bluuebunny/crossref_metadata_2025 huggingface dataset:
Richtig kauen für Ihre Gesundheit
Authors: Nebel Gudrun
Published: October 2018

Ausreichend zu kauen ist wichtig und kann auf verschiedenen Wegen einen Beitrag zur Gesundheit leisten. Ideal ist es, jeden Bissen 30x zu kauen.
Blutzucker im Sinkflug
Authors: Handke Denis
Published: October 2018

Eine Unterzuckerung entwickelt sich innerhalb von Minuten und zeigt sich bis zum Eintreten eines hypoglykämischen Schocks zum Teil nur verschleiert. Betroffen sind fast immer Diabetiker, meist nach Übertherapie mit Insulin oder oralen Antidiabetika oder nach körperlicher Anstrengung, Nahrungskarenz oder Alkoholgenuss. Mit sofortiger Blutzuckermessung, Glukosegabe und ergänzenden Notfallmaßnahmen lassen sich Patienten meist schnell stabilisieren.
Magen unter Strom?
Authors: Jahn Claus
Published: October 2018

Die Funktionelle Dyspepsie wird als Ausschlussdiagnose gestellt, wenn für chronische Magenbeschwerden keine organische Ursache gefunden wird. Leitsymptome der Funktionellen Dyspepsie sind epigastrischer Schmerz, epigastrisches Brennen, Völlegefühl und vorzeitiges Sättigungsgefühl. Als naturheilkundliche Therapeutika kommen unter anderem entkrampfende, schmerzstillende und magensäureregulierende Injektabilia infrage.
Evaluation of a new pan-enteric video capsule endoscopy system in patients with suspected or established inflammatory bowel disease – feasibility study
Authors: Eliakim Rami , Spada Cristiano , Lapidus Alon , Eyal Inbal , Pecere Silvia , Fernández-Urién Ignacio , Lahat Adi , Costamagna Guido , Schwartz Avraham , Ron Yulia , Yanai Henit , Adler Samuel
Published: October 2018

Background and study aims Inflammatory bowel disease (IBD) affects the small bowel and colon. Endoscopic evaluation of these organs is essential. The new pan-enteric Crohn’s capsule (PCC) system is customized for complete coverage of IBD lesions in the entire bowel, allowing assessment and follow-up of disease severity and extent. The aim of this study was to evaluate the functionality of the PCC system in patients with suspected or established IBD.

Patients and methods This was a prospective five-center feasibility study assessing the performance of PCC. Subjects ingested PCC after patency assurance with standard bowel preparation plus boosts. The primary endpoint was successful procedure, that is, video creation and report generation in accordance with methodology. Secondary endpoints were subjective coverage of the entire bowel, duration of reading time, video quality and occurrence of adverse events.

Results Forty-one patients were included in the study with a mean age of 40.8 years ± 15.5, 46 % of whom were males. Seventy-one percent of patients had established Crohn’s disease (CD) and 53 % had active disease. Cleansing was graded good/excellent in 95 %. All 41 videos met the primary endpoint. There was no retention, 83 % reached the toilet while still recording. Thirty-one percent of patients with CD had proximal disease. Bowel coverage was graded 6.7 ± 0.6 and 6.1 ± 1.3 (1 – 7, unconfident – confident), image quality 6.1 ± 0.8 (1 – 7, poor – excellent), and reading time 3.7 ± 1.4 (1 – 7, very short to very long).

Conclusions The PCC system is a minimally invasive system allowing extensive evaluation of the entire bowel in patients with IBD.
Reproducibility, Accuracy and Effect of Autoclave Sterilization on a Thermoplastic Three-Dimensional Model Printed by a Desktop Fused Deposition Modelling Three-Dimensional Printer
Authors: Fournet Alexandre , Bassanino Jean , Manassero Mathieu , Bedu Anne-Sophie , Leperlier Dimitri , Boursier Jean-François
Published: October 2018

Objectives The main purpose of this study was to determine the reproducibility and accuracy of a three-dimensional (3D) bone model printed on a desktop 3D-printer based on fused deposition modelling (FDM) technology with polylactic acid (PLA) and the effect of autoclave sterilization on the printed models.

Methods Computed tomographic images of the tibia were obtained from 10 feline cadavers, used to create a bone surface-rendering file and sent to the 3D printing software. Right and left tibias were each printed five times with the FDM desktop 3D printer using PLA plastic material. Plastic models and cadaveric bones were measured with a profile projector device at six predetermined landmarks. Plastic bones were then sterilized using an autoclave before being re-measured applying the same method. Analyses of printed model size reliability were conducted using intra-class correlation coefficients (ICC) and Bland–Altman plots.

Results The ICC always showed an almost perfect agreement when comparing 3D-printed models issued from the same cadaveric bone. The ICC showed moderate agreement for one measurement and strong/perfect agreement for others when comparing a cadaveric bone with the corresponding 3D model. Concerning the comparison of the same 3D-printed model, before and after sterilization, ICC showed either strong or perfect agreement.

Clinical Significance Rapid-prototyping with our FDM desktop 3D-printer using PLA was an accurate, a reproducible and a sterilization-compliant way to obtain 3D plastic models.
Gender-Related Facial Surgical Goals
Authors: Somenek Michael
Published: October 2018

In the last several years, there has been an increasing demand for surgical facial feminization or masculinization to treat the gender dysphoric patient. However, while aesthetic ideals for facial rejuvenation are well described and taught, there is a relative paucity of literature on how to achieve a feminine or masculine morphology. It is thus becoming increasingly important for facial plastic surgeons to understand patient goals regarding facial feminization or masculinization, and to have a systematic approach for analyzing the female and male face.
Selecting the Best Eyelid Techniques
Authors: Bayrak Sinehan , Kriet John , Humphrey Clint
Published: October 2018

The periorbital region is a focal point on the face. Dermatochalasis, fat herniation, blepharoptosis, brow ptosis, deep tear troughs, and malar fat pad descent are all age-related changes that occur around the eyes, and successful rejuvenation involves addressing all of these changes. Restoring a youthful, vibrant appearance to the eyes and periorbital areas can often only be accomplished with a combination of surgical and nonsurgical interventions. Facial plastic surgeons should have a comprehensive knowledge of all of these options and their applications to ensure good patient outcomes and satisfaction.
Atypical Carcinoid Neuroendocrine Tumor of the Ureter: A Case Report and Literature Review
Authors: Yuen Huay , Rix Gerald , Sen Soumadri , Kusuma Venkata
Published: October 2018

Neuroendocrine tumors (NETs) of the ureter are rare, with less than 40 cases described in the literature. A majority of tumors described are poorly differentiated tumors with a poor prognosis. We present the case of a moderately differentiated atypical carcinoid NET of the ureter with a good postoperative outcome. A literature review was also performed to identify similar cases to compare their management and postoperative outcomes.
C-type lectin receptor LSECtin-mediated apoptotic cell clearance by macrophages directs intestinal repair in experimental colitis
Authors: Yang Zaopeng , Li Qian , Wang Xin , Jiang Xuepei , Zhao Dianyuan , Lin Xin , He Fuchu , Tang Li
Published: October 2018

Significance

The clearance of apoptotic cells is critical for maintaining tissue homeostasis, and myeloid C-type lectin receptors (CLRs) may be prominently involved in the clearance of dying cells and their debris. Here, we report that the CLR member LSECtin is expressed on macrophages, which are engaged in corpse clearance. This engulfment progress by macrophages through LSECtin is critical for intestinal healing. Loss of LSECtin promotes dextran sulfate sodium-induced colitis due to unrepaired intestinal epithelium. These results indicate that corpse clearance by macrophages can direct intestinal regeneration. These findings advance understanding of how homeostasis is maintained within the mucosa.
Introduction
Authors: Bonnet Andreas , Siemund Peter
Published: October 2018

We begin this contribution by briefly explaining the rationale and structure of this volume, but our principal aim here lies in providing a synopsis and synthesis of linguistic and educational approaches to multilingualism and foreign language education in such societal settings. For this purpose, we first of all offer crucial background information on current processes of globalization and the newly emerging multilingual societies, as these appear in a variety of forms. Multilingual societies, in turn, witness diverse settings and modes of language acquisition and learning in which especially the phenomenon of cross-linguistic influence becomes a factor that needs to be taken into consideration and deserves to be explored. We therefore offer a brief state-of-the-art report on language learning on multilingual substrate, before addressing multilingualism as an educational phenomenon including its role and relevance in the foreign language classroom. This furnishes several perspectives, notably that of the learner, the institution, the educational goals, and the requisite methodologies. Individual – and in a different sense also societal – multilingualism is widely assumed to increase metalinguistic awareness, which, in turn, has been argued to facilitate language learning, even though the precise boundary conditions allowing for such facilitative effects are still little understood, nor what facilitation exactly can be taken to mean. We in principle sympathize with the idea of multilingual facilitation effects on foreign language education, not least because language remains an important means to construct and enact individual and social identities and power relations. We also have to acknowledge, though, that the variety of linguistic, psychological and sociological influences on multilingual language acquisition and education is very difficult to control for and hard to factor in. In this sense, our volume needs to be regarded as a first step towards a better understanding of foreign language education in multilingual classrooms, but it is clear that this complicated subject matter urgently requires additional work.
The acquisition of English as an L3 from a sociocultural point of view
Authors: Bonnet Andreas , Jacob Larissa , Schäfer Annika , Schmidt Torben
Published: October 2018

The German reality of linguistic diversity and multilingualism as an outcome of internationalization, migration and globalization is finally being acknowledged by the integration, promotion and implementation of multilingualism in German educational institutions. There is however little empirical evidence on the situation of young, multilingual foreign language learners – findings of large scale and several case studies remain inconclusive to allow for a definitive modelling of third language acquisition. This chapter aims at offering insights into two current exploratory case studies of multilingual learners in primary schools and lower secondary level of education in Germany in order to examine the acquisition of English as a tertiary language from a sociocultural point of view. Following a qualitative approach these projects try to illuminate processes of third language acquisition from the learners’ perspective by conducting reconstructive and narrative methods to capture language learning experiences and processes and their interplay with identity construction. In these two exploratory case studies open and age-appropriate interviews were conducted combined with non-verbal procedures. The data was analysed with the use of the documentary method. The here presented cases, which show a maximum contrast with regard to their orientation towards their foreign language classroom, suggest that there is a strong connection between FL acquisition and identity formation and that its quality is determined by the students’ linguistic and cultural identity, their theory of language acquisition, their attitude towards English and other languages and their perception of FL classroom practice.
Scientific Expertise and Risk Aggregation
Authors: Boyer-Kassem Thomas
Published: October 2018

When scientists are asked to give expert advice on risk-related questions, such as the authorization of medical drugs, deliberation often does not eliminate all disagreements. I propose to model these remaining discrepancies as differences in risk assessments and/or in risk acceptability thresholds. The normative question I consider, then, is how the individual expert views should best be aggregated. I discuss what “best” could mean, with an eye to some robustness considerations. I argue that the majority rule, which is currently often used in expert panels, has significant drawbacks.
Breastfeeding exclusivity and duration: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015
Authors: Santos Iná S , Barros Fernando C , Horta Bernardo L , Menezes Ana M B , Bassani Diego , Tovo-Rodrigues Luciana , Lima Natália P , Victora Cesar G ,   Pelotas Cohorts Study Group, Barros Aluisio J D , Matijasevich Alicia , Bertoldi Andrea Dâmaso , Wehrmeister Fernando C , Gonçalves Helen , Murray Joseph , Assunção Maria Cecilia F , Silveira Mariangela F , Domingues Marlos Rodrigues , Hallal Pedro R C
Published: October 2018

Background

Brazil has made substantial improvements in the duration of breastfeeding. We use data from four population-based cohorts to examine how trends and inequalities in breastfeeding indicators changed over time in a Brazilian city.

Methods

Data from four birth cohorts, each including all births in a calendar year (1982, 1993, 2004 and 2015) in the city of Pelotas were used. Information on breastfeeding was collected when children were aged between 3 and 20 months. The prevalences of continued breastfeeding at 1 year of age and of exclusive breastfeeding at 3 months were calculated according to family income, maternal skin colour and sex.

Results

Prevalence of breastfeeding at 12 months increased from 16% to 41% in the 33-year period. The prevalence of exclusive breastfeeding at 3 months increased from 7% in 1993 to 45% in 2015. Increases in exclusive breastfeeding at 3 months were seen in all socioeconomic groups, but the 2015 rates remain highest (57.2%) among the women in the richest quintile, and lowest among those in the poorest quintile (34.6%). Black mothers were more likely to breastfeed at 12 months than Whites in the four cohorts. In the earlier cohorts, breastfeeding at 12 months was more common among the poor, but by 2015 these differences had disappeared.

Conclusions

There were important positive changes in breastfeeding practices during this period, but less than half of the children in 2015 were receiving the full benefits of breast milk. Improved breastfeeding practices are being adopted by high-income women to a greater extent than by poor women.
Esrrb plays important roles in maintaining self-renewal of trophoblast stem cells (TSCs) and reprogramming somatic cells to induced TSCs
Authors: Gao Haibo , Gao Rui , Zhang Linfeng , Xiu Wenchao , Zang Ruge , Wang Hong , Zhang Yong , Chen Jiayu , Gao Yawei , Gao Shaorong
Published: October 2018

Trophoblast stem cells (TSCs), which can be derived from the trophoectoderm of a blastocyst, have the ability to sustain self-renewal and differentiate into various placental trophoblast cell types. Meanwhile, essential insights into the molecular mechanisms controlling the placental development can be gained by using TSCs as the cell model. Esrrb is a transcription factor that has been shown to play pivotal roles in both embryonic stem cell (ESC) and TSC, but the precise mechanism whereby Esrrb regulates TSC-specific transcriptome during differentiation and reprogramming is still largely unknown. In the present study, we elucidate the function of Esrrb in self-renewal and differentiation of TSCs, as well as during the induced TSC (iTSC) reprogramming. We demonstrate that the precise level of Esrrb is critical for stem state maintenance and further trophoblast differentiation of TSCs, as ectopically expressed Esrrb can partially block the rapid differentiation of TSCs in the absence of fibroblast growth factor 4. However, Esrrb depletion results in downregulation of certain key TSC-specific transcription factors, consequently causing a rapid differentiation of TSCs and these Esrrb-deficient TSCs lose the ability of hemorrhagic lesion formation in vivo. This function of Esrrb is exerted by directly binding and activating a core set of TSC-specific target genes including Cdx2, Eomes, Sox2, Fgfr4, and Bmp4. Furthermore, we show that Esrrb overexpression can facilitate the MEF-to-iTSC conversion. Moreover, Esrrb can substitute for Eomes to generate GEsTM-iTSCs. Thus, our findings provide a better understanding of the molecular mechanism of Esrrb in maintaining TSC self-renewal and during iTSC reprogramming.
Chronic Traumatic Encephalopathy Within an Amyotrophic Lateral Sclerosis Brain Bank Cohort
Authors: Walt Gabriel S , Burris Hannah M , Brady Christopher B , Spencer Keith R , Alvarez Victor E , Huber Bertrand R , Guilderson Latease , Abdul Rauf Nazifa , Collins Derek , Singh Tarnjit , Mathias Rebecca , Averill James G , Walker Sean E , Robey Ian , McKee Ann C , Kowall Neil W , Stein Thor D
Published: October 2018

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive head impacts and has been associated with amyotrophic lateral sclerosis (ALS), a fatal, degenerative neuromuscular disorder. The Department of Veterans Affairs Biorepository Brain Bank (VABBB) is a tissue repository that collects antemortem disease progression data and postmortem central nervous system tissue from veterans with ALS. We set out to determine the frequency of co-morbid ALS and CTE in the VABBB cohort and to characterize the clinical, genetic, and pathological distinctions between participants with ALS only and those with both ALS and CTE (ALS+CTE). Of 155 participants, 9 (5.8%) had neuropathologically confirmed ALS+CTE. Participants with ALS+CTE were more likely to have a history of traumatic brain injury (p < 0.001), served during the first Persian Gulf War (p < 0.05), and to have more severe tau pathology within the frontal cortex and spinal cord (p < 0.05). The most common exposures to head impacts included contact sports (n = 5) and military service (n = 2). Clinically, participants with ALS+CTE were more likely to have bulbar onset ALS (p = 0.006), behavioral changes (p = 0.002), and/or mood changes (p < 0.001). Overall, compared with ALS in isolation, comorbid ALS+CTE is associated with a history of TBI and has a distinct clinical and pathological presentation.
Influence of repeated trace mineral injections during gestation on beef heifer and subsequent calf performance
Authors: Stokes Rebecca S , Ireland Frank A , Shike Daniel W
Published: October 2018

Commercial Angus heifers (n = 190; body weight (BW) = 315 ± 49.3 kg) were used to determine the effects of trace mineral injections during gestation on heifer and subsequent calf performance. Heifers received three previous subcutaneous trace mineral (Multimin 90 [MM]; n = 93) or sterilized physiological saline (CON; n = 97) injections approximately 90 d apart. These treatments were maintained and subsequent injections were given 205, 114, and 44 ± 26 d prepartum. Heifers were provided free-choice inorganic minerals. Heifer BW and body condition scores (BCS) were collected at trial initiation (296 ± 26 d prepartum) and 5- to 10-week intervals thereafter. Liver samples were collected at trial initiation, 5 and 176 ± 3 d postpartum from a subset of cows to determine trace mineral status. Milk production was assessed on 80 cow–calf pairs (40/treatment) at 71 ± 15 d postpartum. Cows were artificially inseminated (AI) 82 d postpartum and then exposed to bulls for 38 d. Data were reported from 174 calves (n = 87 calves/treatment). Calf liver samples were collected 5 and 147 ± 3 d postpartum to determine trace mineral status. Calf weaning BW was collected at 159 ± 26 d postpartum. Calf performance including calving date, birth BW, weaning BW, average daily gain (ADG), and health data were collected. Heifer BW and BCS did not differ (P ≥ 0.72) throughout the experiment. Multimin heifers tended (P = 0.08) to have greater initial liver Se and tended to have decreased (P = 0.08) initial liver Zn compared with CON. At calving, MM cows had increased (P ≤ 0.01) liver Cu and Se. There was no difference (P ≥ 0.47) in Julian calving date, calving percent, or unassisted births. Calf birth BW was lesser (P = 0.02) for MM than CON calves, and MM calves had greater (P = 0.03) liver Cu concentrations at birth than CON calves. Despite MM cows having increased (P < 0.01) milk production, calf weaning BW and ADG were not different (P ≥ 0.87). In addition, calf morbidity and mortality were not different (P ≥ 0.43) between treatments. Calf mineral status was not different (P ≥ 0.57) at the time of weaning regardless of treatment; however, MM cows had decreased (P = 0.03) liver Zn. Multimin cows had decreased (P = 0.05) AI pregnancy rates, yet there was no difference (P = 0.34) in overall pregnancy rate. Supplementing an injectable trace mineral during heifer development and gestation increased cow milk production and resulted in decreased AI pregnancy rates; however, there was no effect on overall pregnancy rates or preweaning calf health or performance.
Comparison of 3 Pediatric Pelvic Osteotomies for Acetabular Dysplasia Using Patient-specific 3D-printed Models
Authors: Caffrey Jason P. , Jeffords Megan E. , Farnsworth Christine L. , Bomar James D. , Upasani Vidyadhar V.
Published: October 2018

Background:

Children with developmental dysplasia of the hip may require a pelvic osteotomy to treat acetabular dysplasia. Three osteotomies are commonly performed in these patients (Pemberton, Dega, and San Diego), though comparative studies of each are limited. The purpose of this study was to compare changes in acetabular morphology (acetabular version, volume, and octant coverage angles) created by these 3 osteotomies using matched patient-specific 3D-printed pelvic models.

Methods:

Fourteen patients with developmental dysplasia of the hip and preoperative computed tomography (CT) imaging were retrospectively included. For each patient CT, bone and cartilage tissues were independently segmented, and 3 identical pelvises were 3D-printed using a dual material printer. Bone was printed with rigid material and cartilage with flexible material to simulate the flexibility of the triradiate cartilage and pubic symphysis. Pemberton, Dega, and San Diego acetabular osteotomies were performed on the triplicate set of 3D prints. Acetabular version, volume, and octant coverage angles (posterior, superior-posterior, superior, superior-anterior, and anterior) were determined before and after each mock surgery by morphologic assessment using preoperative and postoperative CT images.

Results:

San Diego osteotomy yielded a small increase (+3.34±1.71 degrees) in version, compared with decreases with Pemberton (−5.47±1.54 degrees) and Dega (−8.57±1.21 degrees, P<0.05). Acetabular volume decreased similarly for Pemberton (−13.36%±2.88%), Dega (−19.21%±2.73%), and San Diego (−19.29%±2.44%; P=0.215) osteotomies. San Diego osteotomy tended to have a larger postoperative increase in the posterior regions, and the Dega and Pemberton osteotomies tended to have larger postoperative increases in the anterior coverage regions.

Conclusions:

Quantifiable differences were identified in acetabular octant coverage angles and version between the 3 pelvic osteotomies. San Diego osteotomy increased acetabular coverage posteriorly resulting in acetabular anteversion, whereas Pemberton and Dega had greater superior-anterior coverage resulting in relative acetabular retroversion. This study is the first known to utilize 3D-printed models for comparison of surgical approaches in pediatric pelvic osteotomies.
Advances in the management of early pregnancy loss
Authors: Henkel Andrea , Shaw Kate A.
Published: October 2018

Purpose of review

To describe recent advances in management of early pregnancy loss.

Recent findings

Addition of mifepristone to current protocols for medical management of miscarriage increases effectiveness of a single dose of misoprostol and significantly reduces subsequent aspiration procedures. Women with an incomplete evacuation after medical management may be treated expectantly with similar rates of complete expulsion compared with surgical management at 6 weeks. As cytogenetic analysis improves, analysis of products of conception can be performed whether collected after surgical or medical management and is an efficient strategy in starting a recurrent pregnancy loss work-up. For those seeking pregnancy after miscarriage, conception immediately following an early pregnancy loss is not associated with increased risk of subsequent miscarriage. However, recent studies suggest that the original intendedness of the pregnancy resulting in miscarriage does not predict future reproductive goals of the woman, so family planning should be discussed at the time of miscarriage.

Miscarriage is a common experience among reproductive-aged women and advances in medical management and modern-day aspiration techniques make the use of the sharp curette obsolete.
OUTCOME OF ACUTE NONTRAUMATIC VITREOUS HEMORRHAGE IN HEALTHY PATIENTS
Authors: Pighin María S. , Berrozpe Clara , Jürgens Ignasi
Published: October 2018

Purpose:

To compare outcomes in dense vitreous hemorrhage versus mild vitreous hemorrhage due to nontraumatic posterior vitreous detachment.

Methods:

We compared 315 eyes, divided into 2 patient groups, one with dense and the other with mild vitreous hemorrhage. The main outcome measures were final mean best-corrected visual acuity, number of retinal tears, number of retinal detachments, and the number of pars plana vitrectomy and/or scleral buckle surgeries.

Results:

In 33.4% of the patients, posterior vitreous detachment without complications was found. Retinal breaks after posterior vitreous detachment were found in 59% of the eyes. Rhegmatogenous retinal detachment was principally treated with pars plana vitrectomy and scleral buckle. In nonvisible fundus hemorrhage group, 44.4% of the patients underwent vitrectomy. In visible fundus hemorrhage group, 9.52% of the patients underwent pars plana vitrectomy. The mean final visual acuity was 20/25, without significant difference between groups (P = 0.064).

Conclusion:

Acute, spontaneous, nontraumatic posterior vitreous separation with vitreous hemorrhage is associated with a high incidence of retinal complications. Close follow-up is necessary. We did not find significant differences in final visual acuity neither between the two groups nor among the treatments.
Panscleritis as an Unusual Complication of Gonioscopy-assisted Transluminal Trabeculotomy
Authors: Aktas Zeynep , Bektas Caglar , Hasanreisoglu Murat
Published: October 2018

Purpose:

The main purpose of this study was to report a case of panscleritis after gonioscopy-assisted transluminal trabeculotomy (GATT).

Methods:

We describe the case of a 33-year-old man with a history of unilateral anterior uveitis and glaucoma, who developed panscleritis after GATT surgery.

Results:

Uneventful GATT surgery was performed in a glaucomatous left eye. On the second postoperative day, the patient developed tenderness on palpation of the eye. Ophthalmic examination revealed significant diffuse hyperemia, elongated and tortuous upper bulbar conjunctival/scleral vessels, and exudative retinal detachment at the superior nasal quadrant, with diffuse scleral thickening. The patient was diagnosed as having panscleritis, which was attributed to the GATT surgery. Although the scleritis resolved completely with intravenous and oral methylprednisolone treatment, localized retinal detachment persisted.

Conclusions:

Surgery-induced posterior scleritis may occur following minimally invasive glaucoma surgeries such as GATT. Control of uveitis for at least 3 months before surgery is indicated in patients with uveitis if GATT surgery is planned.
Outcomes of Laser Goniopuncture Following Nonpenetrating Deep Sclerectomy With Mitomycin C: A Large Retrospective Cohort Study
Authors: Penaud Benjamin , Leleu Igor , Laplace Olivier , Akesbi Jad , Blumen-Ohana Esther , Nordmann Jean-Philippe
Published: October 2018

Purpose:

To report on the frequency, efficacy, and safety of laser goniopuncture (LGP) in lowering intraocular pressure (IOP) following mitomycin-C-augmented nonpenetrating deep sclerectomy (NPDS) in a large cohort of eyes.

Materials and Methods:

This is a monocenter database retrospective study. We reviewed records of 350 eyes that underwent NPDS between 2009 and 2015, at the National Ophthalmology Center of XV-XX (Paris, France). We recorded the incidence of LGP, the time between NPDS and LGP, IOP efficacy, and the occurrence of complications. The success of the LGP was defined by an IOP<15 mm Hg without hypotonic treatment.

Results:

The mean postoperative follow-up period was 19±15.9 months after the NPDS (range, 6 to 58). LGP was performed in 125 eyes (35.7%) in a mean time after NPDS of 7.4±7.6 months (range, 1 d to 36 mo). Most LGP procedures were performed during the first year (97 eyes, 77.6%). The survival analysis using the Kaplan-Meier method showed a 50% incidence of LGP by 2 years. The mean IOP before LGP was 23.8±7.1 mm Hg. LGP resulted in immediate (day 8) and significant IOP lowering by up to 15±6.8 mm Hg. This decrease was maintained throughout the follow-up period, and the Kaplan-Meier survival success rate at 2 years was 48.9% (95% confidence interval, 39.4-60.8). The most common complication was iris incarceration, which occurred in 22 eyes of 125 LGP (17.6%).

Conclusions:

Most of the eyes that underwent NPDS may require LGP to reduce the IOP to below the target value. Most often, this procedure was performed in the first year after NPDS (77.6%). LGP lowered IOP<15 mm Hg without any hypotonic medication for at least 2 years in 50% of cases. Goniopuncture is associated with potentially significant complications, of which the most common is iris incarceration. We identified 2 predicting factors for iris incarceration: high IOP before LGP and early LGP after NPDS.
Clinical Characteristics of Patients With Schizophrenia Who Successfully Discontinued Antipsychotics
Authors: Tani Hideaki , Suzuki Takefumi , Wolfgang Fleischhacker W. , Tomita Masayuki , Mimura Masaru , Uchida Hiroyuki
Published: October 2018

Purpose/Background

Although discontinuing antipsychotics clearly increases the risk of relapse in schizophrenia, some patients remain clinically well without continuous antipsychotic treatment. However, data on the characteristics of such patients are still scarce.

Methods/Procedures

A systematic literature review was conducted to identify predictive factors for successful antipsychotic discontinuation in schizophrenia using PubMed (last search; June 2018) with the following search terms: (antipsychotic* or neuroleptic) AND (withdraw* or cessat* or terminat* or discontinu*) AND (schizophreni* or psychosis). The search was filtered with humans and English. Factors associated with a lower risk of relapse, when replicated in 2 or more studies with a follow-up period of 3 months or longer, were considered successful.

Findings/Results

Systematic literature search identified 37 relevant articles. Mean relapse rate after antipsychotic discontinuation was 38.3% (95% confidence interval = 16.0%–60.6%) per year. Factors associated with a lower risk of relapse were being maintained on a lower antipsychotic dose before discontinuation, older age, shorter duration of untreated psychosis, older age at the onset of illness, a lower severity of positive symptoms at baseline, better social functioning, and a lower number of previous relapses.

Implications/Conclusions

Although this literature review suggests some predictors for successful antipsychotic withdrawal in patients with schizophrenia, the very limited evidence base and unequivocally high relapse rates after discontinuation must remain a matter of serious debate for risk/benefit considerations.
Evaluation of 30 Day Readmissions After Index Ventricular Assist Device Implantation in the United States
Authors: Setareh-Shenas Saman , Thomas Felix , Cole Robert M. , Lemor Alejandro , Herzog Eyal , Arabia Francisco , Moriguchi Jaime
Published: October 2018

Ventricular assist device (VAD) implantation has improved quality of life and short-term survival for advanced heart failure patients. There are limited data from single-center studies addressing the characteristics and etiologies of 30 day readmissions after VAD implant. We used the Nationwide Readmissions Database (NRD) 2014 to identify insertion of implantable heart assist system during index admission. Primary and secondary outcomes were 30 day readmissions and leading etiologies, respectively. We analyzed 1,481 patients who received VAD during the primary admission of whom 1,315 patients survived to hospital discharge (mortality rate 11.2%), and 60.6% were discharged to a nursing facility. One hundred and thirty-one (10.0%) patients were readmitted within 30 days of primary hospitalization. Leading etiologies of 30 day readmission were bleeding (24%), heart failure (18%), and device complications (14%). Mean length of stay during readmission was 13.8 days with a mortality rate of 2.1%. Fifty percent of 30 day readmissions were readmitted from day 22 to 30. Variables for predictors of 30 day readmissions were not statistically significant. By identifying gastrointestinal bleeding, heart failure, and device complications as leading etiologies of 30 day readmission post-VAD implantation, providers can potentially modify practices to prevent hospital readmissions, decreasing cost of care, and improving the quality of life of patients.
Recurrent respiratory papillomatosis: update 2018
Authors: Derkay Craig S. , Bluher Andrew E.
Published: October 2018

Purpose of review

Recurrent respiratory papillomatosis (RRP) is the most common as well as the costliest benign airway neoplasm in the United States [Ivancic et al. (2018). Laryngoscope Investig Otolaryngol 3:22; Derkay (1995). Arch Otolaryngol Head Neck Surg 121:1386]. In addition, it is potentially deadly, with risk of airway obstruction as well as a 3–7% risk of malignant conversion [Schraff et al. (2004). Arch Otolaryngol Head Neck Surg 130:1039]. This review highlights exciting advancements over the past 1–2 years in scientific understanding of the pathophysiology, epidemiology, natural history, prevention, and treatment of this difficult disease.

Recent findings

Recent studies have yielded the following findings: The primary quality of life reduction that patients perceive is voice-related; the membranous vocal folds are the most frequently involved anatomic subsite in adult-onset RRP; there may be a correlation between laryngopharyngeal reflux, herpes simplex virus type 2, and adult-onset RRP; there has been a decline in RRP incidence in Australia following the implementation of a national vaccination program; addition of educational audiovisual aids assists in vaccine acceptance rates; preventive vaccination can be used as treatment for pediatric as well as adult RRP patients with demonstrable effects on antibody titers and reoperation rates; calreticulin-linked DNA vaccines show promise in reducing the growth rate of human papilloma virus (HPV)11 E6/E7-expressing tumors in mice; injection of bevacizumab is associated with no adverse tissue affects; systemic bevacizumab is effective as a treatment for severe uncontrolled disease; pegylated interferon treatment is effective in select severe pediatric RRP disease; and finally, increased rates of programed death 1 T-lymphocyte infiltration and programed death-ligand 1 expression are seen on both papilloma and infiltrating immune cells.

RRP is declining in incidence but remains a challenging disease to treat with great costs to patients, families, and the healthcare system. As the disease continues to be better understood, new frontiers are opening in treatment, particularly for severe or poorly controlled disease. Until the disease can be eradicated, it remains a vital area of research to help prevent new cases and treat afflicted patients.
Advances in liver xenotransplantation
Authors: Cimeno Arielle , Barth Rolf N. , LaMattina John C.
Published: October 2018

Purpose of review

This review highlights advances in liver xenotransplantation, focusing on immunologic barriers and mechanisms underlying graft failure and recipient demise, and discussion of recent in-vivo results.

Recent findings

Pig to primate models of liver xenotransplantation have been plagued by thrombocytopenia, anemia, and coagulopathy. It is now known that platelet sequestration is mediated by liver sinusoidal endothelial cells and Kupffer cells in part by asialoglycoprotein receptor 1-driven mechanisms. Xenoantigens, specifically N-glycolylneuraminic acid, play a role in graft injury as well as red blood cell consumption. Finally incompatibilities between coagulation cascade molecules contribute to lethal coagulopathy, but can be counteracted with genetic modifications and coagulation factor supplementation. Survival has markedly increased with this strategy.

An increased understanding of the cellular mechanisms responsible for failure of in-vivo pig to primate liver xenotransplant models has led to improved outcomes, and this recent success supports initial clinical application.
Prognostic Value of Volumetric Parameters of Pretreatment 18F-FDG PET/CT in Esophageal Cancer
Authors: Han Sangwon , Kim Yeon Joo , Woo Sungmin , Suh Chong Hyun , Lee Jong Jin
Published: October 2018

Purpose

We performed a systematic review and meta-analysis on the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) derived from pretreatment 18F-FDG PET/CT in patients with esophageal cancer.

Methods

PubMed and EMBASE databases were searched until April 12, 2018, for studies that evaluated MTV or TLG as prognostic factors in esophageal cancer, with overall survival (OS) and event-free survival serving as the end points. Hazard ratios (HRs) were meta-analytically pooled using a random-effects model. Subgroup analyses based on the clinicopathological and PET variables were performed.

Results

In total, 16 studies with 1294 patients were included. The pooled HRs of MTV and TLG for OS were 2.26 (95% confidence interval [CI], 1.73–2.96) and 2.23 (95% CI, 1.73–2.87), respectively. Regarding event-free survival, the pooled HRs of MTV and TLG were 2.03 (95% CI, 1.66–2.49) and 2.57 (95% CI, 1.82–3.62), respectively. Metabolic tumor volume was found to be a significant prognostic factor for OS consistently across multiple subgroups classified based on stage, histological subtype, treatment, delineation of volume of interest, and the determination method of cutoff value, with pooled HRs ranging from 1.96 to 2.54.

Conclusions

In patients with esophageal cancer, MTV and TLG derived from pretreatment 18F-FDG PET are significant prognostic factors. As prognostic biomarkers, volumetric metabolic parameters may bolster the role of 18F-FDG PET in the management of esophageal cancer.
The Influence of Patient Exposure to Breast Reconstruction Approaches and Education on Patient Choices in Breast Cancer Treatment
Authors: Dobke Marek K. , Yee Brittany , Mackert Gina A. , Zhu William Y. , Blair Sarah L.
Published: October 2018

Background

The landscape of surgical and medical management and patient choices for breast cancer treatment changes as breast reconstruction and oncoplastic approaches improve and diversify. Increased access to breast reconstruction, in addition to patient education, influences the breast cancer patient. Therefore, the examination of the possible impact of reconstructive surgery on all stages of the breast cancer management per se seemed timely.

Methods

Plastic surgery consults were arranged for 520 new patients diagnosed with breast cancer (2012–2016) including patients with noninvasive breast cancer but at high risk of further cancer development. To test the plastic surgery impact on patient choices regarding the management of the cancer, a subset of 90 patients was identified to test the plastic surgery impact on patient choices. These patients were referred to plastic surgery, following the first round of consultations by surgical and medical oncologists with only the preliminary oncological management plan defined. After a plastic surgery consultation, but prior to finalization of the overall oncological management plan, they were surveyed on the subject of modification of their personal choices and requests pertaining to their cancer management.

Results

In this subset of 90 patients 40 (44%) returned to their surgical or medical oncologist considering changes of the primary management plan after their plastic surgery consultation. Twenty-six (28%) ultimately altered their plan, and the following patient-driven changes were made: mastectomy as opposed to lumpectomy (18 patients [20%]), contralateral prophylactic mastectomy (11 patients [12%]), nipple/areola removal as opposed to nipple/areola sparing suggested by the oncologists (5 patients [6%]), oncoplastic breast reduction as part of lumpectomy (5 patients [6%]), and other modifications (3 patients [3%]).

Conclusions

Decisions for altering the preliminary oncologic plan or choosing a specific alternative (eg, lumpectomy plus radiation vs mastectomy) resulted from patient education on (1) reconstructive options, (2) aesthetic pitfalls and results. and (3) their interfacing with the oncological outcomes. Ultimately, plastic surgeons influence the multispecialty breast cancer management and patient decision-making process. Therefore, oncological literacy for plastic surgeons is essential to provide state-of-the-art breast cancer care and avoidance of suboptimal patient decisions.
Obstructive Sleep Apnea in Neuro-Ophthalmology
Authors: Wong Brendon , Fraser Clare L.
Published: October 2018

Background:

Obstructive sleep apnea (OSA) is a common pulmonary disorder with many systemic sequelae. Its association with diseases seen in neuro-ophthalmology is being increasingly recognized. Treatment of OSA with continuous positive airway pressure (CPAP) may reverse the pathology in some eye diseases.

Evidence Acquisition:

We conducted a search of the literature using the Ovid Medline database and Google Scholar, focusing on articles that explored the association between OSA and ophthalmic conditions. These included hypertensive retinopathy, diabetic retinopathy, central serous retinopathy (CSR), retinal vein occlusion (RVO), nonarteritic anterior ischemic optic neuropathy (NAION), glaucoma, idiopathic intracranial hypertension (IIH), papilledema, and stroke.

Results:

There is evidence of an independent association between OSA, and both hypertension and Type 2 diabetes mellitus, as well as the retinopathy associated with each disease. Evidence also suggests a link between OSA and CSR, NAION, and stroke. The evidence remains controversial or insufficient for convincing causative association with RVO, glaucoma, and IIH. However, in patients presenting with CSR, and IIH, underlying OSA is a common finding. CPAP reverses some pathological changes, but the evidence is limited.

Conclusions:

OSA is associated with many diseases seen in neuro-ophthalmology clinics. More studies are required to assess the real ability of CPAP to reverse pathological changes. Ophthalmologists can screen for undiagnosed OSA in patients presenting with certain eye diseases.
Impact of the 2015/2016 El Niño on the terrestrial carbon cycle constrained by bottom-up and top-down approaches
Authors: Bastos Ana , Friedlingstein Pierre , Sitch Stephen , Chen Chi , Mialon Arnaud , Wigneron Jean-Pierre , Arora Vivek K. , Briggs Peter R. , Canadell Josep G. , Ciais Philippe , Chevallier Frédéric , Cheng Lei , Delire Christine , Haverd Vanessa , Jain Atul K. , Joos Fortunat , Kato Etsushi , Lienert Sebastian , Lombardozzi Danica , Melton Joe R. , Myneni Ranga , Nabel Julia E. M. S. , Pongratz Julia , Poulter Benjamin , Rödenbeck Christian , Séférian Roland , Tian Hanqin , van Eck Christel , Viovy Nicolas , Vuichard Nicolas , Walker Anthony P. , Wiltshire Andy , Yang Jia , Zaehle Sönke , Zeng Ning , Zhu Dan
Published: October 2018

Evaluating the response of the land carbon sink to the anomalies in temperature and drought imposed by El Niño events provides insights into the present-day carbon cycle and its climate-driven variability. It is also a necessary step to build confidence in terrestrial ecosystems models' response to the warming and drying stresses expected in the future over many continents, and particularly in the tropics. Here we present an in-depth analysis of the response of the terrestrial carbon cycle to the 2015/2016 El Niño that imposed extreme warming and dry conditions in the tropics and other sensitive regions. First, we provide a synthesis of the spatio-temporal evolution of anomalies in net land–atmosphere CO
2
fluxes estimated by two
in situ
measurements based on atmospheric inversions and 16 land-surface models (LSMs) from TRENDYv6. Simulated changes in ecosystem productivity, decomposition rates and fire emissions are also investigated. Inversions and LSMs generally agree on the decrease and subsequent recovery of the land sink in response to the onset, peak and demise of El Niño conditions and point to the decreased strength of the land carbon sink: by 0.4–0.7 PgC yr
−1
(inversions) and by 1.0 PgC yr
−1
(LSMs) during 2015/2016. LSM simulations indicate that a decrease in productivity, rather than increase in respiration, dominated the net biome productivity anomalies in response to ENSO throughout the tropics, mainly associated with prolonged drought conditions.

This article is part of a discussion meeting issue ‘The impact of the 2015/2016 El Niño on the terrestrial tropical carbon cycle: patterns, mechanisms and implications’.
Tree growth and stem carbon accumulation in human-modified Amazonian forests following drought and fire
Authors: Berenguer Erika , Malhi Yadvinder , Brando Paulo , Cardoso Nunes Cordeiro Amanda , Ferreira Joice , França Filipe , Chesini Rossi Liana , Maria Moraes de Seixas Marina , Barlow Jos
Published: October 2018

Human-modified forests are an ever-increasing feature across the Amazon Basin, but little is known about how stem growth is influenced by extreme climatic events and the resulting wildfires. Here we assess for the first time the impacts of human-driven disturbance in combination with El Niño–mediated droughts and fires on tree growth and carbon accumulation. We found that after 2.5 years of continuous measurements, there was no difference in stem carbon accumulation between undisturbed and human-modified forests. Furthermore, the extreme drought caused by the El Niño did not affect carbon accumulation rates in surviving trees. In recently burned forests, trees grew significantly more than in unburned ones, regardless of their history of previous human disturbance. Wood density was the only significant factor that helped explain the difference in growth between trees in burned and unburned forests, with low wood–density trees growing significantly more in burned sites. Our results suggest stem carbon accumulation is resistant to human disturbance and one-off extreme drought events, and it is stimulated immediately after wildfires. However, these results should be seen with caution—without accounting for carbon losses, recruitment and longer-term changes in species composition, we cannot fully understand the impacts of drought and fire in the carbon balance of human-modified forests.

This article is part of a discussion meeting issue ‘The impact of the 2015/2016 El Nino on the terrestrial tropical carbon cycle: patterns, mechanisms and implications’.