bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting 72-hour and 9-day return to the emergency department using machine learning
Authors: Hong Woo Suk , Haimovich Adrian Daniel , Taylor Richard Andrew
Published: July 2019

Objectives

To predict 72-h and 9-day emergency department (ED) return by using gradient boosting on an expansive set of clinical variables from the electronic health record.

Methods

This retrospective study included all adult discharges from a level 1 trauma center ED and a community hospital ED covering the period of March 2013 to July 2017. A total of 1500 variables were extracted for each visit, and samples split randomly into training, validation, and test sets (80%, 10%, and 10%). Gradient boosting models were fit on 3 selections of the data: administrative data (demographics, prior hospital usage, and comorbidity categories), data available at triage, and the full set of data available at discharge. A logistic regression (LR) model built on administrative data was used for baseline comparison. Finally, the top 20 most informative variables identified from the full gradient boosting models were used to build a reduced model for each outcome.

Results

A total of 330 631 discharges were available for analysis, with 29 058 discharges (8.8%) resulting in 72-h return and 52 748 discharges (16.0%) resulting in 9-day return to either ED. LR models using administrative data yielded test AUCs of 0.69 (95% confidence interval [CI] 0.68–0.70) and 0.71(95% CI 0.70–0.72), while gradient boosting models using administrative data yielded test AUCs of 0.73 (95% CI 0.72–0.74) and 0.74 (95% CI 0.73–0.74) for 72-h and 9-day return, respectively. Gradient boosting models using variables available at triage yielded test AUCs of 0.75 (95% CI 0.74–0.76) and 0.75 (95% CI 0.74–0.75), while those using the full set of variables yielded test AUCs of 0.76 (95% CI 0.75–0.77) and 0.75 (95% CI 0.75–0.76). Reduced models using the top 20 variables yielded test AUCs of 0.73 (95% CI 0.71–0.74) and 0.73 (95% CI 0.72–0.74).

Discussion and Conclusion

Gradient boosting models leveraging clinical data are superior to LR models built on administrative data at predicting 72-h and 9-day returns.
Replicated Landscape Genomics Identifies Evidence of Local Adaptation to Urbanization in Wood Frogs
Authors: Homola Jared J , Loftin Cynthia S , Cammen Kristina M , Helbing Caren C , Birol Inanc , Schultz Thomas F , Kinnison Michael T
Published: June 2019

Native species that persist in urban environments may benefit from local adaptation to novel selection factors. We used double-digest restriction-side associated DNA (RAD) sequencing to evaluate shifts in genome-wide genetic diversity and investigate the presence of parallel evolution associated with urban-specific selection factors in wood frogs (Lithobates sylvaticus). Our replicated paired study design involved 12 individuals from each of 4 rural and urban populations to improve our confidence that detected signals of selection are indeed associated with urbanization. Genetic diversity measures were less for urban populations; however, the effect size was small, suggesting little biological consequence. Using an FST outlier approach, we identified 37 of 8344 genotyped single nucleotide polymorphisms with consistent evidence of directional selection across replicates. A genome-wide association study analysis detected modest support for an association between environment type and 12 of the 37 FST outlier loci. Discriminant analysis of principal components using the 37 FST outlier loci produced correct reassignment for 87.5% of rural samples and 93.8% of urban samples. Eighteen of the 37 FST outlier loci mapped to the American bullfrog (Rana [Lithobates] catesbeiana) genome, although none were in coding regions. This evidence of parallel evolution to urban environments provides a powerful example of the ability of urban landscapes to direct evolutionary processes.
Methods to quantify primary plant cell wall mechanics
Authors: Bidhendi Amir J , Geitmann Anja
Published: June 2019

The primary plant cell wall is a dynamically regulated composite material of multiple biopolymers that forms a scaffold enclosing the plant cells. The mechanochemical make-up of this polymer network regulates growth, morphogenesis, and stability at the cell and tissue scales. To understand the dynamics of cell wall mechanics, and how it correlates with cellular activities, several experimental frameworks have been deployed in recent years to quantify the mechanical properties of plant cells and tissues. Here we critically review the application of biomechanical tool sets pertinent to plant cell mechanics and outline some of their findings, relevance, and limitations. We also discuss methods that are less explored but hold great potential for the field, including multiscale in silico mechanical modeling that will enable a unified understanding of the mechanical behavior across the scales. Our overview reveals significant differences between the results of different mechanical testing techniques on plant material. Specifically, indentation techniques seem to consistently report lower values compared with tensile tests. Such differences may in part be due to inherent differences among the technical approaches and consequently the wall properties that they measure, and partly due to differences between experimental conditions.
Principles of Therapeutic Change
Authors: Papiasvili Eva D.
Published: June 2019

This chapter describes how the author would implement each of the empirically based principles of change identified in Chapter 2, as they specific related to the three cases of social anxiety presented in Chapter 8. The chapter begins with the author’s initial reaction to the list of principles, as well as to the task of describing their implementation in her day-to-day clinical work. Also included in the chapter are the author’s case formulation and treatment for each case, which serve as the general context for the author’s detailed explanation of why and how she would apply the principles in ways that are best attuned to the needs of particular clients. The chapter ends with the description of the author’s thoughts and experience about writing this chapter.
Urban design and mental health
Authors: McCay Layla
Published: June 2019

Associations between the urban living environment and mental health are becoming increasingly apparent. People who live in the city often have increased pre-existing risk factors for mental illness. However, intrinsic features of the city’s built environment can further exacerbate people’s risk of mental ill health. Cities can increase people’s exposure to socio-economic disparities and discrimination, deliver sensory input overload, and erode many of the protective factors that are associated with maintaining good mental health. Cities have not yet fully explored and leveraged the role of urban planners and designers in promoting and supporting public mental health. However, opportunities abound. Urban mental health may be improved by designing cities to provide residents with regular access to green space, integrating physical activity opportunities, facilitating positive, natural social interactions, and fostering feelings of safety. Integrating pro-mental-health design features into urban guidelines and recommendations can contribute to public mental health promotion and strengthen cities.
NICE public health guidance update
Authors: Willans Bex , Desai Monica , Owen Lesley , Leng Gillian
Published: July 2019

This article covers recent NICE guidance relevant to public health and has a focus on healthy ageing. The article contextualizes NICE guidance on increasing personal capacity, creating supportive environments and developing longer term strategies to reduce chronic disease and disability through primary prevention.
Genetic variation in dopamine availability modulates the self-reported level of action control in a sex-dependent manner
Authors: Schlüter Caroline , Arning Larissa , Fraenz Christoph , Friedrich Patrick , Pinnow Marlies , Güntürkün Onur , Beste Christian , Ocklenburg Sebastian , Genc Erhan
Published: July 2019

Although procrastination is a widespread phenomenon with significant influence on our personal and professional life, its genetic foundation is somewhat unknown. An important factor that influences our ability to tackle specific goals directly instead of putting them off is our ability to initiate cognitive, motivational and emotional control mechanisms, so-called metacontrol. These metacontrol mechanisms have been frequently related to dopaminergic signaling. To gain deeper insight into the genetic components of procrastination, we examined whether genetically induced differences in the dopaminergic system are associated with interindividual differences in trait-like procrastination, measured as decision-related action control (AOD). Analyzing the data of 278 healthy adults, we found a sex-dependent effect of TH genotype on AOD. Interestingly, only in women, T-allele carriers showed lower AOD values and were therefore more likely to procrastinate. Additionally, we investigated whether differences in the morphology and functional connectivity of the amygdala that were previously associated with AOD happen to be related to differences in the TH genotype and thus to differences in the dopaminergic system. However, there was no significant amygdala volume or connectivity difference between the TH genotype groups. Therefore, this study is the first to suggest that genetic, anatomical and functional differences affect trait-like procrastination independently.
Creating crony capitalism: neoliberal globalization and the fueling of corruption
Authors: Reinsberg Bernhard , Kentikelenis Alexander , Stubbs Thomas
Published: June 2019

This article examines how neoliberal policies mandated by the International Monetary Fund (IMF) impact on corruption in developing countries. Combining domestic political analysis with world systems and dependency theories, we hypothesize that these reforms concentrate losses on influential social groups such as businesses and civil servants, who then engage in corrupt practices to maintain their privileged positions. Using an original dataset of IMF policy reforms from 1980 to 2014, we find robust empirical support for our argument. Results of regression-based analysis demonstrate an effect of IMF policy reforms that hold across multiple samples and measure of corruption: 141 countries using a corruption control measure from the International Country Risk Guide; 70 countries on the Business Environment and Enterprise Performance Survey; and 19 countries from the International Crime Victims Survey. Our findings elucidate the link between neoliberal globalization and political capitalism, while offering important policy lessons regarding the design of IMF policy reforms.
Effect of Adding Dexmedetomidine to Local Anesthetic Agents for Transversus Abdominis Plane Block
Authors: Bansal Prannal , Garg Shashank
Published: June 2019

Background:

Dexmedetomidine (Dex) has been used as an adjuvant in transversus abdominis plane (TAP) blocks. This meta-analysis was aimed at evaluating the effect of Dex in TAP blocks.

Objectives:

Outcome measures were total opiate consumption in 24 hours after surgery, time to systemic rescue analgesia, pain scores after surgery, and adverse events (AEs).

Materials and Methods:

Randomized controlled trials comparing Dex with local anesthetics to local anesthetics alone for analgesia after abdominal surgeries were included. Standardized mean difference (SMD) and mean difference (MD) were used for continuous variables and odds ratio for frequency data.

Results:

Analysis of data from 9 randomized controlled trials (598 patients) showed that the addition of Dex to LAs decreased opiate use in 24 hours after surgery (SMD, −3.07; 95% confidence interval [CI], −4.78 to −1.35), increased time to rescue analgesia (171.8 min; 95% CI, 112.34-231.26), and decreased pain scores (scale of 0 to 10) at 4 hours (MD, −0.36; 95% CI, −0.65 to −0.07) and 8 hours (MD, −0.17; 95% CI, −0.29 to −0.04) after surgery. Frequency of adverse events was similar between the 2 groups (odds ratio, 1; 95% CI, 0.61-1.63). The estimates for pain scores were prone to sensitivity analysis. The estimates for postoperative opiate use, time to rescue analgesia, and pain scores at 8 hours had significant heterogeneity.

Conclusions:

The addition of Dex to LAs in the TAP block for analgesia after abdominal surgeries decreased 24-hour opiate use and increased the overall time to rescue analgesia including certain subgroups without increasing adverse events. Its effect on postoperative pain scores was not as definitive.
Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery
Authors: Hussain Nasir , Brull Richard , McCartney Colin J. L. , Wong Patrick , Kumar Nicolas , Essandoh Michael , Sawyer Tamara , Sullivan Timothy , Abdallah Faraj W.
Published: July 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery.

Methods

Databases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling.

Results

Fourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of −30.5 mg [−42.2, −18.8] (P < 0.00001), and in rest pain area under the curve more than 24 h, by −4.7cm · h [−5.1, −4.2] or −1.2cm [−1.3, −1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes.

Conclusions

We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.
Internal Carotid Artery Blood Flow Response to Anesthesia, Pneumoperitoneum, and Head-up Tilt during Laparoscopic Cholecystectomy
Authors: Skytioti Maria , Elstad Maja , Søvik Signe
Published: July 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Little is known about how implementation of pneumoperitoneum and head-up tilt position contributes to general anesthesia-induced decrease in cerebral blood flow in humans. We investigated this question in patients undergoing laparoscopic cholecystectomy, hypothesizing that cardiorespiratory changes during this procedure would reduce cerebral perfusion.

Methods

In a nonrandomized, observational study of 16 patients (American Society of Anesthesiologists physical status I or II) undergoing laparoscopic cholecystectomy, internal carotid artery blood velocity was measured by Doppler ultrasound at four time points: awake, after anesthesia induction, after induction of pneumoperitoneum, and after head-up tilt. Vessel diameter was obtained each time, and internal carotid artery blood flow, the main outcome variable, was calculated. The authors recorded pulse contour estimated mean arterial blood pressure (MAP), heart rate (HR), stroke volume (SV) index, cardiac index, end-tidal carbon dioxide (ETco
2), bispectral index, and ventilator settings. Results are medians (95% CI).

Results

Internal carotid artery blood flow decreased upon anesthesia induction from 350 ml/min (273 to 410) to 213 ml/min (175 to 249; −37%, P < 0.001), and tended to decrease further with pneumoperitoneum (178 ml/min [127 to 208], −15%, P = 0.026). Tilt induced no further change (171 ml/min [134 to 205]). ETco
2 and bispectral index were unchanged after induction. MAP decreased with anesthesia, from 102 (91 to 108) to 72 (65 to 76) mmHg, and then remained unchanged (Pneumoperitoneum: 70 [63 to 75]; Tilt: 74 [66 to 78]). Cardiac index decreased with anesthesia and with pneumoperitoneum (overall from 3.2 [2.7 to 3.5] to 2.3 [1.9 to 2.5] l · min−1 · m−2); tilt induced no further change (2.1 [1.8 to 2.3]). Multiple regression analysis attributed the fall in internal carotid artery blood flow to reduced cardiac index (both HR and SV index contributing) and MAP (P < 0.001). Vessel diameter also declined (P < 0.01).

Conclusions

During laparoscopic cholecystectomy, internal carotid artery blood flow declined with anesthesia and with pneumoperitoneum, in close association with reductions in cardiac index and MAP. Head-up tilt caused no further reduction. Cardiac output independently affects human cerebral blood flow.
Long-Term Sensorineural Hearing Loss in Patients With Blast-Induced Tympanic Membrane Perforations
Authors: Littlefield Philip D. , Brungart Douglas S.
Published: July 2019

Objective:

To describe characteristics of sensorineural hearing loss (SNHL) in patients with blast-induced tympanic membrane (TM) perforations that required surgery.

Design:

A retrospective review of hearing outcomes in those who had tympanoplasty for combat blast-induced TM perforations. These were sequential cases from one military otolaryngologist from 2007 to 2012. A total of 87 patients were reviewed, and of those, 49 who had appropriate preinjury, preoperative, and long-term audiograms were included. Those with pre-existing hearing loss were excluded. Preinjury audiograms were used to assess how sensorineural thresholds changed in the ruptured ears, and in the contralateral ear in those with unilateral perforations.

Results:

The mean time from injury to the final postoperative audiogram was 522 days. In the ears with TM perforations, 70% had SNHLs of 10 dB or less (by bone conduction pure tone averages). Meanwhile, approximately 8% had threshold shifts >30 dB, averaging 50 dB. The strongest predictor of severe or profound hearing loss was ossicular discontinuity. Thresholds also correlated with bilateral injury and perforation size. In those with unilateral perforations, the SNHL was almost always larger on the side with the perforation. Those with SNHL often had a low-to-mid frequency threshold shift and, in general, audiograms that were flatter across frequencies than those of a typical population of military personnel with similar levels of overall hearing loss.

Conclusions:

There is a bimodal distribution of hearing loss in those who experience a blast exposure severe enough to perforate at least one TM. Most ears recover close to their preinjury thresholds, but a minority experience much larger sensorineural threshold shifts. Blast exposed ears also tend to have a flatter audiogram than most service members with similar levels of hearing loss.
The Association Between Physiological Noise Levels and Speech Understanding in Noise
Authors: Stiepan Samantha , Siegel Jonathan , Lee Jungwha , Souza Pamela , Dhar Sumitrajit
Published: July 2019

Objectives:

Traditionally, elevated hearing thresholds have been considered to be the main contributors to difficulty understanding speech in noise; yet, patients will often report difficulties with speech understanding in noise despite having audiometrically normal hearing. The purpose of this cross-sectional study was to critically evaluate the relationship of various metrics of auditory function (behavioral thresholds and otoacoustic emissions) on speech understanding in noise in a large sample of audiometrically normal-hearing individuals.

Design:

Behavioral hearing thresholds, distortion product otoacoustic emission (DPOAE) levels, stimulus-frequency otoacoustic emission levels, and physiological noise (quantified using OAE noise floors) were measured from 921 individuals between 10 and 68 years of age with normal pure-tone averages. The quick speech-in-noise (QuickSIN) test outcome, quantified as the signal-to-noise ratio (SNR) loss, was used as the metric of speech understanding in noise. Principle component analysis (PCA) and linear regression modeling were used to evaluate the relationship between the measures of auditory function and speech in noise performance.

Results:

Over 25% of participants exhibited mild or worse degree of SNR loss. PCA revealed DPOAE levels at 12.5 to 16 kHz to be significantly correlated with the variation in QuickSIN scores, although correlations were weak (R2 = 0.017). Out of all the metrics evaluated, higher levels of self-generated physiological noise accounted for the most variance in QuickSIN performance (R2 = 0.077).

Conclusions:

Higher levels of physiological noise were associated with worse QuickSIN performance in listeners with normal hearing sensitivity. We propose that elevated physiological noise levels in poorer speech in noise performers could diminish the effective SNR, thereby negatively impacting performance as seen by poorer QuickSIN scores.
Medialized Trochanteric Starting Point and Focused Lateral Endosteal Beak Reaming to Optimize Success of Intramedullary Nailing in Atypical Femur Fractures: A Technical Trick and Case Series
Authors: Berkes Marschall B. , Shaw James C. , Warner Stephen J. , Achor Timothy S.
Published: June 2019

Optimal intramedullary treatment of atypical femur fractures associated with bisphosphonate use requires avoidance of postoperative malreduction, particularly varus. This can be difficult to achieve, given the fracture location, errors with nail entry point, endosteal beaking, and underlying patient osteology, all of which can contribute to postoperative varus and predispose the patient to treatment failure. We present a surgical technique and clinical series of 10 patients emphasizing a medialized trochanteric nail entry point and preferential lateral endosteal reaming to secure a biologically and biomechanically favorable reduction and fixation.
Complications Associated With Minimally Invasive Anterior to the Psoas (ATP) Fusion of the Lumbosacral Spine
Authors: Tannoury Tony , Kempegowda Harish , Haddadi Kaveh , Tannoury Chadi
Published: July 2019

Study Design.

Retrospective cohort study.

Objectives.

To analyze complications associated with minimally invasive anterolateral retroperitoneal antepsoas lumbosacral fusion (MIS-ATP).

Summary of Background Data.

MIS-ATP provides anterolateral access to the lumbar spine allowing for safe anterior lumbar interbody fusions between T12-S1. Anecdotally, many surgeons believe that ATP approach is not feasible at L5-S1 level, predisposing to catastrophic vascular injuries. This approach may help overcome limitations associated with conventional straight anterior lumbar interbody fusions, MIS lateral lumbar interbody fusion, and oblique lateral interbody fusion.

Methods.

A detailed retrospective chart review of patients who had underwent MIS-ATP approach for lumbar fusion between T12-S1 was performed. Available electronic data from surgeries performed between January 2008 and March 2017 was carefully screened for surgical patients treated for spondylolisthesis, spondylosis, stenosis, sagittal, and/or coronal deformity. Detailed review of electronic medical records including operative notes, progress notes, discharge summaries, laboratory results, imaging reports, and clinic visit notes performed by a single independent reviewer not involved in patient care for documented complications. A complication is defined as any adverse event related to the index spine procedure for which patient required specific intervention or treatment.

Results.

Nine hundred forty patients with a total of 2429 interbody fusion levels performed via MIS-ATP were identified during the study period. Sixty-seven patients (7.2%) sustained one or more complications during the perioperative period, of which 25.5% were surgical and 74.5% were medical. Overall, 78 (8.2%) surgical complications pertaining to the index procedure were noted during a postoperative period of 1 year from the date of surgery. No major vascular or direct visceral injuries were encountered.

Conclusions.

MIS-ATP approach provides a safe access to anterolateral interbody fusions between T12-S1. The ATP approach is performed by the spine surgeon, does not require neuromonitoring, and warrants minimal to no psoas muscle retraction resulting in significantly reduced postoperative thigh pain and rare neurologic injuries. Additionally, the direct and clear visualization of the retroperitoneal vasculature provided by the ATP approach minimizes the risk of inadvertent vascular injury.

Level of Evidence: 4
Hazardous air pollutants and telomere length in the Sister Study
Authors: Niehoff Nicole M. , Gammon Marilie D. , Keil Alexander P. , Nichols Hazel B. , Engel Lawrence S. , Taylor Jack A. , White Alexandra J. , Sandler Dale P.
Published: July 2019

Background:

Telomeres are vital for genomic integrity, and telomere length has been linked to many adverse health outcomes. Some hazardous air pollutants or air toxics increase oxidative stress and inflammation, two possible determinants of shortened telomere length. No studies have examined air toxic–telomere length associations in a nonoccupational setting.

Methods:

This study included 731 Sister Study participants (enrolled 2003–2007) who were randomly selected to assess telomere length in baseline blood samples. Multiplex qPCR was used to determine telomere to single copy gene (T/S) ratios. Census tract concentration estimates of 29 air toxics from the 2005 National Air Toxics Assessment were linked to baseline residential addresses. Air toxics were classified into tertile-based categories of the exposure. Multivariable linear regression was used to estimate β coefficients and 95% confidence intervals (CIs) in single-pollutant models. Multipollutant groups were identified with regression trees.

Results:

The average T/S ratio was 1.24. Benzidine (T3 versus T1 β = −0.08; 95% CI = −0.14, −0.01) and 1,4-dioxane (T3 versus T1 β = −0.06; 95% CI = −0.13, 0.00) in particular, as well as carbon tetrachloride, chloroprene, ethylene dibromide, and propylene dichloride, were associated with shorter relative telomere length. Benzidine (P = 0.02) and 1,4-dioxane (P = 0.06) demonstrated some evidence of a monotonic trend. The regression tree identified age, BMI, physical activity, ethylene oxide, acrylonitrile, ethylidene dichloride, propylene dichloride, and styrene in multipollutant groups related to telomere length.

Conclusions:

In this first study of air toxics and telomere length in a nonoccupational setting, several air toxics, particularly 1,4-dioxane and benzidine, were associated with shorter relative telomere length.
Reading between the Lines: A Plastic Surgeon’s Guide to Evaluating the Quality of Evidence in Research Publications
Authors: Gabriel Allen , Maxwell G. Patrick
Published: July 2019

An important component of practicing evidence-based medicine (EBM) in plastic surgery is staying current with published research, an increasingly difficult task given the rapid growth of the literature. This article reviews the methodological aspects specific to the aesthetic surgery field that should be considered when evaluating the quality of evidence in research publications in the context of the level of evidence (LOE) grading scales that are currently used by plastic surgery journals. Reporting the LOE in a research publication can help to highlight the quality of the research and the potential for bias so that the reader may prioritize information accordingly. However, LOE classifications are not an absolute index of the quality of evidence and do not preclude careful evaluation of the study’s methods and results in the context of the authors’ conclusions. As the application of evidence-based medicine expands in the plastic surgery community, surgeons must be mindful of how to appropriately interpret research findings and assess the utility of applying results to their practice.
Femtosecond Laser-Assisted Keratolimbal Allograft Transplantation for the Treatment of Total Limbal Stem Cell Deficiency
Authors: Qi Xiaolin , Duan Fangnan , Li Xiang , Zhang Xiaoyu , Li Na , Liu Mingna , Gao Hua
Published: June 2019

Purpose:

To investigate the surgical procedure and therapeutic efficacy of femtosecond (FS) laser-assisted keratolimbal allograft (KLAL) transplantation in the treatment of eyes with total limbal stem cell deficiency.

Methods:

Ten eyes from 10 patients who underwent FS laser-assisted KLAL transplantation were enrolled. The best-corrected visual acuity (BCVA), ocular surface stability, corneal transparency, and postoperative complications were recorded.

Results:

The keratolimbal grafts prepared using the FS laser were even in thickness and width. After the surgery, glucocorticoid and tacrolimus eye drops were administered locally to the eyes with concentration gradients, and a medium dose was prescribed for maintenance. Within the mean follow-up period of 16.8 ± 7.3 months, 9 of 10 eyes (90.0%) maintained a stable ocular surface and showed significant improvements in corneal transparency and BCVA. Persistent corneal edema only occurred in one eye because of repeated epithelial defects, and the BCVA of this eye did not improve. Confocal microscopy revealed activated dendritic cells in the Bowman membrane at the limbus, but they were always low in density with small dendritic processes. No acute immune rejection, cataracts, or elevation of intraocular pressure were detected.

Conclusions:

The FS laser-assisted KLAL technique can produce ring-shaped grafts with an even depth and width, resulting in a stable ocular surface and good visual prognosis. After surgery, glucocorticoids and potent immunosuppressive eye drops were administered locally with concentration gradients and effectively inhibited acute immune rejection.
Recurrence of Infection in Corneal Grafts After Therapeutic Penetrating Keratoplasty for Microbial Keratitis
Authors: Chatterjee Samrat , Agrawal Deepshikha
Published: June 2019

Purpose:

To determine the factors responsible for the recurrence of infection after therapeutic penetrating keratoplasty (TPK) in severe microbial keratitis.

Methods:

This is a retrospective interventional case series that reviewed the medical records of 229 consecutive patients (2005–2017) who underwent TPK for microbial keratitis at a tertiary eye care center in Central India. The primary outcome was recurrence of the primary infection. The factors responsible for recurrence were identified by univariate and multivariate regression analysis.

Results:

The overall outcomes were clear graft in 50 (21.8%) eyes, failed graft in 139 (60.7%) eyes, evisceration in 19 (8.3%) eyes, phthisis bulbi in 14 (6.1%) eyes, repeat TPK in 2 (0.9%) eyes, and anterior staphyloma in 1 (0.4%) eye. Recurrence occurred in 63 (27.5%) eyes within 16.2 ± 13.8 (range: 2–66) days. Univariate analysis identified fungal etiology (P = 0.001), ulcer size > 60 mm2 (P = 0.001), limbal involvement (P = 0.001), endothelial exudates (P = 0.024), retro-iris exudates (P = 0.001), corneal perforation (P = 0.005), coexisting endophthalmitis (P < 0.001), and graft size ≥ 10 mm2 (P < 0.001) as significant risk factors. Multiple logistic regression identified fungal etiology (P = 0.013), retro-iris exudates (P = 0.011), coexisting endophthalmitis (P = 0.004), and graft size ≥ 10 mm2 (P = 0.058) as independent risk factors for recurrence. Presenting visual acuity of 20/200 or better was seen in 49 (21.4%) and 39 (17%) eyes, and no light perception in 11 (4.8%) and 26 (11.4%) eyes at postoperative months 1 and 3, respectively.

Conclusions:

Fungal etiology, retro-iris exudates, coexisting endophthalmitis, and larger grafts were susceptible to recurrence. Early surgery may mitigate most of these factors. Despite the risk of recurrence, TPK remains an effective treatment in severe nonresponsive keratitis.
Measles Transmission in a Fully Vaccinated Closed Cohort
Authors: Hubiche Thomas , Brazier Camille , Vabret Astrid , Reynaud Sabrina , Roudiere Laurent , del Giudice Pascal
Published: July 2019

We described nosocomially clustered cases of measles secondary to a nonvaccinated index case occurring in a teenage psychiatric unit despite optimum vaccine coverage. Surveillance of this fully vaccinated closed cohort showed a 7% attack rate. Vaccination limited the risk of complicated measles and the onset of a large outbreak.
Orbital Myositis: A Comprehensive Review and Reclassification
Authors: McNab Alan A.
Published: July 2019

Purpose:

Orbital myositis occurs in typical and atypical forms. This review summarizes and updates the current state of knowledge of all forms of inflammation affecting extraocular muscle, excluding thyroid-associated orbitopathy.

Methods:

A comprehensive literature review of orbital myositis was performed.

Results:

Orbital myositis typically occurs in an idiopathic acute form, with painful diplopia due to inflammation in 1 or more extraocular muscles of young adult females, which usually responds to a course of oral corticosteroids. Atypical forms include idiopathic chronic or recurrent orbital myositis, and myositis related to systemic autoimmune, inflammatory, and infective conditions. The commonest associated autoimmune condition is inflammatory bowel disease. Immunoglobulin G4–related ophthalmic disease often affects extraocular muscle. Drug reactions and rarely paraneoplastic disease may also cause extraocular muscle inflammation.

Conclusions:

Orbital myositis occurs in a typical acute steroid responsive form, but atypical forms related to specific autoimmune and inflammatory conditions are increasingly recognized. Orbital myositis has many similarities to uveitis and would benefit from a systematic approach to nomenclature, diagnosis, and treatment.
Prognostic biomarkers of cervical squamous cell carcinoma identified via plasma metabolomics
Authors: Zhou Huihui , Li Qi , Wang Tong , Liang Hong , Wang Yanan , Duan Yani , Song Min , Wang Yaoxian , Jin Hong
Published: June 2019

Cervical cancer is the second most common female malignancy worldwide. The metabolic profile of plasma associated with the prognosis of cervical cancer remains poorly understood. In this cross-sectional study, plasma samples were collected from three groups of patients with CSCC, namely primary patients before treatment (BT group), patients with a poor prognosis (PP group, including patients with distant metastasis and local recurrence), and patients with a good prognosis within two years after the first treatment (GP group). The plasma metabolomics was conducted to detect the dynamic changes of metabolites via ultra-performance liquid chromatography with quadrupole time-of-flight mass spectrometry. Multivariate analyses, including principle component, partial least square-discriminant, and orthogonal projection to latent structure-discriminant analyses, were performed to compare each pair of the three groups. The differential metabolites were identified by comparison of the exact m/z values and mass spectrometry (MS)/MS spectra with the structural information of the metabolites obtained from the Human Metabolome Database (http://www.hmdb.ca/) and LIPID MAPS (http://www.lipidmaps.org/). To screen for potential markers, receiver operating characteristic curve analysis of the differential metabolites. Finally, thirty plasma samples were collected from each group. Multivariate analyses showed that 31 metabolites were significantly different among the 3 groups studied. Of those, the 5 metabolites phosphatidyl choline (15:0/16:0), phosphatidyl glycerol (12:0/13:0), actosylceramide (d18:1/16:0), D-Maltose, and phthalic acid, with an area under the curve above 0.75, were identified as potential biomarkers. The present findings provide evidence for biomarkers to monitor prognosis of patients with CSCC, which may help in better managing the disease.
Late-onset bronchopleural fistula after lobectomy and adjuvant chemotherapy for lung cancer
Authors: Zhang Chu , Pan Yong , Zhang Rui-Mei , Wu Wen-Bin , Liu Dong , Zhang Miao
Published: June 2019

Rationale:

Late-onset bronchopleural fistula (BPF) induced by chemotherapy after lobectomy for lung cancer is rarely reported, lacking reliable preventive approaches. A timely identification and individualized treatment is essential for prognosis.

Patient concerns:

A 52-year-old female patient complained of fever, productive cough, and fatigue 1 week after adjuvant chemotherapy following right lower lobectomy and systemic mediastinal lymph node dissection. Chest computed tomography (CT) indicated pneumothorax and thick-walled empyema cavity within her right-sided thorax.

Diagnoses:

The patient was diagnosed as late-onset BPF based on clinical manifestation and chest radiography.

Interventions:

In addition to antibiotics, a chest tube was reinserted under CT guidance, and vacuum suction was utilized for continuous drainage. Next cycle of adjuvant chemotherapy was terminated.

Outcomes:

The empyema cavity was gradually closed in 1 month after conservative treatment, and the patient survived with good condition up to now.

Lessons:

Late-onset BPF should be kept in mind when the patient suffered from productive cough and chills during postoperative chemotherapy. And a prompt conservative management might be effective.
The Utility of PET/CT in Guiding Radiotherapy Reduction for Children With Hodgkin Lymphoma Treated With ABVD
Authors: Ingley Katrina M. , Nadel Helen R. , Potts Jim E. , Wilson Don C. , Eftekhari Arash , Deyell Rebecca J.
Published: June 2019

ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) is standard upfront chemotherapy for adults diagnosed with Hodgkin lymphoma (HL), but positron emission tomography (PET)-based response data following ABVD is lacking for pediatrics. Among children who received ABVD for HL, we document interim and end of therapy PET-computed tomography (CT) response by Deauville criteria, and survival outcomes following a response-based reduction in involved field radiotherapy (IFRT). Children 18 years of age or below with HL treated with ABVD between 2006 and 2015 who had interim PET/CT scans after 2 cycles of chemotherapy were included. Interim and end of therapy PET/CT scans were retrospectively re-evaluated using Deauville criteria by 3 radiologists. Among 45 children, 32 (71%) met criteria for intermediate risk, 86% achieved rapid early response (RER) and only 4 (9%) received upfront IFRT. Patients achieving RER had superior 5-year event-free survival (EFS) 95%±4% versus 50%±18% (P≤0.001) and overall survival (OS) 100% versus 83%±15% (P=0.025). Patients with bulk who achieved RER and received no IFRT achieved 5-year EFS of 92%±6% and OS 100%. Low, intermediate, and high risk patients had 5-year EFS of 100%, 94%±4%, and 50%±18% (P=0.002) and 5-year OS of 100%, 100%, and 75%±15% (P=0.03). RER following 2 cycles of ABVD is predictive of survival outcomes in children and adolescents with HL and may identify a group who may omit IFRT.
Hepatosplenic αβ T-Cell Lymphoma as Second Malignancy in Young Adult Patient With Previously Undiagnosed Ataxia-Telangiectasia
Authors: Jacobs Michelle F. , Anderson Bailey , Opipari Valerie P. , Mody Rajen
Published: June 2019

Ataxia-telangiectasia is a rare autosomal recessive neurodegenerative disease characterized by ataxia, radiosensitivity, telangiectases, and increased risk for hematologic malignancies. We present a case of a female individual diagnosed with T-cell acute lymphocytic leukemia at 13 years and subsequently with αβ subtype of hepatosplenic T-cell lymphoma (HSTCL) at 20 years. During her diagnostic work up for HSTCL, paired tumor-germline sequencing identified a diagnosis of ataxia-telangiectasia. We also describe a very refractory clinical course of her αβ HSTCL, including only a brief response to multiagent chemotherapy and an allogenic bone marrow transplant.
Comparative study of lactobacilli and bifidobacteria in vaginal tract of individual with bacterial vaginosis and healthy control by quantitative PCR
Authors: Bakhshi Ashraf , Safayi Delouyi Zahra , Taheri Shiva , Alivandi Azadeh , Mohammadzadeh Nima , Dabiri Hossein
Published: June 2019

Background:

Bacterial vaginosis is characterized by a disequilibrium in vaginal microflora with the distinguishing feature of decrease in lactobacilli. The current study aimed to study lactobacilli and bifidobacteria in the vaginal tract of individual with bacterial vaginosis.

Methods:

For this purpose, vaginal swabs of 108 women, including 92 patients with clinical symptoms of bacterial vaginosis and 16 healthy cases were collected. After extraction of DNA from vaginal samples, quantitative PCR was performed for detect the bacterial load and 16SrRNA gene. PCR was performed for the detection of microorganisms related to sexually transmitted infections, which all samples harboring any of such microorganisms was excluded from study.

Results:

There was a positive link between the quantitation of Lactobacillus spp. and Bifidobacterium spp. among patients with bacterial vaginosis and healthy group. Quantitative PCR analysis illustrates that the frequency of Lactobacillus spp. and Bifidobacterium spp. are significantly lower in patients with bacterial vaginosis compared with healthy individuals.

Conclusion:

The current study promotes our understanding about the vaginal Lactobacillus spp. and Bifidobacterium spp. among patients and healthy individuals in Iran. Confirming the link between the frequency of lactobacilli and bacterial vaginosis could help us develop new prebiotics and probiotics for this disorder.
Critical Trio Exome Benefits In-Time Decision-Making for Pediatric Patients With Severe Illnesses*
Authors: Wu En-Ting , Hwu Wuh-Liang , Chien Yin-Hsiu , Hsu Ching , Chen Ting-Fu , Chen Nai-Qi , Chou Hung-Chieh , Tsao Po-Nien , Fan Pi-Chuan , Tsai I-Jung , Lin Shuan-Pei , Hsieh Wu-Shiun , Chang Tung-Ming , Chen Chi-Nien , Lee Chen-Hao , Chou Yen-Yin , Chiu Pao-Chin , Tsai Wen-Hui , Hsiung Hann-Chang , Lai Feipei , Lee Ni-Chung
Published: July 2019

Objectives:

Critical illnesses caused by undiagnosed genetic conditions are challenging in PICUs. Whole-exome sequencing is a powerful diagnostic tool but usually costly and often fail to arrive at a final diagnosis in a short period. We assessed the feasibility of our whole-exome sequencing as a tool to improve the efficacy of rare diseases diagnosis for pediatric patients with severe illness.

Design:

Observational analysis.

Method:

We employed a fast but standard whole-exome sequencing platform together with text mining-assisted variant prioritization in PICU setting over a 1-year period.

Setting:

A tertiary referral Children’s Hospital in Taiwan.

Patients:

Critically ill PICU patients suspected of having a genetic disease and newborns who were suspected of having a serious genetic disease after newborn screening were enrolled.

Interventions:

None.

Measurements and Main Results:

Around 50,000 to 100,000 variants were obtained for each of the 40 patients in 5 days after blood sampling. Eleven patients were immediately found be affected by previously reported mutations after searching mutation databases. Another seven patients had a diagnosis among the top five in a list ranked by text mining. As a whole, 21 patients (52.5%) obtained a diagnosis in 6.2 ± 1.1 working days (range, 4.3–9 d). Most of the diagnoses were first recognized in Taiwan. Specific medications were recommended for 10 patients (10/21, 47.6%), transplantation was advised for five, and hospice care was suggested for two patients. Overall, clinical management was altered in time for 81.0% of patients who had a molecular diagnosis.

Conclusions:

The current whole-exome sequencing algorithm, balanced in cost and speed, uncovers genetic conditions in infants and children in PICU, which helps their managements in time and promotes better utilization of PICU resources.
Effects of Whole-Body Vibration on Motor Impairments in Patients With Neurological Disorders
Authors: Alashram Anas R. , Padua Elvira , Annino Giuseppe
Published: July 2019

Objective

This systematic review was conducted to examine the effects of whole-body vibration training on motor impairments among patients with neurological disorders and to investigate which the whole-body vibration training parameters induced improvement in motor impairments.

Design

PubMed, SCOPUS, PEDro, REHABDATA, and Web of Science were searched for randomized controlled trials and pseudo-randomized controlled trials investigated the effect of whole-body vibration on motor impairments in patients with neurological disorders. The methodological quality was rated using the Cochrane Collaboration’s tool.

Results

Twenty studies were included in this systematic review. Four studies included patients with multiple sclerosis, cerebral palsy (n = 2), stroke (n = 9), Parkinson disease (n = 3), spinal cord injuries (n = 1), and spinocerebellar ataxia (n = 1). The results showed different evidence of benefits and nonbenefits for whole-body vibration training in motor impairments outcomes.

Conclusions

There is weak evidence for a positive effect of short-term whole-body vibration training on spasticity of lower limbs, mobility, balance, and postural control. Besides, positive effect of the long-term effect of whole-body vibration training on mobility in patients with neurological disorders. The optimal whole-body vibration training parameters in treating patients with neurological disorders remain unclear.
The Usefulness of Basic Movement Scale in Hip Fracture Patients
Authors: Goto Ryutaro , Toyama Shogo , Sawada Koshiro , Takamuku Kiyoshi , Kubo Toshikazu , Takahashi Tai
Published: July 2019

Objective

The aim of the study was to investigate the validity of using total score and to examine the constitution and characteristics of the Basic Movement Scale in postsurgery patients with hip fracture.

Design

The dimensionality and the threshold difficulty intervals between each score and item difficulty hierarchy of the Basic Movement Scale were examined using factor analysis and Rasch analysis in 37 patients admitted to our hospital between April and November 2015.

Results

For factor analysis, the contribution ratio of the first factor was 78.9%, that of the second factor was 6.5%, and there were no items that fit the Rasch analysis. The threshold was reversed at 6 of the 48 locations. The difficulty of the 12 Basic Movement Scale items was distributed roughly evenly among all 9 lots, with some deviation. There was one very easy item, and there were some items almost overlapping in difficulty.

Conclusions

The results showed a unidimensional association between the items and evaluation index. The difficulty threshold of each score was approximated to the interval scale. Therefore, the Basic Movement Scale has evident construct validity and enables quantitative evaluation of physical ability, assessment of the effects of daily training, and general predictions of the feasibility of patients' clinical goals.