bluuebunny/crossref_metadata_2025 huggingface dataset:
The bright-star masks for the HSC-SSP survey
Authors: Coupon Jean , Czakon Nicole , Bosch James , Komiyama Yutaka , Medezinski Elinor , Miyazaki Satoshi , Oguri Masamune
Published: May 2017

We present the procedure to build and validate the bright-star masks for the Hyper-Suprime-Cam Strategic Subaru Proposal (HSC-SSP) survey. To identify and mask the saturated stars in the full HSC-SSP footprint, we rely on the Gaia and Tycho-2 star catalogues. We first assemble a pure star catalogue down to GGaia < 18 after removing ∼1.5% of sources that appear extended in the Sloan Digital Sky Survey (SDSS). We perform visual inspection on the early data from the S16A internal release of HSC-SSP, finding that our star catalogue is 99.2% pure down to GGaia < 18. Second, we build the mask regions in an automated way using stacked detected source measurements around bright stars binned per GGaia magnitude. Finally, we validate those masks by visual inspection and comparison with the literature of galaxy number counts and angular two-point correlation functions. This version (Arcturus) supersedes the previous version (Sirius) used in the S16A internal and DR1 public releases. We publicly release the full masks and tools to flag objects in the entire footprint of the planned HSC-SSP observations at 〈ftp://obsftp.unige.ch/pub/coupon/brightStarMasks/HSC-SSP/〉.
Update on the pathogenesis and treatment of juvenile idiopathic arthritis
Authors: Giancane Gabriella , Alongi Alessandra , Ravelli Angelo
Published: May 2017

Purpose of review

To provide an overview of recently published studies on pathogenesis and management of juvenile idiopathic arthritis (JIA).

Recent findings

In the past year, the potential role of network analysis in the understanding of the molecular phenotype of individual JIA subgroups has been highlighted. In addition, potential new targets for pharmacologic interventions have been identified through the elucidation of mechanisms that modulate the function of cells involved in the inflammatory process. There is a growing interest for the role of the gut microbiome in disease pathogenesis, which may open the way to future therapeutic manipulations of fecal microbial population. Recent therapeutic studies have provided important information in large patient samples on the effectiveness and toxicity profile of biologic medications used in JIA. Concomitant administration of methotrexate was found to increase the effectiveness of intra-articular corticosteroid therapy in children with oligoarticular JIA.

A great deal of work is being conducted to better define the molecular phenotype of the individual subsets of JIA and to identify potential new targets for therapeutic interventions. The results of the ongoing large-scale international data collections will help establish the long-term safety profiles of biologic medications, in particular the risk of malignancy.
Should All Massively Transfused Patients Be Treated Equally? An Analysis of Massive Transfusion Ratios in the Nontrauma Setting
Authors: Etchill Eric W. , Myers Sara P. , McDaniel Lauren M. , Rosengart Matthew R. , Raval Jay S. , Triulzi Darrell J. , Peitzman Andrew. B. , Sperry Jason L. , Neal Matthew D.
Published: May 2017

Objectives:

Although balanced resuscitation has become integrated into massive transfusion practice, there is a paucity of evidence supporting the delivery of high ratios of plasma and platelet to RBCs in the nontrauma setting. This study investigated the administration of blood component ratios in the massively transfused nontrauma demographic.

Design:

Retrospective analysis of a prospective, observational cohort of massively bleeding patients.

Setting:

Surgical and critically ill patients at a tertiary medical center between 2011 and 2015.

Patients:

Massively transfused nontrauma patients.

Interventions:

Patients receiving plasma, platelet, and RBC transfusions were categorized into high and low ratio groups and analyzed for differences in characteristics and clinical outcomes.

Measurements and Main Results:

The primary outcome was 30-day mortality. Secondary outcomes included 48-hour mortality, hospital length of stay, ICU length of stay, and ventilator-free days. Among 601 massively transfused nontrauma patients, cardiothoracic surgery and gastrointestinal or hepato-pancreatico-biliary bleeds were the most common indications for massive transfusion. Higher fresh frozen plasma ratios (> 1:2) were not associated with increased 30-day mortality. A high platelets-to-packed RBCs ratio (> 1:2) was associated with decreased 48-hour mortality (10.5% vs 19.3%;p= 0.032), but not 30-day mortality. Fresh frozen plasma-to-packed RBCs and platelets-to-packed RBCs ratios were not associated with 30-day mortality hazard ratios after controlling for baseline characteristics and disease severity.

Conclusions:

The benefits of higher ratios of fresh frozen plasma-to-packed RBCs and platelets-to-packed RBCs described in trials of trauma patients were not observed in this analysis of a nontrauma, massively transfused population. These data suggest that greater than 1:2 ratio transfusion in the setting of massive hemorrhage may not be appropriate for all patients, and that further research to guide appropriate resuscitation strategies in nontrauma patients is warranted.
Single-Operator Ultrasound-Guided Central Venous Catheter Insertion Verifies Proper Tip Placement*
Authors: Galante Ori , Slutsky Tzachi , Fuchs Lior , Smoliakov Alexander , Mizrakli Yuval , Novack Victor , Brotfein Evgeni , Klein Moti , Frenkel Amit , Koifman Leonid , Almog Yaniv
Published: May 2017

Objectives:

To evaluate whether a single-operator ultrasound-guided, right-sided, central venous catheter insertion verifies proper placement and shortens time to catheter utilization.

Design:

Prospective observational study with historical controls.

Setting:

Adult ICUs.

Patients:

Sixty-four consecutive patients undergoing ultrasound-assisted right-sided central venous catheterization compared with 92 serial historic controls who had unassisted central catheter insertion at the same sites.

Interventions:

Subcostal transthoracic echocardiography during catheter insertion.

Measurements and Main Results:

The primary outcome was the correct placement of the catheter tip determined by postprocedural chest radiography. The subclavian site was used in 41 patients (64%) (inserted without ultrasound guidance) in the ultrasound-assisted group and 62 (67%) in the control group, whereas the jugular vein was used in the remaining patients. The tip was accurately positioned in 59 of 68 patients (86.7%) in the ultrasound-assisted group compared with 51 of 94 (54.8%) in the control group (p < 0.001). The median time from end of the procedure to catheter utilization after chest radiography approval was 2.4 hours.

Conclusions:

A single-operator ultrasound-guided central venous catheter insertion is effective in verifying proper tip placement and shortens time to catheter utilization.
Hyperlactatemia, Lactate Kinetics and Prediction of Citrate Accumulation in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy With Regional Citrate Anticoagulation
Authors: Khadzhynov Dmytro , Dahlinger Annette , Schelter Christin , Peters Harm , Kindgen-Milles Detlef , Budde Klemens , Lehner Lukas Johannes , Halleck Fabian , Staeck Oliver , Slowinski Torsten
Published: May 2017

Objectives:

Citrate accumulation is a major complication of regional citrate anticoagulation during continuous renal replacement therapy. We studied the prediction of citrate accumulation during continuous veno-venous hemodialysis with regional citrate anticoagulation by initial lactate concentrations and lactate kinetics.

Design:

A retrospective follow-up analysis from a cohort of critically ill patients.

Setting:

Mixed medical-surgical ICUs at a university hospital.

Patients:

All adult patients with acute kidney injury and treated with regional citrate anticoagulation-continuous veno-venous hemodialysis during a 3-year period (n = 1,070) were included in this retrospective study and screened for metabolic signs of citrate accumulation.

Interventions:

None.

Measurements and Main Results:

The frequency of citrate accumulation during the first 48 hours of therapy was 2.26%. In patients with initial normal lactate (< 2.2 mmol/L), elevated lactate (≥ 2.2 to < 4 mmol/L), or severe hyperlactatemia (≥ 4 mmol/L), the frequency of citrate accumulation was 0.77%, 2.70%, and 6.33%, respectively. Receiver operating characteristics-area under the curve of initial lactate concentration was 0.789 for the prediction of citrate accumulation. Optimal cutoff from receiver operating characteristics (2.39 mmol/L) showed strong negative prediction (99.28%), but weak positive prediction (5.21%). The slope intercept of lactate kinetics over 48 hours was positive and significantly higher in patients with citrate accumulation compared to those without (+0.2 vs –0.006 mmol/L/hr; p < 0.001). In patients with initial severe hyperlactatemia (≥ 4 mmol/L), the median calculated lactate clearance at 6, 12, and 18 hours was 24.0%, 48.1%, and 59.4% in the nonaccumulation group. These clearance rates were significantly higher at each time-point compared to patients with citrate accumulation (–9.8%, –20.5%, and 2.3%, respectively; p < 0.001 for each time-point). The highest receiver operating characteristics-area under the curve for citrate accumulation was observed for 12-hour values of lactate clearance (area under the curve = 0.839; 95% CI, 0.751–0.927) with an optimal cut-off value of 24.3%.

Conclusions:

Risk of citrate accumulation during regional citrate anticoagulation in a well-selected cohort of patients is low even in case of initial severe hyperlactatemia. Lactate kinetics rather than initially elevated lactate concentration should be considered in assessing the risk of citrate accumulation.
Nonlinear Imputation of Pao 2/Fio 2 From Spo 2/Fio 2 Among Mechanically Ventilated Patients in the ICU: A Prospective, Observational Study
Authors: Brown Samuel M. , Duggal Abhijit , Hou Peter C. , Tidswell Mark , Khan Akram , Exline Matthew , Park Pauline K. , Schoenfeld David A. , Liu Ming , Grissom Colin K. , Moss Marc , Rice Todd W. , Hough Catherine L. , Rivers Emanuel , Thompson B. Taylor , Brower Roy G.
Published: May 2017

Objectives:

In the contemporary ICU, mechanically ventilated patients may not have arterial blood gas measurements available at relevant timepoints. Severity criteria often depend on arterial blood gas results. Retrospective studies suggest that nonlinear imputation of Pao
2/Fio
2 from Spo
2/Fio
2 is accurate, but this has not been established prospectively among mechanically ventilated ICU patients. The objective was to validate the superiority of nonlinear imputation of Pao
2/Fio
2 among mechanically ventilated patients and understand what factors influence the accuracy of imputation.

Design:

Simultaneous Spo
2, oximeter characteristics, receipt of vasopressors, and skin pigmentation were recorded at the time of a clinical arterial blood gas. Acute respiratory distress syndrome criteria were recorded. For each imputation method, we calculated both imputation error and the area under the curve for patients meeting criteria for acute respiratory distress syndrome (Pao
2/Fio
2 ≤ 300) and moderate-severe acute respiratory distress syndrome (Pao
2/Fio
2 ≤ 150).

Setting:

Nine hospitals within the Prevention and Early Treatment of Acute Lung Injury network.

Patients:

We prospectively enrolled 703 mechanically ventilated patients admitted to the emergency departments or ICUs of participating study hospitals.

Interventions:

None.

Measurements and Main Results:

We studied 1,034 arterial blood gases from 703 patients; 650 arterial blood gases were associated with Spo
2 less than or equal to 96%. Nonlinear imputation had consistently lower error than other techniques. Among all patients, nonlinear had a lower error (p < 0.001) and higher (p < 0.001) area under the curve (0.87; 95% CI, 0.85–0.90) for Pao
2/Fio
2 less than or equal to 300 than linear/log-linear (0.80; 95% CI, 0.76–0.83) imputation. All imputation methods better identified moderate-severe acute respiratory distress syndrome (Pao
2/Fio
2 ≤ 150); nonlinear imputation remained superior (p < 0.001). For Pao
2/Fio
2 less than or equal to 150, the sensitivity and specificity for nonlinear imputation were 0.87 (95% CI, 0.83–0.90) and 0.91 (95% CI, 0.88–0.93), respectively. Skin pigmentation and receipt of vasopressors were not associated with imputation accuracy.

Conclusions:

In mechanically ventilated patients, nonlinear imputation of Pao
2/Fio
2 from Spo
2/Fio
2 seems accurate, especially for moderate-severe hypoxemia. Linear and log-linear imputations cannot be recommended.
General Pediatrician-Staffed Behavioral/Developmental Access Clinic Decreases Time to Evaluation of Early Childhood Developmental Disorders
Authors: Harrison Meghan , Jones Persephone , Sharif Iman , Di Guglielmo Matthew D.
Published: May 2017

Objective:

To describe and evaluate the effectiveness of a quality improvement project to decrease wait time to evaluation for children referred to Developmental Behavioral Pediatricians (DBPs).

Methods:

The authors created a Behavioral/Developmental Access Clinic (BDAC) staffed by a general pediatrician (GP) and pediatric psychologist. Clinicians in the BDAC provided comprehensive developmental evaluations for children in a discrete age range (<5 yr old). We describe the establishment of the BDAC along with referrals, diagnoses, and recommended follow-up for patients seen by the GP. We used 2-tailed t tests to compare the mean time with initial evaluation for patients seen in BDAC versus a DBP.

Results:

Sixty-three children were seen in BDAC over 6 months. Referrals from the BDAC included: physical/occupational/speech therapy (71%), psychology (35%), audiology (25%), genetics (14%), and neurology (8%). Five patients (8%) were diagnosed with autism spectrum disorder (ASD). Compared with time to appointment with a DBP (327 d), mean time to developmental assessment was shorter for the 45 patients who accepted earlier appointments in the BDAC (159 d), and for the 18 children seen in the BDAC as new referrals (11 d), p < .001. Follow-up with a DBP was recommended for 9 (50%) of the new patient referrals evaluated in BDAC.

Conclusion:

The BDAC allowed for earlier developmental assessment of young children, with potential for earlier diagnosis and treatment of developmental disorders, including ASD. Opportunity for initial evaluation in BDAC decreased the number of patients requiring evaluation by DBPs, improving access to this subspecialty in our institution.
Efficacy of Cyclosporine After Autologous Noncultured Melanocyte Transplantation in Localized Stable Vitiligo—A Pilot, Open Label, Comparative Study
Authors: Mutalik Sharad , Shah Swapnil , Sidwadkar Varsha , Khoja Meenaz
Published: May 2017

BACKGROUND

Understanding the pathogenesis of vitiligo has lead to innovation of new drugs and new uses of the existing drugs to enhance treatment outcome.

OBJECTIVE

The aim of this observational pilot study was to assess the role of cyclosporine (CsA) to tackle the commonest aesthetic problem “perilesional halo” after autologous noncultured melanocyte–keratinocyte cell transplant (NCMKT) for localized, stable vitiligo.

MATERIALS AND METHODS

Of the total 50 enrolled patients who underwent NCMKT for stable/resistant vitiligo, aged 12 to 68 years (mean 29.92 years), 18 were male and 32 were female. Group I (n = 25) patients did not receive any postoperative treatment. Group II (n = 25) patients received CsA postoperatively at 3 mg·kg−1·d−1 for 3 weeks followed by 1.5 mg·kg−1·d−1 for 6 weeks.

RESULTS

In Group I, results were as follows: 28% (n = 7) achieved >75% repigmentation, 16% (n = 4) achieved 50% to 75% repigmentation, 52% (n = 13) achieved 25% to 50% repigmentation, and 4% (n = 1) achieved <25% repigmentation. In Group II, 100% (n = 25) achieved >75% (median 90.7%) repigmentation post-NCMKT at the end of 6 months.

CONCLUSION

This new drug regimen using CsA resulted in rapid and uniform repigmentation without leaving any perilesional halo in Group II patients after NCMKT.
Psychometric properties of the Finnish version of the Women's Health Questionnaire
Authors: Katainen Riina E. , Engblom Janne R. , Vahlberg Tero J. , Polo-Kantola Päivi
Published: May 2017

Objective:

The Women's Health Questionnaire (WHQ) is a validated and commonly used instrument for measuring climacteric-related symptoms. A revised version was previously developed. However, validation in a Finnish population is lacking. As it is important to use qualified instruments, we performed a validation study of the WHQ in a Finnish population.

Methods:

In all, 3,421 women, aged 41 to 54 years, formed the study population. In the original 36-item WHQ, the items were rated on a 1 to 4 scale and on a binary scale (0-1). The scaling of the revised 23-item WHQ was 0 to 100. We evaluated the psychometric properties (internal consistency, correlations between the symptom domains, factor structure, and sampling adequacy) in all three versions.

Results:

For the 1 to 4 scale and on the revised version of the WHQ, the internal consistency was acceptable (the Cronbach's α coefficients >0.70) for most of the domains. On the binary scale, the majority of the coefficient values were below the acceptable level. The original symptom domains, especially those on the revised version, were recognizable from the factors in the exploratory factor analysis, but there were some limitations. The Kaiser-Meyer-Olkin values were high.

Conclusions:

The WHQ is a valid instrument for measuring climacteric-related symptoms in Finnish middle-aged women. The psychometric properties of the revised 23-item WHQ were as good or even better than those of the original 36-item WHQ. Thus, we encourage use of the revised version.
Foreign Body Response to Silicone in Cochlear Implant Electrodes in the Human
Authors: O’Malley Jennifer T. , Burgess Barbara J. , Galler Donald , Nadol Joseph B.
Published: May 2017

Hypothesis:

Silicone as part of a cochlear implant electrode may be responsible for a foreign body response in the human.

Background:

Clinical evidence of a foreign body response to a cochlear implant has been reported. In a previous study, particulate material found within the fibrous sheath and within macrophages surrounding a cochlear implant has been identified as being consistent with platinum. However, to date, there has been no histologic evidence of a role for silicone in this cellular immune response.

Methods:

A total of 44 temporal bone specimens from 36 patients were reviewed by light microscopy for evidence of presumed platinum and/or silicone foreign bodies in an extracellular or intracellular location. Identification of cell type involved in phagocytosis of foreign body material was accomplished using CD163 immunostaining. The identity and source of the foreign body material was confirmed using energy-dispersive X-ray spectroscopy and scanning electron microscopy.

Results:

Evidence for both platinum and silicone was found in all 44 specimens. In three patients, anti-CD 163 immunostaining demonstrated phagocytized platinum and silicone foreign bodies. In five specimens, energy-dispersive X-ray spectroscopy demonstrated that the birefringent foreign bodies were consistent with silicone. Scanning electron microscopy of two electrodes removed from temporal bones demonstrated small cracks, fragmentation, and small circular defects in the silicone carrier.

Conclusion:

Histologic evidence of a foreign body response to the presence of platinum and silicone in a cochlear implant has been demonstrated and may be responsible for some reported delayed failures or extrusion.
Surgical orthodontics
Authors: Strohl Alexis M. , Vitkus Lauren
Published: May 2017

Purpose of review

The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient.

Recent findings

Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of ‘surgery first’ orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes.

A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.
The Effect of Maternal Milk on Tolerance and Growth in Premature Infants
Authors: Hogewind‐Schoonenboom Jacomine E. , Rövekamp‐Abels Lyanne W.W. , de Wijs‐Meijler Daphne P.M. , Maduro Margaux D. , Jansen‐van der Weide Marijke C. , van Goudoever Johannes B. , Hulst Jessie M.
Published: May 2017

Objective:

Early growth rates and feeding advancement rates of preterm infants are thought to influence later health. Feeding advancement is often difficult because of feeding intolerance. Exclusive human milk feeding improves tolerance, but can result in a lower weight gain rate. The addition of human milk fortifier has advantages for growth, but there are concerns that it may nullify the beneficial effect of human milk on tolerance. Therefore, the objective of the present study was to evaluate the relation between the amount of fortified human milk or formula and feeding tolerance and growth in preterm infants.

Methods:

Patients (n = 174) participating in the TOL trial and born with a gestational age 30 weeks or younger were divided into tertiles according to the amount of human milk received during feeding advancement. Data on feeding tolerance during the advancement phase of enteral nutrition and anthropometrics were analysed.

Results:

The infants (n = 59) receiving the lowest percentage of their enteral intake as human milk (0%–57%) had the lowest amount of gastric residuals (P = 0.034) compared with the other 2 tertiles. Time to reach full enteral feeding and other tolerance parameters were not different among the groups. There was no dose response effect of the amount of human milk consumed on growth.

Conclusions:

In preterm infants, an association between type of feeding (human milk vs infant formula) and time to achieve full enteral feeding or short‐term growth was not found. Future prospective trials are needed to verify our results and focus on means to improve tolerance further.
Female Sex, Bilateral Disease, Age Below 3 Years, and Apprehension for Enucleation Contribute to Treatment Abandonment in Retinoblastoma
Authors: Bhargav Anish , Singh Usha , Trehan Amita , Zadeng Zoramathara , Bansal Deepak
Published: May 2017

Treatment abandonment is a major obstacle for treating retinoblastoma in developing countries. The aim was to evaluate plausible causes, outcome, and rate of treatment abandonment in patients with retinoblastoma. The study was retrospective and conducted in a University hospital in North-India. Two cohorts of patients were studied. One was a larger cohort (n=602) of all patients with retinoblastoma in the institution from 2000 to 2014. Limited variables (age, sex, and laterality) were examined in this cohort due to incomplete data/lack of contact. A detailed interview was conducted with contactable caregivers in a smaller cohort (n=104). Noncompliance was observed in 170/602 (28%) patients. Patients below 3 years were more likely to be noncompliant (65.1%), compared with older patients (34.9%) (P=0.003). Compliance was greater among male individuals (64%) than in female individuals (36%) (P=0.017) and in those with unilateral disease (72%) compared with those who had bilateral disease (28%) (P=0.009). Apprehension for enucleation (64% vs. 8%, P=0.0001) and difficulty in attending outpatient services of different departments (61.4% vs. 13.3%, P=0.003) for multimodality treatment were expressed more frequently in the noncompliant than in the compliant group, respectively. The mortality in compliant and noncompliant patients was 7% and 68%, respectively (P=0.0001). The rate of treatment abandonment in 602 patients over a 15-year period was a sizable 28%. The factors contributing to noncompliance included female sex, bilateral disease, age below 3 years, apprehension for enucleation, and difficulty in attending outpatient services of different departments.
Successful Treatment of Transplantation-associated Atypical Hemolytic Uremic Syndrome With Eculizumab
Authors: Hasegawa Daiichiro , Saito Atsuro , Nino Nanako , Uemura Suguru , Takafuji Satoru , Yokoi Takehito , Kozaki Aiko , Ishida Toshiaki , Kawasaki Keiichiro , Yasumi Takahiro , Sakata Naoki , Ohtsuka Yasufumi , Hirase Satoshi , Mori Takeshi , Nishimura Noriyuki , Kusumoto Mayumi , Ogawa Yoshiharu , Tominaga Kenta , Nakagawa Taku , Kanda Kyoko , Tanaka Ryojiro , Kosaka Yoshiyuki
Published: May 2017

We herein reported a 4-month-old boy with transplantation-associated atypical hemolytic uremic syndrome (TA-aHUS) who was successfully treated with eculizumab. The patient diagnosed with type 3 of familial hemophagocytic lymphohistiocytosis underwent cord blood transplantation. After transplantation, he developed TA-aHUS, but plasma exchanges were unsuccessful. We identified deletions in CFH-related gene 1 (del-CFHR1) by the multiplex ligation-dependent probe amplification testing procedure and CFH autoantibodies. Eculizumab has been administered to the patient, with a marked improvement being achieved in thrombocytopenia. He has been well except for the persistent microhematuria for a year after transplantation. Uncontrolled complement activation might be involved in the pathophysiology of TA-aHUS.
Mentoring Nontenured Track Nursing Faculty
Authors: Cullen Deborah , Shieh Carol , McLennon Susan M. , Pike Caitlin , Hartman Taylor , Shah Hena
Published: May 2017

The purpose of this systematic review was to evaluate the effectiveness of mentoring strategies for nursing faculty progression and productivity in the nontenure track at institutions of higher education. Sixty articles were included in the review. Findings revealed that nontenure track nursing faculty require planned programs and mentoring strategies unique to their role and abilities. Schools of nursing can improve on faculty progression, scholarship, and career growth by providing structured mentoring activity.
Pathophysiology of ANCA-associated Vasculitis
Authors: Al-Hussain Turki , Hussein Maged H. , Conca Walter , Al Mana Hadeel , Akhtar Mohammed
Published: May 2017

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is characterized as inflammation of small-sized to medium-sized blood vessels and encompasses several clinicopathologic entities including granulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, and renal-limited ANCA-associated vasculitis. Over the past several decades, significant progress has been made in understanding the pathophysiology of ANCA-associated vasculitis. Although neutrophils contain a multitude of granular proteins, clinically significant autoantibodies are only recognized against myeloperoxidase and proteinase 3, both of which are present in the azurophilic granules. The propensity to develop these antibodies depends on a variety of predisposing factors such as microbial infection, genetic factors, environmental agents, and therapeutic drugs among others. These factors are usually associated with production of proinflammatory cytokines with capacity to prime the neutrophils. As a result a high proportion of neutrophils in circulation may be primed resulting in exposure of cytoplasmic proteins including myeloperoxidase and proteinase 3 on the surface of the neutrophils. Primed neutrophils are activated by interaction with ANCA in circulation. Activated neutrophils attach to and transmigrate through endothelium and accumulate within the vessel wall. These neutrophils degranulate and produce reactive oxygen radicals and ultimately die, causing tissue injury. Endothelial injury results in leakage of serum proteins and coagulation factors causing fibrinoid necrosis. B cells produce ANCAs, as well as neutrophil abnormalities and imbalances in different T-cell subtypes with excess of Th17, which perpetuate the inflammatory process.
An Airway Risk Assessment Score for Unplanned Extubation in Intensive Care Pediatric Patients*
Authors: Vats Atul , Hopkins Clara , Hatfield Kelly M. , Yan Jia , Palmer Robert , Keskinocak Pinar
Published: May 2017

Objective:

As a result of a workshop to identify common causes of unplanned extubation, Children’s Healthcare of Atlanta developed a scoring tool (Risk Assessment Score) to stratify patients into groups of low, moderate, high, and extreme risk. This tool could be used to institute appropriate monitoring or interventions for patients with high risks of unplanned extubation to enhance safety. The objective of this study is to test the hypothesis that the Risk Assessment Score will correlate with the occurrence rate of unplanned extubation in pediatric patients.

Design:

Retrospective review of 2,811 patients at five ICUs conducted between December 2012 and July 2014.

Setting:

Five ICUs at two freestanding pediatric hospitals within a large children’s healthcare system in the United States.

Patients:

All intubated pediatric patients.

Interventions:

Data of intubations and Risk Assessment Score were collected. Extubation outcomes and severity levels were compared across demographic groups and with the maximum Risk Assessment Score of each intubation.

Measurements and Main Results:

Out of 4,566 intubations, 244 were unplanned extubations (5.3%). The occurrence rates of unplanned extubations in those less than 1, 1–6, and more than 6 years old were 6.7%, 3.6%, and 2.7%, respectively, corresponding to a rate of 0.59, 0.53, and 0.58 unplanned extubation every 100 ventilator days. The occurrence rates were 13.6% for patients weighing less than 1 kg (0.59 unplanned extubation per 100 ventilation days) and 3.8% for patients weighing greater than or equal to 1 kg (0.58 unplanned extubation per 100 ventilation days). For intubations with maximum risk score falling in risk categories of low, moderate, high, and extreme, the occurrence rates were 4.7%, 7.7%, 12.0%, and 8.3%, respectively, which corresponded to rates of 0.54, 0.62, 0.95, and 0.92 unplanned extubation per 100 ventilator days.

Conclusions:

Higher Risk Assessment Scores are associated with occurrence rates of unplanned extubation.
The ACA and Cancer Screening and Diagnosis
Authors: Sabik Lindsay M. , Adunlin Georges
Published: May 2017

The Patient Protection and Affordable Care Act (ACA) included multiple provisions expected to increase cancer screening and subsequently early diagnosis of cancer. Key provisions included new coverage options for low-income adults and young adults, as well as elimination of cost sharing for recommended preventive services across most health insurance plans. This article reviews relevant quantitative studies published since the ACA’s passage to assess whether the goal of increasing access to preventive services has been met. Because of lags in data availability, most studies examined only a short period post-ACA. Findings on changes in screening in the general population were mixed, although impacts were greatest among those with lower education and income, as well as groups that previously faced the highest cost barriers to screening. Furthermore, multiple studies found evidence of increases in early-stage diagnoses for certain cancers. Thus, certain targeted populations appear to have better access to cancer screening after the ACA.
Ultrasonography for Preoperative Diagnosis of Retroperitoneal Fibrosis
Authors: Chen Sheng-Jiang , Qin Ling , Xie Yu-Juan , Zhu Jian-Ping , Zhang Qiang , Chen Mei
Published: May 2017

This study aimed to assess the application of ultrasonography for preoperative diagnosis of retroperitoneal fibrosis (RPF). A total of 51 patients with clinically suspected RPF underwent transabdominal ultrasonography and ultrasound-guided histopathologic biopsy (tAU-UGHB). Retroperitoneal fibrosis was diagnosed in 35 patients; of these, 31 cases (88.6%) received a diagnosis using tAU-UGHB. The ultrasonographic images mainly showed solid, irregular isoechoic masses, which were present behind the retroperitoneum and surrounded the abdominal aorta, inferior vena cava, and ureters and had clear borders with the encapsulated structures. Compared with other retroperitoneal lesions, RPF lesions were mainly located below the initial level of the renal artery, and their internal flow signals were not rich (P < 0.05). Retroperitoneal fibrosis had characteristic ultrasonographic features, and color Doppler ultrasound-guided biopsy could be positioned accurately, safely, and efficiently; therefore, tAU-UGHB can be used as an effective modality for preoperative diagnosis of RPF.
Sonographic and Magnetic Resonance Imaging Characteristics of Juvenile Papillomatosis
Authors: Yilmaz Ravza , Bayramoglu Zuhal , Bicen Fuat , Kayhan Arda , Yesil Semen , Acunas Gulden
Published: May 2017

Juvenile papillomatosis (JP) is an infrequently seen benign proliferative lesion in women younger than 30 years. Herein, we present different clinical manifestations of histopathologically proven JP of the breast, in addition to magnetic resonance and sonographic imaging features of these cases. Patient 1 exhibited nipple discharge and papillary carcinoma accompanied after the operation. Patient 2 presented with a giant mass with cystic and numerous solid nodular components that filled the entire right breast. Patient 3 exhibited cystic areas in a well-circumscribed hypoechoic solid mass besides ahypoechoic mass with indistinct borders, which was evaluated as multifocal JP.
Low Serum Angiopoietin-1, High Serum Angiopoietin-2, and High Ang-2/Ang-1 Protein Ratio are Associated with Early Onset Sepsis in Surinamese Newborns
Authors: Zonneveld Rens , Jongman Rianne , Juliana Amadu , Zijlmans Wilco , Plötz Frans , Molema Grietje , van Meurs Matijs
Published: May 2017

Purpose:

Vascular inflammation and leakage in sepsis is mediated by Angiopoietin-1 (Ang-1) and Angiopoietin-2 (Ang-2) and their phosphorylation of the endothelial Tie-2 receptor. This study investigates levels of Ang-1 and Ang-2 in newborns to gain insight in the vascular pathophysiology of early onset sepsis (EOS) within 72 h after birth.

Methods:

A prospective cohort study was performed among 71 Surinamese newborns treated with antibiotics for suspected EOS and 20 control newborns. Newborns with suspected EOS were divided in two groups: blood culture negative and positive EOS. Ang-1 and Ang-2 levels were measured in serum obtained at the start of antibiotic treatment and at re-evaluation after 48 to 72 h.

Results:

In this cohort 8.5% of newborns had a positive blood culture. At the start of antibiotic treatment Ang-1 serum levels were lower (P < 0.01), and Ang-2 and Ang-2/Ang-1 serum protein ratios were higher (P < 0.01 and P < 0.01, respectively) in newborns with blood culture positive EOS than in controls. These levels were not dependent on timing of first blood draw after birth. After 48 to 72 h levels of Ang-1 further decreased in blood culture positive EOS, while in the other groups no change was observed.

Conclusions:

Our findings support the hypothesis that a disbalance in the Angiopoietins plays a role in the vascular pathophysiology of EOS.
Continuous lateral rotational therapy in trauma—A systematic review and meta-analysis
Authors: Schieren Mark , Piekarski Florian , Dusse Fabian , Marcus Hanke , Poels Marcel , Wappler Frank , Defosse Jérôme
Published: May 2017

BACKGROUND

The purpose of this study was to evaluate the impact of continuous lateral rotational therapy (CLRT) on respiratory complications and mortality in patients suffering from trauma.

METHODS

The literature databases PubMed®/Medline® and the Cochrane Library® were systematically searched for prospective controlled trials comparing continuous lateral rotational therapy to conventional manual positioning in trauma patients.

RESULTS

A total of 8 publications (n= 422 patients) with comparable age and injury severity were included in the meta-analysis. A significant reduction in the incidence of nosocomial pneumonia (OR: 0.33, [95%CI: 0.17, 0.65], p=0.001) was observed in patients treated prophylactically with continuous lateral rotational therapy. When used with therapeutic intention, CLRT had no impact on the incidence of pneumonia. There were no significant differences in mortality, duration of mechanical ventilation, or ICU length of stay.

CONCLUSIONS

Analogous to studies evaluating CLRT in medical or mixed patient collectives, CLRT reduced the rates of nosocomial pneumonia in trauma patients. This, however, had no impact on overall mortality. The level of evidence of the studies included was limited by several factors. An adequately powered, well-designed multi-centre randomised controlled trial is required, to validly assess the utility of CLRT for the prevention and treatment of pulmonary complications in patients suffering from trauma.

LEVEL OF EVIDENCE

Systematic review and meta-analysis, level III.
Outcomes after traumatic injury in patients with preexisting psychiatric illness
Authors: Falsgraf Erika , Inaba Kenji , de Roulet Amory , Johnson Megan , Benjamin Elizabeth , Lam Lydia , Matsushima Kazuhide , Strumwasser Aaron , Demetriades Demetrios
Published: May 2017

BACKGROUND

Patients with psychiatric illness have been shown to experience higher rates of traumatic injury. Injury patterns, treatment decisions, and outcomes have not been well characterized in patients with psychiatric illness after injury, in particular those who undergo acute surgical intervention. The purpose of this analysis was to determine mortality, complications, and surgical intervention rates in patients with psychiatric illness after traumatic injury.

METHODS

This is a retrospective study of trauma patients ≥18 years old admitted to LAC + USC Medical Center between January 2008 and March 2015. Patients with psychiatric diagnoses were identified using ICD-9 diagnosis codes. Multivariate logistic regression analyses taking into account demographic and injury characteristics were used to identify associations between psychiatric comorbidity, injury mechanism, surgical interventions, and outcomes in patients after injury.

RESULTS

A total of 26,502 patients were analyzed. Of these, 3,040 (11.5%) had a documented psychiatric comorbidity (2.0% depressive disorder, 0.8% bipolar disorder, 1.3% schizophrenia, 0.5% anxiety disorder, 3.2% substance use disorder). Patients with psychiatric illness were significantly older (49.6 years vs. 42.0 years, p < 0.001), had a lower proportion of penetrating injuries (13.8% vs. 18.1%, p < 0.001), and had a higher incidence of self-inflicted injuries (11.6% vs. 0.72%, p < 0.001). No difference in gender distribution was observed (74.2% men vs. 74.4% men, p = 0.80). Overall mortality was similar in both groups (adjusted odds ratio [aOR], 0.73; p = 0.07). Patients with psychiatric illness were significantly less likely to undergo acute surgical intervention within 6 hours of emergency department admission (aOR, 0.64; p < 0.001). Time from ED arrival to consent for acute surgical intervention was similar in both groups (94.8 min vs. 93.0 min, p = 0.84). No significant difference in mortality after acute surgical intervention was observed (aOR, 0.26; p = 0.10). Psychiatric illness was associated with a significantly higher likelihood of developing complications (aOR, 1.90; p < 0.001) and longer hospital lengths of stay (10.6 days vs. 6.2 days, p < 0.001).

CONCLUSIONS

Trauma patients with comorbid psychiatric illness were observed to have lower rates of acute surgical interventions, higher complication rates, and longer hospital lengths of stay. Further studies are needed to better characterize the causative factors underlying these associations.

LEVEL OF EVIDENCE

Epidemiological, level III.
Animal coloration research: why it matters
Authors: Caro Tim , Stoddard Mary Caswell , Stuart-Fox Devi
Published: May 2017

While basic research on animal coloration is the theme of this special edition, here we highlight its applied significance for industry, innovation and society. Both the nanophotonic structures producing stunning optical effects and the colour perception mechanisms in animals are extremely diverse, having been honed over millions of years of evolution for many different purposes. Consequently, there is a wealth of opportunity for biomimetic and bioinspired applications of animal coloration research, spanning colour production, perception and function. Fundamental research on the production and perception of animal coloration is contributing to breakthroughs in the design of new materials (cosmetics, textiles, paints, optical coatings, security labels) and new technologies (cameras, sensors, optical devices, robots, biomedical implants). In addition, discoveries about the function of animal colour are influencing sport, fashion, the military and conservation. Understanding and applying knowledge of animal coloration is now a multidisciplinary exercise. Our goal here is to provide a catalyst for new ideas and collaborations between biologists studying animal coloration and researchers in other disciplines.

This article is part of the themed issue ‘Animal coloration: production, perception, function and application’.
Genomics of coloration in natural animal populations
Authors: San-Jose Luis M. , Roulin Alexandre
Published: May 2017

Animal coloration has traditionally been the target of genetic and evolutionary studies. However, until very recently, the study of the genetic basis of animal coloration has been mainly restricted to model species, whereas research on non-model species has been either neglected or mainly based on candidate approaches, and thereby limited by the knowledge obtained in model species. Recent high-throughput sequencing technologies allow us to overcome previous limitations, and open new avenues to study the genetic basis of animal coloration in a broader number of species and colour traits, and to address the general relevance of different genetic structures and their implications for the evolution of colour. In this review, we highlight aspects where genome-wide studies could be of major utility to fill in the gaps in our understanding of the biology and evolution of animal coloration. The new genomic approaches have been promptly adopted to study animal coloration although substantial work is still needed to consider a larger range of species and colour traits, such as those exhibiting continuous variation or based on reflective structures. We argue that a robust advancement in the study of animal coloration will also require large efforts to validate the functional role of the genes and variants discovered using genome-wide tools.

This article is part of the themed issue ‘Animal coloration: production, perception, function and application’.
Colour, vision and coevolution in avian brood parasitism
Authors: Stoddard Mary Caswell , Hauber Mark E.
Published: May 2017

The coevolutionary interactions between avian brood parasites and their hosts provide a powerful system for investigating the diversity of animal coloration. Specifically, reciprocal selection pressure applied by hosts and brood parasites can give rise to novel forms and functions of animal coloration, which largely differ from those that arise when selection is imposed by predators or mates. In the study of animal colours, avian brood parasite–host dynamics therefore invite special consideration. Rapid advances across disciplines have paved the way for an integrative study of colour and vision in brood parasite–host systems. We now know that visually driven host defences and host life history have selected for a suite of phenotypic adaptations in parasites, including mimicry, crypsis and supernormal stimuli. This sometimes leads to vision-based host counter-adaptations and increased parasite trickery. Here, we review vision-based adaptations that arise in parasite–host interactions, emphasizing that these adaptations can be visual/sensory, cognitive or phenotypic in nature. We highlight recent breakthroughs in chemistry, genomics, neuroscience and computer vision, and we conclude by identifying important future directions. Moving forward, it will be essential to identify the genetic and neural bases of adaptation and to compare vision-based adaptations to those arising in other sensory modalities.

This article is part of the themed issue ‘Animal coloration: production, perception, function and application’.
The perfection of mimicry: an information approach
Authors: Sherratt Thomas N. , Peet-Paré Casey A.
Published: May 2017

We consider why imperfect deceptive mimics can persist when it appears to be in the predator's interest to discriminate finely between mimics and their models. One theory is that a receiver will accept being duped if the model and mimic overlap in appearance and the relative costs of attacking the model are high. However, a more fundamental explanation for the difficulty of discrimination is not based on perceptual uncertainty, but simply based on a lack of information. In particular, predators in the process of learning may cease sampling imperfect mimics entirely because the immediate pay-off and future value of information is low, allowing such mimics to persist. This outcome will be particularly likely when the model is relatively costly to attack and/or the discriminative rules the predator has to learn are complex. Information limitations neatly explain why predators tend to adopt discriminative rules based on single traits (such as stripe colour), rather than on combinations of traits (such as stripe order). They also explain why predators utilize certain salient discriminative traits while ignoring equally informative ones (a phenomenon known as overshadowing), and why imperfect mimics may be more common in phenotypically diverse prey communities.

This article is part of the themed issue ‘Animal coloration: production, perception, function and application’.
Camouflage through colour change: mechanisms, adaptive value and ecological significance
Authors: Duarte Rafael C. , Flores Augusto A. V. , Stevens Martin
Published: May 2017

Animals from a wide range of taxonomic groups are capable of colour change, of which camouflage is one of the main functions. A considerable amount of past work on this subject has investigated species capable of extremely rapid colour change (in seconds). However, relatively slow colour change (over hours, days, weeks and months), as well as changes arising via developmental plasticity are probably more common than rapid changes, yet less studied. We discuss three key areas of colour change and camouflage. First, we review the mechanisms underpinning colour change and developmental plasticity for camouflage, including cellular processes, visual feedback, hormonal control and dietary factors. Second, we discuss the adaptive value of colour change for camouflage, including the use of different camouflage types. Third, we discuss the evolutionary–ecological implications of colour change for concealment, including what it can tell us about intraspecific colour diversity, morph-specific strategies, and matching to different environments and microhabitats. Throughout, we discuss key unresolved questions and present directions for future work, and highlight how colour change facilitates camouflage among habitats and arises when animals are faced with environmental changes occurring over a range of spatial and temporal scales.

This article is part of the themed issue ‘Animal coloration: production, perception, function and application’.