bluuebunny/crossref_metadata_2025 huggingface dataset:
The mitogen-activated protein kinase 4-phosphorylated heat shock factor A4A regulates responses to combined salt and heat stresses
Authors: Andrási Norbert , Rigó Gábor , Zsigmond Laura , Pérez-Salamó Imma , Papdi Csaba , Klement Eva , Pettkó-Szandtner Aladár , Baba Abu Imran , Ayaydin Ferhan , Dasari Ramakrishna , Cséplő Ágnes , Szabados László
Published: May 2019

Heat shock factors regulate responses to high temperature, salinity, water deprivation, or heavy metals. Their function in combinations of stresses is, however, not known. Arabidopsis HEAT SHOCK FACTOR A4A (HSFA4A) was previously reported to regulate responses to salt and oxidative stresses. Here we show, that the HSFA4A gene is induced by salt, elevated temperature, and a combination of these conditions. Fast translocation of HSFA4A tagged with yellow fluorescent protein from cytosol to nuclei takes place in salt-treated cells. HSFA4A can be phosphorylated not only by mitogen-activated protein (MAP) kinases MPK3 and MPK6 but also by MPK4, and Ser309 is the dominant MAP kinase phosphorylation site. In vivo data suggest that HSFA4A can be the substrate of other kinases as well. Changing Ser309 to Asp or Ala alters intramolecular multimerization. Chromatin immunoprecipitation assays confirmed binding of HSFA4A to promoters of target genes encoding the small heat shock protein HSP17.6A and transcription factors WRKY30 and ZAT12. HSFA4A overexpression enhanced tolerance to individually and simultaneously applied heat and salt stresses through reduction of oxidative damage. Our results suggest that this heat shock factor is a component of a complex stress regulatory pathway, connecting upstream signals mediated by MAP kinases MPK3/6 and MPK4 with transcription regulation of a set of stress-induced target genes.
Epigenetic regulation of sulfur homeostasis in plants
Authors: Huang Xin-Yuan , Li Mengzhen , Luo Rongjian , Zhao Fang-Jie , Salt David E
Published: May 2019

Plants have evolved sophisticated mechanisms for adaptation to fluctuating availability of nutrients in soil. Such mechanisms are of importance for plants to maintain homeostasis of nutrient elements for their development and growth. The molecular mechanisms controlling the homeostasis of nutrient elements at the genetic level have been gradually revealed, including the identification of regulatory factors and transporters responding to nutrient stresses. Recent studies have suggested that such responses are controlled not only by genetic regulation but also by epigenetic regulation. In this review, we present recent studies on the involvement of DNA methylation, histone modifications, and non-coding RNA-mediated gene silencing in the regulation of sulfur homeostasis and the response to sulfur deficiency. We also discuss the potential effect of sulfur-containing metabolites such as S-adenosylmethionine on the maintenance of DNA and histone methylation.
Biomarkers for grain yield stability in rice under drought stress
Authors: Melandri Giovanni , AbdElgawad Hamada , Riewe David , Hageman Jos A , Asard Han , Beemster Gerrit T S , Kadam Niteen , Jagadish Krishna , Altmann Thomas , Ruyter-Spira Carolien , Bouwmeester Harro
Published: May 2019

The metabolic-oxidative stress profile of the rice flag leaf during drought stress in the reproductive stage is highly predictive for grain yield loss sensitivity of 292 accessions at harvest time.
Additive and epistatic interactions between AKR and AIN loci conferring bluegreen aphid resistance and hypersensitivity in Medicago truncatula
Authors: Kamphuis Lars G , Klingler John P , Jacques Silke , Gao Ling-Ling , Edwards Owain R , Singh Karam B
Published: May 2019

We provide the first example of epistasis between resistance genes (AKR and AIN) against a phloem-feeding insect (bluegreen aphid).
Signaling by hydrogen sulfide and cyanide through post-translational modification
Authors: Gotor Cecilia , García Irene , Aroca Ángeles , Laureano-Marín Ana M , Arenas-Alfonseca Lucía , Jurado-Flores Ana , Moreno Inmaculada , Romero Luis C
Published: May 2019

Two cysteine metabolism-related molecules, hydrogen sulfide and hydrogen cyanide, which are considered toxic, have now been considered as signaling molecules. Hydrogen sulfide is produced in chloroplasts through the activity of sulfite reductase and in the cytosol and mitochondria by the action of sulfide-generating enzymes, and regulates/affects essential plant processes such as plant adaptation, development, photosynthesis, autophagy, and stomatal movement, where interplay with other signaling molecules occurs. The mechanism of action of sulfide, which modifies protein cysteine thiols to form persulfides, is related to its chemical features. This post-translational modification, called persulfidation, could play a protective role for thiols against oxidative damage. Hydrogen cyanide is produced during the biosynthesis of ethylene and camalexin in non-cyanogenic plants, and is detoxified by the action of sulfur-related enzymes. Cyanide functions include the breaking of seed dormancy, modifying the plant responses to biotic stress, and inhibition of root hair elongation. The mode of action of cyanide is under investigation, although it has recently been demonstrated to perform post-translational modification of protein cysteine thiols to form thiocyanate, a process called S-cyanylation. Therefore, the signaling roles of sulfide and most probably of cyanide are performed through the modification of specific cysteine residues, altering protein functions.
Livebirth After Uterus Transplantation From a Deceased Donor in a Recipient With Uterine Infertility
Authors: Ejzenberg Dani , Andraus Wellington , Mendes Luana Regina Baratelli Carelli , Ducatti Liliana , Song Alice , Tanigawa Ryan , Rocha-Santos Vinicius , Arantes Rubens Macedo , Soares José Maria , Serafini Paulo Cesar , de Paiva Haddad Luciana Bertocco , Francisco Rossana Pulcinelli , D'Albuquerque Luiz Augusto Carneiro , Baracat Edmund Chada
Published: May 2019

(Abstracted from Lancet 2018;392:2697–2704)

Infertility is common and affects about 10% to 15% of couples. In such couples, 1 in 500 women has infertility due to uterine causes, with uterine agenesis (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome), or due to hysterectomy, malformation, or the sequelae of infection or surgery.
Association Between Fetal Fraction on Cell-Free DNA Testing and First-Trimester Markers for Pre-eclampsia
Authors: Rolnik D. L. , Costa F. Da Silva , Lee T. J. , Schmid M. , McLennan A. C.
Published: May 2019

(Abstracted from Ultrasound Obstet Gynecol 2018;52:722–727)

Screening for chromosomal abnormalities based on cell-free fetal DNA (cfDNA) has been clinically available since 2011. While highly accurate for detection of trisomy 21, the accuracy of the test depends on the proportion of the total cfDNA that contains fetal genetic material (ie, the fetal fraction [FF]), with accuracy being higher when the FF is high and lower when the FF is low.
Chronic Kidney Disease and Pregnancy
Authors: Hui Dini , Hladunewich Michelle A.
Published: May 2019

Chronic kidney disease represents a heterogeneous group of disorders characterized by alterations in the structure and function of the kidney. Chronic kidney disease significantly increases the risk of adverse maternal and perinatal outcomes, and these risks increase with the severity of the underlying renal dysfunction, degree of proteinuria, as well as the frequent coexistence of hypertension. Further, renal anatomic changes result in dilatation of the collecting system, and physiologic adaptations include alterations in the balance of vasodilatory and vasoconstrictive hormones, resulting in decreased systemic and renal vascular resistance, increased glomerular filtration rate, and modifications in tubular function. These alterations have important clinical implications and can make the diagnosis of renal compromise challenging. The effect of pregnancy on kidney disease may manifest as a loss of renal function, particularly in the context of concomitant hypertension and proteinuria, and chronic kidney disease, even when mild, contributes to the high risk of adverse pregnancy outcomes, including increased risks of preeclampsia, preterm delivery, and small-for-gestational age neonates. Strategies for optimization of pregnancy outcomes include meticulous management of hypertension and proteinuria where possible and the initiation of preeclampsia prevention strategies, including aspirin. Avoidance of nephrotoxic and teratogenic medications is necessary, and renal dosing of commonly used medications must also be considered. Mode of delivery in women with chronic kidney disease should be based on usual obstetric indications, although more frequent prenatal assessments by an expert multidisciplinary team are desirable for the care of this particularly vulnerable patient population. Obstetricians represent a critical component of this team responsible for managing each stage of pregnancy to optimize both maternal and neonatal outcomes, but collaboration with nephrology colleagues in combined clinics wherein both specialists can make joint management decisions is typically very helpful.
Intrapartum Glucose Management in Women With Gestational Diabetes Mellitus
Authors: Hamel Maureen S. , Kanno Lindsey M. , Has Phinnara , Beninati Michael J. , Rouse Dwight J. , Werner Erika F.
Published: May 2019

OBJECTIVE:

To assess the effect of tight compared with liberalized intrapartum maternal glucose management on neonatal hypoglycemia risk in pregnancies complicated by gestational diabetes mellitus (GDM).

METHODS:

This was a randomized controlled trial of women with singleton gestations and GDM attempting vaginal delivery. After written informed consent, women were randomly allocated to one of two intrapartum maternal glucose management protocols: tight control (glucose measurements hourly and treatment for maternal glucose levels lower than 60 mg/dL or greater than 100 mg/dL) or liberalized control (glucose measurements every 4 hours and treatment for maternal glucose levels lower than 60 mg/dL or greater than 120 mg/dL). The primary outcome was the first neonatal blood glucose level; a total sample size of 74 was necessary to have 80% power to detect a mean difference of 10 mg/dL between groups. Secondary outcomes included neonatal blood glucose concentrations within the first 24 hours of life, number of glucose treatments (intravenous or oral) received to treat neonatal hypoglycemia, neonatal intensive care unit admission, and neonatal hyperbilirubinemia.

RESULTS:

From February 2016 to April 2018, 76 women were randomized (38 in each group), and all were included in the analysis. Baseline characteristics of the two groups were comparable for all relevant obstetric variables; mean gestational age was 39 weeks in both groups. Antepartum, two thirds of women in each group were treated medically (almost exclusively with insulin). The primary outcome was similar between the tight and liberalized control groups: 53 mg/dL vs 58 mg/dL, mean difference −4.18, 95% CI −12.66 to 4.29. However, mean neonatal glucose level within the first 24 hours of life was lower in the tight control group: 54 mg/dL vs 58 mg/dL, mean difference −3.39, 95% CI −7.07 to 0.29. Other secondary outcomes were similar between groups.

CONCLUSION:

A protocol aimed at tight maternal glucose management in labor compared with liberalized management for women with GDM did not result in better initial neonatal glucose concentrations and was associated with lower mean neonatal blood glucose levels in the first 24 hours of life. This study supports raising the upper threshold for intrapartum maternal glucose and decreasing the frequency of intrapartum glucose assessment for women with GDM.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, http://www.clinicaltrials.gov NCT02596932.
Timing of First Milk Expression to Maximize Breastfeeding Continuation Among Mothers of Very Low-Birth-Weight Infants
Authors: Parker Margaret G. , Melvin Patrice , Graham Dionne A. , Gupta Munish , Burnham Laura A. , Lopera Adriana M. , Zera Chloe A. , Belfort Mandy B.
Published: May 2019

OBJECTIVE:

To estimate the time of first milk expression among mothers of very low-birth-weight (VLBW, 1,500 g or less) infants that predicts the maximal duration of mother's milk provision during hospitalization in the neonatal intensive care unit (NICU).

METHODS:

We performed a secondary analysis and studied 1,157 mother–VLBW infant pairs in nine Massachusetts hospitals born from January 2015 until December 2017. We determined the cut-point for timing of first milk expression after delivery that was associated with the highest probability of any and exclusive provision of mother's milk for the infant at NICU discharge or transfer using recursive partitioning. We estimated hazard ratios (HRs) comparing the probability of continued provision of mother's milk during the hospitalization between mothers who initiated milk expression before compared with after the cut-point (within 8 hours after delivery [referent] vs 9–24 hours), adjusting for gestational age, birth weight, maternal race and ethnicity, and clustering by hospital and plurality in Cox proportional hazards models.

RESULTS:

Sixty-eight percent of mothers first expressed milk within 8 hours after delivery. First milk expression at 9–24 hours was associated with lower odds of any mother's milk provided to the infant on day 7 (adjusted odds ratio [aOR] 0.39 [0.24–0.60]) and discharge or transfer (aOR 0.45 [0.33–0.62]), compared with expression within 8 hours. Findings were similar for exclusive mother's milk. Mothers who first expressed 9–24 hours stopped providing milk earlier in the neonatal hospitalization (adjusted HR 1.64 [1.33–2.01]) compared with mothers who first expressed within 8 hours.

CONCLUSION:

Using a data-driven approach, we identified that first milk expression within 8 hours was superior to 9–24 hours with respect to maximal duration of provision of mother's milk for hospitalized VLBW infants. Randomized control trials are needed to further establish the causal relationship between timing of first milk expression and long-term lactation success among mothers of VLBW infants.
Laparoscopic Compared With Open Surgery for Severe Pelvic Inflammatory Disease and Tubo-Ovarian Abscess
Authors: Shigemi Daisuke , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo
Published: May 2019

OBJECTIVE:

To compare operative outcomes of laparoscopic surgery compared with laparotomy in patients with moderate to severe pelvic inflammatory disease (PID).

METHODS:

Using the Diagnosis Procedure Combination database, a national inpatient database for acute-care inpatients in Japan, we performed a large, nationwide retrospective cohort study. We identified all patients aged 18 years or older who were diagnosed with PID with or without tubo-ovarian abscess and were admitted to a participating hospital from July 2010 to March 2016. We excluded patients who were pregnant, had cancer, or for whom data were missing. We compared outcomes between patients who underwent laparoscopic surgery compared with laparotomy. Propensity score–matched analyses were performed to compare operative outcomes including postoperative length of stay, surgical complications, in-hospital deaths, and revision surgery.

RESULTS:

Of 27,841 patients with PID, 4,419 (15.9%) underwent surgical intervention. From among 749 women undergoing laparoscopy and 3,670 women undergoing laparotomy for PID, 740 pairs were created for propensity score matching. The laparoscopic group had shorter operation duration (125 vs 166 min), fewer blood transfusions (4.7% vs 10.0%), and shorter length of hospital stay (median 5 days vs 7 days; all P<.001) compared with the laparotomy group. There were no significant differences between groups for in-hospital deaths, surgical complications, and revision surgery.

CONCLUSION:

Laparoscopic surgery may have clinical advantages over laparotomy in patients diagnosed with severe PID.
Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs
Authors: Rodriguez Maria I. , Hersh Alyssa , Anderson Lorinda B. , Hartung Daniel M. , Edelman Alison B.
Published: May 2019

OBJECTIVE:

To estimate unintended pregnancies averted and the cost effectiveness of pharmacist prescription of hormonal contraception.

METHODS:

A decision-analytic model was developed to determine the cost effectiveness of expanding the scope of pharmacists to prescribe hormonal contraception compared with the standard of care and contraceptive access in clinics. Our perspective was that of the payor, Oregon Medicaid. Our primary outcome was unintended pregnancies averted. Secondary outcomes included: costs and quality-adjusted life years (QALYs). Model inputs were obtained from an analysis of Medicaid claims for the first 24 months after policy implementation in Oregon, and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed.

RESULTS:

Among Oregon's Medicaid population at risk for unintended pregnancy, the policy expanding the scope of pharmacists to prescribe hormonal contraception averted an estimated 51 unintended pregnancies and saved $1.6 million dollars. Quality of life was also improved, with 158 QALYs gained per 198,000 women. Sensitivity analysis demonstrated that the model was most sensitive to the effect on contraceptive continuation rates. If contraceptive continuation rates among women receiving care from a pharmacist are 10% less than among clinicians, than pharmacist prescription of hormonal contraception will not avert unintended pregnancies.

CONCLUSION:

Pharmacist prescription of hormonal contraception averts unintended pregnancies and is cost effective. Full implementation of the policy is needed for maximum benefits. Prospective data on the effect of the policy on contraceptive continuation rates are needed.
Evaluation of the Effect of Surgeon's Operative Volume and Specialty on Likelihood of Revision After Mesh Midurethral Sling Placement
Authors: Brennand Erin A. , Quan Hude
Published: May 2019

OBJECTIVE:

To estimate rates of revision surgery after insertion of mesh midurethral slings and explore whether physician specialty, annual operative volume, or hospital type are associated with this outcome.

METHODS:

A population-based retrospective cohort of women undergoing midurethral sling procedures over a 13-year interval (2004–2017) in Alberta, Canada was created using administrative health data. The primary outcome was subsequent surgery for revision of midurethral sling, defined by a composite of surgical procedures. Exposures included annual number of midurethral sling procedures performed by the surgeon, surgeon specialty, facility type, patient age, and concomitant prolapse repair. Mixed effects logistic regression using linear spines was used to test a-priori hypothesis that annual surgical volume would be inversely related in a nonlinear fashion to risk of revision.

RESULTS:

In the cohort of 19,511 women, cumulative rates of revision surgery were 3.84% (95% CI 3.54–4.17) at 5 years and 5.26% (95% CI 4.82–5.74) at 10 years. The first year after midurethral sling placement was the most vulnerable window, with 0.40% (95% CI 0.31–0.49) undergoing revision within 30 days and 2.15% (95% CI 1.95–3.52) within 1 year. Concomitant prolapse repairs (odds ratio [OR] 1.24, 95% CI 1.04–1.48) and surgeon's annual volume were associated with revision. After 50 cases per year, odds of revision declined with each additional case (OR 0.99/case, 95% CI 0.98–0.99, OR 0.91/10 cases, 95% CI 0.84–0.98) and plateaued at 110 cases per year. Surgeon specialty, hospital type, and patient age were not associated with outcome.

CONCLUSION:

One in 20 women undergo revision surgery within 10 years after midurethral sling placement. Higher physician surgical volume is associated with decreased risk, with the decline occurring at a threshold of 50 cases annually. Minimum caseload parameters for surgeons performing midurethral sling procedures may improve quality of these procedures.
Shoulder Shrug Maneuver to Facilitate Delivery During Shoulder Dystocia
Authors: Sancetta Ronald , Khanzada Hiba , Leante Ricardo
Published: May 2019

BACKGROUND:

Shoulder dystocia is a potential complication of vaginal delivery that increases the chances of injury to the neonate and the mother. The incidence of dystocia can be up to 3%, and sudden presentation and the lack of reliable predictors make shoulder dystocia a challenge for obstetricians.

TECHNIQUE:

The shoulder shrug technique involves shrugging the posterior shoulder and rotating the head–shoulder unit 180 degrees to resolve the shoulder dystocia.

EXPERIENCE:

We describe successful delivery in three cases of persistent shoulder dystocia using the shoulder shrug technique after the dystocia could not be resolved with McRoberts maneuver.

CONCLUSION:

When successful, the shoulder shrug maneuver may decrease the likelihood of morbidity for the neonate. The technique has resolved dystocia in three cases in which the posterior shoulder could be shrugged. Because it does not take much time to perform the shoulder shrug maneuver, it is worth considering this technique during management of unresolved shoulder dystocia.
Association of Radical Hysterectomy Surgical Volume and Survival for Early-Stage Cervical Cancer
Authors: Matsuo Koji , Shimada Muneaki , Yamaguchi Satoshi , Matoda Maki , Nakanishi Toru , Kikkawa Fumitaka , Ohmichi Masahide , Okamoto Aikou , Sugiyama Toru , Mikami Mikio
Published: May 2019

OBJECTIVE:

To examine the association between surgical volume and survival of women with early-stage cervical cancer who underwent radical hysterectomy.

METHODS:

This is a nationwide multicenter retrospective study examining consecutive women with clinical stage IB1-IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy from 2004 to 2008 (N=5,964). The surgical volume per site over the 5-year period was defined as low-volume (fewer than 32 surgeries, 46 [39.7%] institutions, n=649 [10.9%]), mid-volume (32–104 surgeries, 60 [51.7%] institutions, n=3,662 [61.4%]), and high-volume (105 surgeries or more, 10 [8.6%] institutions, n=1,653 [27.7%]). Surgical volume-specific survival was examined with multivariable analysis and propensity score matching.

RESULTS:

The median number of surgeries per site was 44 (interquartile range, 17–65). The 5-year disease-free survival rates among stage IB1-IIB disease were 77.2%, 79.9%, and 84.5% for low-, mid-, and high-volume groups, respectively. On multivariable analysis, women in high-volume centers had a decreased risk of recurrence (adjusted hazard ratio [HR] 0.69, 95% CI 0.58–0.82, P<.001) and all-cause mortality (adjusted HR 0.73, 95% CI 0.59–0.90, P=.003) compared with those in mid-volume centers. Specifically, women in high-volume centers had a decreased risk of local recurrence (adjusted HR 0.62, 95% CI 0.49–0.78, P<.001) but not distant recurrence (adjusted HR 0.85, 95% CI 0.67–1.06, P=.142) compared with those in mid-volume centers. Among 1,700 women with clinical stage IB1 disease treated with surgery alone, surgery at high-volume centers was associated with a decreased risk of recurrence (adjusted HR 0.45, 95% CI 0.25–0.79, P=.006) and all-cause mortality (adjusted HR 0.29, 95% CI 0.11–0.76, P=.013) compared with surgery at mid-volume centers on multivariable analysis. After propensity score matching, surgery at high-volume centers remained an independent prognostic factor for decreased recurrence (adjusted HR 0.69, 95% CI 0.57–0.84, P<.001) and all-cause mortality (adjusted HR 0.75, 95% CI 0.59–0.95, P=.016) compared with surgery at mid- and low-volume centers on multivariable analysis.

CONCLUSION:

Hospital volume for radical hysterectomy may be a prognostic factor for early-stage cervical cancer. Surgery at high-volume centers is associated with decreased local recurrence risk and improved survival.
The evolving role of anabolic therapy in the treatment of osteoporosis
Authors: Cosman Felicia
Published: May 2019

Purpose of review

Many physicians have long considered anabolic osteoporosis medication to be the last resort for patients after multiple fractures have already occurred. Thinking is evolving toward the view that anabolic agents should be used more proactively earlier in patients who are at high risk for fracture.

Recent findings

Recent data suggest that the three anabolic agents, teriparatide, abaloparatide and romosozumab, reduce nonvertebral and vertebral fractures faster and to a greater extent than the best antiresorptive treatments.

This review will summarize the evolving role of anabolic therapy in the management of the postmenopausal woman at high risk for fracture. Pivotal clinical trial data for the three anabolic agents are overviewed and studies comparing anabolic and antiresorptive medications are described. Studies comparing treatment sequences with anabolic and antiresorptive treatments are also summarized. High-risk patients who should be considered for initial treatment with anabolic medication are defined.
Is Tissue Engineering Helping Orthopaedic Care in Trauma?
Authors: Crist Brett D. , Leach J. Kent , Lee Mark A.
Published: May 2019

Tissue engineering in orthopaedic trauma is needed. Progress has been made in all areas including regenerating bone, cartilage, soft tissue, and making up for bone defects with scaffolds. Bone regeneration and managing bone defects with scaffolds continue to be successful in the basic science realm with promising results, but currently, these successes are mostly limited to small animal models. Cartilage defects have more clinically available treatment options, but the benefits of “off-the-shelf” allograft options, and scaffolds, have little clinical evidence in the acute fracture setting. Most of the true chondrocyte replacement therapies such as matrix-induced autologous chondrocyte implantation and osteochondral allografts require delayed treatment while cell growth or graft matching occurs. Soft-tissue defects can be managed with tissue engineering for the skin with success, but muscle and nerve defects are still limited to the basic science arena. Although significant gains have been made in all areas for tissue engineering in basic science, and is very promising, this success currently comes with limited translation into clinical availability for the orthopaedic trauma patient.
Reliability and Validity of A-Mode Ultrasound to Quantify Body Composition
Authors: Hendrickson Nathan , Davison John , Schiller Luke , Willey Michael
Published: May 2019

Objective:

Immobilization and inadequate nutrition after high-energy trauma result in loss of lean muscle mass. Body composition [percent body fat (%BF), fat mass (FM), fat-free mass (FFM)] is traditionally quantified with techniques that require expensive equipment and/or ionizing radiation. The purpose of this study was to assess reliability and validity of amplitude-mode (A-mode) ultrasound (US) to quantify body composition for use in a randomized clinical trial assessing interventions to prevent muscle loss in young individuals after high-energy musculoskeletal trauma.

Methods:

Thirty-one volunteer subjects underwent body composition assessments using A-mode US and air displacement plethysmography (ADP). Independent raters performed 2 serial US measures. The same raters performed body composition assessment in 12 consecutive subjects that sustained acute musculoskeletal trauma indicated for surgery. Test–retest and inter-rater reliability were assessed using intraclass correlation coefficient (ICC). Agreement between US and ADP was assessed with Bland–Altman analysis.

Results:

Test–retest and inter-rater reliability was excellent for volunteer subjects, with ICC values (%BF, FM, and FFM) of 0.87, 0.90, and 0.99 (rater 1); 0.80, 0.82, and 0.98 (rater 2). FFM measured by US was strongly correlated with ADP measures (r = 0.9635, P < 0.05). Bland–Altman analysis demonstrated no systematic bias between US and ADP measures of body composition. In trauma subjects, the inter-rater reliability was excellent, with ICCs of 0.96, 0.98, and 0.99 for %BF, FM, and FFM, respectively.

Conclusions:

A-mode US is a relatively low-cost tool that provides reliable estimates of body composition and is a viable alternative for monitoring body composition in young, healthy patients.
The Collapsing Flatfoot: Bone Alignment, Bone Alignment, Bone Alignment!
Authors: Roberts Lauren E. , Ellis Scott J.
Published: May 2019

Stage II adult acquired flatfoot deformity involves a loss of the medial longitudinal arch and an increase in hindfoot valgus due to both soft tissue dysfunction and attenuation with subsequent collapse of the foot’s inherent bony architecture. Although there is an important role for soft tissue reconstruction in the majority of cases of adult acquired flatfoot deformity, any soft tissue procedure in the absence of correction of the underlying bony alignment will be prone to failure so these soft tissue procedures should only be performed after maximal bony realignment has been obtained. In this article, we discuss our approach to bony realignment of for stage II flatfoot through use of a medializing calcaneal osteotomy and lateral column lengthening procedures such as the Evan’s osteotomy and the stepcut lengthening calcaneal osteotomy to correct hindfoot valgus and forefoot abduction respectively. Rationale for treatment, indications, preoperative planning, surgical technique, and outcomes are discussed.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Prevalence of sarcopenia and associated factors in climacteric women of the Colombian Caribbean
Authors: Monterrosa-Castro Alvaro , Ortiz-Banquéz Mauricio , Mercado-Lara María
Published: May 2019

Objective:

The aim of the study was to determine the prevalence of sarcopenia and associated factors in climacteric middle-aged women.

Methods:

This was a cross-sectional study carried out in Colombian Caribbean women (40-59 y, n = 403), who were surveyed with a form that included sociodemographic information and two validated tools (the Menopause Rating Scale and the SF-36 Health questionnaire). Calf circumference, handgrip, and gait speed were measured. Low muscle mass (calf circumference <31 cm), reduced muscle strength (<20 kg in handgrip), and lower physical performance (<0.8 m/s gait speed) were estimated. Criteria of the European Working Group on Sarcopenia in Older People were used to identify sarcopenia. Association between sarcopenia (dependent variable) and menopausal symptoms and health perception (independent variables) was estimated.

Results:

Median age of surveyed women was 48 years, with 44.5% being postmenopausal. 9.6% had low muscle mass, 18.1% had reduced muscle strength, and 6.9% had lower physical performance. Presarcopenia was identified in 9.6% and sarcopenia in 7.9% (nonsevere sarcopenia 7.1% and severe sarcopenia 0.8%). Most important factors associated with sarcopenia were feeling full of life only sometimes, feeling a lot of energy only sometimes, having joint/muscular discomfort, history of hysterectomy, hot flashes, mestizo ethnic group, age 50 or more, being postmenopausal, and sleep problems.

Conclusions:

Sarcopenia was present in this middle-aged female Colombian Caribbean sample and associated with various factors such as ethnicity, age, and menopausal symptoms and status.
Transdiagnostic Approach to Olfactory Reference Syndrome: Neurobiological Considerations
Authors: Skimming Kathryn A. , Miller Christopher W. T.
Published: May 2019

Olfactory reference syndrome (ORS) describes a constellation of emotional and behavioral symptoms that cause clinically significant distress or impairment arising from the false belief that one is emitting an offensive odor. Despite cases of ORS reported throughout the world over the last century, our knowledge and understanding of ORS remain relatively poor because of the limited literature—mostly case studies and series, but no clinical trials. ORS continues to pose significant diagnostic challenges within our current frameworks of categorizing mental disorders, including the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases. We review the ORS literature and discuss diagnostic parallels and challenges of placing ORS within specific categories. We also review the current research on the neurocircuitry of olfaction and of disorders with potential clinical relevance to patients presenting with ORS. While no primary neuroscientific research has specifically investigated ORS, an overlapping circuitry has been implicated in the neurobiology of obsessive-compulsive, trauma and stressor, and psychotic spectrum disorders, suggesting that the phenomenology of ORS can best be understood through a dimensional, rather than categorical, approach.
Results From the First Teleglaucoma Pilot Project in Addis Ababa, Ethiopia
Authors: Giorgis Abeba T. , Alemu Abiye M. , Arora Sourabh , Gessesse Girum W. , Melka Fikru , Woldeyes Alemayehu , Amin Samreen , Kassam Faazil , Kurji Ayaz K. , Damji Karim F.
Published: May 2019

Precis:

A teleglaucoma case-finding model was utilized in Ethiopia using a high-risk case identification approach. An overall 7.9% of patients had definite glaucoma, and 13.8% were glaucoma suspects. Most cases could be managed medically.

Background:

This study was carried out to analyze disease prevalence and clinical referral pathways for high-risk patients assessed through a hospital-based teleglaucoma case-finding program.

Methods:

Patients over the age of 35 years were referred from outpatient diabetic and hypertensive clinics. Through a teleglaucoma consultation, a glaucoma specialist provided remote diagnosis and management recommendations. Patient referral pathways were analyzed. Part way through the program, frontline ophthalmic nurses and optometrists were empowered to refer patients to be seen by general ophthalmologists within a week if patients met high-risk criteria. Qualitative stakeholder feedback was also obtained.

Results:

A total of 1002 patients (53% female) were assessed with a mean age of 51.0±11.7 years. The prevalence of glaucoma and glaucoma suspects was 7.9% (79 cases) and 13.8% (138 cases), respectively. Retinopathy was found in 9.1%, with hypertensive retinopathy (2.7%) and diabetic retinopathy (2.5%) representing the majority of cases. Age-related macular degeneration was present in 1.5% and cataract in 16%. An overall 63% of cases were without organic eye disease. 35% of patients were referred to a general ophthalmologist, 0.7% to a glaucoma specialist (for surgery), 1.5% to a retina specialist, and 17.7% to an optometrist for further care. Qualitative analysis revealed that stakeholders felt the value of teleglaucoma would be in triaging patients requiring more urgent management and in identifying disease at an earlier stage.

Conclusions:

There is a high prevalence of glaucoma in Ethiopian patients assessed through this teleglaucoma program. This model and study have also demonstrated various principles behind telemedicine, such as the development of an intelligent triage system, case-finding for a variety of diseases, and consideration of optimal patient flow/referral pathways.
Thromboprophylaxis After Hospitalization for Joint Replacement Surgery
Authors: Giuliano Karen K. , Pozzar Rachel , Hatch Courtney
Published: May 2019

Venous thromboembolism (VTE) is a leading cause of mortality during the perioperative period, with individuals who have undergone hip and knee arthroplasty at the highest risk for VTE. The American College of Chest Physicians recommends 35 days of postoperative thromboprophylaxis and the use of intermittent pneumatic compression (IPC) therapy for mechanical compression after major orthopedic surgery. However, little research has described adherence to these recommendations during recovery at home. The purpose of this cross-sectional descriptive study was to describe thromboprophylaxis prescription, use, and education among patients discharged home after major orthopedic surgery. We surveyed patients within 2 years of major orthopedic surgery. A total of 388 subjects completed the survey. More than three-quarters of respondents reported a thromboprophylaxis duration <35 days. Most (93.8%) respondents were prescribed a pharmacologic agent, while 55.9% were prescribed mechanical compression therapy. Of the respondents who were prescribed mechanical compression therapy, 13.4% were prescribed IPC. Adherence to mechanical compression therapy was moderate, with 63% of respondents wearing mechanical compression therapy ≥75% of the time. The results of this study suggest a need for increased duration of thromboprophylaxis and increased use of IPC in the outpatient setting. Additional research describing prescribers' perceptions of thromboprophylaxis is also needed.
Facial Nerve Translocation for Low Tension Neurorrhaphy to Masseteric Nerve
Authors: Hetzler Laura , MacDowell Sara , Trahan Jason , Arriaga Moises , McDaniel Lee S.
Published: May 2019

Introduction:

The techniques of facial reanimation are continually evolving in search of the ideal method for rehabilitating the paralyzed face. In the past, alternative cranial nerve motor nuclei have been used to power facial musculature. The trigeminal nerve is gaining popularity as a promising nerve to drive facial motion, particularly in the lower face.

Objectives:

This article describes a low-tension technique of using the transposed facial nerve to the trigeminal nerve (masseteric branch) for facial reanimation.

Methods:

Six patients over 2.5 years were treated with facial nerve translocation with division at the geniculate and direct neurorrhaphy to the motor branch of the masseter. Patients were evaluated by physical examination, measurement of oral commissure excursion using MEEI FACE-gram software, video assessment, Sunnybrook Facial Grading System, Facial Disability Index, and Facial Clinimetric Evaluation Scale (FaCE).

Results:

Patients demonstrated early motion within 4 months postoperatively and were placed into facial physical therapy. All demonstrated improvements in oral competence, strong oral commissure excursion with good symmetry, speech improvements, and variable results in facial tone. Synkinesis to the smile antagonists in the lower face was noted and treated with chemodenervation in three of six. No upper division synkinesis was noted.

Conclusion:

The motor branch of the trigeminal nerve is an effective option for facial reanimation via facial nerve translocation and end-to-end neurorrhaphy. Variable results in facial tone were noted with excellent oral commissure excursion. This procedure is safe in the reoperated mastoid.
Efficacy of an antiadhesive agent for the prevention of intra-abdominal adhesions after radical gastrectomy
Authors: Kim Sung Geun , Song Kyo Young , Lee Han Hong , Kim Eun Young , Lee Jun Hyun , Jeon Hae Myung , Jeon Kyung Hwa , Jin Hyung Min , Kim Dong Jin , Kim Wook , Yoo Han Mo , Kim Jeong Gu , Park Cho Hyun
Published: May 2019

Background:

Guardix-SG is a poloxamer-based antiadhesive agent. The aim of this study was to investigate its efficacy in preventing abdominal adhesions in gastric cancer patients undergoing gastrectomy. Few clinical studies have reported that antiadhesive agent reduces the incidence of adhesion after gastrectomy.

Methods:

We conducted a multicenter trial from June 2013 and August 2015 in patients with gastric adenocarcinoma undergoing radical gastrectomy. Patients were randomly assigned to the Guardix treatment or control group. Postoperative adhesions were diagnosed based on postoperative symptoms, plain x-ray films, and computed tomography. The primary endpoint of the study was the incidence of small bowel obstruction in the first postoperative year. The secondary end-point was the safety of Guardix-SG.

Results:

The study included 109 patients in the Guardix group and 105 patients in the control group. The groups were similarly matched with pathological stage, operation type, anastomosis method, midline incision length, and the extent of lymph node dissection. Eight in the Guardix group and 21 in the control group experienced intestinal obstruction during the 1-year follow-up period. The cumulative incidence of small bowel obstruction was significantly lower in the Guardix group compared to that seen in the control group (4.7% vs 8.6% at 6 months and 7.3% vs 20% at 1 year; P = .007, log-rank test). There were no differences in postoperative complications and adverse events.

Conclusion:

Guardix-SG significantly decreased the incidence of intestinal obstruction without affecting the incidence of postoperative complications.
The “safe zone” for infrapectineal plate-screw fixation of quadrilateral plate fractures
Authors: He Li , Sun Yun , Hou Zhiyong , Zhang Qian , Hu Yinghua , Bai Xiangjun , Yi Chengla
Published: May 2019

Extra-articular screw placement in the true pelvis for fixing quadrilateral plate fractures remains challenging. We aimed to define the “safe zone” on the quadrilateral surface to facilitate safe plate-screw placement.

Twenty cadaveric hemipelves were sectioned and assembled to define the projection of the acetabular boundary on the quadrilateral surface. Three lines (X, Y, and Z) were drawn tangent to the projection, with X parallel to the iliopectineal line, Y perpendicular to the iliopectineal line, and Z parallel to the posterior border of the ischial body. Then, the distances between X and the iliopectineal line (D1), Y and the sacroiliac joint (D2), and Z and the posterior border of the ischium (D3) could be used to determine a “safe zone” on the quadrilateral surface for screw insertion. We included 15 patients whose conditions satisfied the definition of a comminuted quadrilateral plate fracture and applied two-ended buttress plates for treatment in accordance with this “safe zone.”

The average D1 was 50.0 mm, the average D2 was 30.6 mm, and the average D3 was 12.4 mm. For all 15 patients with comminuted quadrilateral fracture who were treated, no intraoperative or postoperative screw penetration of the acetabulum was identified, and no loss of reduction was observed during an average follow up of 17.7 months.

The “safe zone” established in this study simplifies extraarticular screw placement for managing quadrilateral plate fractures in the true pelvis. As a result, two-ended buttress plate fixation in the true pelvis becomes safe, therefore, treatment with two-ended buttress plates may represent a viable alternative to single-ended elastic fixation in the management of comminuted quadrilateral fractures.
Radiological and clinical findings of isolated meningeal Rosai–Dorfman disease of the central nervous system
Authors: Wen Jia-Hua , Wang Chao , Jin Yun-Yun , Xu Duo , Jiang Biao , He Xiao-Juan , Min Jie
Published: May 2019

Rosai–Dorfman disease (RDD) with isolated central nervous system (CNS) involvement is an extremely rare disease. Most RDD of the CNS present as dural-based mass mimicking meningioma and other common lesions, which makes preoperative accurate diagnosis of great difficulty. We searched the pathology database in our hospital and 3 cases of RDD with isolated CNS involvement were finally included in our study. Radiological and clinical findings of these three cases were retrospectively analyzed. The lesions of 2 cases were dura-based against the cerebral convexity, presenting as a sheet-shaped thickened dura mater, another case was located just across the cerebral falx, the dural display in the center was intact. The 3 cases showed low signal intensity on T2-weighted image, obviously enhanced, significantly surrounding edema and finger-like protuberance but no invasion of the brain parenchyma or no sign of hyperplasia or sclerosis of the surrounding cranial bones. In conclusion, when we come across a disease that mimicking meningioma, especially when it manifests as the above radiological features, we should considered it might be a kind of proliferative disease of the meninges, such as RDD.
Factors affecting in-hospital delay of intravenous thrombolysis for acute ischemic stroke
Authors: Chai Erqing , Li Changqing , Jiang Lei
Published: May 2019

This study was designed to investigate the factors affecting the in-hospital delay of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS).

Two hundred and forty-eight consecutive AIS patients treated with intravenous administration of alteplase in Gansu Provincial Hospital from December 2014 to August 2018 were enrolled retrospectively in this study. According to door-to-needle (DTN) time, the patients were divided into either a delay group (DTN time > 60 minutes; n = 184) or a non-delay group (DTN time ≤60 minutes; n = 64). The baseline data, laboratory tests, onset-to-door (OTD) time, door-to-accepting time (DTA), door-to-imaging time (DTI), and decision-making time in both groups were recorded. Multivariate logistic analysis was performed to analyze the data.

There were significant differences in previous history of cerebral ischemic attack, emergency system admission, education degree of decision makers, annual income, admission National Institutes of Health Stroke Scale (NIHSS), OTD time, DTA time, decision-making time between the 2 groups (all P < .05). Other baseline data and clinical features showed no significant difference between 2 groups (P > .05). Multivariate logistic regression analysis revealed that the risk of in-hospital delay was lower for the higher NIHSS score (OR = 0.775, 95% CI: 0.644-0.933, P = .007), the longer OTD time (OR = 0.963, 95% CI: 0.937-0.991, P = .010), the shorter decision-making time (OR = 1.224, 95% CI: 1.004-1.492, P = .045).

This study suggested that NIHSS score, OTD time and decision-making time are the independent factors affecting the in-hospital delay of IVT for AIS.
IgA nephropathy associated with erythrodermic psoriasis
Authors: Zhang Li , Xue Shuai , Yu JinYu , Si HeNan , Xu Ying , Li Jia , Ma FuZhe , Xu ZhongGao
Published: May 2019

Rationale:

Cases about IgAN associated with EP are rare and the pathogenesis is poorly understood. We reported a 74-year-old Chinese male who suffered the IgAN and EP at the same time and explored a possible pathophysiologic link and points toward the possible pathogenesis.

Patient concerns:

The patient complained deteriorating symptoms (erythrodermia, skin pruritus, and pain) of psoriasis and obvious pitting edema on his legs.

Diagnosis:

The patient was diagnosed as IgAN and EP concurrently according to medical history, physical examination, laboratory test, and pathology.

Interventions:

Intravenous dexamethasone (5 mg/day) and oral ciclosporin (200 mg twice a day).

Outcomes:

The patient's symptoms of psoriasis and IgA nephropathy improved obviously after 11-day treatment and discharged from the hospital.

Lessons:

IgAN should be considered when the patient is diagnosed as EP. The combination of dexamethasone and ciclosporin may be effective option for patients with IgAN and EP concurrently.
Endometriosis presenting with recurrent massive hemorrhagic ascites and diagnosed by core needle biopsy
Authors: Wang Xue , Li Yiling , Tong Jing , Chang Bing , Zhang Yi , Liu Yanjun , Bing Hao , Guo Liping , Li Dan
Published: May 2019

Rationale:

Recurrent massive hemorrhagic ascites secondary to endometriosis is extremely rare in the medical literature.

Patient concerns:

We report the case of a 24-year-old nulliparous woman presenting with severe abdominal distention, massive ascites, moderate anemia, menstrual pain, and an elevated CA-125 level.

Diagnosis:

We found a thickened peritoneum in the left lower abdomen by ultrasound during the follow-up period, and endometriosis was subsequently diagnosed by performing core needle biopsy (CNB).

Interventions and outcomes:

The patient received medical treatment for endometriosis and had a good response to the treatment.

Lessons:

This is the first case in which endometriosis ectopic to peritoneum was diagnosed by CNB. Endometriosis should be considered a differential diagnosis when recurrent massive hemorrhagic ascites occur. CNB should be valued as a method for diagnosing endometriosis.