bluuebunny/crossref_metadata_2025 huggingface dataset:
iDINGO—integrative differential network analysis in genomics with Shiny application
Authors: Class Caleb A , Ha Min Jin , Baladandayuthapani Veerabhadran , Do Kim-Anh
Published: November 2017

Motivation

Differential network analysis is an important way to understand network rewiring involved in disease progression and development. Building differential networks from multiple ‘omics data provides insight into the holistic differences of the interactive system under different patient-specific groups. DINGO was developed to infer group-specific dependencies and build differential networks. However, DINGO and other existing tools are limited to analyze data arising from a single platform, and modeling each of the multiple ‘omics data independently does not account for the hierarchical structure of the data.

Results

We developed the iDINGO R package to estimate group-specific dependencies and make inferences on the integrative differential networks, considering the biological hierarchy among the platforms. A Shiny application has also been developed to facilitate easier analysis and visualization of results, including integrative differential networks and hub gene identification across platforms.

Availability and implementation

R package is available on CRAN (https://cran.r-project.org/web/packages/iDINGO) and Shiny application at https://github.com/MinJinHa/iDINGO.

Supplementary information

Supplementary data are available at Bioinformatics online.
bioBakery: a meta’omic analysis environment
Authors: McIver Lauren J , Abu-Ali Galeb , Franzosa Eric A , Schwager Randall , Morgan Xochitl C , Waldron Levi , Segata Nicola , Huttenhower Curtis
Published: November 2017

bioBakery is a meta’omic analysis environment and collection of individual software tools with the capacity to process raw shotgun sequencing data into actionable microbial community feature profiles, summary reports, and publication-ready figures. It includes a collection of pre-configured analysis modules also joined into workflows for reproducibility.

Availability and implementation

bioBakery (http://huttenhower.sph.harvard.edu/biobakery) is publicly available for local installation as individual modules and as a virtual machine image. Each individual module has been developed to perform a particular task (e.g. quantitative taxonomic profiling or statistical analysis), and they are provided with source code, tutorials, demonstration data, and validation results; the bioBakery virtual image includes the entire suite of modules and their dependencies pre-installed. Images are available for both Amazon EC2 and Google Compute Engine. All software is open source under the MIT license. bioBakery is actively maintained with a support group at biobakery-users@googlegroups.com and new tools being added upon their release.

Supplementary information

Supplementary data are available at Bioinformatics online.
Genome Context Viewer: visual exploration of multiple annotated genomes using microsynteny
Authors: Cleary Alan , Farmer Andrew
Published: November 2017

The Genome Context Viewer is a visual data-mining tool that allows users to search across multiple providers of genome data for regions with similarly annotated content that may be aligned and visualized at the level of their shared functional elements. By handling ordered sequences of gene family memberships as a unit of search and comparison, the user interface enables quick and intuitive assessment of the degree of gene content divergence and the presence of various types of structural events within syntenic contexts. Insights into functionally significant differences seen at this level of abstraction can then serve to direct the user to more detailed explorations of the underlying data in other interconnected, provider-specific tools.

Availability and implementation

GCV is provided under the GNU General Public License version 3 (GPL-3.0). Source code is available at https://github.com/legumeinfo/lis_context_viewer.

Supplementary information

Supplementary data are available at Bioinformatics online.
Characterization of a Powdery Mildew Resistance Gene in Wheat Breeding Line 10V-2 and Its Application in Marker-Assisted Selection
Authors: Ma Pengtao , Xu Hongxing , Xu Yunfeng , Song Liping , Liang Shuoshuo , Sheng Yuan , Han Guohao , Zhang Xiaotian , An Diaoguo
Published: November 2017

Powdery mildew, caused by Blumeria graminis f. sp. tritici, is a serious disease of wheat (Triticum aestivum L.) throughout the world. Host resistance is the most effective and preferred means for managing this disease. Line 10V-2, a wheat breeding line with superior agronomic performance, shows broad-spectrum seedling resistance to powdery mildew. Genetic analysis demonstrated that its resistance was controlled by a single dominant gene, tentatively designated Pm10V-2. This gene was localized near the documented Pm2 locus on chromosome 5DS using the simple sequence repeat (SSR) marker Cfd81. To saturate the marker map of Pm10V-2, more markers were developed using bulked segregant RNA-Seq. Two single-nucleotide polymorphism (SNP) markers (Swgi047 and Swgi064), three expressed sequence tag markers (Swgi007, Swgi029, and Swgi038), and one SSR marker (Swgi066) were polymorphic between the resistant and susceptible bulks and showed tightly linked to the Pm10V-2 gene. Pm10V-2 was flanked by the new developed markers Swgi064 and Swgi066 at genetic distances of 0.4 and 1.2 centimorgans (cM), respectively, and cosegregated with Swgi007 and Swgi038. The homologous sequence of Pm2a was cloned from 10V-2 based on a recent study. Although the sequence cloned from 10V-2 was completely identical to that of the reported Pm2a-related gene, they did not cosegregate but were separated at a genetic distance of 1.6 cM, indicating that Pm10V-2 was different from the reported of Pm2a-related gene. When inoculated with multiple B. graminis f. sp. tritici isolates, Pm10V-2 had a significantly different resistance spectrum from Pm2a and other powdery mildew (Pm) resistance genes at or near the Pm2 locus. Therefore, Pm10V-2 may be a new Pm2 allele or Pm2-linked gene. To use Pm10V-2 in marker-assisted selection (MAS) breeding, seven markers applicable for MAS were confirmed, including three newly developed markers (Swgi029, Swgi038, and Swgi064) in the present work. Using these markers, a great number of resistant lines with desirable agronomic performance were selected from crosses involving 10V-2, including the breeding line KM5016, which has been entered in the Regional trials in Hebei Province, China.
Decentralization
Authors: Hamilton D. Kirk , Swoboda Sandra M. , Lee Jin-Ting , Anderson Diana C.
Published: November 2017

There is controversy today about whether decentralized intensive care unit (ICU) designs featuring alcoves and multiple sites for charting are effective. There are issues relating to travel distance, visibility of patients, visibility of staff colleagues, and communications among caregivers, along with concerns about safety risk. When these designs became possible and popular, many ICU designs moved away from the high-visibility circular, semicircular, or box-like shapes and began to feature units with more linear shapes and footprints similar to acute bed units. Critical care nurses on the new, linear units have expressed concerns. This theory and opinion article relies upon field observations in unrelated research studies and consulting engagements, along with material from the relevant literature. It leads to a challenging hypothesis that criticism of decentralized charting alcoves may be misplaced, and that the associated problem may stem from corridor design and unit size in contemporary ICU design. The authors conclude that reliable data from research investigations are needed to confirm the anecdotal reports of nurses. If problems are present in current facilities, organizations may wish to consider video monitoring, expanded responsibilities in the current buddy system, and use of greater information sharing during daily team huddles. New designs need to involve nurses and carefully consider these issues.
Evaluating Nurses' Perception of Patient Safety Design Features in Intensive Care Units
Authors: Islam Faria , Rashid Mahbub
Published: November 2017

A methodological study was conducted to test the validity and reliability of the patient safety (PS) scale developed by Rashid (2007) for evaluating nurses' perception of adult intensive care unit (ICU) design features related to patient safety. Data for the study were collected using a Web-based survey instrument. A link to the survey instrument was posted on the Web site of American Association of Critical-Care Nurses (AACN) for ICU nurses in different US states to participate. A sample of 587 valid responses was divided into 2 halves for cross-validation. The first half of the sample was used for exploratory factor analysis and the second half for confirmatory factor analysis. This method was applied to identify any latent factor structure in the PS scale. Based on the factor analyses, 4 relevant PS subscales—Efficient Work Process, Patient Room, Accessibility and Visibility, and Maintain Sterility—were identified. These PS subscales were used to investigate whether ICU unit characteristics, nurse characteristics, and hospital type affected nurses' perception of ICU design features in relation to patient safety. The study shows that nurses' perception of ICU design features related to patient safety can be influenced by such factors as nurse characteristics and unit characteristics. When using the scales, therefore, the designers can be aware of the influence of these external factors on nurses' perception. It is hoped that the PS subscales evaluating nurses' perception of ICU physical environmental features related to patient safety would help designers and health care personnel make better ICU design choices.
Deriving Information Requirements for a Smart Nursing System for Intensive Care Units
Authors: Khanade Kunal , Sasangohar Farzan , Sutherland Steven C. , Alexander Karen E.
Published: November 2017

The workplace environment for intensive care nursing is highly stressful, with long working hours and a dynamic workload that may induce fatigue. The resulting stress and fatigue may reduce nurses' efficiency and may contribute to medical errors. A smart wearable system is being designed to help nurses who experience high levels of stress and fatigue at work. This article documents the systematic process of deriving information requirements from 2 focus groups conducted separately with nurses and nurse managers working in various Southeastern Texas hospitals. While nurses expected functionality such as memory aid tools, health assessment, and stress-reducing exercises, nurse managers expected information about the overall status of the unit's fatigue/stress levels as well as nurses' communication and movement patterns. The derived information requirements will act as an objective assessment of needs and would set the stage for the design of a stress-monitoring tool.
Safety and Security Concerns of Nurses Working in the Intensive Care Unit
Authors: Keys Yolanda , Stichler Jaynelle F.
Published: November 2017

Intensive care units (ICUs) exist to serve as a safe place for critically ill patients to receive care from skilled practitioners. In this qualitative study, ICU nurses shared their perspectives on elements that promote safety and security on their units. After obtaining institutional review board approval, participants participated in telephone interviews with a nurse researcher who has experience as a bedside ICU nurse. Five categories and 14 themes were identified and then confirmed using member checking. Results indicate that participants prefer to provide care in ICUs with no more than 12 to 14 beds and provide the following: visibility of patients and coworkers; more than 1 way to exit; and can be locked in case of emergency or threat. Nearly all respondents mentioned adequate staffing as the most important attribute of a safe, secure care environment for patients and families. More research is needed to identify design features that make the most impact on providing a safe, secure ICU environment.
Intradermal Proliferative Fasciitis Occurring With Chondrodermatitis Nodularis Helicis
Authors: Elsensohn Ashley , Getty Sasha , Shiu Jessica , de Feraudy Sébastien
Published: November 2017

Nodular fasciitis is a benign myofibroblastic tumor. Its uncommon variant, proliferative fasciitis (PF), can present in an even less common intradermal form. We report a case of intradermal PF of the ear in a 45-year-old man who presented with recurrent episodes of pain and swelling of the lesion. Histologic examination showed a dermal, nodular proliferation of ganglion-like basophilic fibroblasts with prominent nuclei and nucleoli, admixed with foamy histiocytes and areas of spindle cells arranged in intersecting fascicles in a fibromyxoid background. Lesional cells stained positive for smooth muscle actin and were negative for AE1/AE3, p63, and Melan-A. CD68 highlighted intervening histiocytes. We postulate that the underlying chondrodermatitis nodularis helicis was a triggering etiology, consistent with the current speculation that intradermal PF results from trauma.
Fractional Carbon Dioxide Laser Resurfacing in Combination With Potent Topical Corticosteroids for Hypertrophic Burn Scars in the Pediatric Age Group: An Open Label Study
Authors: Majid Imran , Imran Saher
Published: November 2017

BACKGROUND

Lasers and potent topical corticosteroids are used as therapeutic options in hypertrophic burn scars.

OBJECTIVE

To assess the therapeutic effect of fractional CO2 laser resurfacing in combination with potent topical corticosteroids on hypertrophic burn scars in pediatric age group.

METHODS

Ten children (5–12 years) with postburn hypertrophic scars were treated with 3 to 5 sessions of fractional CO2 laser resurfacing at 1-month intervals, and triamcinolone suspension was applied immediately after each laser session. Patients were also instructed to apply clobetasol propionate gel for 1 week after each laser session. Response to treatment was assessed using Vancouver Scar Scale (VSS) and Physician Global Assessment (PGA). Tolerability for the procedure and adverse effects were also assessed.

RESULTS

Laser sessions were well tolerated under the effect of topical or local anesthesia. At the time of final assessment, there was mean reduction of 4.2 (range: 2.8–7) in VSS. Reduction of VSS by ≥4 points was observed in 8 of 10 cases, whereas PGA revealed excellent response in 6 of 10 cases. No significant adverse effects were reported by any patient.

CONCLUSION

Fractional CO2 laser resurfacing in combination with potent topical steroids leads to significant therapeutic benefits in children with postburn hypertrophic scars.
Dynamic Model of Applied Facial Anatomy with Emphasis on Teaching of Botulinum Toxin A
Authors: Boggio Ricardo Frota
Published: November 2017

Background:

The use of botulinum toxin type A is considered one of the most revolutionary and promising face rejuvenation methods. Although rare, most of the complications secondary to the use of botulinum toxin A are technician dependent. Among the major shortcomings identified in the toxin administration education is unfamiliarity with applied anatomy. This article proposes the use of body painting as an innovative method of teaching the application of botulinum toxin A.

Methods:

Using the body painting technique, facial anatomy was represented on the face of a model showing the major muscle groups of botulinum toxin A targets. Photographic records and films were made for documentation of represented muscles at rest and contraction.

Results:

Using the body painting technique, each of the muscles involved in facial expression and generation of hyperkinetic wrinkles can be faithfully reproduced on the model’s face. The documentation of the exact position of the points of application, the distribution of the feature points in the muscular area, the proper angulation and syringe grip, as well as the correlation of the points of application with the presence of hyperkinetic wrinkles, could be properly registered, providing professional training with information of great practical importance, development of highly effective treatments, and low complication rates.

Conclusion:

By making it possible to interrelate anatomy of a function, body painting is proposed in the present study as an innovative method, which in a demonstrative and highly didactic manner presents great potential as a teaching tool in the application of botulinum toxin A.
Ischemic Stroke Patients' Decision-Making Process in Their Use of Western Medicine and Alternative and Complementary Medicine
Authors: Hsieh Chen-Ying , Wang Shou-Yu , Chuang Yeu-Hui , Chen Ho-Hsiang
Published: November 2017

Stroke is ranked third among the top 10 causes of death in Taiwan. Besides a high mortality rate, stroke survivors are often left with physical or functional sequela. This study aimed to explore ischemic stroke patients' decision-making process using Western medicine (WM) and complementary and alternative medicine (CAM). This study is a qualitative study based on grounded theory. A total of 12 participants were recruited. Findings revealed that the participants accepted WM and CAM treatments following the onset of ischemic stroke. Three categories and several subcategories emerged from stroke patients' decision-making process. These are “uncertainty of stroke,” “delicate balance between WM and CAM,” and “reestablishing confidence and faith.” Eventually, they exhibited the core category of “breakthrough and the pursuit of a sense of rebirth.” This study also found that the participants were unwilling to inform their health care professionals on their use of CAM. Therefore, health care professionals should empathize with the views and needs of their patients and respect their decision to combine WM with CAM. The views of other medical teams concerning CAM into their analysis of patients' decision-making process are recommended. Therefore, comprehensive insight into ischemic stroke patients' decision-making process for using CAM can be further explored.
AFLIBERCEPT AFTER RANIBIZUMAB INTRAVITREAL INJECTIONS IN EXUDATIVE AGE–RELATED MACULAR DEGENERATION
Authors: Blanco-Garavito Rocio , Jung Camille , Uzzan Joel , Quaranta-ElMaftouhi Maddalena , Coscas Florence , Sahel Jose , Korobelnik Jean-Francois , Béchet Stéphane , Querques Giuseppe , Souied Eric H.
Published: November 2017

Purpose:

To analyze the efficacy of aflibercept switch treatment for regression of pigment epithelial detachment (PED) in patients previously treated with ranibizumab.

Methods:

Multicenter, prospective, nonrandomized clinical trial. One eye of patients presenting neovascular age–related macular degeneration with PED of more than 250 μm in height, with persistent fluid, was included. Patients had to have received at least six ranibizumab intravitreal injections during the 12 months before enrollment. Patients were switched from ranibizumab pro re nata to aflibercept (fixed regimen, 3 monthly intravitreal injections, and then Q6). Main outcome measure was change in PED height from baseline to Week 12 after switch. Secondary outcomes were best-corrected visual acuity and PED volume changes.

Results:

Eighty four patients were included. Mean delay between last ranibizumab intravitreal injection and switch was 44.7 days. Mean maximal PED height at baseline visit was 347 μm (±109) and reduced to a mean of 266 μm (±114) at Week 12 (P < 0.001) and 288.2 μm at Week 32 (P < 0.001). Mean PED volume was reduced from 1.3 mm3 to 0.98 mm3 at Week 12 (P < 0.001). Best-corrected visual acuity improved by 3.3 Early Treatment Diabetic Retinopathy Study letters at Week 32 (P = 0.003).

Conclusion:

Aflibercept switch therapy seems to be effective on large PED in patients previously treated with pro re nata ranibizumab.
EVALUATION OF OBSTRUCTIVE SLEEP APNEA SYNDROME AS A RISK FACTOR FOR DIABETIC MACULAR EDEMA IN PATIENTS WITH TYPE II DIABETES
Authors: Vié Anne-Laure , Kodjikian Laurent , Agard Emilie , Voirin Nicolas , El Chehab Hussam , Denis Philippe , Coste Olivier , Dot Corinne
Published: November 2017

Purpose:

To evaluate the association between obstructive sleep apnea and diabetic macular edema (DME) in patients with Type II diabetes, using the apnea–hypopnea index and other nocturnal hypoxemia parameters.

Methods:

This cross-sectional, case–control study included 99 patients with Type II diabetes: the first group included patients with DME (DME+ group) and the second patients without DME (DME− group). Polysomnography was performed in all patients. The two groups were compared, and the risk factors were studied using logistic regression.

Results:

The DME+ group comprised 38 patients, and the DME− group comprised 61 patients, aged a mean 68.8 years and 66.3 years (P = 0.27), respectively; mean body mass index was 29.7 and 30.9 (P = 0.16), respectively. The mean apnea–hypopnea index was significantly higher in the DME+ group (43.95 [13.5–87.3]) than in the DME− group (35.18 [3.55–90.7]) (P = 0.034). Patients with DME had more severe obstructive sleep apnea (apnea–hypopnea index >30) than the others: 71% versus 50.8% (P = 0.049). Cumulative time of SPO2 below 90% (CT90%) was independently associated with DME after adjusting for confounding factors, whereas there was no difference between the oxygen desaturation index and minimum O2 saturation.

Conclusion:

Severe obstructive sleep apnea (apnea–hypopnea index >30) and parameters of nocturnal hypoxemia (cumulative time of SPO2 below 90%) are associated with DME.
COMPARING MICROPERIMETRIC AND STRUCTURAL FINDINGS IN PATIENTS WITH BRANCH RETINAL VEIN OCCLUSION AND DIABETIC MACULAR EDEMA
Authors: Sachdev Amun , Edington Magdalena , Morjaria Rupal , Chong Victor
Published: November 2017

Purpose:

To compare retinal sensitivity and central retinal thickness in patients with focal diabetic macular edema (DME) and edema secondary to branch retinal vein occlusion (BRVO).

Methods:

In this consecutive, cross-sectional, observational study, patients with either DME or BRVO underwent measurements for best-corrected visual acuity, microperimetry, and spectral domain optical coherence tomography. Retinal thickness and sensitivity were measured using Optos Spectral optical coherence tomography/scanning laser ophthalmoscopy (Optos plc, Dunfermline, Scotland, United Kingdom). Areas defined as abnormal demonstrated edema with clearly defined cystic spaces. Abnormal and control areas were compared in mean retinal sensitivity and mean retinal thickness for both conditions.

Results:

Twenty eyes with focal DME and nine eyes with BRVO were included. In DME, mean retinal thickness was 413.6 ± 84.5 μm and 291.7 ± 36.7 μm in abnormal and control areas, respectively. Mean retinal sensitivity was 10.22 ± 4.23 dB and 12.25 ± 3.57 dB, respectively. In BRVO, mean retinal thickness was 491.4 ± 102.9 μm and 315.9 ± 29.9 μm in abnormal and control areas, respectively. Mean retinal sensitivity was 6.36 ± 5.47 dB and 13.05 ± 2.28 dB. In DME, a decrease in retinal thickness of 0.341 μm correlated with 1 dB reduction of retinal sensitivity, although this was not statistically significant (P = 0.717). In BRVO, however, an increase in retinal thickness of 9.702 μm correlated with 1 dB reduction of retinal sensitivity (P = 0.001).

Conclusion:

In BRVO, an increase in retinal thickness corresponded with a significant reduction in retinal sensitivity; in DME, however, there was no significant correlation between retinal thickness and retinal sensitivity. Further study is required to assess why this is the case. The Optos Spectral optical coherence tomography/scanning laser ophthalmoscopy allows for a reliable point-to-point correlation, as microperimetry and spectral domain optical coherence tomography can be performed in the same device.
EFFICACY OF DOUBLE DOSE PHOTODYNAMIC THERAPY FOR CIRCUMSCRIBED CHOROIDAL HEMANGIOMA
Authors: Lee Ji Hwan , Lee Christopher Seungkyu , Lee Sung Chul
Published: November 2017

Purpose:

To evaluate the efficacy of photodynamic therapy using a double dose of verteporfin for patients with circumscribed choroidal hemangioma.

Methods:

This retrospective comparative case series evaluated data from 10 patients who were treated using double dose photodynamic therapy (12 mg/m2) and seven patients who were treated using the standard dose (6 mg/m2). A laser was applied with a radiant exposure of 50 J/cm2. The ophthalmologic examinations were performed at baseline and 1 year after the treatment and included best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, spectral domain optical coherence tomography, and B-scan ultrasonography.

Results:

The mean age in the double dose group was 51.60 years, compared with 50.57 years in the standard-dose group. The only significant difference between the two groups' baseline characteristics was observed in their initial tumor heights. Foveal center thickness, subretinal fluid, and subfoveal choroidal thickness decreased significantly at 1 year after treatment in both groups. Tumor height and the greatest linear dimension of the tumor's base only decreased significantly in the double dose group (P = 0.031). Both groups did not experience significant visual improvements.

Conclusion:

Double dose photodynamic therapy was effective and safe for treating circumscribed choroidal hemangioma and provided better tumor regression with similar resorption of subretinal fluid, compared with standard-dose photodynamic therapy.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS OF DEEP CAPILLARY PLEXUS MICROISCHEMIA AFTER INTRAVENOUS CHEMOTHERAPY FOR RETINOBLASTOMA
Authors: Sioufi Kareem , Say Emil A. T. , Ferenczy Sandor C. , Leahey Ann M. , Shields Carol L.
Published: November 2017

Purpose:

To study changes in the foveal microvascular anatomy using optical coherence tomography angiography (OCTA) after intravenous chemotherapy (IVC) for retinoblastoma (RB).

Methods:

A retrospective comparative case–control series included 10 age-matched normal eyes with no documented ocular pathology (control), 10 fellow eyes of patients with unilateral RB treated with IVC (RB fellow), and 10 eyes with extramacular RB in patients with bilateral RB treated with IVC (RB tumor). All eyes were scanned using enhanced depth imaging optical coherence tomography and OCTA. Enhanced depth imaging optical coherence tomography measurements of central macular thickness and subfoveolar choroidal thickness as well as OCTA measurements of foveal avascular zone (FAZ) area in superficial (sFAZ) and deep (dFAZ) plexus and capillary density (CD) in the superficial (sCD) and deep (dCD) plexus were performed. Comparison among the three groups was conducted.

Results:

Among the three cohorts (control, RB fellow, and RB tumor), there was no difference in mean age at measurement (12, 10, and 12 years) and mean interval between last IVC and OCTA (RB fellow and RB tumor) (9, 10 years). Optical coherence tomography and OCTA revealed no significant difference in central macular thickness (all P ≥ 0.161), choroidal thickness (all P ≥ 0.066), sFAZ (all P ≥ 0.618), dFAZ (all P ≥ 0.610), and sCD (all P ≥ 0.638) comparing controls versus RB fellow, controls versus RB tumor, and RB fellow versus RB tumor. By contrast, mean dCD was significantly greater in controls (52%), compared with both RB fellow (49%, P = 0.026) and RB tumor (48%, P = 0.028) groups, but no difference was found between RB fellow and RB tumor (49% vs. 48%, P = 0.515). LogMAR visual acuity showed no difference among the three groups (all P ≥ 0.150).

Conclusion:

At mean 10-year follow-up, slight reduction in dCD seems to occur after IVC for RB without alterations in central macular thickness, choroidal thickness, FAZ, or sCD and without visual compromise.
Stapes Release in Tympanosclerosis
Authors: Bedri Es-Hak , Teferi Nebiat , Redleaf Miriam
Published: November 2017

Tympanosclerosis in the middle ear space is common in Ethiopia and often involves the ossicles and particularly the stapes. Ear operations in Ethiopia are relatively expensive in this country of limited medical resources and a low average living wage. In this setting, 2-stage operations using prostheses become prohibitively expensive. Therefore, the recommended 2-stage approach for tympanic membrane perforation with tympanosclerosis and stapes fixation is impractical for Ethiopia.

We present a series of 67 patients who had a single stage tympanoplasty, removal of tympanosclerosis from the stapes suprastructure, and ossicular chain reconstruction using ossicular interposition. Crucial is the surgical technique employed for peeling the mound of tympanosclerotic plaque off of the stapes, which we term the stapes release. Controls were 67 patients with similar perforations and air-bone gap, but no tympanosclerosis. Most controls had ossciular discontinuity and were reconstructed with type III tympanoplasty.

Air-bone gap improved in both groups: 18 dB (11 dB standard deviation) in the stapes release group, and 23 dB (11 dB standard deviation) in the control group. Paired t test found these improvements in each group significant at p < 0.001. Among the preoperative subjects there were 40 with air-bone gap greater than 45 dB, and none less than 20 dB. Among the postoperative subjects, none had air-bone gap worse than 45 dB, while 25/67 (37%) stapes release and 44/67 (66%) controls had air-bone gap better than 20 dB. Three patients in each group failed to close their perforations completely (96% closure rate).

The only complications were two early cases of transient facial nerve weakness, which was avoided in subsequent cases by an alteration in technique. There was no deterioration of sensorineural hearing levels in either group's subjects postoperatively.

In conclusion, stapes release with ossicular interposition can be performed at the same time as tympanoplasty without exacerbation of sensorineural hearing loss. Tympanic membrane closure and hearing levels were similar between patients with and without stapes fixation from tympanosclerosis.
Toward Optimizing Cervical Vestibular Evoked Myogenic Potentials (cVEMP): Combining Air-Bone Gap and cVEMP Thresholds to Improve Diagnosis of Superior Canal Dehiscence
Authors: Noij Kimberley S. , Duarte Maria J. , Wong Kevin , Cheng Y. Song , Masud Salwa , Herrmann Barbara S. , Curtin Hugh D. , Kanumuri Vivek V. , Guinan John J. , Kozin Elliott D. , Tarabichi Osama , Jung David H. , Lee Daniel J. , Rauch Steven D.
Published: November 2017

Objective:

To develop a novel approach combining low-frequency air-bone gap (ABG) and cervical vestibular evoked myogenic potential (cVEMP) thresholds to improve screening for superior canal dehiscence (SCD) syndrome.

Study Design:

Retrospective study.

Setting:

Tertiary care center.

Patients:

One hundred forty patients with SCD and 21 healthy age-matched controls were included. Ears for each patient were divided into three groups based on computed tomography (CT) findings: 1) dehiscent, 2) thin, or 3) unaffected.

Main Outcome Measures:

cVEMP and audiometric thresholds were analyzed and differences among groups were evaluated.

Results:

We define the third window indicator (TWI) as the cVEMP thresholds at 500, 750, and 1000 Hz adjusted for the ABG at 250 Hz (i.e., subtracting ABG from cVEMP threshold). The TWI differentiates between dehiscent and nondehiscent control ears with a sensitivity of 82% and specificity of 100%, corresponding to a positive predictive value of 100%. ABGs and cVEMP thresholds were similar for healthy controls and patients with thin bone over the superior canal.

Conclusion:

This is the largest study to date examining the usefulness of cVEMPs in the diagnosis of SCD. Our “third window indicator” (TWI) combines cVEMP thresholds with the ABG at 250 Hz to improve the ability to screen patients with SCD symptoms
Bleeding Complication Rates Are Higher in Females after Continuous-Flow Left Ventricular Assist Device Implantation
Authors: Yavar Zubin , Cowger Jennifer A. , Moainie Sina L. , Salerno Christopher T. , Ravichandran Ashwin K.
Published: November 2017

The aims of this analysis were to characterize the burden and timing of bleeding events in females versus males on left ventricular assist device (LVAD) support. A single-center retrospective review of 375 patients receiving continuous-flow LVADs was performed. Bleeding events included gastrointestinal, naso-oropharyngeal, gynecologic (GYN), intracranial hemorrhage (ICH), and mediastinal bleeding. Cox hazard ratios (HRs) [95% CI] and incident event rates for females versus males were calculated. Eighty-four females (22%) and 291 males (78%) received an LVAD. There were 189 patients with 406 bleeding events over a median 399 days of support. Two-year freedom from bleeding was 33 ± 6.2% in females and 46 ± 3.7% in males (p = 0.027). Correlates of bleeding included female sex (adjusted HR = 1.6 [1.1–2.2]) and older age (adjusted HR = 1.2 [1.1–1.3] per 10 years). There was no sex-associated difference in 30 day mediastinal bleeding (males 12%; females 16% at 30 days; overall p = 0.35), but incident event rates for overall bleeding and naso-oropharyngeal bleeding were higher in females (p < 0.05) and trends were noted in ICH (eppy: 0.06 male vs. 0.10 female, p = 0.14). Eight females (10%) experienced 12 GYN bleeding events; five required surgical intervention. In summary, females had a 60% higher hazard of bleeding than males with significant morbidity encountered from mucosa (including vaginal) bleeding. Future large device studies should be inclusive of sex-specific outcomes.
Insufflation With Carbon Dioxide During Pediatric Colonoscopy for Control of Postprocedure Pain
Authors: Thornhill Chad , Navarro Fernando , Alabd Alrazzak Baraa , Hashmi S. Shahrukh , DebRoy Ashish N. , Rhoads Jon M. , Imseis Essam
Published: November 2017

Goals:

To determine if carbon dioxide (CO2) insufflation in children would improve postprocedure pain following colonoscopy in children.

Background:

CO2 insufflation during colonoscopy has been found to reduce postcolonoscopy pain in the adult population, but limited data exist in pediatrics.

Materials and Methods:

We conducted a prospective study with 40 pediatric patients scheduled for outpatient colonoscopy. Patients were enrolled continuously and were randomized to receive CO2 or air insufflation. Patients and colonoscopists were blinded to insufflation method. End tidal CO2 (EtCO2) was documented throughout the procedure. Abdominal pain was established preprocedure then at 1-, 6-, and 24-hour postprocedure. Subject demographics, indications, colonoscopists’ year of training, time to cecum, adverse events, and final diagnoses were recorded.

Results:

Twenty patients were randomized to each group. Patients receiving air had a statistically significant increase in pain from baseline at 1- and 6-hours after colonoscopy (P=0.007 and 0.008). This was not seen in the CO2 group (P=0.740 and 0.289). There was an increase in postprocedure pain in the air group compared with CO2 group at the 1-hour mark (P=0.032). EtCO2 increased during the procedure, regardless of insufflation method, but no difference was seen between groups (P=0.822).

Conclusions:

Our results demonstrate that higher levels of pain were reported by patients following air compared with those receiving CO2 insufflation. This is the first study to show CO2 is as safe as air, with no increase in EtCO2 between groups in the pediatric population. CO2 is an effective and safe modality and should be considered for pediatric colonoscopies.
Distinct Microbial Populations Exist in the Mucosa-associated Microbiota of Diarrhea Predominant Irritable Bowel Syndrome and Ulcerative Colitis
Authors: Zhong Wenting , Lu Xiaolan , Shi Haitao , Zhao Gang , Song Yahua , Wang Yonghua , Zhang Jing , Jin Yaofeng , Wang Shenhao
Published: November 2017

Goals:

The goal of this study was to observe the bacterial colonization in the intestinal mucosa in the patients with diarrhea predominant irritable bowel syndrome (IBS-D) and ulcerative colitis (UC), and compare the mucosa-associated microbiota among the IBS-D patients, UC patients and the healthy control, and explore the correlation of the mucosa-associated microbiota with clinical manifestations.

Study:

A total of 20 IBS-D patients, 28 patients with UC (16 active, 12 inactive) and 16 healthy subjects were enrolled in the study. They all underwent colonoscopies in the Gastrointestinal Endoscopy Center in the Second Affiliated Hospital of Xi’an Jiaotong University from June 2016 to October 2016. The mucosa specimens were taken at the junction of rectum and sigmoid colon for fluorescent in situ hybridization (FISH). Then the observed mucosa-associated microbiota was counted and compared.

Results:

(1) In the IBS-D patients, the mucosa-associated bacteria were found to colonize in the surface of mucosa and the adjacent mucin layer. And in active UC, Escherichia coli, and Bacteroides were found in the lamina propria, in addition to bacterial colonization in the above-mentioned areas. (2) The total count of mucosa-associated bacteria and the individual counts of E. coli, Clostridium, and Bacteroides were significantly increased, and Bifidobacteria significantly decreased (P<0.05) in the IBS-D patients and UC patients. Counts of Lactobacillus were decreased only in UC patients compared with the healthy control. And a significantly larger variation of the above-mentioned bacterial counts was found in the patients with UC, particularly in those with active UC, compared with those with IBS-D (P<0.05); the counts in the UC group were 1.3 to 5.3 times more or less than those in the IBS-D group. (3) Compared with healthy controls and IBS-D, the total count of bacteria and the individual counts of E. coli and Bacteroides in the lamina propria in active UC were significantly increased (P<0.05). (4) A significant negative correlation of the counts of Lactobacillus and Bifidobacteria with the defecation frequency and fecal characteristics (P<0.05) was found in the IBS-D patients; in those with UC, both the total count of bacteria and the individual counts of E. coli, Clostridium, Bacteroides, Lactobacillus, and Bifidobacteria were significantly correlated, positively or negatively, with the related clinical manifestations and the activity of the disease (P<0.05).

Conclusions:

Compared with the healthy control, intestinal microecology was changed most obviously in UC with much smaller differences though in the same direction in IBS-D. The translocation of some bacteria into the lamina propria was found in UC, particularly in active UC. The changes of mucosa-associated microbiota were related more or less to some clinical manifestations in IBS-D and UC.
Are rehabilitation outcomes after severe anoxic brain injury different from severe traumatic brain injury? A matched case–control study
Authors: Adigüzel Emre , Yaşar Evren , Kesikburun Serdar , Demir Yasin , Aras Berke , Safaz Ismail , Alaca Ridvan , Tan Arif K.
Published: November 2017

Many reports have investigated rehabilitation outcomes after a traumatic brain injury (TBI); however, comparably less is known about whether they differ from outcomes of an anoxic brain injury (ABI). Thus, we aimed to compare the rehabilitation outcomes of patients with ABI with control patients who have TBI. Forty participants with ABI and 40 participants with TBI were included in this retrospective study. Participants with ABI were matched with participants with TBI who had similar clinical characteristics such as age, initial Functional Independence Measurement (FIM) score, and duration of coma. FIM and Functional Ambulation Classification (FAC) scores on rehabilitation admission and on rehabilitation discharge were recorded. The FIM score in the ABI group was 41.7±28.5 on rehabilitation admission and increased to 57.1±31.4 on rehabilitation discharge. The FIM score in the TBI group was 40.8±24.0 on rehabilitation admission and increased to 65.9±35.3 on rehabilitation discharge. There was no statistically significant difference in the FIM scores on rehabilitation discharge between groups. Initial FAC was similar in both groups and there was no statistically significant difference in the FAC scores on rehabilitation discharge. The multiple linear regression analysis showed that intensive care unit length of stay had an inverse relationship with the FAC change. We did not find significant differences in the rehabilitation outcomes of participants with ABI compared with participants with TBI. Considering the lack of information in the literature on ABI rehabilitation, this study may be important to guide rehabilitation teams.
Intraventricular Hemorrhage in Moderate to Severe Congenital Heart Disease
Authors: Ortinau Cynthia M. , Anadkat Jagruti S. , Smyser Christopher D. , Eghtesady Pirooz
Published: November 2017

Objectives:

Determine the prevalence of intraventricular hemorrhage in infants with moderate to severe congenital heart disease, investigate the impact of gestational age, cardiac diagnosis, and cardiac intervention on intraventricular hemorrhage, and compare intraventricular hemorrhage rates in preterm infants with and without congenital heart disease.

Design:

A single-center retrospective review.

Setting:

A tertiary care children's hospital.

Patients:

All infants admitted to St. Louis Children's Hospital from 2007 to 2012 with moderate to severe congenital heart disease requiring cardiac intervention in the first 90 days of life and all preterm infants without congenital heart disease or congenital anomalies/known genetic diagnoses admitted during the same time period.

Interventions:

None.

Measurements and Main Results:

Cranial ultrasound data were reviewed for presence/severity of intraventricular hemorrhage. Head CT and brain MRI data were also reviewed in the congenital heart disease infants. Univariate analyses were undertaken to determine associations with intraventricular hemorrhage, and a final multivariate logistic regression model was performed. There were 339 infants with congenital heart disease who met inclusion criteria and 25.4% were born preterm. Intraventricular hemorrhage was identified on cranial ultrasound in 13.3% of infants, with the majority of intraventricular hemorrhage being low-grade (grade I/II). The incidence increased as gestational age decreased such that intraventricular hemorrhage was present in 8.7% of term infants, 19.2% of late preterm infants, 26.3% of moderately preterm infants, and 53.3% of very preterm infants. There was no difference in intraventricular hemorrhage rates between cardiac diagnoses. Additionally, the rate of intraventricular hemorrhage did not increase after cardiac intervention, with only three infants demonstrating new/worsening high-grade (grade III/IV) intraventricular hemorrhage after surgery. In a multivariate model, only gestational age at birth and African-American race were predictors of intraventricular hemorrhage. In the subset of infants with CT/MRI data, there was good sensitivity and specificity of cranial ultrasound for presence of intraventricular hemorrhage.

Conclusions:

Infants with congenital heart disease commonly develop intraventricular hemorrhage, particularly when born preterm. However, the vast majority of intraventricular hemorrhage is low-grade and is associated with gestational age and African-American race
Pediatric Critical Care Medicine Training: 2004–2016*
Authors: van der Velden Meredith G. , Barrett Megan K. , Sampadian Gretchen A. , Brilli Richard J. , Burns Jeffrey P.
Published: November 2017

Objectives:

To describe growth trends in the number of programs, positions, and applicants in pediatric critical care medicine fellowship training as part of the Pediatric Critical Care Medicine Training Study.

Design:

Descriptive study.

Settings:

Available archived Match data through the National Resident Matching Program and training data from the Accreditation Council for Graduate Medical Education.

Patients:

None.

Interventions:

None.

Measurements and Main Results:

We analyzed all data on programs, positions, and applicants through the National Resident Matching Program Specialties Matching Service during the study period of 2004 to 2016. We also analyzed available training data available through the Accreditation Council for Graduate Medical Education for the corresponding study period. During the 12-year study period, there was a statistically significant expansion in programs (38%), positions (82%), and applicants (151%). Correspondingly, the percentage of pediatric critical care medicine programs participating in the Match as a percentage of all Accreditation Council for Graduate Medical Education–accredited programs for that academic year increased 24%. As of 2015, 94% of total first year positions offered for pediatric critical care medicine were through the Match.

Conclusions:

For the period 2004 to 2016, there was a substantial increase in positions and applicants applying for training in pediatric critical care medicine. We document an increase in demand (i.e., applicants) that has been matched by an increase in supply (i.e., positions) for pediatric critical care medicine fellowship training. The nearly complete use of the National Resident Matching Program for placing applicants in training positions in pediatric critical care medicine suggests that these data can be used to inform workforce analysis in pediatric critical care medicine.
Pneumonia in a Teenager Hiding a Fire-Eating Stunt
Authors: Ghezzi Michele , Odoni Marta , Testagrossa Oriana , Messina Daniela , Ruocco Jorge Daniel , Lovati Camillo , Kantar Ahmad
Published: November 2017

Pneumonia in children due to hydrocarbon aspiration is usually the result of an uncommon accidental event. However, an acute and severe type of pneumonia induced by hydrocarbon aspiration is occasionally experienced by entertainers known as fire-eaters. Different approaches to treat fire-eater's pneumonia appear in the literature. Although there is no consensus regarding the management of this condition, the use of antibiotic therapy is well recognized and recommended by some, whereas others recommend only supportive treatment. Steroids are indicated in severe cases.

Here, we report the case of a boy who developed severe pneumonia after inhaling hydrocarbons during an attempt to mimic a fire-eater show. Slow resolution was achieved after broad-spectrum antibiotic therapy in addition to systemic and inhaled steroids and physiotherapy.