bluuebunny/crossref_metadata_2025 huggingface dataset:
Chromatin and lamin A determine two different mechanical response regimes of the cell nucleus
Authors: Stephens Andrew D. , Banigan Edward J. , Adam Stephen A. , Goldman Robert D. , Marko John F.
Published: January 2017

The cell nucleus must continually resist and respond to intercellular and intracellular mechanical forces to transduce mechanical signals and maintain proper genome organization and expression. Altered nuclear mechanics is associated with many human diseases, including heart disease, progeria, and cancer. Chromatin and nuclear envelope A-type lamin proteins are known to be key nuclear mechanical components perturbed in these diseases, but their distinct mechanical contributions are not known. Here we directly establish the separate roles of chromatin and lamin A/C and show that they determine two distinct mechanical regimes via micromanipulation of single isolated nuclei. Chromatin governs response to small extensions (<3 μm), and euchromatin/heterochromatin levels modulate the stiffness. In contrast, lamin A/C levels control nuclear strain stiffening at large extensions. These results can be understood through simulations of a polymeric shell and cross-linked polymer interior. Our results provide a framework for understanding the differential effects of chromatin and lamin A/C in cell nuclear mechanics and their alterations in disease.
ORCAN—a web-based meta-server for real-time detection and functional annotation of orthologs
Authors: Zielezinski Andrzej , Dziubek Michal , Sliski Jan , Karlowski Wojciech M
Published: January 2017

ORCAN (ORtholog sCANner) is a web-based meta-server for one-click evolutionary and functional annotation of protein sequences. The server combines information from the most popular orthology-prediction resources, including four tools and four online databases. Functional annotation utilizes five additional comparisons between the query and identified homologs, including: sequence similarity, protein domain architectures, functional motifs, Gene Ontology term assignments and a list of associated articles. Furthermore, the server uses a plurality-based rating system to evaluate the orthology relationships and to rank the reference proteins by their evolutionary and functional relevance to the query. Using a dataset of ∼1 million true yeast orthologs as a sample reference set, we show that combining multiple orthology-prediction tools in ORCAN increases the sensitivity and precision by 1–2 percent points.

Availability and Implementation

The service is available for free at http://www.combio.pl/orcan/.

Supplementary information

Supplementary data are available at Bioinformatics online.
Chainy: an universal tool for standardized relative quantification in real-time PCR
Authors: Mallona Izaskun , Díez-Villanueva Anna , Martín Berta , Peinado Miguel A
Published: January 2017

Chainy is a cross-platform web tool providing systematic pipelines and steady criteria to process real-time PCR data, including the calculation of efficiencies from raw data by kinetic methods, evaluation of the suitability of multiple references, standardized normalization using one or more references, and group-wise relative quantification statistical testing. We illustrate the utility of Chainy for differential expression and chromatin immunoprecipitation enrichment (ChIP-QPCR) analysis.

Availability and Implementation

Chainy is open source and freely available at http://maplab.cat/chainy

Supplementary information

Supplementary data are available at Bioinformatics online.
Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices
Authors: Mathis Michael R. , Sathishkumar Subramanian , Kheterpal Sachin , Caldwell Matthew D. , Pagani Francis D. , Jewell Elizabeth S. , Engoren Milo C.
Published: January 2017

Background

Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns.

Methods

The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015. The authors described perioperative profiles of noncardiac surgery cases, including patient, left ventricular assist device, surgical case, and anesthetic characteristics, as well as staffing by cardiac/noncardiac anesthesiologists. Through univariate and multivariable analyses, the authors studied acute kidney injury as a primary outcome; secondary outcomes included elevated serum lactate dehydrogenase suggestive of left ventricular assist device thrombosis, intraoperative bleeding complication, and intraoperative hypotension. The authors additionally studied major perioperative complications and mortality.

Results

Two hundred and forty-six patients underwent 702 procedures. Of 607 index cases, 110 (18%) experienced postoperative acute kidney injury, and 16 (2.6%) had elevated lactate dehydrogenase. Of cases with complete blood pressure data, 176 (27%) experienced intraoperative hypotension. Bleeding complications occurred in 45 cases (6.4%). Thirteen (5.3%) patients died within 30 days of surgery. Independent risk factors associated with acute kidney injury included major surgical procedures (adjusted odds ratio, 4.4; 95% CI, 1.1 to 17.3; P = 0.03) and cases prompting invasive arterial line monitoring (adjusted odds ratio, 3.6; 95% CI, 1.3 to 10.3; P = 0.02) or preoperative fresh frozen plasma transfusion (adjusted odds ratio, 1.7; 95% CI, 1.1 to 2.8; P = 0.02).

Conclusions

Intraoperative hypotension and acute kidney injury were the most common complications in left ventricular assist device patients presenting for noncardiac surgery; perioperative management remains a challenge.
Quantifying Baseline Fixed Charge Density in Healthy Human Cartilage Endplate
Authors: Wu Yongren , Cisewski Sarah E. , Sun Yi , Damon Brooke J. , Sachs Barton L. , Pellegrini Vincent D. , Slate Elizabeth H. , Yao Hai
Published: January 2017

Study Design.

Regional measurements of fixed charge densities (FCDs) of healthy human cartilage endplate (CEP) using a two-point electrical conductivity approach.

Objective.

The aim of this study was to determine the FCDs at four different regions (central, lateral, anterior, and posterior) of human CEP, and correlate the FCDs with tissue biochemical composition.

Summary of Background Data.

The CEP, a thin layer of hyaline cartilage on the cranial and caudal surfaces of the intervertebral disc, plays an irreplaceable role in maintaining the unique physiological mechano-electrochemical environment inside the disc. FCD, arising from the carboxyl and sulfate groups of the glycosaminoglycans (GAG) in the extracellular matrix of the disc, is a key regulator of the disc ionic and osmotic environment through physicochemical and electrokinetic effects. Although FCDs in the annulus fibrosus (AF) and nucleus pulposus (NP) have been reported, quantitative baseline FCD in healthy human CEP has not been reported.

Methods.

CEP specimens were regionally isolated from human lumbar spines. FCD and ion diffusivity were concurrently investigated using a two-point electrical conductivity method. Biochemical assays were used to quantify regional GAG and water content.

Results.

FCD in healthy human CEP was region-dependent, with FCD lowest in the lateral region (P = 0.044). Cross-region FCD was 30% to 60% smaller than FCD in NP, but similar to the AF and articular cartilage (AC). CEP FCD (average: 0.12 ± 0.03 mEq/g wet tissue) was correlated with GAG content (average: 31.24 ± 5.06 μg/mg wet tissue) (P = 0.005). In addition, the cross-region ion diffusivity in healthy CEP (2.97 ± 1.00 × 10−6 cm2/s) was much smaller than the AF and NP.

Conclusion.

Healthy human CEP acts as a biomechanical interface, distributing loads between the bony vertebral body and soft disc tissues and as a gateway impeding rapid solute diffusion through the disc.

Level of Evidence: N/A
Evaluating Nurses' Satisfaction With Two Nursing Information Systems
Authors: Khajouei Reza , Abbasi Reza
Published: January 2017

Evaluating user satisfaction is one of the methods to ensure the usability of information systems. Considering the importance of nursing information systems in patient health, the objective of this study is to evaluate nurses' satisfaction with two widely used nursing information systems (Peyvand Dadeh and Tirazhe) in Iran. This descriptive-analytical study was done on 230 nurses in all teaching hospitals of Kerman University of Medical Sciences in 2015. Data were collected using an augmented version of a questionnaire developed by IBM. Data were analyzed by SPSS.16 using descriptive and analytical statistical methods including t test, analysis of variance, and Pearson correlation coefficient. The mean of overall satisfaction with the two systems was 61 ± 2.2 and 74 ± 2.4, respectively. The mean of satisfaction with different systems dimensions, that is, ease of use, information quality, and interface quality, was, respectively, 24 ± 1.9, 26 ± 9.7, and 12 ± 4.7 for Tirazhe and 29 ± 1.1, 39 ± 1.04 and 13 ± 5.3 for Peyvand Dadeh system. Nurses’ satisfaction with both systems was at a medium level. The majority of nurses were relatively satisfied with the information quality and user interface quality of these systems. The results suggest that designing nursing information systems in accordance with their users’ need improves usability. Hence, policy and decision makers of healthcare institutions should invest on usability when purchasing such systems.
ACR Appropriateness Criteria® Locally Advanced, High-Risk Prostate Cancer
Authors: McLaughlin Patrick W. , Liss Adam L. , Nguyen Paul L. , Assimos Dean G. , D’Amico Anthony V. , Gottschalk Alexander R. , Gustafson Gary S. , Keole Sameer R. , Liauw Stanley L. , Lloyd Shane , Movsas Benjamin , Prestidge Bradley R. , Showalter Timothy N. , Taira Al V. , Vapiwala Neha , Davis Brian J.
Published: January 2017

Purpose:

To present the most updated American College of Radiology consensus guidelines formed from an expert panel on treatment of locally advanced, high-risk prostate cancer

Methods:

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Results:

The panel summarized the most recent and relevant literature on the topic and voted on 4 clinical variants illustrating the appropriate management of locally advanced, high-risk cancer. Numerical rating and commentary reflecting the panel consensus was given for each treatment approach in each variant.

Conclusions:

Aggressive local approaches including surgery followed by adjuvant XRT, beam combined with androgen deprivation therapy, and beam combined with brachytherapy have resulted in unpresented success in locally advanced, high-risk prostate cancer. By combining most recent medical literature and expert opinion, this guideline can aid clinicians in the appropriate integration of available therapeutic modalities.
Perceived Racial Bias and Health-Related Stigma Among Youth with Sickle Cell Disease
Authors: Wakefield Emily O. , Popp Jill M. , Dale Lourdes P. , Santanelli James P. , Pantaleao Ashley , Zempsky William T.
Published: January 2017

Objective:

Little is known about the role of perceived racial bias and health-related stigma on the health of youth with sickle cell disease (SCD). The purpose of this study was to investigate the occurrence of perceived racial bias and health-related stigma among youth with SCD and its relationship with psychological and physical well-being.

Methods:

Twenty-eight youth with SCD, ages 13 to 21, were recruited from outpatient and inpatient settings at an urban children's medical center. Participants completed measures of perceived racial bias, perceived health-related stigma, depression, quality of life, and pain burden.

Results:

Most participants endorsed occurrences of racial bias and health-related stigma. The findings indicate that greater perceived racial bias was associated with greater pain burden, and greater perceived health-related stigma was related to lower quality of life.

Conclusion:

Perceived racial bias and health-related stigma may be important to consider for future research investigating the psychological and physiological features of SCD for youth.
A Cross-Sectional Review of Reporting Variation in Postoperative Bowel Dysfunction After Rectal Cancer Surgery
Authors: Chapman Stephen J. , Bolton William S. , Corrigan Neil , Young Neville , Jayne David G.
Published: January 2017

BACKGROUND:

Postoperative bowel dysfunction affects quality of life after sphincter-preserving rectal cancer surgery, but the extent of the problem is not clearly defined because of inconsistent outcome measures used to characterize the condition.

OBJECTIVE:

The purpose of this study was to assess variation in the reporting of postoperative bowel dysfunction and to make recommendations for standardization in future studies. If possible, a quantitative synthesis of bowel dysfunction symptoms was planned.

DATA SOURCES:

MEDLINE and EMBASE databases, as well as the Cochrane Library, were queried systematically between 2004 and 2015.

STUDY SELECTION:

The studies selected reported at least 1 component of bowel dysfunction after resection of rectal cancer.

MAIN OUTCOME MEASURES:

The main outcome measures were reporting, measurement, and definition of postoperative bowel dysfunction.

RESULTS:

Of 5428 studies identified, 234 met inclusion criteria. Widely reported components of bowel dysfunction were incontinence to stool (227/234 (97.0%)), frequency (168/234 (71.8%)), and incontinence to flatus (158/234 (67.5%)). Urgency and stool clustering were reported less commonly, with rates of 106 (45.3%) of 234 and 61 (26.1%) of 234. Bowel dysfunction measured as a primary outcome was associated with better reporting (OR = 3.49 (95% CI, 1.99–6.23); p < 0.001). Less than half of the outcomes were assessed using a dedicated research tool (337/720 (46.8%)), and the remaining descriptive measures were infrequently defined (56/383 (14.6%)).

LIMITATIONS:

Heterogeneity in the reporting, measurement, and definition of postoperative bowel dysfunction precluded pooling of results and limited interpretation.

CONCLUSIONS:

Considerable variation exists in the reporting, measurement, and definition of postoperative bowel dysfunction. These inconsistencies preclude reliable estimates of incidence and meta-analysis. A broadly accepted outcome measure may address this deficit in future studies.
Bio-Thiersch as an Adjunct to Perineal Proctectomy Reduces Rates of Recurrent Rectal Prolapse
Authors: Eftaiha Saleh M. , Calata Jed F. , Sugrue Jeremy J. , Marecik Slawomir J. , Prasad Leela M. , Mellgren Anders , Nordenstam Johan , Park John J.
Published: January 2017

BACKGROUND:

The rates of recurrent prolapse after perineal proctectomy vary widely in the literature, with incidences ranging between 0% and 50%. The Thiersch procedure, first described in 1891 for the treatment of rectal prolapse, involves encircling the anus with a foreign material with the goal of confining the prolapsing rectum above the anus. The Bio-Thiersch procedure uses biological mesh for anal encirclement and can be used as an adjunct to perineal proctectomy for rectal prolapse to reduce recurrence.

OBJECTIVE:

The aim of this study was to evaluate the Bio-Thiersch procedure as an adjunct to perineal proctectomy and its impact on recurrence compared with perineal proctectomy alone.

DESIGN:

A retrospective review of consecutive patients undergoing perineal proctectomy with and without Bio-Thiersch was performed.

SETTINGS:

Procedures took place in the Division of Colon and Rectal Surgery at a tertiary academic teaching hospital.

PATIENTS:

Patients who had undergone perineal proctectomy and those who received perineal proctectomy with Bio-Thiersch were evaluated and compared.

INTERVENTIONS:

All of the patients with rectal prolapse received perineal proctectomy with levatorplasty, and a proportion of those patients had a Bio-Thiersch placed as an adjunct.

MAIN OUTCOME MEASURES:

The incidence of recurrent rectal prolapse after perineal proctectomy alone or perineal proctectomy with Bio-Thiersch was documented.

RESULTS:

Sixty-two patients underwent perineal proctectomy (8 had a previous prolapse procedure), and 25 patients underwent perineal proctectomy with Bio-Thiersch (12 had a previous prolapse procedure). Patients who received perineal proctectomy with Bio-Thiersch had a lower rate of recurrent rectal prolapse (p < 0.05) despite a higher proportion of them having had a previous prolapse procedure (p < 0.01). Perineal proctectomy with Bio-Thiersch had a lower recurrence over time versus perineal proctectomy alone (p < 0.05).

LIMITATIONS:

This study was limited by nature of being a retrospective review.

CONCLUSIONS:

Bio-Thiersch as an adjunct to perineal proctectomy may reduce the risk for recurrent rectal prolapse and can be particularly effective in patients with a history of previous failed prolapse procedures.
Reducing Readmissions While Shortening Length of Stay: The Positive Impact of an Enhanced Recovery Protocol in Colorectal Surgery
Authors: Shah Puja M. , Johnston Lily , Sarosiek Bethany , Harrigan Amy , Friel Charles M. , Thiele Robert H. , Hedrick Traci L.
Published: January 2017

BACKGROUND:

Hospital readmission rates are an increasingly important quality metric since enactment of the 2012 Hospital Readmissions Reduction Program. The proliferation of enhanced recovery protocols and earlier discharge raises concerns for increased readmission rates.

OBJECTIVE:

We evaluated the effect of enhanced recovery on readmissions and identified risk factors for readmission.

DESIGN:

This study involved implementation of a multidisciplinary enhanced recovery protocol.

SETTINGS:

It was conducted at a large academic medical center

PATIENTS:

All patients undergoing elective colorectal surgery between 2011 and 2015 at our center were included.

MAIN OUTCOME MEASURES:

This cohort study compared patients before and after enhanced recovery initiation, looking at 30-day readmission as the primary outcome. A multivariable logistic regression model identified predictors of 30-day readmission. Kaplan–Meier analysis identified differences in time to readmission.

RESULTS:

A total of 707 patients underwent colorectal procedures between 2011 and 2015, including 383 patients before enhanced recovery protocol was implemented and 324 patients after enhanced protocol was implemented. Length of stay decreased from a median 5 days to a median 4 days before and after enhanced recovery implementation (p < 0.0001). Thirty-day readmission decreased from 19% (72/383) in the pre-enhanced recovery pathway to 12% (38/324) in the enhanced recovery pathway (p = 0.009). Twenty-one percent (21/99) of patients who underwent ileostomy were readmitted before enhanced recovery implementation compared with 19% (18/93) of patients who underwent ileostomy after enhanced recovery implementation (p = 0.16). Multivariable logistic regression identified ileostomy as increasing the risk of readmission (p = 0.04), whereas enhanced recovery protocol decreased the risk of readmission (p = 0.006).

LIMITATIONS:

The study is limited because it was conducted at a single institution and used a before-and-after study design.

CONCLUSIONS:

These data suggest that use of a standardized enhanced recovery protocol significantly reduces length of stay and readmission rates in an elective colorectal surgery population. However, the presence of an ileostomy maintains a high association with readmission, serving as a significant burden to patients and providers alike. Ongoing efforts are needed to further improve the management of patients undergoing ileostomy in the outpatient setting after discharge to prevent readmissions.
Hypertension's 3 Dilemmas and 3 Solutions: Pharmacology of the Kidney in Hypertension
Authors: Pettinger William A.
Published: January 2017

Abstract:Summary

The Hypertension Community has 3 conflicting dilemmas: a goal systolic pressure of 120 mm Hg or less (the SPRINT Trials), 40% of our 60,000,000 hypertensives still sustain blood pressures above 140/90 mm Hg, and our most potent antihypertensive drug minoxidil sits on the sidelines, imprisoned in the Food and Drug Administration's Black Box designation. My solutions to these dilemmas are: (1) review of the facts of our most potent antihypertensive drug minoxidil which is essentially free of toxicity, (2) treatment focus on the fundamental cause of high blood pressure, that is excess dietary sodium and, (3) prevention of, and/or reversal of, the fundamental mechanism of worsening hypertension, arteriolar hypertrophy.

The Hypertension Community has 3 conflicting dilemmas: a goal systolic pressure of 120 mm Hg or less (the SPRINT Trials), 40% of our 60,000,000 hypertensives still sustain blood pressures above 140/90 mm Hg, and our most potent antihypertensive drug minoxidil sits on the sidelines, imprisoned in the Food and Drug Administration's Black Box designation. My solutions to these dilemmas are: (1) review of the facts of our most potent antihypertensive drug minoxidil which is essentially free of toxicity, (2) treatment focus on the fundamental cause of high blood pressure (HBP) and excess dietary sodium and, (3) prevention of, and/or reversal of, the fundamental mechanism of worsening hypertension, arteriolar hypertrophy. My focus at UT Southwestern in Dallas was on extremely severely hypertensive patients with a quantifiable, measurable complication of HBP, progression of nephrosclerotic damage to kidneys. This model had the greatest likelihood of exposing fundamental disregulatory mechanisms in hypertensive patients (which it did) and the potential for study of the most relevant antihypertensive drug interactions to achieve optimal blood pressure control (which it did). By maintaining diastolic pressures at 80 mm Hg or less in the first National Institutes of Health–supported, long-term randomized clinical trial to save the kidneys, the bases for a fundamental blood pressure support mechanism (arteriolar hypertrophy) was illuminated but not fully described until now. This fundamental hypertensinogenic mechanism results from HBP but with time and severity, becomes its own raison d'être. I am now aged 84 years. As a result of a stroke 20 years ago, which caused permanent double vision, and because of poor blood pressure control with triple therapy, I started using minoxidil 5 mg/d along with atenolol and occasional furosemide. Now, along with some dietary salt restriction, my resting blood pressure is 110/65–125/75 and, despite >30 years history of HBP, I have no retinal arteriolar hypertrophy nor arcus senilis (Dr. Schwartz-U. of Miami) which is almost universally present at this age. Yes, prevention of, or reversal of, arteriolar hypertrophy should be a central focus of HBP treatment. I simply wish to share a bit of accumulated wisdom that might be of use to others.
Angiogenic and Antiangiogenic Markers for Prediction and Risk Classification of Preeclampsia
Authors: MALSHE AMOL K. , SIBAI BAHA M.
Published: January 2017

Preeclampsia is a pregnancy-specific hypertensive disorder with multisystem involvement and is a significant cause of obstetric morbidity and mortality worldwide. A major issue in the treatment of preeclampsia stems from its still significant rates of misclassification and misdiagnosis. Angiogenic factors have been speculated as a possible diagnostic modality due to a perceived imbalance in angiogenesis in preeclampsia. Factors currently studied include soluble fms-like protein kinase 1 and placental growth factor. Because of significant mortality associated with preeclampsia it is felt that both early and accurate diagnosis of preeclampsia is imperative if this disease process is to be treated.
Mental Health Problems in a Community After the Great East Japan Earthquake in 2011: A Systematic Review
Authors: Ando Shuntaro , Kuwabara Hitoshi , Araki Tsuyoshi , Kanehara Akiko , Tanaka Shintaro , Morishima Ryo , Kondo Shinsuke , Kasai Kiyoto
Published: January 2017

Introduction

On March 11, 2011, the Great East Japan Earthquake caused a tsunami and led to the collapse of the Fukushima-Daiichi Nuclear Power Plant, thus severely damaging the surrounding area.

Methods

A systematic review was conducted in March 2015 with the following objectives: (1) to clarify the type, severity, and prevalence of mental health problems in the areas affected by the disaster, (2) to investigate trends in mental health problems over time, (3) to reveal demographic and socio-environmental characteristics associated with the post-disaster risk for developing mental health problems, and (4) to examine the impact of this natural disaster on the mental health of people in Fukushima.

Results

Forty-two papers were included in this review. The reported prevalence of posttraumatic stress reaction exceeded 10% in all studies. While some longitudinal studies observed an improvement in posttraumatic stress reaction over time, none reported a decrease in depression. Most risk factors for mental health problems were related to resettlement of daily lives, preexisting illnesses, and social networks. Overall, the reported prevalence of posttraumatic stress reaction seemed to be higher in Fukushima than in other affected areas.

Conclusion

Given that some mental health problems had not improved even two years after the disaster occurred, long-term mental health support is required for people in the affected area. Our finding that mental health problems seemed to be more severe in residents of Fukushima than among those in other areas suggests that residents in this prefecture require special care.
Predictors of Employment Outcomes in Veterans With Traumatic Brain Injury: A VA Traumatic Brain Injury Model Systems Study
Authors: Dillahunt-Aspillaga Christina , Nakase-Richardson Risa , Hart Tessa , Powell-Cope Gail , Dreer Laura E. , Eapen Blessen C. , Barnett Scott D. , Mellick Dave , Haskin Adam , Silva Marc A.
Published: January 2017

Objectives:

To examine the length of time to return to work (RTW) among service members and veterans (SM/V) with traumatic brain injury (TBI) and to identify variables predictive of RTW.

Setting:

Department of Veterans Affairs Polytrauma Rehabilitation Centers (VA PRC).

Participants:

SM/V enrolled in the VA PRC Traumatic Brain Injury Model Systems database who were of 18 to 60 years of age and admitted with the diagnosis of TBI.

Design:

Prospective observational cohort study.

Main Outcome Measures:

Employment status at 1-year postinjury follow-up; Time to Employment (ie, number of days it took to RTW) as documented during 1-year postinjury follow-up.

Results:

The final sample (n = 293) included male (96%) SM/V with severe TBI (69%). Approximately 21% of the sample participants were employed at 1 year postinjury. Younger individuals who self-identified as nonminority returned to work sooner. Significant associations were observed for time to employment for cause of injury and injury severity.

Conclusions:

Few SM/V with moderate to severe TBI returned to work at 1 year postinjury. Predictors such as younger age at the time of injury, minority status, and severity of TBI affected time to and probability of RTW. Findings from this study have important implications for rehabilitation planning and service delivery across the continuum of recovery.
Brain Cholinergic Function and Response to Rivastigmine in Patients With Chronic Sequels of Traumatic Brain Injury: A PET Study
Authors: Östberg Anna , Virta Jere , Rinne Juha O. , Oikonen Vesa , Luoto Pauliina , Någren Kjell , Arponen Eveliina , Tenovuo Olli
Published: January 2017

Objective:

To investigate quantitative positron emission tomography (PET) findings and to study whether the cholinergic function differs between respondents to cholinergic medication versus nonrespondents.

Setting:

Outpatient clinic and university PET imaging center.

Participants:

We studied 17 subjects for more than 1 year after at least moderate traumatic brain injury. Ten of the subjects were respondents and 7 nonrespondents to cholinergic medication.

Design:

Cholinergic function was assessed with [methyl-11C] N-methylpiperidyl-4-acetate-PET (11C-MP4A-PET), which reflects the activity of the acetylcholinesterase (AChE) enzyme. The subjects were PET scanned twice: without medication and after a 4-week treatment with rivastigmine 1.5 mg twice a day.

Measures:

Regional cerebral AChE activity was measured with PET.

Results:

At baseline Statistical Parametric Mapping analyses showed significantly lower AChE activity in respondents bilaterally in the frontal cortex as compared with nonrespondents. Region of interest (ROI) analysis revealed that the difference was most pronounced in the lateral frontal cortex (−9.4%, P = .034) and anterior cingulate (−6.0%, P = .049). After rivastigmine treatment, AChE activity was notably lower throughout the cortex in both respondents and nonrespondents, without significant differences between them.

Conclusion:

Our study suggests that frontal cholinergic dysfunction is associated with the clinical response to cholinergic stimulation in patients with traumatic brain injury.
SURGICAL OUTCOMES OF 27-GAUGE VITRECTOMY FOR A CONSECUTIVE SERIES OF 163 EYES WITH VARIOUS VITREOUS DISEASES
Authors: Yoneda Kazuhito , Morikawa Keisuke , Oshima Yusuke , Kinoshita Shigeru , Sotozono Chie ,   Japan Microincision Vitrectomy Surgery Study Group
Published: January 2017

Purpose:

To evaluate the safety and efficacy of 27-gauge vitrectomy for various vitreoretinal disorders.

Methods:

In this retrospective comparative study, 163 consecutive eyes with various diseases that underwent 27-gauge pars plana vitrectomy with or without ultraspeed transformer by a single surgeon from June 2012 through December 2014 were analyzed in regard to best-corrected visual acuity, intraocular pressure, intraoperative and postoperative complications, and surgery time.

Results:

In 2 eyes (1.2%), peripheral retina breaks were encountered intraoperatively, yet no other complications were found in those eyes. No cases required larger-gauge vitrectomy. Mean best-corrected visual acuity improved from 20/58 (logarithm of the minimum angle of resolution, 0.46 ± 0.64) preoperatively to 20/32 (logarithm of the minimum angle of resolution, 0.20 ± 0.40) postoperatively (P < 0.001). Mean follow-up was 16.7 months (range, 6–33 months). Intraocular pressure remained stable throughout the postoperative course. Hypotony was seen in 15 eyes (9.2%) at 1-day postoperative, yet that spontaneously improved within 1 week. No case of retinal detachment or endophthalmitis was recorded. In macular surgeries, such as idiopathic epiretinal membrane and macular hole combined with cataract surgery, the mean surgery time was 32.1 ± 6.9 minutes with ultraspeed transformer (n = 38) and 37.1 ± 7.7 minutes without ultraspeed transformer (n = 40) (P = 0.004).

Conclusion:

The 27-gauge pars plana vitrectomy was found to be safe and effective for treating various vitreoretinal disorders.
Advantages of Anterior Segment Optical Coherence Tomography Evaluation of the Kayser–Fleischer Ring in Wilson Disease
Authors: Sridhar Mittanamalli S.
Published: January 2017

Purpose:

To present anterior segment optical coherence tomography (AS-OCT) findings of the Kayser–Fleischer (KF) ring in Wilson disease (WD) and to discuss the potential advantages of evaluating the KF ring by AS-OCT.

Methods:

This is a retrospective case series of 7 patients with WD with KF rings seen in our institute during the study period (August 2015 to June 2016). All patients underwent slit-lamp examination of the cornea and AS-OCT (Optovue RTVue Premier). In 2 patients, the length of the KF ring was measured using the gray scale of AS-OCT.

Results:

The KF ring on the gray scale of AS-OCT was visualized as a hyperreflective deep corneal layer at the level of Descemet membrane in all eyes. The OCT color scale revealed the KF ring as a greenish, greenish-yellow, yellow, or yellow-orange band. The gray scale of AS-OCT could easily measure the length of the KF ring in patients 6 and 7.

Conclusions:

AS-OCT is an alternative method of evaluating the KF ring in WD, which can be used in combination with slit-lamp examination. The KF ring can be easily measured using the gray scale of AS-OCT. Further studies are required to study the potential advantages of AS-OCT including assessing the density of the KF ring, as a tool to assess response to treatment in WD, in differentiating the KF ring of WD disease from copper deposits in other situations and pigmented corneal rings in non-Wilsonian liver disease.
The Hook and Release Technique During Enucleation Surgery
Authors: Jordan David R. , Stoica Bazil , Dutton Jonathan J.
Published: January 2017

Purpose:

To describe the results and potential benefit of direct muscle release from the globe during enucleation surgery without identifying sutures in the rectus muscle insertion sites, a technique referred to as the hook and release technique.

Methods:

Single center, retrospective chart review of patients who underwent enucleation with direct removal of the rectus muscles without identifying sutures in their insertion sites between January 2011 and September 2015 was carried out. The inclusion criteria were primary enucleation without previous strabismus surgery, retinal detachment surgery, or orbital surgery that entered the fibrous connective tissue framework. Forty charts of enucleated patients that had direct release of their extraocular muscles without identifying sutures before releasing them from the globe were identified and reviewed. The primary outcome measure was intraoperative or immediate postoperative complications. This retrospective chart review was performed with research ethics board approval and in compliance with the Declaration of Helsinki.

Results:

Data show that following the hook and release technique, the rectus muscles were easily located and reconnected to the orbital implant wrap. The oblique muscles were not reattached. In each of the 40 patients, the 4 rectus muscles were easily located by gently applying traction anteriorly at the conjunctiva/Tenons’ edge using double-pronged skin hooks. There was no instance of a lost or slipped muscle following the hook and release technique.

Conclusion:

The hook and release technique is a simple and efficient method to remove the 4 rectus muscles from the globe and still easily locate them. They are not “lost” and do not “slip out of position” but held in place by the orbital connective tissue framework and the extraocular muscle pulley system. This technique has been very helpful teaching resident staff how to do enucleation surgery as it avoids the more time consuming placement of double-armed locking sutures through the rectus muscle insertions and the potential risk of globe penetration while the muscles remain attached to the eye. If the surgeon desires to attach the muscles to the orbital implant, then sutures are passed after the eye is removed, thus eliminating the worry of globe penetration and avoiding accidentally cutting preplaced extraocular muscle sutures during the remaining enucleation procedure.
Effects of Lifestyle Intervention on Physiological Outcomes in Chinese Adults With, or at High Risk of, Metabolic Syndrome
Authors: Lo Sally Wai Sze , Chair Sek Ying , Lee Iris Fung Kam
Published: January 2017

Background:

Metabolic syndrome (MS) increases the risk of cardiovascular events and the development of diabetes. This article reports the effects of lifestyle intervention on the physiological outcomes of people with or at high risk of MS in the community setting of Hong Kong.

Methods:

Chinese adults with 2 or more MS components were recruited from 13 community centers, which were cluster-randomized to the intervention or control group. The intervention group received a low-intensity lifestyle intervention program for people with MS consisting of group sessions, individual counseling, and telephone follow-ups over 3 months. The control group received standard care plus an attention placebo. The primary outcomes were body weight and waist circumference, whereas the secondary outcomes included blood pressure, lipids, glucose, and number of MS components. Linear mixed-effects models were used to compare the effects of the program between the 2 groups.

Results:

The final sample consisted of 183 adults (19.1% male) with a mean (SD) age of 54.0 (7.8) years. At 3 months, overall MS prevalence was reduced to 13.8%. Compared with the control group, subjects in the intervention group exhibited a reduced waist circumference (β = −.146, P = .008) when the interaction effects of time and group were considered simultaneously. However, no significant differences were found for changes in the other measured outcomes.

Conclusion:

A low-intensity lifestyle intervention program for people with MS can reduce central obesity among people with or at high risk for MS. Further research is necessary to confirm the long-term physiological effects of the intervention.
The Impact of Self-management Knowledge and Support on the Relationships Among Self-efficacy, Patient Activation, and Self-management in Rural Patients With Heart Failure
Authors: Young Lufei , Kupzyk Kevin , Barnason Susan
Published: January 2017

Background:

Self-management (SM) is an essential component of heart failure (HF) management. The mechanisms to improve SM behaviors are unclear.

Objective:

The objective of this study is to examine whether patient activation mediates the effect of self-efficacy on SM behaviors in rural HF patients.

Methods:

A secondary analysis was conducted using data collected from a randomized controlled trial aimed to improve SM behaviors. The main variables included were SM knowledge, self-efficacy, patient activation, and SM behaviors.

Results:

Mediation analysis showed patient activation mediated the effect of self-efficacy on SM. Both self-efficacy and patient activation were significantly related to SM behaviors, respectively (r = 0.46, P < .001; β = .48, P = .001). However, self-efficacy was no longer directly related to SM behaviors when patient activation was entered into the final model (β = .17, P = .248). Self-management knowledge and support were significant moderators. In patients with high levels of SM knowledge, patient activation did not mediate the effect of self-efficacy on SM behaviors (β = .15, P = .47). When SM support was entered in the path model, patient activation was not a significant mediator between self-efficacy and SM behavior at high (β = .27, P = .27) or low (β = .27, P = .25) levels of SM support.

Conclusions:

Study findings suggest that targeted SM support for high-risk HF patients with low SM knowledge and support may be useful. In addition, strategies to increase patient activation may improve HF patients’ SM confidence.
Lack of Evidence to Support the Beneficial Role of Intratympanic Dexamethasone Injection in Acute Peripheral Facial Palsy
Authors: Kim Su Jin , Lee Jun , Lee Ho Yun
Published: January 2017

Objectives:

Adjunctive intratympanic dexamethasone injection (IT-DEX) has been used for the treatment of acute peripheral facial palsy (APFP). However, there are controversies regarding the validity of this treatment. In this study, we aimed to verify the feasibility of IT-DEX treatment for APFP.

Study Design:

Retrospective cohort study.

Setting:

Local university hospital.

Patients and Methods:

Data of patients treated for APFP between 2015 and 2018, and whose follow-up records for more than 3 months were available, were collected and analyzed based on whether adjuvant IT-DEX was administered.

Main Outcome Measures:

House–Brackmann grading at the initial visit, and at 2, 6, and 10 to 16 weeks after discharge. Patients with House–Brackmann I at any time point were regarded as having complete recovery (CR).

Results:

A total of 108 patients [57 men, 51 women; mean age, 48 ± 15.67 yr (range: 18–85 yr)] were enrolled in the study. Adjunctive IT-DEX was administered to 41.7% (n = 45) of patients during hospitalization. CR was observed in 71.7% of IT-DEX-treated patients; however, it was not significantly different from the conventional treatment group (79.4%) (p > 0.05). Multiple regression analysis revealed that better facial grade at week 2 [EXP(B) = 7.407, 95% CI = 1.828–30.303, p = 0.005] was significantly associated with CR. However, the number of IT-DEX treatment sessions was not a significant prognostic factor for predicting CR.

Conclusion:

Additional beneficial treatment effect was not observed with adjuvant IT-DEX. Thus, the use of IT-DEX for APFP should be reconsidered until scientific evidence for the basis of its use is established.
Delayed Vestibular Schwannoma Regrowth Following Shrinkage After Stereotactic Radiosurgery: Implication for Life-Long Surveillance
Authors: Stapleton Emma , Crowther John A. , Locke Richard , Kontorinis Georgios
Published: January 2017

Objective:

To enhance understanding of the behavior of vestibular schwannomas (VS) after stereotactic radiosurgery (SRS), including the potential for late tumor regrowth, and the need for lifelong radiological and clinical surveillance.

Patients:

From a total of 540 patients with VS and out of 95 patients receiving SRS for their growing VS, the cases of two women patients aged 58 and 59 years with medium sized, growing VS are presented.

Intervention:

Both patients were treated with SRS. Following treatment, both patients had close clinical follow-up and serial magnetic resonance imaging (MRI).

Main Outcome Measures:

Post-SRS clinical assessment and serial MRI to determine VS size and respond to treatment.

Results:

Close clinical follow-up after SRS identified no change in symptoms in one patient; the other developed ipsilateral facial nerve twitching without weakness. Serial MRI identified that in both patients, VS that had initially decreased in size following SRS, exhibited significant late regrowth after a 3-year period, reaching the pretreatment size.

Conclusions:

This is the first report of late vestibular schwannoma regrowth following a period of significant shrinkage after SRS. Potential reason may be the presence of living cells within the tumor; the possibility of malignant transformation should also be taken into account. Following SRS, patients with VS warrant lifelong radiological and clinical surveillance, even following good response, as there seems to be a small chance of initial regression followed by further growth. Microsurgery for tumor removal and histological diagnosis is indicated in such cases.
First Report: Linear Incision for Placement of a Magnetically Coupled Bone-Anchored Hearing Implant
Authors: Barry Jonnae Y. , Reghunathan Saranya , Jacob Abraham
Published: January 2017

Objectives:

Discuss use of a linear incision for placement of a magnetically coupled bone anchored hearing implant.

Methods:

Case series.

Results:

Two patients underwent placement of magnetically coupled bone-anchored hearing implants (BAHI) through linear incisions. The first, a 40-year-old female with congenital single-sided deafness, previously had successful implantation of a percutaneous bone anchored hearing implant through a linear incision; unfortunately, she developed pain and intermittent drainage at her abutment site with time, resulting in a request for removal of her device. As an alternative to complete removal, we offered to replace the percutaneous implant with a magnetically coupled BAHI, employing the same linear incision previously. The second patient, a 53-year-old obese female with limited neck mobility and mixed hearing loss, underwent primary placement of a magnetically coupled BAHI through a linear incision. Limitations in neck mobility and patient body habitus precluded use of a traditional C-shaped incision. Both patients underwent surgery successfully, healed without incident, had their devices activated 6 weeks after their procedures, and are able to wear their implants more than 8 hours per day without discomfort.

Conclusion:

Surgical techniques for bone-anchored implants continue to evolve. Though manufacturers of magnetically coupled devices recommend using C-shaped incisions with large skin flaps, our first reported cases suggest that a small linear incision immediately overlying the implant magnet may be an acceptable alternative. Potential benefits include a smaller incision, less hair removal, smaller flap, decreased surgical time, and less postoperative pain.
Cochlear Nerve Deficiency and Brain Abnormalities in Pediatric Patients
Authors: Morlet Thierry , Pazuniak Markian , O’Reilly Robert C. , Kandula Vinay , Choudhary Arabinda K.
Published: January 2017

Hypothesis:

To investigate the intracranial abnormalities present in children with cochlear nerve deficiency (CND), including abnormalities of other cranial nerves, and to describe their auditory abilities.

Background:

The prevalence of CND has increased with the development of high resolution magnetic resonance imaging (MRI). There are varying degrees of CND from true aplasia to hypoplasia. The etiology of CND remains unclear and it may be associated with intracranial abnormalities in some instances. CND needs to be identified as early as possible to ensure prompt and adequate management of hearing loss since hearing aids and cochlear implants may not be an option.

Methods:

A retrospective chart review of 56 ears of pediatric patients with CND was conducted between August 2006 and November 2014 at a tertiary care pediatric hospital.

Results:

27.6% of children had cochlear abnormalities and 48.9.8% had concomitant vestibular anomalies. Five patients had absent or abnormal facial nerves and two patients had aplastic bilateral olfactory nerves. In the 27 ears with an absent nerve that were functionally tested, eight (29.6%) had partial hearing which indicates the presence of an extremely small nerve whose size is below the limits of spatial resolution of the MRI.

Conclusion:

MRI is becoming the initial imaging choice for children with sensorineural hearing loss to identify CND and other brain anomalies. Concomitant vestibular and cochlear abnormalities were observed in respectively half and one-third of the pediatric patients with CND. The incidence of vestibular malformation suggests that balance testing should be recommended for most if not all CND patients.