap procedure. Second, missing values were simulated in these 1000 completed case data for comparison purposes, using eight different missing data scenarios. Third, missing values were imputed using five different imputation methods (1, random imputation; 2, item mean; 3, individual mean; 4, multiple imputation, and 5, sparse nonnegative matrix factorization. The performance for each imputation method was assessed using the root mean square error and dimension score bias.

Results

The five imputation methods yielded close root mean square errors, with an advantage for the multiple imputation. The bias differences were greater regarding the dimension scores, with a clear advantage for multiple imputation. The worst performance was achieved by the mean imputation methods.

Discussion and Conclusions

We recommend the use of multiple imputation to handle missing data in HSOPS-based surveys, whereas mean imputation methods should be avoided. Overall, these results suggest the possibility of optimizing the HSOPS instrument, which should be reduced without loss of overall information.
An Ancillary Sign in the Diagnosis of Bankart and Bankart Variants in Patients With Glenohumeral Instability on Nonarthrographic Magnetic Resonance Imaging: Preglenoid Fat Thickness
Authors: Polat Gökhan , Oğul Hayri , Yalcin Ahmet , Tuncer Kutsi , Kaya Serhat , Pirimoğlu Berhan , Sade Recep , Kantarci Mecit
Published: March 2019

Objective

We investigated whether preglenoid fat thickness can be used as an ancillary sign for preliminary diagnosis of Bankart and its variants on nonarthrographic magnetic resonance imaging.

Materials and Methods

Sixty-eight anterior dislocation patients were included in this retrospective study. Forty-eight patients with Bankart and its variants, as detected by arthroscopy and magnetic resonance arthrography, were included in the study group. The study group was divided into osseous Bankart, labral Bankart, Perthes, and anterior labroligamentous periosteal sleeve avulsion subgroups. Twenty patients with no detected labral pathologies by arthroscopy and magnetic resonance arthrography were included in the control group. In these patients, preglenoid fat tissue thickness at the anteroinferior portion was measured at the level of the glenoid tubercle. Thickness of preglenoid fat tissue was compared between groups with different labral pathologies and those with normal labrum.

Results

The preglenoid fat tissue thickness was 2.65 ± 1.05 mm in the control group and 0.90 ± 0.59 mm in the study group (P < 0.0001). Patients with preglenoid fat tissue thinner than 1.6 mm showed a significantly increased likelihood of having Bankart and its variants in receiver operating characteristic analysis (sensitivity of 95.8% and specificity of 85%). There was no significant difference in preglenoid fat tissue thickness between the subgroups of the study group (osseous Bankart, labral Bankart, Perthes, and anterior labroligamentous periosteal sleeve avulsion).

Conclusion

Preglenoid fat tissue measurement can be used as an ancillary sign in the diagnosis of Bankart and Bankart variants in glenohumeral instability patients.
Identification of Nonaggressive Pulmonary Nodules Using an Optimized Scoring System
Authors: Stephens Matthew J. , Rho Byung H. , Curran-Everett Douglas , Carr Laurie , Bowler Russell , Lynch David
Published: March 2019

Purpose:

The purpose of this study was to define the optimal scoring method for identifying benign intrapulmonary lymph nodes.

Materials and Methods:

Subjects for this study were selected from the COPDGene study, a large multicenter longitudinal observational cohort study. A retrospective case-control analysis was performed using identified nodules on a subset of 377 patients who demonstrated 765 pulmonary nodules on their baseline computed tomography (CT) study. Nodule characteristics of 636 benign nodules (which resolved or showed <20% growth rate at 5 y follow-up) were compared with 51 nodules that occurred in the same lobe as a reported malignancy. Two radiologists scored each pulmonary nodule on the basis of intrapulmonary lymph node characteristics. A simple scoring strategy weighing all characteristics equally was compared with an optimized scoring strategy that weighed characteristics on the basis of their relative importance in identifying benign pulmonary nodules.

Results:

A total of 479 of 636 benign pulmonary nodules had the majority of lymph node characteristics, whereas only 1 subpleural nodule with the majority of lymph node characteristics appeared to be malignant. Only 279 of 479 (58%) of benign pulmonary nodules with the majority of lymph node characteristics were intrafissural or subpleural. The optimized scoring strategy showed improved performance compared with the simple scoring strategy with average area under the curve of 0.80 versus 0.55. Optimized cutoff scores showed negative likelihood values for both readers of <0.2. A simulation showed a potential reduction in CT utilization of up to 36% for Fleischner criteria and up to 5% for LUNG-RADS.

Conclusions:

Nodules with the majority of lymph node characteristics, regardless of location, are likely benign, and weighing certain lymph node characteristics greater than others can improve overall performance. Given the potential to reduce CT utilization, lymph node characteristics should be considered when recommending appropriate follow-up.
Is There a Change in Electroconvulsive Therapy Practice Following the New Mental Health Act 2014 in Victoria?
Authors: Das Partha , Jagadheesan Karuppiah , Walker Frances , Lakra Vinay , Lautenschlager Nicola T. , Ferraro Angelo , Rudolph Devapriya
Published: March 2019

Objectives

The main objective of our study was to examine whether there has been any change to electroconvulsive therapy (ECT) practice since the new Mental Health Act 2014 (MHA) in a public metropolitan mental health service in Victoria.

Methods

This retrospective study examined any change in ECT rate following the new MHA. We compared sociodemographic, clinical, and ECT-related variables for patients treated before (July 1, 2013, and June 30, 2014) and after (1st July 2014 and the 30th June 2015) the new MHA.

Results

A reduction of 11.15% in ECT use per 1000 admissions and 16.4% in ECT use per 100,000 persons was observed subsequent to the new MHA. Hospital legal status at admission positively predicted the chance of starting ECT treatment under involuntary consent. Hospital legal status at admission and discharge, history of involuntary ECT, and final Clinical Global Impression–Severity scores positively predicted, but the year of treatment negatively predicted the chance of completing ECT treatment under involuntary consent.

Conclusions

The new MHA appeared to have been associated with reduced ECT use and lower rate of completing ECT under involuntary consent.
Changes in physiological characteristics and functional compounds of ‘Kkwariput’, ‘Gilsang’ and ‘Cheongyang’ pepper fruit after harvest
Authors: Park Me-Mea , Yang Eun-Young , Baek Dong-Ryeol , Chae Soo-Young , Lee Jung-Soo , Hong Yoon-Pyo
Published: March 2019

Three cultivars of green pepper with unique fruit shapes, ‘Kkwariput’, ‘Gilsang’, and ‘Cheongyang’, were investigated for changes in physiology and functional compounds during storage to optimize postharvest management. The results showed that the respiration and ethylene production rates of ‘Gilsang’ were lower than those of ‘Kkwariput’ and ‘Cheongyang’, having the lowest weight loss during storage at both 4℃ and 20℃. The ‘Cheongyang’ pepper exhibited the highest firmness among the three cultivars, and it remained high until the end of storage. The soluble solids content and the titratable acidity were significantly higher in ‘Cheongyang’ than in ‘Gilsang’ and ‘Kkwariput’. With regards to fruit color, in all three cultivars the L* values decreased while the a* values increased with storage time. Based on the appearance index, ‘Cheongyang’ had a longer shelf life at 20℃ than ‘Gilsang’ or ‘Kkwariput’. However, ‘Gilsang’ showed the lowest seed browning rate at 5 day at 20℃ among the three cultivars after 14 day of cold storage at 4℃. The results of functional compounds analysis showed that capsaicin content increased with storage time, with the highest content found in ‘Cheongyang’. Antioxidant capacity, as determined by ABTS and DPPH assays, increased with storage time, and ‘Cheongyang’ showed higher antioxidant retention capacity than ‘Gilsang’ and ‘Kkwariput’. The highest vitamin C content was also found in ‘Cheongyang’. Based on the overall superior results of the ‘Cheongyang’ cultivar, this study suggests a close correlation between the retention capacity of functional compounds and the shelf life in green peppers.
Simultaneous tracking of division and differentiation from individual hematopoietic stem and progenitor cells reveals within-family homogeneity despite population heterogeneity
Authors: Tak Tamar , Prevedello Giulio , Simon Gaël , Paillon Noémie , Duffy Ken R. , Perié Leïla
Published: March 2019

The advent of high throughput single cell methods such as scRNA-seq has uncovered substantial heterogeneity in the pool of hematopoietic stem and progenitor cells (HSPCs). A significant issue is how to reconcile those findings with the standard model of hematopoietic development, and a fundamental question is how much instruction is inherited by offspring from their ancestors. To address this, we further developed a high-throughput method that enables simultaneously determination of common ancestor, generation, and differentiation status of a large collection of single cells. Data from it revealed that while there is substantial population-level heterogeneity, cells that derived from a common ancestor were highly concordant in their division progression and share similar differentiation outcomes, revealing significant familial effects on both division and differentiation. Although each family diversifies to some extent, the overall collection of cell types observed in a population is largely composed of homogeneous families from heterogeneous ancestors. Heterogeneity between families could be explained, in part, by differences in ancestral expression of cell-surface markers that are used for phenotypic HSPC identification: CD48, SCA-1, c-kit and Flt3. These data call for a revision of the fundamental model of haematopoiesis from a single tree to an ensemble of trees from distinct ancestors where common ancestor effect must be considered. As HSPCs are cultured in the clinic before bone marrow transplantation, our results suggest that the broad range of engraftment and proliferation capacities of HSPCs could be consequences of the heterogeneity in their engrafted families, and altered culture conditions might reduce heterogeneity between families, possibly improving transplantation outcomes.
The McGill Face Database: validation and insights into the recognition of facial expressions of complex mental states
Authors: Schmidtmann Gunnar , Jennings Ben J. , Sandra Dasha A. , Pollock Jordan , Gold Ian
Published: March 2019

Current databases of facial expressions of mental states typically represent only a small subset of expressions, usually covering the basic emotions (fear, disgust, surprise, happiness, sadness, and anger). To overcome these limitations, we introduce a new database of pictures of facial expressions reflecting the richness of mental states. 93 expressions of mental states were interpreted by two professional actors and high-quality pictures were taken under controlled conditions in front and side view. The database was validated with two different experiments (N=65). First, a four-alternative forced choice paradigm was employed to test the ability of participants to correctly select a term associated with each expression. In a second experiment, we employed a paradigm that did not rely on any semantic information. The task was to locate each face within a two-dimensional space of valence and arousal (mental state – space) employing a “point-and-click” paradigm. Results from both experiments demonstrate that subjects can reliably recognize a great diversity of emotional states from facial expressions. Interestingly, while subjects’ performance was better for front view images, the advantage over the side view was not dramatic. To our knowledge, this is the first demonstration of the high degree of accuracy human viewers exhibit when identifying complex mental states from only partially visible facial features. The McGill Face Database provides a wide range of facial expressions that can be linked to mental state terms and can be accurately characterized in terms of arousal and valence.