bluuebunny/crossref_metadata_2025 huggingface dataset:
The open flux evolution of a solar-mass star on the main sequence
Authors: See V. , Jardine M. , Vidotto A. A. , Donati J.-F. , Saikia S. Boro , Fares R. , Folsom C. P. , Jeffers S. V. , Marsden S. C. , Morin J. , Petit P. ,   the BCool Collaboration
Published: October 2017

Magnetic activity is known to be correlated to the rotation period for moderately active main-sequence solar-like stars. In turn, the stellar rotation period evolves as a result of magnetized stellar winds that carry away angular momentum. Understanding the interplay between magnetic activity and stellar rotation is therefore a central task for stellar astrophysics. Angular momentum evolution models typically employ spin-down torques that are formulated in terms of the surface magnetic field strength. However, these formulations fail to account for the magnetic field geometry, unlike those that are expressed in terms of the open flux, i.e. the magnetic flux along which stellar winds flow. In this work, we model the angular momentum evolution of main-sequence solar-mass stars using a torque law formulated in terms of the open flux. This is done using a potential field source surface model in conjunction with the Zeeman–Doppler magnetograms of a sample of roughly solar-mass stars. We explore how the open flux of these stars varies with stellar rotation and choice of source surface radii. We also explore the effect of field geometry by using two methods of determining the open flux. The first method only accounts for the dipole component while the second accounts for the full set of spherical harmonics available in the Zeeman–Doppler magnetogram. We find only a small difference between the two methods, demonstrating that the open flux, and indeed the spin-down, of main-sequence solar-mass stars is likely dominated by the dipolar component of the magnetic field.
Prophylactic Negative Pressure Wound Therapy for Obese Women After Cesarean Delivery
Authors: Smid Marcela C. , Dotters-Katz Sarah K. , Grace Matthew , Wright Sarah T. , Villers Margaret S. , Hardy-Fairbanks Abbey , Stamilio David M.
Published: October 2017

OBJECTIVE:

To summarize available studies on wound complication outcomes after prophylactic negative pressure wound therapy for obese women (body mass index 30 or greater).

DATA SOURCES:

We conducted a systematic review and meta-analysis using electronic database search (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Google scholar, and Web of Science), Cochrane, and trial registries including ClinicalTrials.gov.

METHODS OF STUDY SELECTION:

We conducted an electronic search of research articles from 1966 to January 2017 for randomized controlled trials (RCTs), prospective cohort, and retrospective cohort studies of negative pressure wound therapy compared with standard dressing after cesarean delivery among obese women. Our primary outcome was defined as a composite of wound complication, including wound or surgical site infection, cellulitis, seroma, hematoma, wound disruption, or dehiscence. For cohort studies and RCTs, we performed a descriptive systematic review. For available RCTs, we performed a meta-analysis and pooled risk ratios using a random-effects model. We assessed for heterogeneity using χ2 test for heterogeneity and I
2 test. We assessed for publication bias using a funnel plot.

TABULATION, INTEGRATION, AND RESULTS:

Of 10 studies meeting eligibility criteria, five were RCTs and five were cohort studies. Results of cohort studies were varied; however, all had a high potential for selection bias. In the meta-analysis, there was no difference in primary composite outcome among those women with negative pressure wound therapy (16.8%) compared with those who had standard dressing (17.8%) (risk ratio 0.97, 95% CI 0.63–1.49). There was no statistically significant heterogeneity (χ2 test 4.80, P=.31, I
2=17%).

CONCLUSION:

Currently available evidence does not support negative pressure wound therapy use among obese women for cesarean wound complication prevention.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO: International prospective register of systematic reviews, 42016033948.
Emergency Department Care in the Postpartum Period
Authors: Batra Priya , Fridman Moshe , Leng Mei , Gregory Kimberly D.
Published: October 2017

OBJECTIVE:

To use population data to identify patient characteristics associated with a postpartum maternal emergency department visit within 90 days of discharge after birth.

METHODS:

This retrospective cross-sectional study analyzed linked maternal discharge and emergency department data for all live California births from 2009 to 2011. The primary outcome was at least one emergency department visit within 90 days of hospital discharge after birth. Secondary outcomes included three or more visits within 90 days (“high utilization”) and inpatient readmission. Independent variables included demographics (age, race or ethnicity, payer, income) and clinical characteristics (length of stay, antepartum complications, mode of delivery, and severe maternal morbidity at delivery). Multilevel logistic regression identified variables associated study outcomes; we validated the predictive model with a split-sample approach and receiver operating characteristic curve analysis.

RESULTS:

Of 1,071,232 deliveries included, 88,674 women (8.3%) visited the emergency department at least once in the 90 days after delivery discharge. Emergency department use was significantly associated with Medicaid insurance (adjusted odds ratio [OR] 2.15, 95% CI 2.08–2.21), age younger than 20 years (adjusted OR 2.08, 95% CI 1.98–2.19), severe maternal morbidity at delivery (adjusted OR 1.58, 95% CI 1.49–1.71), antepartum complications (adjusted OR 1.46, 95% CI 1.42–1.50), and cesarean delivery (adjusted OR 1.40, 95% CI 1.37–1.44). Approximately one fifth of visits occurred within 4 days of discharge, and more than half were within 3 weeks. High utilizers comprised 0.5% of the entire sample (5,171 women) and only 1.2% of women presenting for emergency department care were readmitted. Receiver operating curve model analysis using the validation sample supported predictive accuracy for postpartum emergency department use (area under the curve=0.95).

CONCLUSION:

One in 12 California women visited the emergency department in the first 90 days after postpartum discharge. Women at increased risk for postpartum emergency department use per our validated model (eg, low income, birth complications) may benefit from earlier scheduled postpartum visits.
Salpingectomy for Sterilization
Authors: Powell C. Bethan , Alabaster Amy , Simmons Sarah , Garcia Christine , Martin Maria , McBride-Allen Sally , Littell Ramey D.
Published: October 2017

OBJECTIVE:

To evaluate the utilization rate of salpingectomy for cesarean deliveries and postpartum and interval tubal sterilization procedures.

METHODS:

This is a retrospective cohort study using the electronic medical record to identify women older than 18 years of age undergoing surgical sterilization from June 2011 to May 2016 in an integrated health care system. The primary objective is to describe the change in utilization rate of salpingectomy for tubal sterilization procedures over time and after a systemwide practice recommendation was issued in 2013. Rates of salpingectomy and tubal occlusion were calculated for each of the five 1-year intervals in the study. Secondary outcomes included blood loss, operating time, length of stay, readmission, and emergency department visits.

RESULTS:

A total of 10,741 tubal sterilization procedures were identified. There was an increase in salpingectomies from 0.4% (8/1,938; 95% CI 0.2–0.8) to 35.5% (902/2,538; 95% CI 33.7–37.4) of tubal sterilization procedures performed over the study period (test for trend, P<.001). Salpingectomy instead of tubal occlusion increased at cesarean delivery from 0.1% (1/1,141; 95% CI 0.0–0.5) to 9.2% (125/1,354; 95% CI 7.8–10.9) (test for trend, P<.001); postpartum from 0% (0/124; 95% CI 0.0–3.0) to 4.5% (9/201; 95% CI 2.4–8.3) (test for trend, P=.003); and as an interval (nonpartum) tubal sterilization procedure from 1% (7/673; 95% CI 0.5–2.1) to 78% (768/983; 95% CI 75.4–80.6) (test for trend, P<.001). Median operative minutes was increased from 52 (95% CI 51–52) to 61.5 (95% CI 57–64), from 33 (95% CI 32–34) to 50 (95% CI 35–64), and from 30 (95% CI 29–30) to 33 (95% CI 32–33), respectively, for salpingectomy compared with tubal occlusion at cesarean delivery and postpartum and interval sterilization. Median blood loss was similar for salpingectomy and tubal occlusion at cesarean delivery (660 mL; 95% CI 600–700 mL compared with 700 mL; 95% CI 680–700 mL) and interval sterilization (both 5 mL; 95% CI 5–5 mL) but was more for salpingectomy postpartum (250 mL; 95% CI 200–500 mL compared with 200 mL; 95% CI 200–200 mL).

CONCLUSION:

There was a significant increase in salpingectomy for sterilization from June 2011 to May 2016. In the final year of the study, salpingectomy accounted for 78% of interval laparoscopic tubal sterilization procedures and 9% of intrapartum and postpartum procedures.
Inflammation in bone physiology and pathology
Authors: Adamopoulos Iannis E.
Published: October 2017

Purpose of review

Bone is constantly being remodeled throughout adult life through constant anabolic and catabolic actions that maintain tissue homeostasis. A number of hormones, cytokines growth factors, and the proximity of various cells to bone surfaces influence this process. Inflammatory changes at the bone microenvironment result in alterations leading to both excessive bone loss and bone formation. Detailed understanding of the physiological and pathological mechanisms that dictate these changes will allow us to harness inflammatory signals in bone regeneration.

Recent findings

Recent reports have suggested that inflammatory signals are able to stimulate transcription factors that regulate osteoblast differentiation from their precursors.

In this review, we summarized current understanding of the roles of inflammation in bone resorption and bone formation, which give rise to different disorders and discuss the huge potential of harnessing these inflammatory signals to achieve bone regeneration.
An Anatomic and Radiographic Study of the Distal Tibial Epiphysis
Authors: Nguyen Cynthia V. , Greene Janelle D. , Cooperman Daniel R. , Liu Raymond W.
Published: October 2017

Background:

Although the undulating shape of the distal tibial epiphysis is well recognized, its anatomic features have not been well quantified in the literature. To guide the placement of surgical implants about the distal tibial physis, we investigated the topographical anatomy of the distal tibial epiphysis and explored the ability of standard radiographs to visualize the physis.

Methods:

We studied 30 cadaveric distal tibial epiphyses in specimens 3 to 14 years of age. Anteroposterior (AP) and lateral radiographs were obtained of each specimen and then repeated after flexible radiopaque markers were placed on the major undulations. All radiographs were analyzed to determine the height or depth of each landmark, and measurements with and without markers for each landmark were compared using intraclass correlation coefficients (ICC). In 9 specimens, similar measurements were obtained on high-resolution 3-dimensional (3D) surface scans.

Results:

There were 4 distinct physeal undulations usually present: an anteromedial peak (Kump’s bump), a posterolateral peak, an anterior central valley, and a posterior central valley. On the 3D scans, Kump’s bump averaged 5.0 mm (range, 3.0 to 6.4 mm), the posterolateral peak 2.4 mm (range, 1.2 to 5.0 mm), the anterior valley 1.3 mm (range, 0 to 3.6 mm), and the posterior valley 0.77 mm (range, 0 to 2.7 mm). Lateral radiographs with markers correlated with measurements from 3D scans better than those without markers (ICC=0.61 vs. 0.24). For AP radiographs, correlation was good to excellent regardless of marker use (ICC=0.76 vs. 0.66).

Conclusions:

There are 4 major undulations of the distal tibial physis. Kump’s bump is the largest. A centrally placed epiphyseal screw in the medial/lateral direction or screws from anterolateral to posteromedial and anteromedial to posterolateral would tend to avoid both valleys. Particular caution should be taken when placing metaphyseal screws in the anteromedial or posterolateral distal tibia. Physeal undulations were more difficult to visualize on the lateral view.

Clinical Relevance:

This study provides quantitative data on the topography of the distal tibial physis to aid hardware placement. Lateral views should be interpreted with caution, as the physeal undulations are not as visible, whereas AP views can be interpreted with more confidence.
Trends and Disparities in Cervical Spine Fusion Procedures Utilization in the New York State
Authors: Feng Rui , Finkelstein Mark , Bilal Khawaja , Oermann Eric K. , Palese Michael , Caridi John
Published: October 2017

Study Design.

A retrospective review of the Statewide Planning and Research Cooperative System database of the New York State.

Objective.

This study examined the rate of increase of cervical spine fusion procedures at low-, medium-, and high-volume hospitals, and analyzed racial and socioeconomic characteristics of the patient population treated at these three volume categories.

Summary of Background Data.

There has been a steady increase in spinal fusion procedures performed each year in the United States, especially cervical and lumbar fusion. Our study aims to analyze the rate of increase at low-, medium-, and high-volume hospitals, and socioeconomic characteristics of the patient populations at these three volume categories.

Methods.

The New York State, Statewide Planning and Research Cooperative System (SPARCS) database was searched from 2005 to 2014 for the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Procedure Codes 81.01 (Fusion, atlas-axis), 81.02 (Fusion, anterior column, other cervical, anterior technique), and 81.03 (Fusion, posterior column, other cervical, posterior technique). Patients’ primary diagnosis (ICD-9-CM), age, race/ethnicity, primary payment method, severity of illness, length of stay, hospital of operation were included. All 122 hospitals were categorized into high-, medium-, and low-volume. Trends in annual number of cervical spine fusion surgeries in each of the three hospital volume groups were reported using descriptive statistics.

Results.

Low-volumes centers were more likely to be rural and non-teaching hospitals. African American patients comprised a greater portion of patients at low-volume hospitals, 15.1% versus 11.6% compared with high-volume hospitals. Medicaid and self-pay patients were also overrepresented at low-volume centers, 6.7% and 3.9% versus 2.6% and 1.7%, respectively. Compared with Caucasian patients, African American patients had higher rates of postoperative infection (P = 0.0020) and postoperative bleeding (P = 0.0044). Compared with privately insured patients, Medicaid patients had a higher rate of postoperative bleeding (P = 0.0266) and in-hospital mortality (P = 0.0031).

Conclusion.

Our results showed significant differences in hospital characteristics, racial distribution, and primary payments methods between the low- and high-volume categories. African American and Medicaid patients had higher rates of postoperative bleeding, despite similar rates between the three volume categories. This suggests racial and socioeconomic disparities remains problematic for disadvantaged populations, some of which may be attributed to accessibility to care at high-volume centers.

Level of Evidence: 3
Healing Time Correlates With the Quality of Scaring: Results From a Prospective Randomized Control Donor Site Trial
Authors: Werdin Frank , Tenenhaus Mayer , Becker Martin , Rennekampff Hans-Oliver
Published: October 2017

BACKGROUND

Scar formation remains a potential problem after surgery or trauma. Factors influencing scar tissue have been recognized, most notably healing time and wound depth.

OBJECTIVE

To examine the association between healing time and the quality of scar tissue formation.

MATERIALS AND METHODS

Scarring was assessed at 3 and 12 months after treatment in an RCT of 219 patients and consecutive 438 split-thickness skin graft donor sites. The primary end point of the study was healing time and the quality of scar tissue, which was scored by a validated scar scale evaluating scar height, surface, and color.

RESULTS

The mean time of wound healing was 15.8 days, with a mean scar score of 6.89 at 3 months and 4.66 at 12 months. There was a significant (p < .000001) and linear correlation between healing time and scar quality. Of particular note, at 12 months, all subparameters of the score demonstrated worsening with prolonged time to heal.

CONCLUSION

The authors could objectively demonstrate that epithelialization time is an important factor influencing scar quality. In contrast to previous assumptions, this correlation follows linearly. It is reasonable then to assume that treatment strategies expediting healing will also improve scar outcome.
NOVEL CONE DYSTROPHY WITH CENTRAL ELLIPSOID ZONE LOSS ASSOCIATED WITH HUMAN RETINAL FASCIN GENE (FSCN2) MUTATION
Authors: Gui Wei , Nusinowitz Steven , Sarraf David
Published: October 2017

Purpose:

To report the first case of a cone dystrophy with central ellipsoid zone loss associated with a mutation in the human retinal fascin gene (FSCN2).

Methods:

Multimodal retinal imaging findings including spectral domain optical coherence tomography and fundus autofluorescence are presented. The results of functional testing and mutational analysis are also discussed.

Patients:

Single patient with a diagnosis of cone dystrophy.

Results:

Spectral domain optical coherence tomography imaging illustrated central loss of the ellipsoid zone band in each eye. Full-field and multifocal electroretinogram testing confirmed a diagnosis of cone dystrophy in a 35-year-old male patient. Subsequent cone dystrophy genetic panel identified a novel mutation (p.Pro406Leu:c.1217C>T) in the FSCN2 gene.

Conclusion:

This is the first case report of a patient diagnosed with cone dystrophy associated with a novel mutation in the FSCN2 gene. FSCN2 genetic testing should be considered in patients with central ellipsoid loss and cone dystrophy, especially as specific gene therapy treatments emerge in the future.
ACUTE MACULAR NEURORETINOPATHY AND PERIPHERAL RETINAL VASCULAR ABNORMALITIES IN A PATIENT BORN HIV SEROPOSITIVE
Authors: Giuffrè Chiara , Rabiolo Alessandro , Corbelli Eleonora , Carnevali Adriano , Sacconi Riccardo , Querques Lea , Bandello Francesco , Querques Giuseppe
Published: October 2017

Purpose:

To describe the case of a born HIV seropositive woman who developed outer retinal alterations secondary to vascular abnormalities in the perimacular region and in the periphery of both eyes.

Methods:

Case report.

Results:

A 21-year-old woman born HIV seropositive was referred for a routinary visit. Her best-corrected visual acuity was 20/20 in both eyes, and during the visit, only mild superotemporal metamorphopsia in the left eye was reported. Multimodal imaging disclosed findings consistent with acute macular neuroretinopathy such as reddish-brown lesions at fundus examination and disruption of ellipsoid zone at spectral domain optical coherence tomography. Peripheral vascular alterations were also noted at fluorescein angiography.

Conclusion:

Several associations or risk factors have been identified in patients with acute macular neuroretinopathy, including oral contraceptives, epinephrine/ephedrine, or systemic shock. To the best of our knowledge, this is the first case describing peripheral vascular alterations and acute macular neuroretinopathy in association with HIV seropositivity at birth.
Spontaneous Resolution of Delayed Suprachoroidal Hemorrhage in the Single Eye Following Needling in Congenital Glaucoma
Authors: Rezapour Jasmin , Hoffmann Esther M. , Prokosch-Willing Verena , Gericke Adrian , Pfeiffer Norbert
Published: October 2017

Introduction:

Suprachoroidal hemorrhage (SCH) is a rare, but potentially vision-threatening event with poor long-term visual prognosis. At present, there is disagreement whether surgical intervention or conservative treatment is superior in the management. We report on a case of spontaneous resolution of severe SCH after needling procedure in the only eye of a young patient with congenital glaucoma.

Case Presentation:

A 43-year-old woman with congenital glaucoma was scheduled for bleb needling in her only eye. Preoperative best-corrected visual acuity was 20/40 and intraocular pressure 20 mm Hg. On the third postoperative day, she developed a massive delayed SCH with appositional (kissing) choroidal bullae and visual acuity was hand motion. Scleral drainage was performed after 10 days, but did not show a significant decrease of the choroidal swelling and further conservative treatment was discussed. After 2 months, choroidal swelling had completely resolved, best-corrected visual acuity was 20/50, and intraocular pressure was 11 mm Hg.

Discussion:

Full functional recovery and decrease of choroidal swelling may be attained with a conservative treatment of massive delayed SCH after needling procedure in congenital glaucoma.
The Impact of Medication Anticholinergic Burden on Cognitive Performance in People With Schizophrenia
Authors: Ang Mei San , Abdul Rashid Nur Amirah , Lam Max , Rapisarda Attilio , Kraus Michael , Keefe Richard S.E. , Lee Jimmy
Published: October 2017

Background

Cognitive deficits are prevalent in people with schizophrenia and associated with functional impairments. In addition to antipsychotics, pharmacotherapy in schizophrenia often includes other psychotropics, and some of these agents possess anticholinergic properties, which may impair cognition. The objective of this study was to explore the association between medication anticholinergic burden and cognition in schizophrenia.

Methods

Seven hundred five individuals with schizophrenia completed a neuropsychological battery comprising Judgment of Line Orientation Test, Wechsler Abbreviated Scale of Intelligence Matrix Reasoning, Continuous Performance Test–Identical Pairs Version, and the Brief Assessment of Cognition in Schizophrenia. Cognitive g and 3 cognitive factor scores that include executive function, memory/fluency, and speed of processing/vigilance, which were derived from a previously published analysis, were entered as cognitive variables. Anticholinergic burden was computed using 2 anticholinergic scales: Anticholinergic Burden Scale and Anticholinergic Drug Scale. Duration and severity of illness, antipsychotic dose, smoking status, age, and sex were included as covariates.

Results

Anticholinergic burden was associated with poorer cognitive performance in cognitive g, all 3 cognitive domains and most cognitive tasks in multivariate analyses. The associations were statistically significant, but the effect sizes were small (for Anticholinergic Burden Scale, Cohen f
2 = 0.008; for Anticholinergic Drug Scale, Cohen f
2 = 0.017).

Conclusions

Although our results showed a statistically significant association between medications with anticholinergic properties and cognition in people with schizophrenia, the impact is of doubtful or minimal clinical significance.
A Preliminary Study of the Effects of a Multitheory-Driven Intervention in Adults With Prediabetes Mellitus
Authors: TSAI Fu-Mian , LIN Chiu-Chu , LIN Huey-Shyan , LIU Yi
Published: October 2017

Background:

Prediabetes mellitus (pre-DM) is an important predictive indicator of Type 2 diabetes. A person with pre-DM is eight times more likely to develop diabetes than a person without pre-DM. Prior research suggests that proactive interventions may delay the progression of this disease and reduce the rate of disease development.

Purpose:

The purposes of this preliminary study were to develop a multitheory-driven lifestyle intervention protocol for adults with pre-DM and to evaluate its feasibility and impacts on knowledge regarding pre-DM, dietary behaviors, and physical activity (primary outcomes) as well as to describe the disease progression indicators (secondary outcomes).

Methods:

A single-group, longitudinal study design was used. Thirty-nine participants were included in the analysis. A generalized estimating equation model was used to determine the trends in changes in the outcomes. All of the participants underwent testing at baseline (T0) and at 3 (T1), 6 (T2), and 12 (T3) months after the 4-week lifestyle intervention.

Results:

There were significantly increasing trends for each study parameter (Pre-DM Knowledge Assessment Form-12, p < .01; Dietary Behavior Scale, p < .01) and significantly positive changes in body weight (p < .01), body mass index (p < .01), fasting glucose level (p < .01), and glycated hemoglobin level (p < .01) over the 12-month study period.

Conclusions/Implications for Practice:

This study supports the feasibility of the developed multitheory-driven lifestyle intervention protocol and suggests that its application may improve the effectiveness of diabetes prevention programs in clinical settings. Further randomized controlled trials are needed.
A Systematic Review of Reminiscence Therapy for Older Adults in Taiwan
Authors: Yen Hsin-Yen , Lin Li-Jung
Published: October 2017

Background:

Population aging is an increasing phenomenon in many countries around the world. It has been estimated that more than one quarter of all older adults experience a mental or neurological disorder or disease such as dementia, depression, anxiety, and substance abuse. Reminiscence is a popular treatment for enhancing well-being in older adults. Previous studies have shown that reminiscence therapy improves the cognitive functions, behaviors, and other psychosocial outcomes in older adult patients. The themes and materials that are used in reminiscence treatments for the older adults in Taiwan differ from those used in other countries because of Taiwan’s unique historical background and culture.

Purpose:

The main purpose of the current study was to review systematically the application and outcomes of reminiscence therapy in Taiwan.

Method:

The terms “reminiscence,” “dementia,” “Alzheimer’s disease,” and “Taiwan” were used in an Integrated Resources Search that was conducted at National Taiwan Normal University. Sixteen articles were systematically reviewed using a synthesis of two matrices of experimental designs and intervention designs.

Result:

Reminiscence group sizes ranged between 7 and 12 participants, session frequencies were all once a week for periods lasting between 4 and 16 weeks, and session durations ranged from 30 minutes to 2 hours. The memories of the participants were stimulated using materials dating from their youth such as Taiwanese folk songs, toys, photos, radio programs, newspapers, and food and drinks. In terms of research methodology, most of the studies that were reviewed used quasi-experimental designs without random assignment or control group due to sample size. A minority of the reviewed studies applied the randomized controlled treatment method. Only a few of the studies evaluated indicators in pretest, posttest, and follow-up periods. The results of these studies identified several benefits of reminiscence therapy in Taiwanese older adults, including improvements in cognitive function, anxiety, depressive symptoms, self-esteem, life satisfaction, and personal interaction.

Conclusions:

Reminiscence is a good noninvasive treatment for the prevention and treatment of mental diseases in Taiwanese older adults. Furthermore, reminiscence promotes mental health in older adults. Finally, this study provides recommendations for further study and clinical application of reminiscence therapy in Taiwan.
Acute life-threatening hypoxemia during mechanical ventilation
Authors: Piraino Thomas , Fan Eddy
Published: October 2017

Purpose of review

To describe current evidence-based practice in the management of acute life-threatening hypoxemia in mechanically ventilated patients and some of the methods used to individualize the care of the patient.

Recent findings

Patients with acute life-threatening hypoxemia will often meet criteria for severe ARDS, for which there are only a few treatment strategies that have been shown to improve survival outcomes. Recent findings have increased our knowledge of the physiological effects of spontaneous breathing and the application of PEEP. Additionally, the use of advanced bedside monitoring has a promising future in the management of hypoxemic patients to fine-tune the ventilator and to evaluate the individual patient response to therapy.

Treating the patient with acute life-threatening hypoxemia during mechanical ventilation should begin with an evidence-based approach, with the goal of improving oxygenation and minimizing the harmful effects of mechanical ventilation. The use of advanced monitoring and the application of simple maneuvers at the bedside may assist clinicians to better individualize treatment and improve clinical outcomes.
Bovine Colostrum for Preterm Infants in the First Days of Life
Authors: Juhl Sandra Meinich , Ye Xuqiang , Zhou Ping , Li Yanqi , Iyore Elisabeth Omolabake , Zhang Lixia , Jiang Pingping , van Goudoever Johannes B. , Greisen Gorm , Sangild Per Torp
Published: October 2017

Objectives:

Mother's own milk (MM) is the best nutrition for newborn preterm infants, but is often limited in supply just after birth. Pasteurized human donor milk (DM), and especially preterm infant formula (IF) are less optimal diets than MM. We hypothesized that it is feasible to use bovine colostrum (BC), the first milk from cows, as a supplement to MM, during the first weeks after preterm birth.

Methods:

In an open‐label, randomized, controlled pilot safety trial, supplementation of MM with BC was compared with DM supplementation (Danish unit) or IF supplementation (Chinese unit). If MM was limited or lacking, BC, DM or IF were given according to local feeding guidelines during the first 14 days of life.

Results:

Forty infants were included and randomized in Denmark and in China, with gestational ages 29.9 ± 0.4 and 31.1 ± 0.2 weeks, respectively. Infants supplemented with BC received more enteral protein (P < 0.05) and tended to reach full enteral feeding earlier (China only). Eight infants fed BC showed a temporary elevation in plasma tyrosine on day 7, versus 2 infants in the DM/IF groups. There were no differences between diet groups in feeding intolerance or clinical adverse events.

Conclusions:

Our results indicate that it is feasible to use BC as a supplement to MM during the first weeks of life to increase enteral protein intake in preterm infants. Plasma tyrosine levels may be a good marker for excessive protein intake. A larger randomized trial is required to test the safety and possible short‐ and long‐term clinical benefits of BC supplementation during the first weeks of life for preterm infants.
Holder‐Pasteurized Human Donor Milk
Authors: de Waard Marita , Mank Elise , van Dijk Karin , Schoonderwoerd Anne , van Goudoever Johannes B.
Published: October 2017

Objective:

When own mother's milk falls short, pasteurized human donor milk is recommended as alternative feeding for preterm infants. Donor milk has to meet the highest safety standards, but its processing and storage is expensive. The recommended storage time of pasteurized donor milk is 3 months. The objective of the present study was to determine whether the frozen storage time of pasteurized donor milk can be extended beyond 3 months without compromising its safety and quality.

Methods:

For this prospective observational study breast milk samples of 34 unique women, collected between November 2014 and June 2015, were provided by the Dutch Human Milk Bank. Samples were Holder pasteurized within 3 months after expression and stored at −20°C. Analysis of both bacterial growth (by inoculation of milk on a blood and a cysteine‐, lactose‐, and electrolyte‐deficient agar) and fat, crude protein, carbohydrate and energy content of milk (analyzed by infrared spectroscopy) was done monthly during the first 6 months and every 2 months thereafter, up to 1 year postpasteurization.

Results:

Thirty of 306 (9.8%) follow‐up samples showed bacterial growth when cultured. None of the samples showed sequential contamination with the same strain up to 8 months of frozen storage. No significant decreases in macronutrients and energy content were observed over 8 months.

Conclusion:

Pasteurized human donor milk can be stored safely for 8 months at −20°C, without compromising its macronutrient and energy content. This longer storage time will reduce disposal of expired donor milk and subsequently reduce costs.
Prenatal Diagnosis of a Melanotic Neuroectodermal Tumor of Infancy (MNTI): A Case Report With a Favorable Outcome After Chemotherapy Failure and Incomplete Resection
Authors: Moreau Audrey , Galmiche Louise , Belhous Kahina , Franchi Gerald , Couloigner Vincent , Nevoux Jerome , Antoine Aymard Pierre , Picard Arnaud , Minard-Colin Veronique , Kadlub Natacha
Published: October 2017

We present the case of a woman referred to our department at 34 weeks of pregnancy with a fetal ultrasonographic scan showing a mass that had developed within the right maxilla with invasion of the orbit. A retrospective examination showed that this tumor had been present since the 12th week of pregnancy. At 39+4 weeks of gestation, a boy was born. He presented a black firm aspect in the maxilla. A computed tomographic scan and magnetic resonance imaging revealed a soft tissue swelling over the right maxilla, extending into the orbit but without invasion of the globe. Surgical biopsy confirmed a melanotic neuroectodermal tumor of infancy. The pathologic examination did not show any neuroblast-like component on the hematoxylin eosin saffron staining. Because of the extension and the size of the lesion, neoadjuvant chemotherapy was carried out. At day 21, the patient received 1 cycle of low-dose cyclophosphamide and vincristine, 2 cycles of etoposide and carboplatin, and thereafter 1 cycle of cyclophosphamide, adriamycin, and vincristin because the lesion kept growing. After stabilization of the size of the tumor, at 4 months, a maxillectomy and partial resection of the orbital floor and lateral orbital wall was performed on the patient. As a complete resection would have required orbital exenteration, surgery was performed deliberately incomplete leaving a macroscopic residue (R2). At 2.5 years of follow-up, the patient showed complete remission with no lesions evident on magnetic resonance imaging.
An Update on the Diagnosis, Grading, and Staging of Appendiceal Mucinous Neoplasms
Authors: Valasek Mark A. , Pai Reetesh K.
Published: October 2017

Despite advances in our understanding of appendiceal mucinous neoplasms and their relationship to the pseudomyxoma peritonei syndrome, the classification of mucinous tumors of the appendix is still confusing. This review will provide an update on the various classification systems that have been recently proposed for appendiceal mucinous neoplasia, with a particular emphasis on how to handle and report the histologic findings for these tumors using the newly published Peritoneal Surface Oncology Group International (PSOGI) and American Joint Committee on Cancer (AJCC) eighth edition guidelines. A simplified approach to diagnostic reporting of appendiceal mucinous neoplasms based on the 3-tier AJCC grading scheme is detailed and specific criteria for assessing grade in appendiceal mucinous neoplasia will be outlined. In addition, histologic mimics of appendiceal mucinous neoplasia and how to distinguish these mimics from mucinous neoplasia will be discussed. Finally, despite improvements in diagnostic terminology, significant challenges in classifying appendiceal mucinous neoplasia persist and diagnostic strategies will be detailed to assist practicing pathologists in these challenging scenarios.
Hepatobiliary Mucinous Cystic Neoplasms With Ovarian Type Stroma (So-Called “Hepatobiliary Cystadenoma/Cystadenocarcinoma”)
Authors: Quigley Brian , Reid Michelle D. , Pehlivanoglu Burcin , Squires Malcolm H. , Maithel Shishir , Xue Yue , Hyejeong Choi , Akkas Gizem , Muraki Takashi , Kooby David A. , Sarmiento Juan M. , Cardona Ken , Sekhar Aarti , Krasinskas Alyssa , Adsay Volkan
Published: October 2017

The literature is highly conflicting on hepatobiliary mucinous cystic neoplasms (MCNs), aka “hepatobiliary cystadenoma/cystadenocarcinoma,” largely because ovarian stroma (OS) was not a requirement until WHO-2010 and is not widely applied even today. In this study, MCNs (with OS) accounted for 24 of 229 (11%) resected hepatic cysts in one institution. Eight of the 32 (25%) cysts that had been originally designated as hepatobiliary cystadenoma/cystadenocarcinoma at the time of diagnosis proved not to have an OS during this review and were thus re-classified as non-MCN. In total, 36 MCNs (with OS) were analyzed—24 from the institutional files and 12 consultation cases. All were women. Mean age was 51 (28 to 76 y). Mean size was 11 cm (5 to 23 cm). Most (91%) were intrahepatic and in the left lobe (72%). Preoperative imaging mentioned “neoplasm” in 14 (47%) and carcinoma was a differential in 6 (19%) but only 2 proved to have carcinoma. Microscopically, only 47% demonstrated diffuse OS (>75% of the cyst wall/lining); OS was often focal. The cyst lining was often composed of non-mucinous biliary epithelium, and this was predominant in 50% of the cases. Degenerative changes of variable amount were seen in most cases. In situ and invasive carcinoma was seen in only 2 cases (6%), both with small invasion (7 and 8 mm). Five cases had persistence/recurrence, 2 confirmed operatively (at 7 mo and 15 y). Of the 2 cases with carcinoma, one had “residual cyst or hematoma” by radiology at 4 months, and the other was without disease at 3 years. In conclusion, many cysts (25%) previously reported as hepatobiliary cystadenoma/cystadenocarcinoma are not MCNs. True MCNs are uncommon among resected hepatic cysts (11%), occur exclusively in females, are large, mostly intrahepatic and in the left lobe (72%). Invasive carcinomas are small and uncommon (6%) compared with their pancreatic counterpart (16%). Recurrences are not uncommon following incomplete excision.
Despite Diagnostic Morphology, Many Mixed Endometrial Carcinomas Show Unexpected Immunohistochemical Staining Patterns
Authors: Matrai Cathleen E. , Pirog Edyta C. , Ellenson Lora Hedrick
Published: October 2017

Historically, endometrial carcinomas have been classified primarily according to their histology. However, the use of immunohistochemistry has become commonplace in their evaluation, particularly in diagnostically challenging cases. Our objective was to evaluate mixed endometrial carcinomas using a well-established panel of biomarkers to assess the consistency and utility of these stains in clinical diagnosis. Eighteen cases comprised of various combinations of classical serous (SC), endometrioid (EC), and clear cell (CC) morphologies were identified and subjected to a panel of immunohistochemical markers including p53, p16, Ki67, estrogen receptor, progesterone receptor, and Napsin A. Intensity and extent of staining were evaluated on 4-tiered and 5-tiered scales, respectively. The typical immunostaining pattern expected for the individual tumor components was seen in only 3 cases, while in 15 cases an unexpected pattern was observed with at least one immunomarker. By tumor type, the most common unexpected finding in EC/SC carcinoma cases was diffuse positivity for p16 and/or estrogen receptor/progesterone receptor in both components, while in SC/CC, diffuse positivity for p53 in both components was most frequently seen, and in SC/CC/EC, Napsin A negativity was most commonly observed. Despite displaying diagnostic morphology, components of many mixed endometrial carcinomas may not exhibit expected immunohistochemical features. This may be due to the fact that these carcinomas arise from a single clone with subsequent divergence, resulting in a tumor with both mixed histologic and genetic features. It is important to note that these tumors may not demonstrate the immunohistochemical prototype of their constituents and should be approached accordingly from a diagnostic perspective.
The Analysis of Cell Cycle–related Proteins in Ovarian Clear Cell Carcinoma Versus High-grade Serous Carcinoma
Authors: Hazama Yukiko , Moriya Takuya , Sugihara Mika , Sano Rikiya , Shiota Mitsuru , Nakamura Takafumi , Shimoya Koichiro
Published: October 2017

In Japan, the frequency of ovarian clear cell carcinoma (CCC) is twice as high as that in the United States and Europe. Often, patient prognosis with CCC is poor because of chemoresistance. Here, we focus on the cell cycle, which is one of the mechanisms of chemoresistance. To detect the informative markers and improve the strategy of chemotherapy for CCC, we performed immunohistochemical staining of cell cycle–related proteins in ovarian malignant tumors. We detected that each of the 29 samples of CCC and high-grade serous carcinoma (HGSC) were necessary to reveal the significant differences in immunostaining and prognosis. We performed the immunostaining analysis using the antibodies of cell cycle–related proteins such as Ki-67, Cdt1, MCM7, and geminin. The positive rate of Cdt1 in the CCC group was significantly higher than that in the HGSC group (P<0.0001). However, the positive rate of geminin in the HGSC group was significantly higher than that in the CCC group (P<0.0001). The overall survival of CCC patients with high labeling index of Cdt1 was significantly worse than that of CCC patients with low labeling index of Cdt1 (P=0.004). The study results suggested that the cancer cells of CCC and HGSC exist in the G1 phase and S, G2, and M phases, respectively. The differences in cell cycle of CCC might be one of the reasons for chemotherapy resistance. Further investigations are necessary to reveal the usefulness of Cdt1 as a biomarker in CCC.
Assessing Lifetime Stress Exposure Using the Stress and Adversity Inventory for Adults (Adult STRAIN): An Overview and Initial Validation
Authors: Slavich George M. , Shields Grant S.
Published: October 2017

Objective

Numerous theories have proposed that acute and chronic stressors may exert a cumulative effect on life-span health by causing biological “wear and tear,” or allostatic load, which in turn promotes disease. Very few studies have directly tested such models, though, partly because of the challenges associated with efficiently assessing stress exposure over the entire life course. To address this issue, we developed the first online system for systematically assessing lifetime stress exposure, called the Stress and Adversity Inventory (STRAIN), and describe its initial validation here.

Methods

Adults recruited from the community (n = 205) were administered the STRAIN, Childhood Trauma Questionnaire—Short Form, and Perceived Stress Scale, as well as measures of socioeconomic status, personality, social desirability, negative affect, mental and physical health complaints, sleep quality, computer-assessed executive function, and doctor-diagnosed general health problems and autoimmune disorders.

Results

The STRAIN achieved high acceptability and was completed relatively quickly (mean = 18 minutes 39 seconds; interquartile range = 12–23 minutes). The structure of the lifetime stress data best fit two latent classes overall and five distinct trajectories over time. Concurrent associations with the Childhood Trauma Questionnaire—Short Form and Perceived Stress Scale were good (r values = .147–.552). Moreover, the STRAIN was not significantly related to personality traits or social desirability characteristics and, in adjusted analyses, emerged as the measure most strongly associated with all six of the health and cognitive outcomes assessed except current mental health complaints (β values = .16–.41; risk ratios = 1.02–1.04). Finally, test-retest reliability for the main stress exposure indices over 2–4 weeks was excellent (r values = .904–.919).

Conclusions

The STRAIN demonstrated good usability and acceptability; very good concurrent, discriminant, and predictive validity; and excellent test-retest reliability.
Incidence of Tuberculosis Among HIV-Positive Individuals Initiating Antiretroviral Treatment at Higher CD4 Counts in the HPTN 071 (PopART) Trial in South Africa
Authors: Bock Peter , Jennings Karen , Vermaak Redwaan , Cox Helen , Meintjes Graeme , Fatti Geoffrey , Kruger James , De Azevedo Virginia , Maschilla Leonard , Louis Francoise , Gunst Colette , Grobbelaar Nelis , Dunbar Rory , Limbada Mohammed , Floyd Sian , Grimwood Ashraf , Ayles Helen , Hayes Richard , Fidler Sarah , Beyers Nulda ,   on behalf of the HPTN 071, PopART team
Published: October 2017

Introduction:

Antiretroviral treatment (ART) guidelines recommend life-long ART for all HIV-positive individuals. This study evaluated tuberculosis (TB) incidence on ART in a cohort of HIV-positive individuals starting ART regardless of CD4 count in a programmatic setting at 3 clinics included in the HPTN 071 (PopART) trial in South Africa.

Methods:

A retrospective cohort analysis of HIV-positive individuals aged ≥18 years starting ART, between January 2014 and November 2015, was conducted. Follow-up was continued until 30 May 2016 or censored on the date of (1) incident TB, (2) loss to follow-up from HIV care or death, or (3) elective transfer out; whichever occurred first.

Results:

The study included 2423 individuals. Median baseline CD4 count was 328 cells/μL (interquartile range 195–468); TB incidence rate was 4.41/100 person-years (95% confidence interval [CI]: 3.62 to 5.39). The adjusted hazard ratio of incident TB was 0.27 (95% CI: 0.12 to 0.62) when comparing individuals with baseline CD4 >500 and ≤500 cells/μL. Among individuals with baseline CD4 count >500 cells/μL, there were no incident TB cases in the first 3 months of follow-up. Adjusted hazard of incident TB was also higher among men (adjusted hazard ratio 2.16; 95% CI: 1.41 to 3.30).

Conclusions:

TB incidence after ART initiation was significantly lower among individuals starting ART at CD4 counts above 500 cells/μL. Scale-up of ART, regardless of CD4 count, has the potential to significantly reduce TB incidence among HIV-positive individuals. However, this needs to be combined with strengthening of other TB prevention strategies that target both HIV-positive and HIV-negative individuals.
Propagation of BOLD activity reveals task-dependent directed interactions across human visual cortex
Authors: Gravel Nicolás , Renken Remco J. , Harvey Ben M. , Deco Gustavo , Cornelissen Frans W. , Gilson Matthieu
Published: October 2017

It has recently been shown that large-scale propagation of blood-oxygen level dependent (BOLD) activity is constrained by anatomical connections and reflects transitions between behavioral states. It remains to be seen, however, if the propagation of BOLD activity can also relate to the brain anatomical structure at a more local scale. Here, we hypothesized that BOLD propagation reflects structured neuronal activity across early visual field maps. To explore this hypothesis, we characterize the propagation of BOLD activity across V1, V2 and V3 using a modeling approach that aims to disentangle the contributions of local activity and directed interactions in shaping BOLD propagation. It does so by estimating the effective connectivity (EC) and the excitability of a noise-diffusion network to reproduce the spatiotemporal covariance structure of the data. We apply our approach to 7T fMRI recordings acquired during resting state (RS) and visual field mapping (VFM). Our results reveal different EC interactions and changes in cortical excitability in RS and VFM, and point to a reconfiguration of feedforward and feedback interactions across the visual system. We conclude that the propagation of BOLD activity has functional relevance, as it reveals directed interactions and changes in cortical excitability in a task-dependent manner.