bluuebunny/crossref_metadata_2025 huggingface dataset:
Insight into the dielectric response of transformer oil-based nanofluids
Authors: Dong Ming , Dai Jianzhuo , Li Yang , Xie Jiacheng , Ren Ming , Dang Zhimin
Published: February 2017

The oil-based nanofluids with greater dielectric strength have attracted much attention as a crucial insulating materials in high-voltage oil-immersed power equipment. In fact, the different microstructures of the transformer oil-based nanofluids (TNFs) would result in different dielectric properties. In this work, the broadband dielectric spectroscopy measurement was used to establish the linkage between the electric double layer (EDL) and dielectric response properties of TNFs which was performed at 298K temperature and with frequency range from 10-2Hz∼106Hz. The modified Havriliak-Negami (HN) model function was used to analyze the measured results. The results demonstrate that both the real and imaginary parts of dielectric spectra of two kinds of oil are composed of the conductivity and polarization process. Compared with pure oil, two polarization process could be observed for the TNFs, explained by the EDL structure reasonably. The introduction of the EDL structure provides an idea to account for the insulating strength improvement of TNFs for the first time.
Seasonal habitats, decadal trends in abundance and cultural values of magpie geese (Anseranus semipalmata) on coastal floodplains in the Kakadu Region, northern Australia
Authors: Bayliss Peter , Ligtermoet Emma
Published: February 2017

The magpie goose is an iconic tropical species highly valued as a conservation asset and by Aboriginal people as a cultural resource. Most of the global population occurs in the Kakadu Region of northern Australia, which is at high risk from the combined impacts of invasive species and future sea-level rise. Future management responses require an increased understanding of their spatial and temporal dynamics and customary value. Historical aerial-survey data of geese and their nests in the Kakadu Region (1981–2006, 25 years) were used to characterise seasonal use of floodplains. Habitat ‘hotspots’ co-occurred with high abundance of plants that provide nesting material in the wet season and food in the dry season, particularly the bulbs of Eleocharis dulcis sedge. Goose numbers across the Northern Territory (1958–2000, n=42 years) exhibited 20-year decadal trends coupled with similar trends in rainfall and stream flow (1954–2006), which in turn were influenced strongly by global-scale interactions between the El Niño–Southern Oscillation and Pacific Decadal Oscillation. Stream flow drives the spatial and temporal dynamics of magpie geese at regional and decadal scales through its direct influence on floodplain-vegetation dynamics. Customary harvesting practices of geese and their eggs ascertained from interviews (2011–2014) showed that their cultural value extends beyond consumption, highlighting the need to address socio-ecological contexts in future management responses.
Entropy-driven segregation of polymer-grafted nanoparticles under confinement
Authors: Zhang Ren , Lee Bongjoon , Stafford Christopher M. , Douglas Jack F. , Dobrynin Andrey V. , Bockstaller Michael R. , Karim Alamgir
Published: February 2017

Significance

Functional polymer nanocomposite thin films demand precise control over the spatial organization of nanoparticles on microscales and nanoscales. We demonstrate that conformational chain entropy can be used as a driving force to direct nanoparticle redistribution in blend systems where the enthalpic interactions are negligible. Tunable segregation of polymer-grafted nanoparticles is achieved within topographically patterned polymeric thin films by varying the relative confinement entropy of chains grafted to nanoparticles versus matrix chains. We identify key factors governing this confinement-induced segregation phenomenon and demonstrate the applicability of this technique to different pattern geometries and nanoparticle systems.
Clustered brachiopod Hox genes are not expressed collinearly and are associated with lophotrochozoan novelties
Authors: Schiemann Sabrina M. , Martín-Durán José M. , Børve Aina , Vellutini Bruno C. , Passamaneck Yale J. , Hejnol Andreas
Published: February 2017

Significance

Hox genes pattern the anteroposterior axis of all animals that have left and right body sides. In many animals, Hox genes are clustered along the chromosomes and expressed in spatial and temporal order. This coordinated regulation is thought to have preserved the cluster through a developmental constraint. Our study of the genomic organization and the embryonic spatial and temporal expression of Hox genes in sessile marine animals called lampshells (brachiopods) shows that along with having a broken Hox cluster, they lack both temporal and spatial collinearity. Furthermore, we present molecular evidence that the hard tissues (chaetae and shells) of segmented worms, mollusks, and brachiopods share a common origin that dates back to the Early Cambrian.
Clinical, genetic, and structural basis of congenital adrenal hyperplasia due to 11β-hydroxylase deficiency
Authors: Khattab Ahmed , Haider Shozeb , Kumar Ameet , Dhawan Samarth , Alam Dauood , Romero Raquel , Burns James , Li Di , Estatico Jessica , Rahi Simran , Fatima Saleel , Alzahrani Ali , Hafez Mona , Musa Noha , Razzghy Azar Maryam , Khaloul Najoua , Gribaa Moez , Saad Ali , Charfeddine Ilhem Ben , Bilharinho de Mendonça Berenice , Belgorosky Alicia , Dumic Katja , Dumic Miroslav , Aisenberg Javier , Kandemir Nurgun , Alikasifoglu Ayfer , Ozon Alev , Gonc Nazli , Cheng Tina , Kuhnle-Krahl Ursula , Cappa Marco , Holterhus Paul-Martin , Nour Munier A. , Pacaud Daniele , Holtzman Assaf , Li Sun , Zaidi Mone , Yuen Tony , New Maria I.
Published: February 2017

Significance

Congenital adrenal hyperplasia resulting from mutations in the
CYP11B1
gene, which encodes a steroidogenic enzyme 11β-hydroxylase, is a rare inherited disorder associated with hyperandrogenemia, short stature, hypertension, and virilization of female newborns. We present a comprehensive clinical, genetic, and hormonal characterization for 68 of 108 patients with a genotype from an International Consortium on Rare Steroid Disorders. We also use computational modeling to define the effect of each of the missense mutations on the structure of 11β-hydroxylase, information that can be used to predict clinical severity prenatally in high-risk mothers.
A simplified Kronecker rule for one hook shape
Authors: Liu Ricky
Published: February 2017

Recently Blasiak has given a combinatorial rule for the Kronecker coefficient

g

λ
μ
ν

g_{\lambda \mu \nu }

when

μ
\mu

is a hook shape by defining a set of colored Yamanouchi tableaux with cardinality

g

λ
μ
ν

g_{\lambda \mu \nu }

in terms of a process called conversion. We give a characterization of colored Yamanouchi tableaux that does not rely on conversion, which leads to a simpler formulation and proof of the Kronecker rule for one hook shape.
Core engagement with β-arrestin is dispensable for agonist-induced vasopressin receptor endocytosis and ERK activation
Authors: Kumari Punita , Srivastava Ashish , Ghosh Eshan , Ranjan Ravi , Dogra Shalini , Yadav Prem N. , Shukla Arun K.
Published: February 2017

G protein–coupled receptors (GPCRs) exhibit highly conserved activation and signaling mechanisms by which agonist stimulation leads to coupling of heterotrimeric G proteins and generation of second messenger response. This is followed by receptor phosphorylation, primarily in the carboxyl terminus but also in the cytoplasmic loops, and subsequent binding of arrestins. GPCRs typically recruit arrestins through two different sets of interactions, one involving phosphorylated receptor tail and the other mediated by the receptor core. The engagement of both set of interactions (tail and core) is generally believed to be necessary for arrestin-dependent functional outcomes such as receptor desensitization, endocytosis, and G protein–independent signaling. Here we demonstrate that a vasopressin receptor (V2R) mutant with truncated third intracellular loop (V2RΔICL3) can interact with β-arrestin 1 (βarr1) only through the phosphorylated tail without engaging the core interaction. Of interest, such a partially engaged V2RΔICL3-βarr1 complex can efficiently interact with clathrin terminal domain and ERK2 MAPK in vitro. Furthermore, this core interaction–deficient V2R mutant exhibits efficient endocytosis and ERK activation upon agonist stimulation. Our data suggest that core interaction with βarr is dispensable for V2R endocytosis and ERK activation and therefore provide novel insights into refining the current understanding of functional requirements in biphasic GPCR-βarr interaction.
Irradiation strongly reduces tumorigenesis of human induced pluripotent stem cells
Authors: Inui Shoki , Minami Kazumasa , Ito Emiko , Imaizumi Hiromasa , Mori Seiji , Koizumi Masahiko , Fukushima Satsuki , Miyagawa Shigeru , Sawa Yoshiki , Matsuura Nariaki
Published: February 2017

Induced pluripotent stem (iPS) cells have demonstrated they can undergo self-renewal, attain pluripotency, and differentiate into various types of functional cells. In clinical transplantation of iPS cells, however, a major problem is the prevention of tumorigenesis. We speculated that tumor formation could be inhibited by means of irradiation. Since the main purpose of this study was to explore the prevention of tumor formation in human iPS (hiPS) cells, we tested the effects of irradiation on tumor-associated factors such as radiosensitivity, pluripotency and cell death in hiPS cells. The irradiated hiPS cells showed much higher radiosensitivity, because the survival fraction of hiPS cells irradiated with 2 Gy was < 10%, and there was no change of pluripotency. Irradiation with 2 and 4 Gy caused substantial cell death, which was mostly the result of apoptosis. Irradiation with 2 Gy was detrimental enough to cause loss of proliferation capability and trigger substantial cell death in vitro. The hiPS cells irradiated with 2 Gy were injected into NOG mice (NOD/Shi-scid, IL-2 Rγnull) for the analysis of tumor formation. The group of mice into which hiPS cells irradiated with 2 Gy was transplanted showed significant suppression of tumor formation in comparison with that of the group into which non-irradiated hiPS cells were transplanted. It can be presumed that this diminished rate of tumor formation was due to loss of proliferation and cell death caused by irradiation. Our findings suggest that tumor formation following cell therapy or organ transplantation induced by hiPS cells may be prevented by irradiation.
Current Clinical Brain Tumor Imaging
Authors: Villanueva-Meyer Javier E. , Mabray Marc C. , Cha Soonmee
Published: February 2017

Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors. This review provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, we focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse.
Takotsubo Syndrome After Cardiopulmonary Resuscitation During Emergency Cesarean Delivery
Authors: Kraft Katrina , Graf Matthias , Karch Martin , Felberbaum Ricardo
Published: February 2017

BACKGROUND:

Takotsubo syndrome is a rare, stress-related, and reversible form of acute heart failure primarily affecting postmenopausal women. It is characterized by left ventricular dysfunction with a classic apical and midventricular wall motion abnormality (apical ballooning).

CASE:

A 28-year-old woman, gravida 2 para 1, at 30 4/7 weeks of gestation was admitted with fetal bradycardia, a fully dilated cervix, and breech presentation. During emergency cesarean delivery, the patient had intraoperative cardiac arrest. Resuscitation was successful. Twelve hours postoperatively, after demonstrating symptoms of acute heart failure, she was diagnosed with Takotsubo syndrome.

CONCLUSION:

Peripartum Takotsubo syndrome must be differentiated from peripartum cardiomyopathy. Cesarean delivery and sympathomimetic medications can increase the risk of occurrence. Early recognition and interdisciplinary management are essential in the prevention of serious and potentially fatal complications.
Interpregnancy Interval and Adverse Pregnancy Outcomes
Authors: Hanley Gillian E. , Hutcheon Jennifer A. , Kinniburgh Brooke A. , Lee Lily
Published: February 2017

OBJECTIVE:

To examine the association between interpregnancy interval and maternal–neonate health when matching women to their successive pregnancies to control for differences in maternal risk factors and compare these results with traditional unmatched designs.

METHODS:

We conducted a retrospective cohort study of 38,178 women with three or more deliveries (two or greater interpregnancy intervals) between 2000 and 2015 in British Columbia, Canada. We examined interpregnancy interval (0–5, 6–11, 12–17, 18–23 [reference], 24–59, and 60 months or greater) in relation to neonatal outcomes (preterm birth [less than 37 weeks of gestation], small-for-gestational-age birth [less than the 10th centile], use of neonatal intensive care, low birth weight [less than 2,500 g]) and maternal outcomes (gestational diabetes, beginning the subsequent pregnancy obese [body mass index 30 or greater], and preeclampsia–eclampsia). We used conditional logistic regression to compare interpregnancy intervals within the same mother and unconditional (unmatched) logistic regression to enable comparison with prior research.

RESULTS:

Analyses using the traditional unmatched design showed significantly increased risks associated with short interpregnancy intervals (eg, there were 232 preterm births [12.8%] in 0–5 months compared with 501 [8.2%] in the 18–23 months reference group; adjusted odds ratio [OR] for preterm birth 1.53, 95% confidence interval [CI] 1.35–1.73). However, these risks were eliminated in within-woman matched analyses (adjusted OR for preterm birth 0.85, 95% CI 0.71–1.02). Matched results indicated that short interpregnancy intervals were significantly associated with increased risk of gestational diabetes (adjusted OR 1.35, 95% CI 1.02–1.80 for 0–5 months) and beginning the subsequent pregnancy obese (adjusted OR 1.61, 95% CI 1.05–2.45 for 0–5 months and adjusted OR 1.43, 95% CI 1.10–1.87 for 6–11 months).

CONCLUSION:

Previously reported associations between short interpregnancy intervals and adverse neonatal outcomes may not be causal. However, short interpregnancy interval is associated with increased risk of gestational diabetes and beginning a subsequent pregnancy obese.
Acute Respiratory Distress Syndrome in Pregnant Women
Authors: Rush Barret , Martinka Pawel , Kilb Brett , McDermid Robert C. , Boyd John H. , Celi Leo Anthony
Published: February 2017

OBJECTIVE:

To estimate the rate of acute respiratory distress syndrome (ARDS) in pregnant patients as well as to investigate clinical conditions associated with mortality.

METHODS:

We used the Nationwide Inpatient Sample from 2006 to 2012 to identify a cohort of pregnant patients who underwent mechanical ventilation for ARDS. A multivariate model predicting in-hospital mortality was created.

RESULTS:

A total of 55,208,382 hospitalizations from the 2006–2012 Nationwide Inpatient Samples were analyzed. There were 2,808 pregnant patients with ARDS who underwent mechanical ventilation included in the cohort. The overall mortality rate for the cohort was 9%. The rate of ARDS requiring mechanical ventilation increased from 36.5 cases (95% confidence interval [CI] 33.1–39.8) per 100,000 live births in 2006 to 59.6 cases (95% CI 57.7–61.4) per 100,000 live births in 2012. Factors associated with a higher risk of death were prolonged mechanical ventilation (adjusted odds ratio [OR] 1.69, 95% CI 1.25–2.28), renal failure requiring hemodialysis (adjusted OR 3.40, 95% CI 2.11–5.47), liver failure (adjusted OR 1.71, 95% CI 1.09–2.68), amniotic fluid embolism (adjusted OR 2.31, 95% CI 1.16–4.59), influenza infection (OR 2.26, 95% CI 1.28–4.00), septic obstetric emboli (adjusted OR 2.15, 95% CI 1.17–3.96), and puerperal infection (adjusted OR 1.86, 95% CI 1.28–2.70). Factors associated with a lower risk of death were: insurance coverage (adjusted OR 0.56, 95% CI 0.37–0.85), tobacco use (adjusted OR 0.53, 95% CI 0.31–0.90), and pneumonia (adjusted OR 0.70, 95% CI 0.50–0.98).

CONCLUSION:

In this nationwide study, the overall mortality rate for pregnant patients mechanically ventilated for ARDS was 9%. The rate of ARDS requiring mechanical ventilation increased from 36.5 cases (95% CI 33.5–41.8) per 100,000 live births in 2006 to 59.6 cases (95% CI 54.3–65.3) per 100,000 live births in 2012.
Modified Beef Tongue Model for Fourth-Degree Laceration Repair Simulation
Authors: Illston Jana D. , Ballard Alicia C. , Ellington David R. , Richter Holly E.
Published: February 2017

BACKGROUND:

An existing model for fourth-degree laceration repair uses beef tongue with plastic or vinyl tubing. This modified model substitutes beef tripe for the anal mucosa and chicken leg muscles for the anal sphincter muscle analogs to create a realistic model.

METHOD:

Tripe is tunneled through the body of the trimmed beef tongue and sutured like an ostomy to simulate the anal canal. The tongue is incised toward the tripe “anal canal.” Chicken leg muscles are tunneled from the incision out to the cut edges of the beef tongue to create anal sphincter muscle analogs. Procedures can be repeated on the opposite side. Two double-sided models can be made per tongue.

EXPERIENCE:

The model can be refrigerated or frozen and thawed before use. A fourth-degree laceration can be cut immediately before use. Materials were obtained at a local supermarket for $5–7 per half-tongue, double-sided model. Residents responded positively to the model and stated that animal tissue provided realistic haptic simulation.

CONCLUSION:

The modified beef tongue model utilizing tripe and chicken leg muscles as anal mucosa and anal sphincter muscle analogs, respectively, provided excellent perceived haptic fidelity. Moreover, it is an innovative, inexpensive, and well-received teaching tool to augment resident education.
Detecting Pulmonary Edema in Obstetric Patients Through Point-of-Care Lung Ultrasonography
Authors: Pachtman Sarah , Koenig Seth , Meirowitz Natalie
Published: February 2017

BACKGROUND:

Point-of-care lung ultrasonography is used in critical care settings for evaluating respiratory symptoms. Lung ultrasonography is sensitive and specific for the diagnosis of pulmonary edema in nonpregnant patients but is not well-studied in pregnancy.

TECHNIQUE:

Lung ultrasonography was performed using a portable ultrasound machine with a 2- to 5-MHz curvilinear probe that is available on many labor and delivery units.

EXPERIENCE:

Lung ultrasonography guided management decisions in a case of shortness of breath after induction of labor for preeclampsia and a case of hemolysis, elevated liver enzymes, and low platelet count syndrome complicated by pulmonary edema. Findings expedited diagnosis and treatment in both cases.

CONCLUSION:

Lung ultrasonography has potential to be used in obstetrics for detecting pulmonary edema in preeclampsia. It is a well-established tool in critical care settings and use in obstetric patients should be studied given the availability of ultrasonography on labor and delivery and the importance of timely care for critically ill pregnant patients. It is a safe modality to evaluate pregnant women with respiratory symptoms and the necessary skills can be easily acquired by obstetric practitioners familiar with obstetric ultrasonography. Training of obstetric practitioners in this application of ultrasonography is needed.
Association Between Senior Obstetrician Supervision of Resident Deliveries and Mode of Delivery
Authors: Bardos Jonah , Loudon Holly , Rekawek Patricia , Friedman Frederick , Brodman Michael , Fox Nathan S.
Published: February 2017

OBJECTIVE:

In December 2012, the Mount Sinai Hospital implemented a program to have senior obstetricians (more than 20 years of experience) supervise residents on labor and delivery during the daytime. The objective of this study was to estimate the association of resident supervision by senior obstetricians with mode of delivery.

METHODS:

This was a retrospective cohort study of all resident deliveries at Mount Sinai from July 2011 to June 2015. We included all patients with live, term, singleton, vertex fetuses. We compared delivery outcomes between patients delivered before December 2012 and patients delivered December 2012 and later using logistic regression analysis to control for age, body mass index, parity, induction, and prior cesarean delivery. During the study period there were no other specific departmental initiatives to increase forceps deliveries aside from having six obstetricians with significant experience in operative deliveries supervise and teach residents on labor and delivery.

RESULTS:

There were 5,201 live, term, singleton, vertex deliveries under the care of residents, 1,919 (36.9%) before December 2012 and 3,282 (63.1%) December 2012 or later. The rate of forceps deliveries significantly increased from 0.6% to 2.6% (adjusted odds ratio [OR] 8.44, 95% confidence interval [CI] 3.1–23.1), and the rate of cesarean deliveries significantly decreased from 27.3% to 24.5% (adjusted OR 0.68, 95% CI 0.55–0.83). There were no statistically significant differences in the rates of third- or fourth-degree lacerations or 5-minute Apgar scores less than 7. Among nulliparous women, the forceps rate increased from 1.0% to 3.4% (adjusted OR 4.87, 95% CI 1.74–13.63) and the cesarean delivery rate decreased from 25.6% to 22.7% (adjusted OR 0.69, 95% CI 0.53–0.89). The increase in forceps deliveries and the decrease in cesarean deliveries were seen only in daytime hours (7 am to 7 pm), that is, the shift that was covered by senior obstetricians.

CONCLUSION:

Having senior obstetricians supervise resident deliveries is significantly associated with an increased rate of forceps deliveries and a decreased rate of cesarean deliveries.
Elbow fractures: current concepts
Authors: Orvets Nathan D. , Chamberlain Aaron M.
Published: February 2017

Establishing a stable and congruent joint that allows for early elbow range of motion improves outcomes in elbow fracture management. This review highlights advances in both operative and nonoperative management of common elbow fracture patterns. Advances in imaging, injury classification, surgical techniques, and implants continue to contribute to improved outcomes in elbow fracture management.
Superior capsule reconstruction
Authors: Peterson Alexander B. , Park Maxwell C.
Published: February 2017

Superior capsule reconstruction (SCR) is a relatively new advancement in the realm of treating irreparable rotator cuff tears (RCTs). The surgery involves anchoring a graft between the superior glenoid and greater tuberosity, with the goal of restoring the continuity of the capsule and mechanical balance of the glenohumeral joint. Although the body of evidence surrounding SCR is in its infancy, it has been shown to be biomechanically superior to patch grafting procedures. Additionally, it provides the advantage over tendon transfers in that it does not burn bridges for subsequent interventions. A series of high-level biomechanical studies, which are highlighted in this review, have provided helpful information for the evolution and refinement of the SCR technique, including the importance of side-to-side suturing of the graft with the remnant cuff as well as the utility of concomitant acromioplasty. Early clinical results are promising for SCR, with both strong objective and subjective outcomes.
Infection and Complications After Low-velocity Intra-articular Gunshot Injuries
Authors: Nguyen Mai P. , Reich Michael S. , O'Donnell Jeffrey A. , Savakus Jonathan C. , Prayson Nicholas F. , Golob Joseph F. , McDonald Amy A. , Como John J. , Vallier Heather A.
Published: February 2017

Objectives:

The purpose of this study is to characterize the demographics, interventions, infection rates, and other complications after intra-articular (IA) gunshot wounds.

Design:

Retrospective review.

Setting:

Level I trauma center.

Patients/Participants:

Fifty-three patients with 55 civilian low-velocity IA gunshot injuries with a minimum of 4 weeks follow-up were included in the study. Seven patients had associated vascular injuries.

Interventions:

Most patients (84.9%) received antibiotic prophylaxis, consisting most often of cefazolin (93.3%). Based on injury pattern and surgeon preference, joint injuries were either treated nonoperatively (43.6%), with surgical debridement only (20.0%), with surgical debridement plus fracture fixation and/or neurovascular repair (32.7%), or with percutaneous fracture fixation without debridement (3.6%).

Main Outcome Measures:

Incidence of deep infection.

Results:

Two joints (3.6%) developed deep infections. Both had associated vascular injuries. Patients with vascular injuries were at higher risk of infection compared with those without vascular injury (28.6% vs. 0.0%, P = 0.02). Two of 24 (8.3%) injuries that were originally managed nonoperatively required delayed surgical procedures, 1 for bullet removal and 1 for ulnar nerve allograft. No patient treated nonoperatively developed an infection.

Conclusions:

The incidence of infection after IA gunshot injuries is low with the routine use of antibiotic prophylaxis. In the absence of IA pathology, IA gunshot injuries do not appear to necessitate surgical debridement to decrease the risk of infection. Patients with vascular injury deserve special attention, as they are at higher risk of infection.

Level of Evidence:

Prognostic Level III. See Instructions for authors for a complete description of levels of evidence.
Biopharmaceuticals: Reference Products and Biosimilars to Treat Inflammatory Diseases
Authors: Gils Ann , Bertolotto Antonio , Mulleman Denis , Bejan-Angoulvant Theodora , Declerck Paul J.
Published: February 2017

Biopharmaceuticals are primarily therapeutic proteins developed to perform specific functions by acting on the disease pathophysiology. Compared with low-molecular chemically synthesized drugs, production of biopharmaceuticals is much more complex and routes of administration and pharmacokinetics differ. Biopharmaceuticals are blockbusters in the treatment of inflammatory diseases, such as psoriasis, multiple sclerosis, rheumatic diseases, and inflammatory bowel diseases, and the introduction of these drugs has revolutionized treatment. Disadvantages include their high costs and the fact that they can evoke antidrug antibodies leading to decreased efficacy. Treatment can be optimized through the development of dosing algorithms and cost can be reduced by biosimilars, after a comparable biological activity, safety, and efficacy have been demonstrated.
Determinant Variables, Enteric Pathogen Burden, Gut Function and Immune-related Inflammatory Biomarkers Associated With Childhood Malnutrition
Authors: Lima Aldo A. M. , Leite Álvaro M. , Di Moura Alessandra , Lima Noélia L. , Soares Alberto M. , Abreu Cláudia B. , Filho José Quirino , Mota Rosa M. S. , Lima Ila F. N. , Havt Alexandre , Medeiros Pedro H. Q. S. , Prata Mara M. G. , Guedes Marjorie M. , Cavalcante Paloma A. , Veras Herlice N. , Santos Ana K. S. , Moore Sean R. , Pinkerton Relana C. , Houpt Eric R. , Guerrant Richard L.
Published: February 2017

Malnutrition results in serious consequences for growth and cognitive development in children. We studied select child and maternal biologic factors, socioeconomic factors, enteric pathogenic burden and gut function biomarkers in 402 children 6–24 months of age in Northeastern Brazil. In this prospective case–control study, not being fed colostrum [odds ratio (OR): 3.29, 95% confidence interval (CI): 1.73–6.26], maternal age ≥18 years (OR: 1.88, 95% CI: 1.10–3.22) and no electric fan (OR: 2.46, 95% CI: 1.22–4.96) or bicycle (OR: 1.80, 95% CI: 1.10–2.95) in the household were positively associated, and higher birth weight (OR: 0.27, 95% CI: 0.19–0.38), larger head circumference (OR: 0.74, 95% CI: 0.66–0.82) and shortness of breath in the last 2 weeks (OR: 0.49, 95% CI: 0.27–0.90) were negatively associated with malnutrition. Subclinical enteric pathogen infections were common, and enteroaggregative Escherichia coli infections were more prevalent in malnourished children (P = 0.045). Biomarkers such as the lactulose–mannitol test, myeloperoxidase, neopterin and calprotectin were highly elevated in both malnourished and nourished children. Nourished children had a better systemic immune response than the malnourished children, as detected by elevated serum amyloid A-1 and soluble cluster of differentiation protein 14 biomarkers (P < 0.001). Serum amyloid A-1 and soluble cluster of differentiation protein 14 were also associated with better nutritional Z scores. Neonatal, maternal and socioeconomic factors were associated with malnutrition in children. There was a substantial subclinical enteric pathogen burden, particularly with enteroaggregative E. coli, in malnourished children.
Less Anti‐infliximab Antibody Formation in Paediatric Crohn Patients on Concomitant Immunomodulators
Authors: Kansen Hannah M. , van Rheenen Patrick F. , Houwen Roderick H.J. , Tjon A Ten Walther , Damen Gerard M. , Kindermann Angelika , Escher Johanna C. , Wolters Victorien M. ,   Kids with Crohn's, Colitis (KiCC) Working Group for Collaborative Paediatric IBD Research in the Netherlands
Published: February 2017

Objectives:

To evaluate the effect of immunomodulators on formation of antibodies to infliximab (ATI) in paediatric patients with Crohn disease (CD) and the association of ATI and loss of response.

Methods:

Retrospective multicentre observational study (January 2009–December 2014) among Dutch children with CD treated with infliximab (IFX). ATI formation was analysed with Chi‐square test and time‐to‐ATI formation with Kaplan‐Meier and log‐rank test.

Results:

A total of 229 children were identified. ATIs were measured in 162 patients (70.7%) and 25 (15%) developed ATIs: 6 of 62 (10%) on continuous combined immunosuppression (CCI), 11 of 81 (14%) on early combined immunosuppression (ECI), and 8 of 19 (42%) on IFX monotherapy. ATI formation was higher in patients on IFX monotherapy compared to CCI (P = 0.003) and ECI (P = 0.008), whereas no significant difference was found between CCI and ECI. Sixteen out of 25 patients (64%) with ATIs had loss of response, compared with 32 of 137 patients (19%) without ATIs (P < 0.00002, log rank 0.02). Among patients treated with ECI, 10 of 55 (18%) developed ATIs within the first 12 months, compared to 1 of 26 (4%) after more than 12 months.

Conclusions:

In children with CD combination therapy is associated with significant reduction of antibody formation and prolonged effectivity compared to IFX monotherapy. ECI for at least 12 months, followed by IFX monotherapy, may be an equally effective alternative to CCI.
Syphilis Masquerading As Mass Lesions: The Utility of Modern-Day Imaging and Molecular Sequencing in Clinical Diagnosis
Authors: Lin Ray Junhao , Choudhury Saugata , Lee Cheng Chuan , Lee Tau Hong
Published: February 2017

Syphilis has been known to present in a myriad of symptoms throughout the ages, and until this day, the diagnosis remains elusive to the modern physician. We present 2 unusual cases of syphilis that posed diagnostic challenges even in the current era of new and advancing diagnostic tests.
Comparison of In-Person Versus Telephone Interviews for Early Syphilis and Human Immunodeficiency Virus Partner Services in King County, Washington (2010–2014)
Authors: Heumann Christine L. , Katz David A. , Dombrowski Julia C. , Bennett Amy B. , Manhart Lisa E. , Golden Matthew R.
Published: February 2017

Background

The relative effectiveness of in-person versus telephone interviews for human immunodeficiency virus (HIV)/sexually transmitted disease partner services (PS) is uncertain.

Methods

We compared outcomes of in-person versus telephone PS interviews for early syphilis (ES) and newly diagnosed HIV in King County, Washington from 2010 to 2014. We used multivariable Poisson regression to evaluate indices (number of partners per original patient [OP]) for partners named, notified, tested, diagnosed, and treated (ES only). Analyses controlled for OP age, sex, race/ethnicity, sexual orientation, time to interview, place of diagnosis, and staff performing interviews.

Results

For ES, 682 and 646 OPs underwent in-person and telephone interviews, respectively. In-person syphilis PS were associated with higher indices of partners named (in-person index [IPI], 3.43; telephone index [TI], 2.06; adjusted relative risk [aRR], 1.68; 95% confidence interval [CI], 1.55–1.82), notified (IPI, 1.70; TI, 1.13; aRR, 1.39; 95% CI, 1.24–1.56), tested (IPI, 1.15; TI, 0.72; aRR, 1.34; 95% CI, 1.16–1.54), and empirically treated (IPI, 1.03; TI, 0.74; aRR, 1.19; 95% CI, 1.03–1.37), but no difference in infected partners treated (IPI, 0.28; TI, 0.24; aRR, 0.93; 95% CI, 0.72–1.21). For HIV, 358 and 489 OPs underwent in-person and telephone interviews, respectively. In-person HIV PS were associated with higher indices of partners named (IPI, 1.87; TI, 1.28; aRR, 1.38; 95% CI, 1.18–1.62), notified (IPI, 1.38; TI, 0.92; aRR, 1.24; 95% CI, 1.03–1.50), and newly diagnosed with HIV (IPI, 0.10; TI, 0.05; aRR, 2.17; 95% CI, 1.04–4.50), but no difference in partners tested (IPI, 0.61; TI, 0.48; aRR, 1.15; 95% CI, 0.88–1.52).

Conclusions

Although in-person syphilis PS were associated with some increased PS indices, they did not increase the treatment of infected partners. In contrast, in-person HIV PS resulted in increased HIV case finding. These data support prioritizing in-person PS for HIV and suggest that in-person PS for syphilis may not have major public health benefit.
A Handoffs Software Led to Fewer Errors of Omission and Better Provider Satisfaction: A Randomized Control Trial
Authors: Kashiouris Markos G. , Stefanou Christos , Sharma Deepankar , Yshii-Tamashiro Cecilia , Vega Ryan , Hartigan Sarah , Albrecht Charles , Brown Robert H.
Published: February 2017

Background

Computer-assisted communication is shown to prevent critical omissions (“errors”) in the handoff process.

Objective

The aim of the study was to study this effect and related provider satisfaction, using a standardized software.

Methods

Fourteen internal medicine house officers staffed 6 days and 1 cross-covering teams were randomized to either the intervention group or control, employing usual handoff, so that handoff information was exchanged only between same-group subjects (daily, for 28 days).

Results

In the intervention group, fewer omissions (among those studied) occurred intravenous access (17 versus 422, P < 0.001), code status (1 versus 158, P < 0.001), diet/nothing per mouth (28 versus 477, P < 0.001), and deep venous thrombosis prophylaxis (17 versus 284, P < 0.001); duration to compose handoff was similar; and physicians perceived less workload adjusted for patient census and provider characteristics (P = 0.004) as well as better handoff quality (P < 0.001) and clarity (P < 0.001).

Conclusions

The intervention was associated with fewer errors and superior provider satisfaction.
Patients’ and Care Partners’ Perspectives on Dignity and Respect During Acute Care Hospitalization
Authors: Gazarian Priscilla K. , Morrison Constance R.C. , Lehmann Lisa Soleymani , Tamir Orly , Bates David W. , Rozenblum Ronen
Published: February 2017

Background

Delivering patient-centered care (PCC) is essential to our healthcare system. Patient dignity and respect are foundational elements of PCC. Understanding patients’ and their care partner’s perspectives on the meaning of dignity and respect within a clinical care environment is critical to achieving our goal of PCC.

Objective

The aim of the study was to understand how patients and their care partners define, describe, and experience dignity and respect during hospitalization.

Methods

We conducted a qualitative study with 22 patients and care partners hospitalized in high-acuity patient care areas in 1 academic medical center. Data collected from semistructured interviews were analyzed using grounded theory open coding in Atlas Ti software.

Results

Our data provide a definition of dignity and respect during hospitalization from the patient and care partner perspective and a conceptual model of the factors needed to enhance patients’ and care partners’ experience of dignity and respect in the hospital setting. Dignity was felt to be intrinsic to personhood including the recognition of that person’s value by others. Respect was characterized as the behavioral or social norms that acknowledge dignity. Determinants of dignity and respect were categorized at the organizational (macro) level and within the microsystem between clinicians, patients, and their care partners.

Conclusions

The definition of dignity and respect and the conceptual model presented here represent an important supplement to our understanding of dignity and respect during hospitalization. Healthcare organizations should focus on the key factors found in this study to create a culture that treats patients with dignity and respect.
In Vivo Ultrasound Characteristics of Vaginal Mesh Kit Complications
Authors: Javadian Pouya , Quiroz Lieschen H. , Shobeiri S. Abbas
Published: February 2017

Objective

The objective of this study was to investigate the ultrasound characteristics of vaginal mesh in women with vaginal mesh complications.

Methods

This was a cross-sectional study of women presenting with extrusion complications from vaginal mesh kit for prolapse at our tertiary care center between years 2009 and 2014. We included women who concurrently underwent a 3-dimensional endovaginal ultrasound (EVUS) as part of the clinical evaluation. We excluded women with incomplete charts and poor imaging quality. Subjects were categorized by the presence or absence of associated pelvic pain. Based on ultrasound findings, we compared the location of mesh, the appearance of mesh pattern (flat, folding, prominence, convoluted), and other EVUS characteristics of mesh.

Results

Forty-six women with vaginal mesh complications and good image quality were included. When comparing mesh length between posterior and anterior compartments, the posterior meshes were significantly longer than the anterior meshes (42.1 [SD, 11.9] mm vs 25.8 [SD, 9] mm; P < 0.0001) and more often associated with pain. In the posterior compartment, the mean mesh length seen on EVUS was significantly longer in women with pain than in women without pain (46.5 [SD, 9] mm vs 31.8 [SD, 12.1] mm; P = 0.0001). There was also a higher proportion of a “flat” mesh pattern, 14 (58.3%) of 25, in the posterior compartment associated with the presence of pain (P = 0.013). In the posterior compartment, a smaller distance between the distal edge of the mesh and the anal sphincter was significantly associated with the presence of pain (8 mm [0–37] vs 21 mm [8–35], P = 0.024). In both compartments, the EVUS had 100% sensitivity for detection of mesh extrusions.

Conclusions

In this population of patients presenting with mesh complications, the posterior meshes were more often visualized as a “flat” pattern with a higher frequency of pain. Mesh complications of the anterior compartment had a higher frequency of folding and shrinkage.
Calcitonin gene-related peptide in peripheral blood as a biomarker for migraine
Authors: Ramón César , Cernuda-Morollón Eva , Pascual Julio
Published: February 2017

Purpose of review

There is no available biomarker for any of the primary headaches, including migraine. As demonstrated in jugular blood, during a migraine attack, trigeminal activation releases several neuropeptides, very especially calcitonin gene-related peptide (CGRP), which gives rise to the typical throbbing migraine pain. Here, we review the current evidence for measurement of peripheral CGRP levels as a potential biomarker for trigemino-vascular activation in migraine.

Recent findings

Several studies, including a limited number of migraine patients, have shown increased peripheral CGRP levels during migraine attacks. The maximum increase in plasma CGRP levels was reached within 2 h of the onset of the attacks and can be reverted by triptans. In addition, CGRP levels measured in peripheral blood outside migraine attacks and in the absence of symptomatic medication have been shown to be increased in chronic migraine patients. Increased CGRP levels were able to predict the response to onabotulinumtoxinA treatment and were reduced 1 month after onabotulinumtypeA therapy.

Although CGRP data must be confirmed and expanded in future studies and specificity of CGRP levels should be studied in entities able to resemble migraine, it seems that peripheral CGRP levels are a good biomarker of acute migraine and somewhat specific and sensitive interictally in chronic migraine.
Postviral autoimmune encephalitis: manifestations in children and adults
Authors: Prüss Harald
Published: February 2017

Purpose of review

Autoimmune encephalitis is an increasingly recognized neuropsychiatric condition seen in patients of all ages. Herpes virus infections of the brain can antedate the development of pathogenic autoantibodies against N-methyl-D-aspartate receptors and further neuronal surface proteins, leading to neuronal dysfunction and relapsing symptoms. This review will recapitulate the recent scientific progress, clinical manifestations in children and adults, therapeutic options, and etiological concepts on how autoimmunity develops.

Recent findings

Postviral autoimmune encephalitis has been established as disease mechanism after herpes simplex virus encephalitis. Relapsing symptoms in the absence of virus occur in up to 20% of cases. The clinical presentation is relatively stereotyped in children, consisting of choreoathetosis and reduced levels of consciousness. Adults commonly present with psychiatric abnormalities and cognitive changes. Virus-induced antibody generation seems to be a widespread mechanism not confined to Herpesviridae and N-methyl-D-aspartate receptor antibodies

The presence of prolonged, atypical, or relapsing symptoms after virus encephalitis must be actively determined, requiring early follow-up visits of patients, and should always prompt the search for underlying autoantibodies. Relapsing symptoms can markedly improve with immunotherapy, thus treatment, including corticosteroids, plasma separation, immunoglobulins, and rituximab is usually recommended, even if no specific antibody was detected.
Seizures and risk of epilepsy in autoimmune and other inflammatory encephalitis
Authors: Spatola Marianna , Dalmau Josep
Published: February 2017

Purpose of review

The aim of this study was to assess the seizure manifestations and risk of epilepsy in encephalitis associated with antibodies against neuronal cell-surface (autoimmune encephalitis) or myelin-associated antigens, and to review several chronic epileptic disorders, including Rasmussen's encephalitis, fever-induced refractory epileptic syndromes (FIRES) and new-onset refractory status epilepticus (NORSE).

Recent findings

Seizures are a frequent manifestation of autoimmune encephalitis. Some autoimmune encephalitis may associate with characteristic features: faciobrachial dystonic seizures (anti-LGI1 encephalitis), electroencephalogram extreme delta brush (anti-NMDAR) or multifocal FLAIR-MRI abnormalities (anti-GABAAR). In anti-LGI1 encephalitis, cortical, limbic and basal ganglia dysfunction results in different types of seizures. Autoimmune encephalitis or myelin-antibody associated syndromes are often immunotherapy-responsive and appear to have a low risk for chronic epilepsy. In contrast patients with seizures related to GAD65-antibodies (an intracellular antigen) frequently develop epilepsy and have suboptimal response to treatment (including surgery). Rasmussen's encephalitis or FIRES may occur with autoantibodies of unclear significance and rarely respond to immunotherapy. A study of patients with NORSE showed that 30% developed chronic epilepsy.

Although seizures are frequent in all types of autoimmune encephalitis, the risk for chronic epilepsy is dependent on the antigen: lower if located on the cell-surface, and higher if intracellular. For other disorders (Rasmussen's encephalitis, FIRES, NORSE), the prognosis remains poor.
Sensorimotor control dynamics and cultural biases: learning to move in the right (or left) direction
Authors: Waterman Amanda H. , Giles Oscar T. , Havelka Jelena , Ali Sumaya , Culmer Peter R. , Wilkie Richard M. , Mon-Williams Mark
Published: February 2017

The nativist hypothesis suggests universal features of human behaviour can be explained by biologically determined cognitive substrates. This nativist account has been challenged recently by evolutionary models showing that the cultural transmission of knowledge can produce behavioural universals. Sensorimotor invariance is a canonical example of a behavioural universal, raising the issue of whether culture can influence not only which skills people acquire but also the development of the sensorimotor system. We tested this hypothesis by exploring whether culture influences the developing sensorimotor system in children. We took kinematic measures of motor control asymmetries in adults and children from differing cultures where writing follows opposite directions. British and Kuwaiti adults (
n
 = 69) and first grade (5–6 year old) children (
n
 = 140) completed novel rightward and leftward tracing tasks. The Kuwaitis were better when moving their arm leftward while the British showed the opposite bias. Bayesian analysis techniques showed that while children were worse than adults, they also showed asymmetries—with the asymmetry magnitude related to accuracy levels. Our findings support the idea that culture influences the sensorimotor system.
The use of clamping grips and friction pads by tree frogs for climbing curved surfaces
Authors: Endlein Thomas , Ji Aihong , Yuan Shanshan , Hill Iain , Wang Huan , Barnes W. Jon P. , Dai Zhendong , Sitti Metin
Published: February 2017

Most studies on the adhesive mechanisms of climbing animals have addressed attachment against flat surfaces, yet many animals can climb highly curved surfaces, like twigs and small branches. Here we investigated whether tree frogs use a clamping grip by recording the ground reaction forces on a cylindrical object with either a smooth or anti-adhesive, rough surface. Furthermore, we measured the contact area of fore and hindlimbs against differently sized transparent cylinders and the forces of individual pads and subarticular tubercles in restrained animals. Our study revealed that frogs use friction and normal forces of roughly a similar magnitude for holding on to cylindrical objects. When challenged with climbing a non-adhesive surface, the compressive forces between opposite legs nearly doubled, indicating a stronger clamping grip. In contrast to climbing flat surfaces, frogs increased the contact area on all limbs by engaging not just adhesive pads but also subarticular tubercles on curved surfaces. Our force measurements showed that tubercles can withstand larger shear stresses than pads. SEM images of tubercles revealed a similar structure to that of toe pads including the presence of nanopillars, though channels surrounding epithelial cells were less pronounced. The tubercles' smaller size, proximal location on the toes and shallow cells make them probably less prone to buckling and thus ideal for gripping curved surfaces.