bluuebunny/crossref_metadata_2025 huggingface dataset:
Factorial electrochemical design for tailoring of morphological and optical properties of Cu2O
Authors: Cembrero-Coca Paula , Cembrero Jesús , Busquets-Mataix David , Pérez-Puig Miguel Angel , Marí Bernabé , Pruna Alina
Published: July 2017

The electrodeposition of cuprous oxide (Cu2O) onto FTO-coated glass substrate was studied by using a statistical approach in order to control the Cu2O morphology and optical properties. The factorial design considered four electrodeposition conditions at two representative levels as input variables (electrolyte temperature and pH, deposition potential and duration) and the deposition charge and morphology of obtained Cu2O as the output variables. The morphology analysis showed the highest influence on crystal shape was exhibited by electrolyte temperature and pH, reaching significance levels of 95 and 98%, respectively. Temperature as low as 35°C and pH 12.2 results in cubic morphology, while other parameters result in octahedron shape. The highest absorbance was exhibited by the Cu2O with cubic morphology.
Development and Implementation of an Alcohol Withdrawal Protocol using a 5-Item Scale, the Brief Alcohol Withdrawal Scale (BAWS)
Authors: Rastegar Darius A. , Applewhite Dinah , Alvanzo Anika A. H. , Welsh Christopher , Niessen Timothy , Chen Edward S.
Published: July 2017

Background

The standard of care for management of alcohol withdrawal is symptom-triggered treatment using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). Many items of this 10-question scale rely on subjective assessments of withdrawal symptoms, making it time-consuming and cumbersome to use. Therefore, there is interest in shorter and more objective methods to assess alcohol withdrawal symptoms.

Methods

A 6-item withdrawal scale developed at another institution was piloted. Based on comparison with the CIWA-Ar, this was adapted into a 5-item scale named the Brief Alcohol Withdrawal Scale (BAWS). The BAWS was compared with the CIWA-Ar and a withdrawal protocol utilizing the BAWS was developed. The new protocol was implemented on an inpatient unit dedicated to treating substance withdrawal. Data was collected on the first 3 months of implementation and compared with the 3 months prior to that.

Results

A BAWS score of 3 or more predicted CIWA-Ar score ≥8 with a sensitivity of 85.3% and specificity of 65.8%. The demographics of the patients in the 2 time periods were similar: the mean age was 45.9; 70.6% were male; 30.9% received concurrent treatment for opioid withdrawal; and 14.2% were receiving methadone maintenance. During the BAWS phase, patients received significantly less diazepam (mean dose 81.4 vs. 60.3 mg, P < .001). There was no significant difference in length of stay. No patients experienced a seizure, delirium, or required transfer to a higher level of care during any of the 664 admissions in either phase.

Conclusions

This simple protocol utilizing a 5-item withdrawal scale performed well in this setting. Its use in other settings, particularly with patients with concurrent medical illnesses or more severe withdrawal, needs to be explored further.
Cave fragmentation in a cave-to-mill context at the New Afton Mine part I: fragmentation and hang-up frequency prediction
Authors: Nadolski S. , Munkhchuluun M. , Klein B. , Elmo D. , Hart Craig
Published: July 2017

Block and panel caving methods are increasingly being proposed as an economical means for the excavation of ore deposits. The development of methods for predicting cave fragment size holds significant potential for reducing risk associated with cave mining projects. A fragmentation study was carried out for the New Afton B1 and B2 caves to generate fragmentation models that could be applied to future lifts. In part 1 of this paper, implications of fragmentation size for the mine are considered, whereas the effects on mill performance are addressed in part 2. Fragmentation measurements, from sieving and image-based methods, as well as historical logs of hang-up events are presented. Measurements showed that for the B1 and B2 caves, secondary fragmentation size, representing the size of material at drawpoints, is strongly related to faulting, height of draw and effects of the cave boundary.
The N-terminus of IFT46 mediates intraflagellar transport of outer arm dynein and its cargo-adaptor ODA16
Authors: Hou Yuqing , Witman George B.
Published: July 2017

Cilia are assembled via intraflagellar transport (IFT). The IFT machinery is composed of motors and multisubunit particles, termed IFT-A and IFT-B, that carry cargo into the cilium. Knowledge of how the IFT subunits interact with their cargo is of critical importance for understanding how the unique ciliary domain is established. We previously reported a Chlamydomonas mutant, ift46-1, that fails to express the IFT-B protein IFT46, has greatly reduced levels of other IFT-B proteins, and assembles only very short flagella. A spontaneous suppression of ift46-1 restored IFT-B levels and enabled growth of longer flagella, but the flagella lacked outer dynein arms. Here we show that the suppression is due to insertion of the transposon MRC1 into the ift46-1 allele, causing the expression of a fusion protein including the IFT46 C-terminal 240 amino acids. The IFT46 C-terminus can assemble into and stabilize IFT-B but does not support transport of outer arm dynein into flagella. ODA16, a cargo adaptor specific for outer arm dynein, also fails to be imported into the flagella in the absence of the IFT46 N-terminus. We conclude that the IFT46 N-terminus, ODA16, and outer arm dynein interact for IFT of the latter.
GLASS: assisted and standardized assessment of gene variations from Sanger sequence trace data
Authors: Pal Karol , Bystry Vojtech , Reigl Tomas , Demko Martin , Krejci Adam , Touloumenidou Tasoula , Stalika Evangelia , Tichy Boris , Ghia Paolo , Stamatopoulos Kostas , Pospisilova Sarka , Malcikova Jitka , Darzentas Nikos ,   European Research Initiative on CLL (ERIC)—TP53 Network
Published: July 2017

Motivation

Sanger sequencing is still being employed for sequence variant detection by many laboratories, especially in a clinical setting. However, chromatogram interpretation often requires manual inspection and in some cases, considerable expertise.

Results

We present GLASS, a web-based Sanger sequence trace viewer, editor, aligner and variant caller, built to assist with the assessment of variations in ‘curated’ or user-provided genes. Critically, it produces a standardized variant output as recommended by the Human Genome Variation Society.

Availability and implementation

GLASS is freely available at http://bat.infspire.org/genomepd/glass/ with source code at https://github.com/infspiredBAT/GLASS.

Supplementary information

Supplementary data are available at Bioinformatics online.
The Point Mutation G461S in the MfCYP51 Gene is Associated with Tebuconazole Resistance in Monilinia fructicola Populations in Brazil
Authors: Lichtemberg Paulo S. F. , Luo Yong , Morales Rafael G. , Muehlmann-Fischer Juliana M. , Michailides Themis J. , May De Mio Louise L.
Published: July 2017

The ascomycete Monilinia fructicola is the causal agent of brown rot of stone fruit in Brazil, causing major pre- and postharvest losses. For many years, the demethylation inhibitor (DMI) fungicide tebuconazole has been used as the most effective active ingredient for controlling brown rot and, as a result, strains of M. fructicola resistant to this ingredient have emerged in many Brazilian states producing stone fruit. The aim of this study was to investigate the mechanisms associated with the resistance of M. fructicola to DMI tebuconazole. By sequencing the M. fructicola CYP51 (MfCYP51) gene, encoding the azole target sterol 14α-demethylase, a mutation was identified at the nucleotide position 1,492, causing the amino acid substitution from glycine to serine at the codon position 461, associated with reduced tebuconazole sensitivity. In addition, it was observed that MfCYP51 gene expression could play a secondary role in DMI fungicide resistance of M. fructicola strains in Brazil. However, for the specific isolate found to exhibit elevated expression levels of MfCYP51, no insertions that would trigger gene expression were found. Based on the point mutation associated with tebuconazole resistance, an allele-specific polymerase chain reaction method was developed to quickly identify resistant genotypes within the Brazilian population. This is the first report determining molecular mechanisms for DMI resistance identification for M. fructicola isolates from Brazil. This information provides an important advancement for risk assessment of DMI fungicides used to manage brown rot of stone fruit.
Student Hotspotting: Teaching the Interprofessional Care of Complex Patients
Authors: Bedoya Pablo , Neuhausen Katherine , Dow Alan W. , Brooks E. Marshall , Mautner Dawn , Etz Rebecca S.
Published: July 2017

Problem

Individuals with complex health and social needs drive much of the total cost of care. Addressing these individuals’ needs and decreasing costs requires interprofessional teams, called “hotspotters,” who engage with communities with high utilization. Training health professions students to succeed in the hotspotting approach may benefit trainees, academic health centers (AHCs), and communities.

Approach

The Camden Coalition of Healthcare Providers and the Association of American Medical Colleges launched the Interprofessional Student Hotspotting Learning Collaborative in 2014. The goal was to train health professions students working in interprofessional teams at U.S. AHCs to meet the needs of complex patients, providing home visits and intensive case management for up to five patients over six months. The authors report themes from 20 reflections from the five-student Virginia Commonwealth University (VCU) team.

Outcomes

Across 10 sites, 57 students participated during June–December 2014. The review of the VCU experience demonstrated that the hotspotting program was successful in teaching students how social determinants affect health and the benefits of interprofessional teamwork for addressing the unmet health and social needs of complex patients. Key elements that students identified for improvement were more program structure; protected time for program activities; and formalized processes for recruiting, retaining, and transitioning patients.

Next Steps

Future iterations of the program should strengthen the curriculum on caring for complex patients, provide protected time or academic credit, and formally integrate teams with primary care. A larger study evaluating the program’s impact on patients, health systems, and communities should be undertaken.
A Novel Pediatric Residency Coaching Program: Outcomes After One Year
Authors: Rassbach Caroline E. , Blankenburg Rebecca
Published: July 2017

Problem

The ACGME requires all residency programs to assess residents on specialty-specific milestones. Optimal assessment of competence is through direct observation of performance in clinical settings, which is challenging to implement.

Approach

The authors developed the Stanford Pediatric Residency Coaching Program to improve residents’ clinical skill development, reflective practice, feedback, and goal setting, and to improve learner assessment. All residents are assigned a dedicated faculty coach who coaches them throughout their training in various settings in an iterative process. Each coaching session consists of four parts: (1) direct observation, (2) facilitated reflection, (3) feedback from the coach, and (4) goal setting. Coaches document each session and participate in the Clinical Competency Committee. Initial program evaluation (2013 –2014) focused on the program’s effect on feedback, reflection, and goal setting. Pre- and postintervention surveys of residents and faculty assessed the quantity and quality of feedback provided to residents and faculty members’ confidence in giving feedback.

Outcomes

Review of documented coaching sessions showed that all 82 residents had 3 or more direct observations (range: 3–12). Residents and faculty assessed coaches as providing higher-quality feedback and incorporating more reflection and goal setting than noncoaches. Coaches, compared with noncoaches, demonstrated increased confidence in giving feedback on clinical reasoning, communication skills, and goal setting. Noncoach faculty reported giving equal or more feedback after the coaching program than before.

Next Steps

Further evaluation is under way to explore how coaching residents can affect patient-level outcomes, and to better understand the benefits and challenges of coaching residents.
Surgical treatment of displaced pediatric lateral condyle fractures of the humerus by the posterior approach
Authors: Conaway William K. , Hennrikus William L. , Ravanbakhsh Samine , Winthrop Zachary , Mahajan John
Published: July 2017

The surgical approach for open reduction and internal fixation of lateral condyle fractures in children is controversial. Some authors recommend the lateral approach to the elbow over the posterior approach because of theoretical concern for injury to the vascular supply of the distal humerus and potential avascular necrosis (AVN). The purpose of this retrospective case series study is to report the outcomes of open reduction and internal fixation of displaced lateral condyle fractures of the humerus by the posterior approach. Fifteen consecutive cases were reviewed and the posterior approach resulted in minimal postoperative loss of motion, no angular deformity, cosmetic scars, and no AVN. We support that AVN occurs because of stripping of soft tissues from the lateral condyle fragment and not the approach used. Stripping of soft tissues is not required when using the posterior approach because of excellent visualization of the fracture reduction.
Effects of ceftriaxone on conditioned nicotine reward in rats
Authors: Philogene-Khalid Helene L. , Simmons Steven J. , Muschamp John W. , Rawls Scott M.
Published: July 2017

Nicotine is the addictive compound in tobacco products which exerts psychosomatic effects that contribute to abuse and to low rates of abstinence in treatment-seeking smokers. At present, the most successful smoking cessation aide helps one in four individuals quit smoking at 1 year postcessation. New adjunctive therapies are needed to improve status of smoking-related public health crises, and β-lactam antibiotics are one class of potential therapies as they favorably augment extrasynaptic glutamate clearance. Our study used two-chamber place conditioning to assess effects of ceftriaxone (CTX) on persistence of conditioned nicotine reward. Rats were conditioned to associate nicotine (0.4 mg/kg, subcutaneous) with one context and vehicle with an alternative context. After initial post-test, rats received either daily ceftriaxone (200 mg/kg, intraperitoneal) or saline. All rats showed nicotine place preference during post-test 1. CTX-treated rats meeting extinction criterion by post-test 7 showed significantly reduced preference for the nicotine-paired context during post-test 2 compared with vehicle-treated rats. We interpret these data to support the further study of CTX as a smoking cessation aide. Our results suggest that CTX reduces persistence of conditioned nicotine reward and may be helpful for improving abstinence rates in a subset of treatment-seeking smokers.
Maternal separation induces long-term effects on monoamines and brain-derived neurotrophic factor levels on the frontal cortex, amygdala, and hippocampus: differential effects after a stress challenge
Authors: Récamier-Carballo Soledad , Estrada-Camarena Erika , López-Rubalcava Carolina
Published: July 2017

The maternal separation (MS) paradigm is a well-known animal model that resembles the stress of early adverse life experiences and produces structural and functional abnormalities when animals are adults. The present study analyzed the effect of MS, in adult mice, on brain-derived neurotrophic factor (BDNF), serotonin (5-HT), and dopamine (DA) levels, and the turnover rate in the hippocampus, frontal cortex, and amygdala, and brain regions that are associated with emotion. Also, the effects of MS in depression-like responses in adult mice were studied. The results showed that MS from postnatal day 8–21 induces depression-like behaviors. In MS mice, the three brain areas showed differential responses in 5-HT, DA, and BDNF concentrations both in basal levels and when animals were challenged with an acute stressor in adulthood. Specifically, under basal conditions, MS increased monoamine and BDNF levels in the hippocampus and amygdala, but decreased these levels in the frontal cortex. In MS, but not in control mice, the amygdala responded to the stress challenge, whereas the frontal cortex showed no response. Finally, the hippocampus showed increased 5-HT and DA activity, but not increased BDNF after the stress challenge in MS mice. The present results support the theory of the hypofunctionality of the frontal cortex and hyperactivity of mesolimbic areas in depression-like conditions.
Effect of CYP3A4 and CYP3A5 Genetic Polymorphisms on the Pharmacokinetics of Sirolimus in Healthy Chinese Volunteers
Authors: Zhang Jing , Dai Ying , Liu Zhihong , Zhang Minxin , Li Chen , Chen Dingxiong , Song Hongtao
Published: July 2017

Background:

Sirolimus is a promising immunosuppressive drug for preventing the rejection of organ transplants. However, inter-individual variability in sirolimus pharmacokinetics causes adverse drug reactions, compromising therapeutic efficacy. Sirolimus is primarily metabolized by cytochrome CYP3A4 and CYP3A5. This study aimed to clarify the effect of CYP3A genetic polymorphisms, including the CYP3A4*1G and CYP3A5*3 polymorphisms, on the pharmacokinetics of sirolimus.

Methods:

Thirty-one healthy Chinese volunteers were included in this study. Their genotypes were determined using the Sequenom MassARRAY iPLEX platform, and blood sirolimus concentrations at different time points were analyzed by liquid chromatography–tandem mass spectrometry (LC-MS/MS). The pharmacokinetic parameters were calculated using WinNonlin version 5.2 software.

Results:

The allele frequencies of CYP3A4*1G and CYP3A5*3 were 25.8% and 71.0%, respectively. In CYP3A4*1G carriers (n = 13), the area under the curve AUC0–144, AUC0–∞, and Cmax were significantly lower (P < 0.05) than CYP3A4*1/*1 homozygous subjects (n = 18). Briefly, the AUC0–144, AUC0–∞, and Cmax of *1G/
*1G carrier were 315.2 ± 91.5, 372.0 ± 108.2, and 10.2 ± 1.6 ng/mL, respectively, and those of *1/*1 G*1/*1 G carrier were 440.8 ± 130.6, 537.4 ± 167.5, and 13.7 ± 4.3, respectively, whereas those of CYP3A4*1/*1 homozygous subjects were 540.2 ± 150.6, 626.6 ± 166.9, and 19.8 ± 7.5 ng/mL, respectively. In CYP3A5-nonexpressing subjects (*3/*3 homozygous carriers, n = 15), the AUC0–144 and Cmax were 549.6 ± 137.9 and 19.9 ± 7.9 ng/mL, respectively, and were significantly higher (P < 0.05) than the values in CYP3A5-expressing subjects (*1/*1homozygous carrier, n = 2; 314.2 ± 129.3 and 10.3 ± 2.2 ng/mL; *1/*3 heterozygous carrier, n = 15; 440.2 ± 146.3 and 14.6 ± 5.1 ng/mL, respectively).

Conclusions:

CYP3A4 and CYP3A5 genetic polymorphisms are important factors affecting pharmacokinetic parameters of sirolimus. Our data support the monitoring of blood sirolimus concentrations, especially in CYP3A5*1 and CYP3A4*1 G carriers, to ensure accurate dosing in the clinical setting.
Dried Blood Spot Sampling for Tacrolimus and Mycophenolic Acid in Children: Analytical and Clinical Validation
Authors: Martial Lisa C. , Hoogtanders Karin E. J. , Schreuder Michiel F. , Cornelissen Elisabeth A. , van der Heijden Jac , Joore Manuela A. , Van Maarseveen Erik M. , Burger David M. , Croes Sander , Brüggemann Roger J. M. , Aarnoutse Rob E.
Published: July 2017

Background:

Tacrolimus and mycophenolic acid (MPA) are the backbone of immunosuppressive therapy after pediatric kidney transplantation. Dosing of these drugs is individualized by therapeutic drug monitoring. Dried blood spot (DBS) sampling may prove beneficial over conventional venous sampling. We aimed to develop and clinically validate a DBS method for tacrolimus and MPA in children.

Methods:

A joint DBS liquid chromatography-mass spectrometry assay for tacrolimus and MPA was developed. DBS-specific items included the hematocrit effect and influence of spot volume. Subsequently, a clinical validation study among children aged 2–18 years was performed to assess the agreement between observed and DBS-predicted venous concentrations. Agreement of the methods was assessed with Passing–Bablok regression, Bland–Altman plots, and quantification of the DBS predictive performance in terms of bias (median percentage prediction error) and precision (median absolute percentage prediction error), both should be <15%.

Results:

A total of 40 tacrolimus and 32 MPA samples were available from 28 children. Conversion factors were used to predict venous concentrations from DBS. For tacrolimus, 95% of the individual ratios of predicted and observed concentrations were within a range of 0.74–1.28, with 85% of these ratios between 0.80 and 1.20 (Bland–Altman plots). For MPA, the 95% limits of agreement represented a broader range of 0.49–1.49%, and 72% of individual ratios were between the 0.80 and 1.20 limits. Median percentage prediction error and median absolute percentage prediction error were less than 15% for both drugs.

Conclusions:

A DBS assay was developed for tacrolimus and MPA. Tacrolimus venous concentrations could be adequately predicted from DBS. DBS analysis of MPA seemed to be a semiquantitative measurement at the most when compared with conventional plasma analysis, considering the high variability between observed and predicted concentrations. Next, home-based DBS sampling of tacrolimus for the purpose of therapeutic drug monitoring will be implemented into routine clinical care.
Recurrence Rates Over 20 Years in the Treatment of Malignant Melanoma: Immediate Versus Delayed Reconstruction
Authors: Koolen Pieter G.L. , Matos Tiago R. , Ibrahim Ahmed M.S. , Sun Jie , Lee Bernard T. , Frankenthaler Robert A. , Lin Samuel J.
Published: July 2017

Background:

Wide local excision (WLE) with a safety margin is the standard of treatment for primary head and neck cutaneous malignant melanoma (HNCMM). Studies have demonstrated inconsistency in recurrence rates following immediate versus delayed reconstruction. The objectives of this study were to assess and compare recurrence rates after WLE of HNCMM followed by immediate or delayed reconstruction in determining recurrence-free survival estimates.

Methods:

A consecutive, retrospective analysis of 451 patients undergoing WLE of primary HNCMM followed by reconstruction over a period of 20 years was performed. Patients were divided into 2 groups based on timing of reconstruction (immediate versus delayed). Univariate analyses were performed to assess distributions. Kaplan–Meier survival analysis and multivariate Cox proportional hazard analyses were performed to estimate recurrence-free survival.

Results:

Tumor specimen positive margins were comparable between immediate and delayed reconstruction groups (P = 0.129). Univariate analysis demonstrated comparable local melanoma recurrence after immediate or delayed reconstruction (41.4% versus 53.3%; P = 0.399). After adjusting for prognostic factors, multivariate analysis also failed to demonstrate an association between reconstruction timing and local recurrence-free survival (P = 0.167).

Conclusions:

In this long-term study, we were not able to demonstrate an association between reconstruction timing and local recurrence-free survival after excision WLE of HNCMM, rendering immediate reconstruction a reliable approach. In addition, the presence of ulceration and a positive sentinel lymph node were positively associated with the risk of recurrence.
COMPARISON OF 2D AND 3D VIDEO DISPLAYS FOR TEACHING VITREORETINAL SURGERY
Authors: Chhaya Nisarg , Helmy Omar , Piri Niloofar , Palacio Agustina , Schaal Shlomit
Published: July 2017

Purpose:

To compare medical students' learning uptake and understanding of vitreoretinal surgeries by watching either 2D or 3D video recordings.

Methods:

Three vitreoretinal procedures (tractional retinal detachment, exposed scleral buckle removal, and four-point scleral fixation of an intraocular lens [TSS]) were recorded simultaneously with a conventional recorder for two-dimensional viewing and a VERION 3D HD system using Sony HVO-1000MD for three-dimensional viewing. Two videos of each surgery, one 2D and the other 3D, were edited to have the same content side by side. One hundred UMass medical students randomly assigned to a 2D group or 3D, then watched corresponding videos on a MacBook. All groups wore BiAL Red-blue 3D glasses and were appropriately randomized. Students filled out questionnaires about surgical steps or anatomical relationships of the pathologies or tissues, and their answers were compared.

Results:

There was no significant difference in comprehension between the two groups for the extraocular scleral buckle procedure. However, for the intraocular TSS and tractional retinal detachment videos, the 3D group performed better than 2D (P < 0.05) on anatomy comprehension questions.

Conclusion:

Three-dimensional videos may have value in teaching intraocular ophthalmic surgeries. Surgical procedure steps and basic ocular anatomy may have to be reviewed to ensure maximal teaching efficacy.
Comparison of Collagen Cross-Linking and Amniotic Membrane Transplantation in an Experimental Alkali Burn Rabbit Model
Authors: Subasi Sevgi , Altintas Ozgul , Yardimoglu Melda , Yazir Yusufhan , Karaman Suleyman , Rencber Selenay Furat , Kavram Kubra
Published: July 2017

Purpose:

To compare the effects of collagen cross-linking (CXL) and amniotic membrane transplantation (AMT) on acute corneal alkali burns.

Methods:

After establishment of an alkali burn model, 32 rabbits were divided into 4 groups: control group, AMT group, CXL group, and AMT + CXL (combined) group. Clinical parameters, including epithelial wound, opacity, ulceration, and neovascularization, were evaluated on postinjury days 1, 7, 14, and 18. Histological parameters were examined in hematoxylin/eosin (H&E) and Masson trichrome–stained corneal sections. Immunohistochemical analyses, including a terminal deoxynucleotidyl transferase–mediated biotin–deoxyuridine triphosphate nick-end labeling assay and cluster of differentiation 68 (CD68) labeling, were performed to determine the apoptotic index and macrophage activation.

Results:

On postinjury day 18, the epithelial wound of AMT {4.08% [interquartile range (IQR), 0.68%–5.22%]}, CXL [1.84% (IQR, 0.01%–3.89%)], and combined [3.44% (IQR, 0.01%–4.36%)] groups were significantly lower than the control [15.23% (IQR, 9.86%–23.06%)] group (P = 0.003). No significant difference was detected between the groups in terms of opacity (P = 0.303). Neovascularization was the least severe in the CXL group [16.18% (IQR, 8.39%–21.28%)] and the most severe in the AMT [34.47% (IQR, 17.71%–62.77%)] and combined [35.12% (IQR, 31.96%–59.98%)] groups on day 18 (P = 0.033). Significant increases in the apoptotic index and CD68 labeling were detected in the CXL and combined groups compared with those in the control group (P = 0.047 and P = 0.001, respectively).

Conclusions:

CXL treatment is an effective adjuvant treatment for promoting reepithelialization, reducing inflammation and neovascularization, and preventing ulceration in acute alkali burns. Providing AMT after suppressing inflammation may be a more effective treatment.
A Lacrimal Gland Choristoma of the Lacrimal Sac
Authors: Wang Yvonne , Jakobiec Frederick A. , Zakka Fouad R. , Lee Nahyoung Grace
Published: July 2017

Choristomatous lacrimal gland tissue has been detected in many different sites of the ocular adnexa, but has never before been convincingly described in the submucosa of the lacrimal sac. A 77-year-old woman with epiphora had a biopsy of the sac wall preformed during a dacryocystorhinostomy that contained such a lacrimal choristoma. Zymogen granules were found in the cytoplasm of the secretory cells with the periodic acid-Schiff reaction. No mucus-producing cells, as found in normal sac submucosal glands, were detected using the Alcian blue, mucicarmine, and Gomori methenamine silver histochemical stains. Gross cystic fluid protein-15 positivity was demonstrated immunohistochemically. The clinical implications of this choristoma are explored.
Crisaborole Topical Ointment, 2%
Authors: Parker James K. , Jacob Sharon E.
Published: July 2017

A drug is defined as a substance that exerts a physiologic effect upon introduction to a biological system. These drugs may come in various forms including ingested pills, topical creams or ointments, and inhaled or injected substances. The purpose of this column is to bring attention to common drugs used in dermatology, their usage and purpose, their mechanisms, and available alternatives. This edition focuses on crisaborole and its use in the treatment of atopic dermatitis.
Impact of Ramadan on emergency department visits and on medical emergencies
Authors: Al Assaad Reem G. , Bachir Rana , El Sayed Mazen J.
Published: July 2017

Background

Fasting during Ramadan is important to Muslims. This study describes changes in emergency department (ED) visits and in frequencies of emergency conditions and impact on clinical outcomes during Ramadan in a tertiary care center in Beirut, Lebanon.

Patients and methods

Patients presenting to ED during Ramadan 1 month before and 1 month after Ramadan over a 3-year period with specific conditions (acute coronary syndrome, stroke, seizure, diabetes, renal colic, headache or hypertension) were included. Clinical and sociodemographic characteristics, ED volume, diagnoses, and outcomes were examined during two periods (Ramadan vs. non-Ramadan). Multiple logistic regressions were performed to identify the impact of Ramadan on ED bounce-back and mortality at ED discharge.

Results

A total of 3536 patients were included. The daily average ED volume was higher during non-Ramadan months (145.65±22.14) compared with Ramadan (128.85±14.52). The average ED length of stay was higher during Ramadan (5.42±14.86 vs. 3.96±4.29 h; P=0.006). Frequencies and admission rates for the selected diseases were comparable during the two periods, except for patients with acute coronary syndrome or stroke who had lower admission rates during Ramadan.

ED bounce-back rates and mortality at ED discharge were higher during Ramadan (odds=1.34, 95% confidence interval: 1.03–1.74 and odds ratio=2.88, 95% confidence interval: 1.01–8.27, respectively).

Conclusion

EDs might experience a decrease in volumes, higher length of stay, and potentially worse outcomes during Ramadan. Changes in the frequencies of ED visits related to common conditions are not expected. Prospective studies documenting fasting status would clarify further the impact of Ramadan.
The impact of medical specialist staffing on emergency department patient flow and satisfaction
Authors: van der Linden M. Christien , de Beaufort Roeline A.Y. , Meylaerts Sven A.G. , van den Brand Crispijn L. , van der Linden Naomi
Published: July 2017

Objective

The aim of this study was to describe the impact of additional medical specialists, non-emergency physicians (non-EPs), performing direct supervision or a combination of direct and indirect supervision at an EP-led emergency department (ED), on patient flow and satisfaction.

Patients and methods

An observational, cross-sectional, three-part study was carried out including staff surveys (n=379), a before and after 16-week data collection using data of visits during the peak hours (n=5270), and patient questionnaires during 1 week before the pilot and during week 5 of the pilot. Content analysis and descriptive statistics were used for analyses.

Results

The value of being present at the ED was acknowledged by medical specialists in 49% of their surveys and 35% of the EPs’ and ED nurses’ surveys, especially during busy shifts. Radiologists were most often (67.3%) convinced of their value of being on-site, which was agreed upon by the ED professionals. Perceived improved quality of care, shortening of length of stay, and enhanced peer consultation were mentioned most often.

During the pilot period, length of stay of boarded patients decreased from 197 min (interquartile range: 121 min) to 181 min (interquartile range: 113 min, P=0.006), and patient recommendation scores increased from −15 to +20.

Conclusion

Although limited by the mix of direct and indirect supervision, our results suggest a positive impact of additional medical specialists during busy shifts. Throughput of admitted patients and patient satisfaction improved during the pilot period. Whether these findings differ between direct supervision and combination of direct and indirect supervision by the medical specialists requires further investigation.
Endoscopic mucosal resection and endoscopic submucosal dissection: technique and new directions
Authors: Nishizawa Toshihiro , Yahagi Naohisa
Published: July 2017

Purpose of review

Most of small tumours in gastrointestinal tract are easily removed by endoscopic mucosal resection (EMR). However, EMR are sometimes not reliable to ensure the complete resection for large tumours. Although endoscopic submucosal dissection (ESD) was developed, it had a higher risk for complications such as perforation and bleeding. The techniques and clinical outcomes of EMR and ESD are reviewed.

Recent findings

ESD is more effective for early gastric and oesophageal cancer with higher en-bloc resection rate and lower local recurrence in comparison to EMR. Several studies report favourable long-term outcomes of ESD. ESD has become a standard technique in Japan and other East Asian countries. Piecemeal resection using EMR technique is widely accepted for colorectal large adenomas and results in good clinical outcomes in most patients. However, apparent cancerous lesions need endoscopic en-bloc resection by ESD.

Further development of the technique, devices and training systems will promote worldwide standardization of ESD.
Antibiotic resistance in Helicobacter pylori
Authors: Alba Claudio , Blanco Ana , Alarcón Teresa
Published: July 2017

Purpose of review

Treatment of Helicobacter pylori is difficult nowadays because of its high resistance. The prevalence and mechanism of resistance, the different methods to detect it and the clinical implication of resistance were addressed in several research papers last year.

Recent findings

Clarithromycin-resistant H. pylori has been recognized by the WHO as ‘high priority’, for which new antibiotics are needed. Moreover, the Maastricht consensus recommended, in areas with high resistance, that susceptibility tests should be performed, at least after a treatment failure.

Metronidazole and clarithromycin resistance rates are alarming although they vary among populations. Tetracycline and amoxicillin-resistance are very low in most countries. H. pylori resistance can be detected by phenotypic or by molecular methods. Different break points may be used when performing an antimicrobial susceptibility test, so comparing resistance among different populations is challenging. Genomic techniques open new possibilities in the diagnosis of H. pylori, and the detection of H. pylori and its antimicrobial resistance in faeces is an interesting approach. Eradication rates are dependent on the susceptibility of the strain to metronidazole and clarithromycin, being lower in patients infected with a resistant strain.
The Influence of Income and Formal Education on Damage in Brazilian Patients With Systemic Lupus Erythematosus
Authors: Teixeira Roberto Cordeiro de Andrade , Borba Neto Eduardo Ferreira , Christopoulos Georges Basile , Sato Emilia Inoue
Published: July 2017

Objective

The aim of this study was to evaluate the association of socioeconomic status and American College of Rheumatology/Systemic Lupus International Collaborating Clinics Damage Index (SDI) score in Brazilian patients with systemic lupus erythematosus (SLE).

Methods

Five hundred twenty-three patients (SLE ACR criteria) 18 years or older who were at 12 months or greater since diagnosis were included. Socioeconomic status was assessed by per-capita income and years of education. Race was categorized as white and nonwhite. The SDI and Mexican SLE Disease Activity Index were used.

Statistical Analysis

Mean ± SD and median were used for descriptive analysis. Student t test, Mann-Whitney U test, χ2 test, and Spearman rank correlation coefficient and univariate and multivariate regression analyses were performed. The level of significance was set at 5% for all statistical tests.

Results

Ninety-six percent were female, 51.2% were nonwhite, and the mean age was 37.8 ± 1.4 years. Disease duration was 8.2 ± 10.3 years and formal education was 10.2 ± 3.5 years. Unemployment among patients was 63.7%, with median monthly per-capita income of US $276. Mean SDI score was 1.4 ± 1.52, and 65.6% had some type of damage (SDI ≥1). Patients with SDI of 1 or greater had lower income (P = 0.039). Nonwhite patients had higher SDI than did white patients (P = 0.005). The SDI presented a positive correlation with disease duration (P < 0.001) and age (P < 0.001) and a negative correlation with years of education (P = 0.001). Working patients had lower SDI than did inactive ones (P ≤ 0.001). In a multivariate analysis, older age, higher disease duration, nonwhite race, low income, and out-of-work profile were associated with damage.

Conclusions

Besides nonmodifiable characteristics such as longer disease duration and older age, low income was also associated with damage. Therefore, interventions to give adequate socioeconomic support are necessary to improve outcome, mainly in poorer and nonwhite SLE patients.
Rheumatologists Modestly More Likely to Counsel Smokers in Visits Without Rheumatoid Arthritis Control
Authors: Vreede Andrew P. , Johnson Heather M. , Piper Megan , Panyard Daniel J. , Wong Joanna C. , Bartels Christie M.
Published: July 2017

Background

Among patients with rheumatoid arthritis (RA), smoking increases risk of severe RA and pulmonary and cardiovascular disease. Despite this, little is known about smoking cessation counseling by rheumatologists.

Objectives

We examined predictors of tobacco counseling in RA patients who smoke including the effect of perceived RA control. We hypothesized that patients with controlled RA would receive more counseling according to the competing demands model, which explains that preventive care gaps occur as a result of competing provider, patient, and clinic factors.

Methods

This secondary data analysis involved RA patients with an additional cardiovascular disease risk factor identified in an academic medical center 2004–2011. Trained abstractors assessed documented smoking counseling and rheumatologists’ impression of RA control in clinic notes. We used multivariable logistic regression to predict having received smoking cessation counseling, including sociodemographics and comorbidity in models.

Results

We abstracted 3396 RA visits, including 360 visits (10%) with active smokers. Perceived controlled RA was present in 31% of visits involving smokers (39% in nonsmokers). Beyond nurse documentation, providers documented smoking status in 39% of visit notes with smokers and smoking cessation counseling in 10%. Visits with controlled versus active RA were less likely to include counseling (odds ratio, 0.3; confidence interval, 0.1–0.97). Counseling was more likely in visits with prevalent cardiovascular, pulmonary, and psychiatric disease, but decreased with obesity.

Conclusions

Smoking cessation counseling was documented in 10% of visits and was less likely when RA was controlled. Given smoking’s impact on RA and long-term outcomes, systematic cessation counseling efforts are needed.
The Diagnostic Value of 3-Dimensional Sampling Perfection With Application Optimized Contrasts Using Different Flip Angle Evolutions (SPACE) MRI in Evaluating Lower Extremity Deep Venous Thrombus
Authors: Wu Gang , Xie Ruyi , Zhang Xiaoli , Morelli John , Yan Xu , Zhu Xiaolei , Li Xiaoming
Published: July 2017

Objectives

The aim of this study was to evaluate the diagnostic performance of noncontrast magnetic resonance imaging utilizing sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE) in detecting deep venous thrombus (DVT) of the lower extremity and evaluating clot burden.

Materials and Methods

This prospective study was approved by the institutional review board. Ninety-four consecutive patients (42 men, 52 women; age range, 14–87 years; average age, 52.7 years) suspected of lower extremity DVT underwent ultrasound (US) and SPACE. The venous visualization score for SPACE was determined by 2 radiologists independently according to a 4-point scale (1–4, poor to excellent). The sensitivity and specificity of SPACE in detecting DVT were calculated based on segment, limb, and patient, with US serving as the reference standard. The clot burden for each segment was scored (0–3, patent to entire segment occlusion). The clot burden score obtained with SPACE was compared with US using a Wilcoxon test based on region, limb, and patient. Interobserver agreement in assessing DVT (absent, nonocclusive, or occlusive) with SPACE was determined by calculating Cohen kappa coefficients.

Results

The mean venous visualization score for SPACE was 3.82 ± 0.50 for reader 1 and 3.81 ± 0.50 for reader 2. For reader 1, sensitivity/specificity values of SPACE in detecting DVT were 96.53%/99.90% (segment), 95.24%/99.04% (limb), and 95.89%/95.24% (patient). For reader 2, corresponding values were 97.20%/99.90%, 96.39%/99.05%, and 97.22%/95.45%. The clot burden assessed with SPACE was not significantly different from US (P > 0.05 for region, limb, patient). Interobserver agreement of SPACE in assessing thrombosis was excellent (kappa = 0.894 ± 0.014).

Conclusions

Non–contrast-enhanced 3-dimensional SPACE magnetic resonance imaging is highly accurate in detecting lower extremity DVT and reliable in the evaluation of clot burden. SPACE could serve as an important alternative for patients in whom US cannot be performed.
Male Fertility After Inguinal Hernia Mesh Repair
Authors: Kohl Andreas Pagh , Andresen Kristoffer , Rosenberg Jacob
Published: July 2017

Objective:

To determine whether patients who receive an inguinal hernia repair father the same number of children as the background population.

Background:

Although the effect of inguinal hernia repair on male fertility has previously been investigated through indirect measures, no previous studies have evaluated the final measure of male fertility, which is the number of children fathered by patients.

Methods:

Prospectively collected data on 32,621 male patients between the ages of 18 and 55 years who received 1 or more inguinal hernia repairs during the years 1998 to 2012 were found in 5 comprehensive Danish linked registers. Patients were matched with 97,805 controls, and the number of fathered children was recorded as the primary outcome.

Results:

Patients who were operated unilaterally fathered more children than controls (156 vs 147 children per 1000 individuals, P = 0.02), whereas patients who were operated bilaterally fathered the same number of children as controls. Unilateral Lichtenstein operation resulted in an increase in number of children fathered by patients (161 vs 151 children per 1000 patients, P = 0.009). No difference in the number of children fathered was found for any year following operation. Meanwhile, time between operation and first child was longer among controls than patients (log-rank P = 0.003). The youngest (18–30 years of age) bilaterally operated patients fathered the same number of children as controls.

Conclusions:

Patients who underwent inguinal hernia repair using Lichtenstein technique or laparoscopic approach did not father fewer children than expected. Thus, inguinal hernia repair using Lichtenstein or laparoscopic approach did not impair male fertility.
Venous thromboembolism after major venous injuries: Competing priorities
Authors: Frank Brian , Maher Zoё , Hazelton Joshua P. , Resnick Shelby , Dauer Elizabeth , Goldenberg Anna , Lubitz Andrea L. , Smith Brian P. , Saillant Noelle N. , Reilly Patrick M. , Seamon Mark J.
Published: July 2017

BACKGROUND

Venous thromboembolism (VTE) after major vascular injury (MVI) is particularly challenging because the competing risk of thrombosis and embolization after direct vessel injury must be balanced with risk of bleeding after surgical repair. We hypothesized that venous injuries, repair type, and intraoperative anticoagulation would influence VTE formation after MVI.

METHODS

A multi-institution, retrospective cohort study of consecutive MVI patients was conducted at three urban, Level I centers (2005–2013). Patients with MVI of the neck, torso, or proximal extremities (to elbows/knees) were included. Our primary study endpoint was the development of VTE (DVT or pulmonary embolism [PE]).

RESULTS

The 435 major vascular injury patients were primarily young (27 years) men (89%) with penetrating (84%) injuries. When patients with (n = 108) and without (n = 327) VTE were compared, we observed no difference in age, mechanism, extremity injury, tourniquet use, orthopedic and spine injuries, damage control, local heparinized saline, or vascular surgery consultation (all p > 0.05). VTE patients had greater Injury Severity Score (ISS) (17 vs. 12), shock indices (1 vs. 0.9), and more torso (58% vs. 35%) and venous (73% vs. 48%) injuries, but less often received systemic intraoperative anticoagulation (39% vs. 53%) or postoperative enoxaparin (47% vs. 61%) prophylaxis (all p < 0.05). After controlling for ISS, hemodynamics, injured vessel, intraoperative anticoagulation, and postoperative prophylaxis, multivariable analysis revealed venous injury was independently predictive of VTE (odds ratio, 2.7; p = 0.002). Multivariable analysis of the venous injuries subset (n = 237) then determined that only delay in starting VTE chemoprophylaxis (odds ratio, 1.3/day; p = 0.013) independently predicted VTE after controlling for ISS, hemodynamics, injured vessel, surgical subspecialty, intraoperative anticoagulation, and postoperative prophylaxis. Overall, 3.4% of venous injury patients developed PE, but PE rates were not related to their operative management (p = 0.72).

CONCLUSION

Patients with major venous injuries are at high risk for VTE, regardless of intraoperative management. Our results support the immediate initiation of postoperative chemoprophylaxis in patients with major venous injuries.

LEVEL OF EVIDENCE

Therapeutic/care management, level IV.
Significance and popularity in music production
Authors: Monechi Bernardo , Gravino Pietro , Servedio Vito D. P. , Tria Francesca , Loreto Vittorio
Published: July 2017

Creative industries constantly strive for fame and popularity. Though highly desirable, popularity is not the only achievement artistic creations might ever acquire. Leaving a longstanding mark in the global production and influencing future works is an even more important achievement, usually acknowledged by experts and scholars. ‘Significant’ or ‘influential’ works are not always well known to the public or have sometimes been long forgotten by the vast majority. In this paper, we focus on the duality between what is successful and what is significant in the musical context. To this end, we consider a user-generated set of tags collected through an online music platform, whose evolving co-occurrence network mirrors the growing conceptual space underlying music production. We define a set of general metrics aiming at characterizing music albums throughout history, and their relationships with the overall musical production. We show how these metrics allow to classify albums according to their current popularity or their belonging to expert-made lists of important albums. In this way, we provide the scientific community and the public at large with quantitative tools to tell apart popular albums from culturally or aesthetically relevant artworks. The generality of the methodology presented here lends itself to be used in all those fields where innovation and creativity are in play.