bluuebunny/crossref_metadata_2025 huggingface dataset:
Connections between unit-regularity, regularity, cleanness, and strong cleanness of elements and rings
Authors: Nielsen Pace , Šter Janez
Published: October 2016

We construct an example of a unit-regular ring which is not strongly clean, answering an open question of Nicholson. We also characterize clean matrices with a zero column, and this allows us to describe an interesting connection between unit-regular elements and clean elements. Next we study in arbitrary rings those elements whose powers are regular, and provide a method for constructing inner inverses which satisfy many additional strong relations. As a corollary we show that if each of the powers

a
,

a
2

,
…
,

a
n

a,a^2,\ldots , a^n

is a regular element in some ring

R
R

(for some

n
≥
1

n\geq 1

), then there exists

w
∈
R

w\in R

such that

a
k

w
k

a
k

=

a
k

a^k w^k a^k=a^k

and

w
k

a
k

w
k

=

w
k

w^k a^k w^k=w^k

for

1
≤
k
≤
n

1\leq k\leq n

. Similar statements are also obtained for unit-regular elements. The paper ends with a large number of examples elucidating further connections (and disconnections) between cleanness, regularity, and unit-regularity.
Personal health records in the Netherlands: potential user preferences quantified by a discrete choice experiment
Authors: Determann Domino , Lambooij Mattijs S , Gyrd-Hansen Dorte , de Bekker-Grob Esther W , Steyerberg Ewout W , Heldoorn Marcel , Pedersen Line Bjørnskov , de Wit G Ardine
Published: October 2016

Objective: To identify groups of potential users based on their preferences for characteristics of personal health records (PHRs) and to estimate potential PHR uptake.

Methods: We performed a discrete choice experiment, which consisted of 12 choice scenarios, each comprising 2 hypothetical PHR alternatives and an opt-out. The alternatives differed based on 5 characteristics. The survey was administered to Internet panel members of the Dutch Federation of Patients and Consumer Organizations. We used latent class models to analyze the data.

Results: A total of 1,443 potential PHR users completed the discrete choice experiment. We identified 3 latent classes: “refusers” (class probability 43%), “eager adopters” (37%), and “reluctant adopters” (20%). The predicted uptake for the reluctant adopters ranged from 4% in the case of a PHR with the worst attribute levels to 68% in the best case. Those with 1 or more chronic diseases were significantly more likely to belong to the eager adopter class. The data storage provider was the most decisive aspect for the eager and reluctant adopters, while cost was most decisive for the refusers. Across all classes, health care providers and independent organizations were the most preferred data storage providers.

Conclusion: We identified 3 groups, of which 1 group (more than one-third of potential PHR users) indicated great interest in a PHR irrespective of PHR characteristics. Policymakers who aim to expand the use of PHRs will be most successful when health care providers and health facilities or independent organizations store PHR data while refraining from including market parties.
The effect of a disc on the population of cuspy and cored dark matter substructures in Milky Way-like galaxies
Authors: Errani Raphaël , Peñarrubia Jorge , Laporte Chervin F. P. , Gómez Facundo A.
Published: October 2016

We use high-resolution N-body simulations to study the effect of a galactic disc on the dynamical evolution of dark matter substructures with orbits and structural parameters extracted from the Aquarius A-2 merger tree (Springel et al. 2008a). Satellites are modelled as equilibrium N-body realizations of generalized Hernquist profiles with 2 × 106 particles and injected in the analytical evolving host potential at zinfall, defined by the peak of their mass evolution. We select all substructures with M200(zinfall) ≥ 108 M⊙ and first pericentric distances rp < r200. Motivated by observations of Milky Way dwarf spheroidal galaxies, we also explore satellite models with cored dark matter profiles with a fixed core size rc = 0.8 as where as is the Hernquist scale radius. We find that models with cuspy satellites have twice as many surviving substructures at z = 0 than their cored counterparts, and four times as many if we only consider those on orbits with rp ≲ 0.1 r200. For a given profile, adding an evolving disc potential reduces the number of surviving substructures further by a factor of ≲ 2 for satellites on orbits that penetrate the disc (rp ≲ 20 kpc). For large rp, where tidal forces and the effect of the disc become negligible, the number of satellites per pericentre bin converges to similar values for all four models.
Machine-learning selection of optical transients in the Subaru/Hyper Suprime-Cam survey
Authors: Morii Mikio , Ikeda Shiro , Tominaga Nozomu , Tanaka Masaomi , Morokuma Tomoki , Ishiguro Katsuhiko , Yamato Junji , Ueda Naonori , Suzuki Naotaka , Yasuda Naoki , Yoshida Naoki
Published: October 2016

We present an application of machine-learning (ML) techniques to source selection in the optical transient survey data with the Hyper Suprime-Cam (HSC) on the Subaru telescope. Our goal is to select real transient events accurately and in a timely manner out of a large number of false candidates, obtained by the standard difference-imaging method. We have developed the transient selector, which is based on majority voting of the three ML machines of AUC Boosting, Random Forest, and Deep Neural Networks. We applied it to our observing runs of Subaru-HSC in 2015 May and August, and proved it to be efficient in selecting optical transients. The false positive rate was 1.0% at the true positive rate of 90% in the magnitude range of 22.0–25.0 mag for the May data. For the August run, we successfully detected and reported 10 supernovae candidates within the same day as the observation. From these runs, we learned the following lessons: (1) training using artificial objects is effective in filtering false candidates out, especially for faint objects, and (2) a combination of ML by majority voting is advantageous.
The Role of Cognition and Social Functioning as Predictors in the Transition to Psychosis for Youth With Attenuated Psychotic Symptoms
Authors: Addington Jean , Liu Lu , Perkins Diana O. , Carrion Ricardo E. , Keefe Richard S. E. , Woods Scott W.
Published: October 2016

In the literature, there have been several attempts to develop prediction models for youth who are at clinical high risk (CHR) of developing psychosis. Although there are no specific clinical or demographic variables that seem to consistently predict the later transition to psychosis in those CHR youth, in addition to attenuated psychotic symptoms, the most commonly occuring predictors tend to be poor social functioning and certain cognitive tasks. Unfortunately, there has been little attempt to replicate alogorithms. A recently published article by Cornblatt et al suggested that, for individuals with attentuated psychotic symptoms (APS), disorganized communication, suspiciousness, verbal memory, and a decline in social functioning were the best predictors of later transition to psychosis (the RAP model). The purpose of this article was to first test the prediction model of Cornblatt et al with a new sample of individuals with APS from the PREDICT study. The RAP model was not the best fit for the PREDICT data. However, using other variables from PREDICT, it was demonstrated that unusual thought content, disorganized communication, baseline social functioning, verbal fluency, and memory, processing speed and age were predictors of later transition to psychosis in the PREDICT sample. Although the predictors were different in these 2 models, both supported that disorganized communication, poor social functioning, and verbal memory, were good candidates as predictors for later conversion to psychosis.
Chylous Ascites Complicating Modified Radical Hysterectomy for Placenta Percreta
Authors: Miller Heather , Anderson Matthew L. , Smith Christopher P. , Shamshirsaz Alireza A. , Fox Karin A.
Published: October 2016

BACKGROUND:

Chylous ascites is defined as the pathologic accumulation of lymphatic fluid within the peritoneal cavity and has been reported to complicate gynecologic surgeries, with an incidence of 0.17–2%. We report a case of chylous ascites after complex surgery for placenta percreta.

CASE:

A 26-year-old woman underwent cesarean delivery followed by bilateral uterine artery embolization and modified radical hysterectomy at 26 5/7 weeks of gestation for placenta percreta invading the urinary bladder. No surgical dissection was performed above the pelvic brim or deep into the pelvic sidewalls. On postoperative day 4, milky fluid consistent with chylous ascites was noted coming from a percutaneous drain. This completely resolved after 12 days of conservative management with intravenous nutritional support.

CONCLUSION:

Chylous ascites is a potential complication of modified radical hysterectomy for placenta percreta that responds to conservative management.
Women's Sexual Function, Satisfaction, and Perceptions After Starting Long-Acting Reversible Contraceptives
Authors: Higgins Jenny A. , Sanders Jessica N. , Palta Mari , Turok David K.
Published: October 2016

OBJECTIVE:

To document how long-acting reversible contraception (LARC) affects women's sexual outcomes.

METHODS:

In this prospective, observational cohort study, we enrolled new-start intrauterine device and contraceptive implant users attending four family planning clinics. Data collection occurred at baseline, 1 month, and 3 months. Primary outcomes were the Female Sexual Function Index, New Sexual Satisfaction Scale, and perceived sexual effects of method (positive, negative, or none). Secondary outcomes included other factors associated with LARC's sexual acceptability, including the ability to “let go” in sex, sense of control over pregnancy, and bleeding changes. Chi square and F-tests assessed differences between method groups at baseline. Mixed-effects models, robust Wald χ2 tests, and conditional logistic regression documented differences from baseline and trends over time.

RESULTS:

In December 2014 to April 2015, 200 patients consented and enrolled in the study. Among 159 women who completed three survey rounds, 20% selected copper intrauterine devices, 46% levonorgestrel intrauterine devices, and 34% implants. Sexual functioning and satisfaction scores did not change over time. However, across methods, participants were more likely to report improvements to their sexual lives compared with baseline (χ2
P<.001). By 3 months, 40% (n=64) reported positive changes and 17% (n=27) negative changes. Positive sexual changes were associated with one's sense of control over pregnancy and one's ability to “let go” in sex. Negative sexual changes were largely attributable to increased vaginal bleeding.

CONCLUSION:

Although new LARC users reported no measurable objective change in sexual function or satisfaction, a sizable minority reported perceived positive, method-related sexual changes.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, www.clinicaltrials.gov, NCT02734199.
Disorders of Sexual Development in Adult Women
Authors: Gomez-Lobo Veronica , Amies Oelschlager Anne-Marie ,   for the North American Society for Pediatric and Adolescent Gynecology
Published: October 2016

Disorders (differences) of sexual development encompass a variety of conditions with atypical development of chromosomal, gonadal, or anatomic sex. Three of the most common differences of sex development conditions include congenital adrenal hyperplasia, complete androgen insensitivity, and Turner syndrome. Obstetrician–gynecologists who care for affected individuals in their practice must be familiar with the genetic, endocrine, and anatomic considerations of the most common conditions to provide optimal care. As women with these conditions transition to adult care, the gynecologist needs to assess the patient's understanding and educate her regarding her diagnosis and ongoing medical care. All of these conditions may affect self-perception, mental health, fertility, sexual function, and bone and cardiovascular health. Women with congenital adrenal hyperplasia need lifelong endocrine management and require genetic counseling before pregnancy. Women with androgen insensitivity syndrome require counseling regarding gonadectomy and hormone replacement therapy and may require vaginal elongation for intercourse. Most women with Turner syndrome experience premature ovarian insufficiency and require long-term estrogen replacement. Women with Turner syndrome often have congenital anomalies and autoimmune disorders, which require regular monitoring and care during adulthood. The purpose of this review is to provide the obstetrician–gynecologist who cares for adult women with the most common disorders (differences) of sexual development conditions an outline of the current recommendations for screening and ongoing health care with particular emphasis on the underlying genetics, management of subfertility, infertility and sexual concerns, approach to hypogonadism, and understanding of associated comorbidities.
Enoxaparin and Aspirin Compared With Aspirin Alone to Prevent Placenta-Mediated Pregnancy Complications
Authors: Haddad Bassam , Winer Norbert , Chitrit Yvon , Houfflin-Debarge Véronique , Chauleur Céline , Bages Karine , Tsatsaris Vassilis , Benachi Alexandra , Bretelle Florence , Gris Jean-Christophe , Bastuji-Garin Sylvie ,   for the Heparin-Preeclampsia (HEPEPE) Trial Investigators
Published: October 2016

OBJECTIVE:

To evaluate whether daily enoxaparin, added to low-dose aspirin, started before 14 weeks of gestation reduces placenta-mediated complications in pregnant women with previous severe preeclampsia diagnosed before 34 weeks of gestation.

METHODS:

In this open-label multicenter randomized trial, we enrolled consenting pregnant women with previous severe preeclampsia diagnosed before 34 weeks of gestation, gestational age at randomization of 7–13 weeks, singleton pregnancy, and no plan for anticoagulation. Eligible patients were randomly assigned to a one-to-one ratio to receive daily either 4,000 international units enoxaparin plus 100 mg aspirin or 100 mg aspirin alone. Randomization was done by a web-based randomization system. The primary composite outcome comprised maternal death, perinatal death, preeclampsia, small for gestational age (less than the 10th percentile), and placental abruption. A sample size of 232 women equally divided into two groups was needed to detect a significant reduction in primary outcome from 55% in the aspirin group to 36.7% in the enoxaparin-aspirin group (α: 0.05, β: 0.8, two-sided).

RESULTS:

Between November 14, 2009, and February 21, 2015, 257 participants were enrolled. Baseline demographic and clinical factors were similar between groups. Eight women were excluded after randomization (six in the enoxaparin–aspirin group and two in the aspirin group), leaving 124 participants assigned to enoxaparin–aspirin and 125 to aspirin. Five participants were lost to follow-up (two in the enoxaparin–aspirin group and three in the aspirin group). There was no significant difference between the groups in the primary outcome: enoxaparin–aspirin 42 of 122 (34.4%) compared with aspirin alone 50 of 122 (41%) (relative risk 0.84, 95% confidence interval 0.61–1.16, P=.29). The occurrence of complications did not differ between the two groups.

CONCLUSION:

Antepartum prophylactic enoxaparin does not significantly reduce placenta-mediated complications in women receiving low-dose aspirin for previous severe preeclampsia diagnosed before 34 weeks of gestation.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, https://clinicaltrials.gov, NCT00986765.
Antenatal Corticosteroids and Outcomes of Small-for-Gestational-Age Neonates
Authors: Melamed Nir , Pittini Alex , Barrett Jon , Shah Jyotsna , Yoon Eugene W. , Lemyre Brigitte , Lee Shoo K. , Murphy Kellie E. , Shah Prakesh S. ,   for the Canadian Neonatal Network Investigators
Published: October 2016

OBJECTIVE:

To assess the association of antenatal corticosteroids and neonatal outcomes of preterm small-for-gestational-age (SGA) neonates and estimate whether the association is similar to that observed in appropriate-for-gestational-age (AGA) neonates.

METHODS:

We conducted a retrospective cohort study using data collected on singleton neonates born between 24 0/7 and 33 6/7 weeks of gestation and admitted to tertiary neonatal units in Canada between 2010 and 2014. Outcomes of SGA neonates (birth weight less than the 10th percentile) who received antenatal corticosteroids 1–7 days before birth (n=698) were compared with those of SGA neonates who did not receive antenatal corticosteroids (n=220). A similar comparison was performed between AGA neonates (birth weight between 10th and 90th percentile) who received antenatal corticosteroids 1–7 days before birth (n=3,781) and AGA neonates that did not receive antenatal corticosteroids (n=1,868). The association of antenatal corticosteroid exposure with outcomes was assessed using multivariable logistic regression and adjusted odds ratios (ORs) were compared between SGA and AGA groups.

RESULTS:

Of the 6,567 neonates eligible for the study, 918 (14.0%) were SGA. Women in the SGA group who were exposed to antenatal corticosteroids had a lower rate of neonatal death (7% compared with 12%, P=.01) compared with those not exposed to antenatal corticosteroids, whereas the rate of composite outcome was similar between the two groups (28% compared with 30%, P=.56). After adjustment for potential confounders, exposure to antenatal corticosteroids 1–7 days before birth was associated with beneficial effects among both the SGA and AGA groups with similar reduced odds of neonatal death (SGA: adjusted OR 0.29 [95% confidence interval (CI) 0.15–0.57] compared with AGA: adjusted OR 0.40 [95% CI 0.29–0.54], P=.40), composite outcome (SGA: adjusted OR 0.53 [95% CI 0.33–0.87] compared with AGA: adjusted OR 0.51 [95% CI 0.42–0.62], P=.85), need for mechanical ventilation (SGA: adjusted OR 0.60 [95% CI 0.39–0.91] compared with AGA: adjusted OR 0.54 [95% CI 0.46–0.64], P=.70), and severe brain injury (SGA: adjusted OR 0.42 [95% CI 0.22–0.84] compared with AGA: adjusted OR 0.39 [95% CI 0.30–0.51], P=.80). Similar reduction in the odds of neonatal death was observed in the subgroup of neonates with birth weight less than the fifth percentile for gestational age and sex: adjusted OR 0.38 (95% CI 0.16–0.92).

CONCLUSION:

For SGA preterm neonates, exposure to antenatal corticosteroids 1–7 days before birth was associated with decreased odds of neonatal mortality and morbidity similar in magnitude to that observed among AGA neonates.
Female Genital Mutilation
Authors: Abdulcadir Jasmine , Catania Lucrezia , Hindin Michelle Jane , Say Lale , Petignat Patrick , Abdulcadir Omar
Published: October 2016

Female genital mutilation comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs for nonmedical reasons. Health care providers for women and girls living with female genital mutilation have reported difficulties in recognizing, classifying, and recording female genital mutilation, which can adversely affect treatment of complications and discussions of the prevention of the practice in future generations. According to the World Health Organization, female genital mutilation is classified into four types, subdivided into subtypes. An agreed-upon classification of female genital mutilation is important for clinical practice, management, recording, and reporting, as well as for research on prevalence, trends, and consequences of female genital mutilation. We provide a visual reference and learning tool for health care professionals. The tool can be consulted by caregivers when unsure on the type of female genital mutilation diagnosed and used for training and surveys for monitoring the prevalence of female genital mutilation types and subtypes.
Breastfeeding Initiation Associated With Reduced Incidence of Diabetes in Mothers and Offspring
Authors: Martens Patricia J. , Shafer Leigh Anne , Dean Heather J. , Sellers Elizabeth A. C. , Yamamoto Jennifer , Ludwig Sora , Heaman Maureen , Phillips-Beck Wanda , Prior Heather J. , Morris Margaret , McGavock Jonathan , Dart Allison B. , Shen Garry X.
Published: October 2016

OBJECTIVE:

To examine associations between breastfeeding initiation and subsequent diabetes among First Nations (indigenous people in Canada who are not Métis or Inuit) and non–First Nations mothers and their offspring with and without gestational diabetes mellitus (GDM).

METHODS:

This retrospective database study included 334,553 deliveries (1987–2011) in Manitoba with up to 24 years of follow-up for diabetes using population-based databases. Information of breastfeeding initiation before hospital discharge was obtained from hospital abstracts recorded by nurses in postpartum wards. Cox proportional hazard models were applied to examine the association between breastfeeding initiation and risk of diabetes in mothers and their offspring.

RESULTS:

Breastfeeding initiation was recorded in 83% of non–First Nations mothers and 56% of First Nations mothers (P<.001). Breastfeeding initiation was associated with a reduced risk of incident (later developed) diabetes in non–First Nations mothers without GDM (hazard ratio [HR] 0.73 [or −27% of risk], 95% confidence interval [CI] 0.68–0.79), non–First Nations mothers with GDM (HR 0.78 or −22% of risk, CI 0.69–0.89), First Nations mothers without GDM (HR 0.89 or −11% of risk, CI 0.81–0.98), and First Nations mothers with GDM (HR 0.82 or −18% of risk, CI 0.73–0.92) with 24 years of follow-up or less. With 24 years of follow-up or less, breastfeeding initiation was associated with a 17% lower risk of youth-onset type 2 diabetes in offspring (HR 0.83, CI 0.69–0.99, P=.038). The association between breastfeeding initiation and subsequent diabetes in mothers and offspring was independent of family income, rural residence, First Nations status, GDM, parity, gestational hypertension, and age of the mother.

CONCLUSION:

Breastfeeding initiation is associated with a reduced risk of diabetes among women and their offspring in Manitoba. The results suggest that breastfeeding might be a potentially modifiable factor to reduce the risk of diabetes in both First Nations and non–First Nations women and children.
Maternal Diabetes, Birth Weight, and Neonatal Risk of Congenital Heart Defects in Norway, 1994–2009
Authors: Leirgul Elisabeth , Brodwall Kristoffer , Greve Gottfried , Vollset Stein E. , Holmstrøm Henrik , Tell Grethe S. , Øyen Nina
Published: October 2016

OBJECTIVE:

To investigate the association between pregestational or gestational diabetes and offspring risk of congenital heart defects and the association between large-for-gestational-age birth weight and risk of cardiac defects in offspring of diabetic women.

METHODS:

Information on pregestational and gestational diabetes, cardiac defects, and birth weight among all births in Norway in 1994–2009 was ascertained from the Medical Birth Registry of Norway, national health registries, and the Cardiovascular Disease in Norway project. The relative risk (RR) compared offspring risk of cardiac defects for maternal diabetes with offspring risk in nondiabetic mothers adjusted for year of birth, maternal age, and parity.

RESULTS:

Among 914,427 births (live births, stillbirths, terminated pregnancies), 5,618 (0.61%) were complicated by maternal pregestational diabetes and 9,726 (1.06%) by gestational diabetes. Congenital heart defects were identified in 10,575 offspring. The prevalence of cardiac defects differed between groups: 344 of 10,000 births to women with pregestational diabetes, 172 of 10,000 to women with gestational diabetes, and 114 of 10,000 in women without diabetes (adjusted RRs 2.92, 95% confidence interval [CI] 2.54–3.36 and 1.47, 95% CI 1.26–1.71). During the study period, the adjusted RRs for congenital heart defects did not change. The risk of cardiac defects in neonates very large for gestational age (birth weight greater than 3 standard deviations above the mean) was compared with neonates with birth weight appropriate for gestational age. For pregestational diabetes, the prevalences of offspring cardiac defects were 561 compared with 248 per 10,000 births (adjusted RR 2.23, 95% CI 1.39–3.59) and for gestational diabetes 388 compared with 132 per 10,000 (adjusted RR 2.73, 95% CI 1.53–4.85).

CONCLUSION:

The increased risk of having a child with a congenital heart defect has not changed for diabetic women in Norway since 1994. Among women with pregestational or gestational diabetes, having a large-for-gestational-age neonate was associated with a two- to threefold increased risk of cardiac defects compared with neonates with normal birth weight.
Factors Associated With Recurrence After Surgical Resection in Women With Intravenous Leiomyomatosis
Authors: Yu Xin , Zhang Guorui , Lang Jinghe , Liu Bao , Zhao Dachun
Published: October 2016

OBJECTIVE:

To analyze the recurrence features and prognostic factors of patients with intravenous leiomyomatosis after complete tumor resection.

METHODS:

We conducted a retrospective study of 58 patients with intravenous leiomyomatosis with follow-up data out of 75 patients treated from September 2005 to September 2015 and an analysis of postoperative recurrence features and prognostic factors.

RESULTS:

The average patient age was 45.4 years. The preoperative diagnosis rate was low. Among the 58 total patients, 31 had tumors that spread to the inferior vena cava and heart. During the median follow-up of 11.5 months, recurrence occurred in 18 patients at a rate of 31.0% (95% confidence interval 19.0–43.0%). Recurrence was associated with the preoperative tumor extent, and large vein involvement (16/31 compared with 2/27, P=.02) was a risk factor for postoperative recurrence. Postoperative recurrence was not associated with age (1/10 in 50 years or older compared with 17/48 younger than 50 years, P=.35), involvement of the heart (10/22 compared with 8/36, P=.28), resection of the uterus (16/51 compared with 2/7, P=.84) or bilateral ovaries (15/40 compared with 3/18, P=.65) with complete tumor removal, the choice of one-stage or two-stage surgery (11/45 for one-stage surgery compared with 7/13 for two-stage surgery, P=.20), postoperative antiestrogen hormone therapy (10/24 compared with 8/34, P=.53), or the hormone therapy duration (5/17 in the over-6-months group compared with 13/41 in the under-6-months group, P=.81).

CONCLUSION:

The postoperative recurrence rate of intravenous leiomyomatosis was high, and large vein involvement was associated with an increased risk of recurrence. Continued postoperative follow-up is important. Neither resection of bilateral ovaries nor postoperative hormone therapy was associated with recurrence.
Abdominal Incision Injection of Liposomal Bupivacaine and Opioid Use After Laparotomy for Gynecologic Malignancies
Authors: Kalogera Eleftheria , Bakkum-Gamez Jamie N. , Weaver Amy L. , Moriarty James P. , Borah Bijan J. , Langstraat Carrie L. , Jankowski Christopher J. , Lovely Jenna K. , Cliby William A. , Dowdy Sean C.
Published: October 2016

OBJECTIVE:

To investigate opioid use and pain scores associated with incisional injection of liposomal bupivacaine compared with bupivacaine hydrochloride after laparotomy for gynecologic malignancies.

METHODS:

A retrospective cohort study was conducted to compare abdominal incision infiltration with liposomal bupivacaine with bupivacaine hydrochloride after modification of a pre-existing enhanced recovery pathway. Patients undergoing staging laparotomy or complex cytoreductive surgery under the updated pathway were compared with patients treated under the original pathway (historic controls). Endpoints included cumulative opioid use (primary outcome) in oral morphine equivalents and cumulative pain score.

RESULTS:

In the complex cytoreductive cohort, median oral morphine equivalents were lower in the liposomal bupivacaine group through 24 hours (30 compared with 53.5 mg, P=.002), 48 hours (37.5 compared with 82.5 mg, P=.005), and the length of stay (62 compared with 100.5 mg, P=.006). Fewer liposomal bupivacaine patients required intravenous rescue opioids (28.9% compared with 55.6%, P<.001) or patient-controlled analgesia (4.1% compared with 33.3%, P<.001). Cumulative pain score was no different between groups through 48 hours (161 compared with 158, P=.69). Postoperative nausea and ileus were less frequent in patients receiving liposomal bupivacaine. Median hospital stay was 5 days in both groups. In the staging laparotomy cohort, cumulative opioids and cumulative pain score were no different between groups (through 48 hours: 162 compared with 161, P=.62; 38 compared with 38, P=.68, respectively). Intravenous rescue opioids (15.3% compared with 28.6%, P=.05) and patient-controlled analgesia (1.4% compared with 8.3%, P=.05) were used less frequently in the liposomal bupivacaine group. Median hospital stay was 4 days in both groups. Despite the higher cost of liposomal bupivacaine, total pharmacy costs did not differ between groups.

CONCLUSION:

Abdominal incision infiltration with liposomal bupivacaine was associated with less opioid and patient-controlled analgesia use with no change in pain scores compared with bupivacaine hydrochloride after complex cytoreductive surgery for gynecologic malignancies. Improvements were also seen in patients undergoing staging laparotomy.
Exogenous IL-2 Induces FoxP3+ Th17 Cells In Vivo in Melanoma Patients
Authors: Diller Maggie L. , Kudchadkar Ragini R. , Delman Keith A. , Lawson David H. , Ford Mandy L.
Published: October 2016

Th17 cells represent a distinct subset of CD4+ effector T cells with potent pathogenic qualities, capable of directly mediating tumor cell destruction. IL-2 has frequently been shown to have a negative effect on Th17 differentiation while supporting regulatory T-cell (FoxP3+CD4+, TREG) growth and development in both in vitro models and in vivo animal models. We investigated the effect of in vivo IL-2 on both the Th17 and FoxP3+CD4+ T-cell compartments in a human model of cancer. High-dose IL-2 (HDIL-2) was administered at a dose of 720,000 IU/kg to patients with melanoma (n=7) and peripheral blood was collected at baseline and at 24, 48, 72, and 96 hours posttreatment. Peripheral blood mononuclear cells (PBMCs) were isolated and subjected to intracellular cytokine and extracellular receptor staining for flow cytometry. We report that HDIL-2 increased both frequencies and absolute numbers of Th17 cells on day 4 of treatment. The administration of HDIL-2 to patients with melanoma increased IL-6 production by peripheral immune cells, a cytokine vital in the downregulation of FoxP3 expression and expansion of the Th17-cell population. Furthermore, we demonstrated that FoxP3+CD4+ T cells express IL-17 in patients with melanoma undergoing HDIL-2 therapy. Taken together, our findings indicate that HDIL-2 combined with the conditions of malignancy create an immune environment supportive of Th17 differentiation and that expansion of this compartment may occur through the transdifferentiation of IL-17-secreting FoxP3+CD4+ T cells.
Analysis of the Abscopal Effect With Anti-PD1 Therapy in Patients With Metastatic Solid Tumors
Authors: Ribeiro Gomes Jéssica , Schmerling Rafael A. , Haddad Carolina K. , Racy Douglas J. , Ferrigno Robson , Gil Erlon , Zanuncio Pedro , Buzaid Antônio C.
Published: October 2016

Abscopal effect is a rare phenomenon characterized by tumor regression of untreated metastatic lesions after a local therapy (eg, radiotherapy). We studied the probability of abscopal effect with radiotherapy associated with anti-programmed death cell 1 (PD1) therapy after progression on anti-PD1. This study is a retrospective analysis of patients treated with nivolumab or pembrolizumab for melanoma, non–small cell lung cancer (NSCLC) and renal cancer at Antônio Ermírio de Moraes Oncology Center, Brazil. To be eligible for this analysis, patients must have had unequivocal evidence of disease progression on anti-PD1 therapy and subsequent radiotherapy for any tumor site while still receiving anti-PD1. The abscopal effect was characterized as a response outside the irradiated field after radiotherapy plus anti-PD1. Sixteen patients were evaluated, including 12 metastatic melanoma, 2 metastatic NSCLC, and 2 metastatic renal cell carcinoma. The median time to disease progression on anti-PD1 was 3 months. The radiotherapy field included lung, lymph nodes, and bones, with a median total dose of 24 Gy (1–40 Gy), usually in 3 fractions (1–10 fractions). Three patients with melanoma developed an abscopal effect at a rate of 18.7% (25% among melanoma patients). Of note, one of them achieved a remarkable complete response lasting >6 months. Three patients with melanoma obtained a significant local response after radiotherapy, despite no response in distant metastases. Eleven patients presented disease progression after radiotherapy. No increased toxicity was observed. In conclusion, no patients with NSCLC or renal cancer showed abscopal effect, but 25% of patients with melanoma showed regression of nonirradiated lesions when anti-PD1 was continued after radiation to a tumor site that had progressed on anti-PD1 monotherapy.
A Prospective, Open-Label, Observational, Postmarket Study Evaluating VYC-17.5L for the Correction of Moderate to Severe Nasolabial Folds Over 12 Months
Authors: Sattler Gerhard , Philipp-Dormston Wolfgang G. , Van Den Elzen Helga , Van Der Walt Cornelius , Nathan Myooran , Kolodziejczyk Julia , Kerson Graeme , Dhillon Benjeev
Published: October 2016

BACKGROUND

VYC-17.5L (17.5 mg/mL hyaluronic acid, 0.3% lidocaine) is a dermal filler intended for deep dermis injection for the treatment of skin depressions.

OBJECTIVE

To evaluate 12-month effectiveness and safety of VYC-17.5L for the treatment of moderate/severe nasolabial folds (NLFs).

METHODS

Subjects ≥18 years old with moderate/severe NLFs were recruited (N = 70). Injected volume was aimed at achieving optimum correction; top-up treatment was given at 2 weeks if needed. The primary endpoint was investigator-assessed change in NLF severity over 12 months using the validated photonumeric NLF Severity Scale. Secondary endpoints included investigator- and subject-assessed satisfaction and safety. Adverse events judged to be more severe or prolonged than routinely observed were recorded.

RESULTS

Sixty-five subjects completed study requirements. Mean volume injected was 3.0 ± 1.0 mL for both NLFs combined. Significant improvement was maintained in investigator-assessed NLF severity at 12 months, and investigators and subjects reported high satisfaction with VYC-17.5L throughout the study. Two unexpected adverse events were reported: (1) redness, swelling, and decreased sensitivity (resolved after 4 days) and (2) swelling (resolved after 48 hours); neither event was serious or life threatening.

CONCLUSION

VYC-17.5L is effective and well tolerated for the treatment of moderate to severe NLFs for 1 year.
An investigation of life circumstances associated with the experience of hot flashes in Campeche, Mexico
Authors: Huicochea-Gómez Laura , Sievert Lynnette Leidy , Cahuich-Campos Diana , Brown Daniel E.
Published: October 2016

Objective:

The purpose of this study was to better understand the experience ofcalores(hot flashes) in the state of Campeche, Mexico, and characteristics of women's lives. This study was carried out to understand the sociocultural context of women's lives before conducting a larger semistructured survey in the same communities.

Methods:

Eighty-five women from rural and urban settings participated in open-ended interviews about the menopausal transition, with particular attention to hot flashes. Univariate and logistic regression analyses identified potential determinants of hot flashes. Qualitative responses were analyzed for central themes from the 40 women who experienced “calores” associated with menopause at the time of interview.

Results:

The word “calores” was used to describe a variety of sensations and experiences related to the hot climate, infections, going in and out of air-conditioning, emotional stress, and physical exertion, as well as the symptom associated with menopause. In quantitative analyses, the likelihood of experiencing hot flashes varied by menopause status and rural/urban residence. In qualitative analyses, themes that characterized the lives of women with hot flashes were as follows: the search for, and the availability of, biomedical care; presence or absence of networks of social support; marital status and quality of the relationship; and occupational stress.

Conclusions:

Hot flash questionnaires can elicit different symptom frequencies depending on the language used and the sociocultural context of women's lives. Qualitative findings suggest that the themes most likely to influence the perception and experience of hot flashes in Campeche are biomedicine, social support, marriage, and stress.
Cultural issues in menopause: an exploratory qualitative study of Macedonian women in Australia
Authors: Strezova Anita , O’Neill Sheila , O’Callaghan Cathy , Perry Astrid , Liu Jinzhu , Eden John
Published: October 2016

Objective:

This study explored the attitudes to, and experience of, menopause among Macedonian women living in Australia, including attitudes and responses to hormone therapy (HT) and complementary therapies, as well as related psycho-sexual, relationship and other midlife issues.

Methods:

Using qualitative methodology, the study was based on seven unstructured, nondirective group discussions. Natural social groups were recruited, meeting wherever each group felt most at home. A total of 81 participants ranged in age from 45 to 75 years. The women included both first-generation immigrants and women born in Australia to Macedonian parents. A bilingual Macedonian researcher conducted the fieldwork.

Results:

Participants typically claimed they lacked information about menopause in their native language, and their knowledge of HT was highly variable. Some women only felt comfortable approaching Macedonian doctors. Others reported an easing of symptoms when they revisited their homeland. Deeply religious participants claimed their faith helped them through this phase of life, and that they were as likely to consult a priest as a doctor. A recurring theme was that Macedonian men tended to regard their wives differently after menopause, sometimes treating them as “non-sexual.” Women regarded this shift in male attitudes as a precipitating factor in domestic violence, extramarital affairs and divorce. Symptoms such as hot flashes and mood swings were associated with negative attitudes toward menopause.

Conclusions:

Culturally determined attitudes appear to affect the perception and experience of menopause. Other influencing factors include migration, women's roles, marital status, religion, use of herbal and traditional remedies, social situation, access to information, knowledge and experience of menopausal symptoms.
Extended-release oxybutynin therapy for vasomotor symptoms in women: a randomized clinical trial
Authors: Simon James A. , Gaines Tatiana , LaGuardia Katherine D.
Published: October 2016

Objective:

Assess effects of once-daily, extended-release oxybutynin chloride on frequency and severity of vasomotor symptoms in healthy, postmenopausal symptomatic women.

Methods:

A 12-week, multicenter, double-blind, placebo-controlled, phase 2 clinical trial randomized naturally postmenopausal women experiencing at least seven moderate-to-severe vasomotor symptoms daily to oxybutynin 15 mg once daily (n = 73) or placebo (n = 75). Co-primary outcomes were the change from baseline to week 12 in the frequency and severity of moderate-to-severe vasomotor symptoms.

Results:

Significant reductions in both frequency and severity of moderate-to-severe vasomotor symptoms in women who received oxybutynin compared with placebo were observed at all weeks of treatment (P ≤ 0.007, all time points) through week 12. Mean changes in frequency in the oxybutynin and placebo groups were −9.48 and −4.69 episodes/d, respectively, at week 12. Mean changes in severity (scale 0-3) in the oxybutynin and placebo groups were −1.27 and −0.30, respectively, at week 12. At the end of treatment, 73% of women in the oxybutynin group and 26.1% in the placebo group rated symptom improvement “much better” (P ≤ 0.001). Women treated with oxybutynin showed significant improvement in sleep quality, sleep disturbance, and the global sleep index on the Pittsburgh Sleep Quality Index (P ≤ 0.023). Dry mouth was reported by 52.1% of participants given oxybutynin and 5.3% of participants given placebo, leading to discontinuation of oxybutynin in 6.8% of participants.

Conclusions:

Oxybutynin is an effective, nonhormonal therapy for moderate-to-severe vasomotor symptoms in postmenopausal women.
Reinserting the Hump in Primary Rhinoplasty: The Gain Is Three-fold
Authors: Constantinidis Jannis , Fyrmpas Georgios
Published: October 2016

Background:

Hump reduction in aesthetic rhinoplasty destabilizes the middle vault. Secondary maneuvers are necessary to avoid the long-term functional and aesthetic sequelae of middle vault collapse. We describe a new technique of reinserting the resected hump that combines (a) placement of the modified hump between the upper laterals and (b) bridging sutures between the upper laterals.

Methods:

Retrospective review of patients undergoing primary aesthetic rhinoplasty with hump resection.

Results:

Sixty-two patients, 46 with a straight and 16 with a deviated nose, enrolled. Twenty-three patients were operated through an open approach and 39 through a closed approach. Osteotomies were necessary in 56 patients. Mean follow-up was 13 months (range, 9–16 mo). A satisfactory result was achieved in all but 3 patients who had visible irregularities. Two of them required minimal rasping under local anesthesia and the third patient refused any further treatment.

Conclusions:

Our modification of Skoog’s original technique has certain advantages: the hump acts as a spreader and onlay graft, which preserves the natural dorsal lines. The sutures increase the nasal valve angle while preventing displacement of the reinserted hump. Indications include a straight or mildly deviated nose, a long thin-skinned nose with short nasal bones. The technique is also feasible through the closed or open approach and offers a valuable alternative to spreader grafts or flaps.
ANALYSIS OF AGE-RELATED CHOROIDAL LAYERS THINNING IN HEALTHY EYES USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY
Authors: Ruiz-Medrano Jorge , Flores-Moreno Ignacio , Peña-García Pablo , Montero Javier A. , García-Feijóo Julián , Duker Jay S. , Ruiz-Moreno José M.
Published: October 2016

Purpose:

To study the changes in the choroidal layers thickness with age in a healthy population using swept-source optical coherence tomography.

Methods:

Retrospective data analysis of a subgroup of eyes from a previous single-center, prospective, cross-sectional, noninterventional study. One hundred and sixty-nine healthy eyes were evaluated using swept-source optical coherence tomography. Inclusion criteria were best-corrected visual acuity between 20/20 and 20/25, spherical equivalent between ±3 diopters, and no systemic or ocular diseases. Two independent investigators determined the macular horizontal choroidal thickness (CT) and the Haller's layer thickness across a 9 mm line centered at the fovea. Subjects were divided into five age groups.

Results:

Mean subfoveal choroidal thickness was 305.76 ± 80.59 μm (95% confidence interval: 294.85–319.33). Mean subfoveal thickness for Haller's layer was 215.47 ± 67.70 μm (95% confidence interval: 207.30–227.86) and mean subfoveal thickness for choriocapillaris plus Sattler's layer was 87.31 ± 40.40 μm (95% confidence interval: 83.38–95.65). No significant differences were found due to gender. Choroidal thickness profile was similar between groups with choroidal thickness and Haller's layer thickness decreasing with age (P = 0.002).

Conclusion:

Choroidal and Haller's layer thickness profiles are similar between different age groups. Age-related choroidal thinning is mostly at the expense of Haller's layer.
REVERSIBLE NYCTALOPIA ASSOCIATED WITH VITAMIN A DEFICIENCY AFTER RESECTED MALIGNANT ILEAL CARCINOID AND PANCREATIC ADENOCARCINOMA
Authors: Hansen Bradley A. , Mendoza-Santiesteban Carlos E. , Hedges Thomas R.
Published: October 2016

Purpose:

To describe the rapid time course of visual and electroretinographic recovery from vitamin A deficiency in a patient with a history of multiple resected abdominal tumors, including ileal carcinoid and pancreatic adenocarcinoma.

Methods:

A 61-year-old white man with a history of resected malignant ileal carcinoid and Stage III pancreatic adenocarcinoma referred with complaints of 6 weeks of difficulty with night vision.

Results:

Initial testing showed significantly reduced scotopic rod responses in both eyes and decreased vitamin A levels and a normal cancer-associated retinopathy laboratory panel. He had complete recovery of both his symptoms and full-field electroretinography within 5 days of starting intramuscular vitamin A.

Conclusion:

Vitamin A deficiency–related retinopathy after abdominal surgery may be an underreported complication. This case provides a unique clinical perspective in our patient with a history of ileal carcinoid and Stage III pancreatic adenocarcinoma and confirms that rapid symptomatic and electroretinographic recovery is possible with appropriate treatment.
NOVEL PRERETINAL HAIR PIN–LIKE VESSEL IN RETINAL ASTROCYTIC HAMARTOMA WITH VITREOUS HEMORRHAGE
Authors: Soeta Megumi , Arai Yusuke , Takahashi Hidenori , Fujino Yujiro , Tanabe Tatsuro , Inoue Yuji , Kawashima Hidetoshi
Published: October 2016

Backgroud/Purpose:

To report a case of retinal astrocytic hamartoma with vitreous hemorrhage and a hair pin-like vessel adhering to a posterior vitreous membrane. A 33-year-old man with a retinal astrocytic hamartoma presented with vitreous hemorrhage 5 times.

Methods:

Multimodal imaging, including fundus photography, fluorescein angiography, optical coherence tomography, and B-mode ultrasonography.

Results:

Multimodal imaging demonstrated a novel hair pin-like vessel that adhered to the posterior vitreous membrane.

Conclusion:

Some cases of retinal astrocytic hamartoma with vitreous hemorrhage may be related to structure abnormalities of tumor vessels.