bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Soil Physical Conditions on Emission of Allyl Isothiocyanate and Subsequent Microbial Inhibition in Response to Brassicaceae Seed Meal Amendment
Authors: Wang Likun , Mazzola Mark
Published: October 2018

Generation of allyl isothiocyanate (AITC) in soil treated with residues of specific Brassicaceae species yields direct and indirect suppression of soilborne plant pathogens. Soil physical conditions demonstrably affected the quantity of AITC generated in response to soil incorporation of a Brassica juncea/Sinapis alba seed meal (SM) formulation. The concentration of AITC generated in SM-amended soil increased with an increase in temperature from 10 to 30°C. AITC emission was also elevated with an increase in soil water potential from −1,000 kPa through −40 kPa; however, a significant decrease in AITC emission was observed in a saturated soil environment (0 kPa). Peak AITC emission was obtained 2 to 3 h after SM amendment under optimal conditions but the peak was delayed in soils incubated at low temperature or in extreme moisture environments. Although AITC production varied significantly across different orchard soils, all three orchard soils yielded the same pattern of AITC release in response to SM amendment over the spectrum of soil water potentials examined in this study. Mycelial growth inhibition in fungi and oomycetes isolated from apple roots was dependent on both AITC concentration and exposure time. Pythium ultimum exhibited sensitivity to AITC at concentrations ranging from 0.01 to 0.22 µg g−1 of soil, whereas Hypocrea lixii was insensitive to AITC. Exposure to AITC at a concentration of 0.22 µg g−1 of soil for a period of 2 h restricted hyphal growth of Rhizoctonia solani AG-5, Ilyonectria destructans, and Mortierella alpina. R. solani AG-5 exhibited significant growth inhibition when incubated at AITC concentrations of 0.008 to 0.011 µg g−1 of soil for 10 h. These findings provide information that will be useful in the management of appropriate soil variables to obtain optimal yields of AITC in response to SM soil amendments and indicate that a standard soil moisture prescription may be suitable for use when applying this SM formulation for soilborne disease control.
Quantifying the Effects of a G137S Substitution in the Cytochrome bc1 of Venturia effusa on Azoxystrobin Sensitivity Using a Detached Leaf Assay
Authors: Standish Jeffrey R. , Brenneman Timothy B. , Stevenson Katherine L.
Published: October 2018

The quinone outside inhibitor (QoI) fungicides are known for their inherently high resistance risk owing to substitutions in amino acid residues 129, 137, or 143 of the cytochrome b gene of phytopathogens. In Venturia effusa, cause of pecan scab, an intron adjacent to position 143 likely reduces this risk; however, the effects of a recently discovered substitution at position 137 (G137S) are unknown. Traditional in vitro assays are not useful for determining sensitivity of isolates of V. effusa to the QoI fungicides, owing to the fungitoxic effects of required alternative oxidase inhibitors. A detached leaf assay was developed to quantify the sensitivity of 59 isolates to azoxystrobin: 45 wild-type isolates and 14 carrying G137S. Isolate EC50 values ranged from <0.0001 to 0.3047 µg/ml; EC50 values for wild-type isolates ranged from <0.0001 to 0.2007 µg/ml (median 0.0023 µg/ml), whereas EC50 values for G137S isolates ranged from 0.0033 to 0.3047 µg/ml (median 0.0178 µg/ml). The median EC50 value for G137S isolates was significantly greater than that of the wild-type isolates; however, there was overlap between the two groups. This is the first report of sensitivity of V. effusa isolates to a QoI fungicide and evidence of G137S as a potential mechanism of partial resistance. However, although a complete control failure is unlikely, the impact of this substitution on QoI efficacy in Georgia pecan orchards remains to be determined.
Fungicide Dip Treatments for Management of Botrytis cinerea Infection on Strawberry Transplants
Authors: Oliveira Michelle S. , Cordova Leandro G. , Marin Marcus V. , Peres Natalia A.
Published: October 2018

Botrytis cinerea, the causal agent of Botrytis fruit rot, is annually introduced into Florida strawberry fields by infected transplants. The disease can be managed by fungicide sprays throughout the season; however, previous studies have demonstrated that several chemical classes are no longer effective owing to B. cinerea resistance. The objectives of this study were to evaluate the effectiveness of preplant fungicide-dip treatments of strawberry transplants on reducing B. cinerea colonization and to evaluate fungicide sensitivity of surviving B. cinerea isolates. Transplants of two strawberry cultivars, Winterstar ‘FL 05-107’ and ‘Florida Radiance’, were dipped in 11 different fungicides. After the plant establishment period, eight leaves per plot were collected before and 14 days after treatment to evaluate B. cinerea incidence. Isolates (n = 139) obtained from the transplants were tested for fungicide sensitivity. Plant diameter was measured 47 days after planting. All treatments, including the controls, reduced B. cinerea incidence by at least 77% compared with predip incidence. However, fungicide-resistant isolates were recovered from all treatments tested.
Promise and Pitfalls of Endemic Resistance for Cultural Resources Threatened byPhytophthora ramorum
Authors: Cobb Richard C. , Ross Noam , Hayden Katherine J. , Eyre Catherine A. , Dodd Richard S. , Frankel Susan J. , Garbelotto Matteo , Rizzo David M.
Published: October 2018

Invasive forest pathogens can harm cultural, economic, and ecological resources. Here, we demonstrate the potential of endemic tree pathogen resistance in forest disease management using Phytophthora ramorum, cause of sudden oak death, in the context of management of tanoak (Notholithocarpus densiflorus), an ecologically unique and highly valued tree within Native American communities of northern California and southern Oregon in the United States. We surveyed resistance to P. ramorum on the Hoopa Valley Indian Reservation and Yurok Indian Reservation in a set of study sites with variable management intensities. Variation in resistance was found at all sites with similar mean and variation across stands, and resistance tended to have a random spatial distribution within stands but was not associated with previous stand management (thinning or prescribed fire) or structural characteristics such as tree density, basal area, or pairwise relatedness among study trees. These results did not suggest host, genetic, management, or environment interactions that could be easily leveraged into treatments to increase the prevalence of resistant trees. We applied epidemiological models to assess the potential application of endemic resistance in this system and to examine our assumption that in planta differences in lesion size—our measure of resistance—reflect linkages between mortality and transmission (resistance) versus reduced mortality with no change in transmission (tolerance). This assumption strongly influenced infection dynamics but changes in host populations—our conservation focus—was dependent on community-level variation in transmission. For P. ramorum, slowing mortality rates (whether by resistance or tolerance) conserves host resources when a second source of inoculum is present; these results are likely generalizable to pathogens with a broader host range. However, when the focal host is the sole source of inoculum, increasing tolerant individuals led to the greatest stand-level pathogen accumulation in our model. When seeking to use variation in mortality rates to affect conservation strategies, it is important to understand how these traits are linked with transmission because tolerance will be more useful for management in mixed-host stands that are already invaded, compared with single-host stands with low or no pathogen presence, where resistance will have the greatest conservation benefits.
Incontinence-Associated Dermatitis: State of the Science and Knowledge Translation
Authors: McNichol Laurie L. , Ayello Elizabeth A. , Phearman Laura A. , Pezzella Patricia A. , Culver Elizabeth A.
Published: October 2018

This review of the literature updates and considers the evidence on incontinence-associated dermatitis (IAD). Best practice strategies for the management of skin damage from IAD (both prevention and treatment) are provided. A mnemonic to help clinicians translate IAD evidence into practice is introduced. Workplace experiences supplement this evidence synthesis. Approaches to assist in translation of this knowledge and evidence into practice are also provided.
Preventing sudden infant death syndrome and other sleep-related infant deaths
Authors: Maged Mazal , Rizzolo Denise
Published: October 2018

Sudden infant death syndrome, a type of sleep-related sudden unexpected infant death (SUID) is the leading cause of postneonatal mortality in the United States and the third leading cause of infant death overall. Despite the evidence-based risk-reduction strategies and the highly publicized campaigns for a safe sleep environment, some infants continue to sleep in unsafe sleep conditions. Clinicians need to know the current best practices to reduce the incidence of sleep-related SUID and be knowledgeable to counsel caregivers who may resist adhering to these recommendations. This article describes the different types of SUID, associated risk factors, and highlights recommendations to help parents and caregivers ensure safe sleep environments for infants.
Brush up your professional nursing résumé
Authors: Jilk Erin M. , Crawford Cecelia L. , Kawar Lina Najib , Medina-Gulapa Eiselle
Published: October 2018

Learn how to avoid common mistakes with these tips.
Portable Infrared Pupillometer in Patients With Subarachnoid Hemorrhage: Prognostic Value and Circadian Rhythm of the Neurological Pupil Index (NPi)
Authors: Natzeder Samuel , Mack David J. , Maissen Gabriela , Strässle Christian , Keller Emanuela , Muroi Carl
Published: October 2018

Background:

Portable automated infrared pupillometry is becoming increasingly popular. To generate an objective reference base, the Neurological Pupil index (NPi) which combines different values of the pupillary light reflex is being introduced into clinical practice. In this explorative study, we examined different aspects of the NPi in relation to clinical severity and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Materials and Methods:

Patients with serial assessment of the NPi (NeurOptics pupillometer NPi-200, Irvine, CA) starting no later than day 2 after aSAH onset were included in the study. Relative numbers of pathologic NPi’s, absolute NPi values, and their variances were compared according to aSAH clinical severity grade, functional outcome, and case fatality. The correlation between NPi and intracranial pressure, and NPi periodicity, were also examined.

Results:

In total, 18 patients with 4456 NPi values were eligible for inclusion in the analysis. The general trend of the NPi over time reflected the course of the neurological illness. Mean NPi tended to be lower in patients with clinically severe compared with nonsevere aSAH (3.75±0.40 vs. 4.56±0.06; P=0.171), and in patients with unfavorable compared with favorable outcomes (3.64±0.48 vs. 4.50±0.08; P=0.198). The mean variance of the NPi was higher in patients with severe compared with nonsevere aSAH (0.49±0.17 vs. 0.06±0.02; P=0.025). Pathologic NPi values were recorded more frequently in patients with severe compared with nonsevere aSAH (16.3%±8.8% vs. 0.0%±0.0%; P=0.002), and in those with unfavorable compared with favorable outcomes (19.2%±10.6% vs. 0.7%±0.6%; P=0.017). NPi was inversely correlated with intracranial pressure (Spearman r=−0.551, P<0.001). We observed a circadian pattern of NPi’s which was seemingly disrupted in patients with fatal outcome.

Conclusions:

On the basis of this preliminary study, the assessment of NPi by pupillometry is feasible and might complement multimodal neuromonitoring in patients with aSAH.
Effect of Minimum-Volume Standards on Patient Outcomes and Surgical Practice Patterns for Hysterectomy
Authors: Ruiz Maria P. , Chen Ling , Hou June Y. , Tergas Ana I. , St Clair Caryn M. , Ananth Cande V. , Neugut Alfred I. , Hershman Dawn L. , Wright Jason D.
Published: October 2018

OBJECTIVE:

To model the effect of implementing minimum-volume standards for women who underwent hysterectomy on patient outcomes and surgeon practice patterns.

METHODS:

We conducted a retrospective cohort study using the New York Statewide Planning and Research Cooperative System to capture data for all women who underwent hysterectomy from 2010 to 2014. We estimated the number of hysterectomies performed by each patient's physician during the prior year. Multivariable models were used to estimate the ratio of observed to expected complications based on each surgeon's volume during the prior year. The mean observed/expected ratio of surgeons was then plotted by volume. The number of patients and surgeons who would be eliminated and the reduction in complications if minimum-volume standards (lowest fifth and 10th percentiles) were implemented were analyzed. Separate analyses were performed for each route of hysterectomy.

RESULTS:

We identified a total of 127,202 patients. For abdominal hysterectomy, increasing surgeon volume was associated with a decreasing rate of complications (P<.001). Overall, 17.5% of surgeons (n=1,260) had a prior year volume of one abdominal hysterectomy. The mean observed/expected ratio of surgeons with a prior year abdominal hysterectomy volume of one was 1.47 (SD 2.71). Within this group of surgeons, 31.4% had an observed/expected ratio of 1 or greater, indicating a higher than expected complication rate, and 68.7% of the surgeons had a observed/expected ratio of less than 1, suggesting a lower complication rate than expected based on case mix. Selection of a prior year volume standard of one would restrict 12.5% of surgeons performing robotic-assisted, 16.8% of those performing laparoscopic, and 27.6% of surgeons performing vaginal hysterectomy.

CONCLUSION:

Implementing minimum-volume standards for hysterectomy, for even the lowest volume physicians, would restrict a significant number of gynecologic surgeons, including many with outcomes that are better than predicted.
Incidence of Venous Thromboembolism After Different Modes of Gynecologic Surgery
Authors: Jorgensen Elisa M. , Li Anjie , Modest Anna M. , Leung Katherine , Moore Simas Tiffany A. , Hur Hye-Chun
Published: October 2018

OBJECTIVE:

To evaluate the incidence of postoperative venous thromboembolism after gynecologic surgery by mode of incision.

METHODS:

We conducted a retrospective cohort study of all patients who underwent gynecologic surgery from May 2006 to June 2015 at two tertiary care academic hospitals in Massachusetts. Billing and diagnosis codes were used to identify surgeries and cases of venous thromboembolism.

RESULTS:

A total of 43,751 surgical encounters among 37,485 individual patients were noted during the study. The overall incidence of venous thromboembolism is 0.2% for all gynecologic surgeries, 0.7% for hysterectomy, and 0.2% for myomectomy. Compared with patients undergoing laparotomy, patients who underwent minimally invasive gynecologic surgery were less likely to develop venous thromboembolism (laparoscopy risk ratio 0.22, 95% CI 0.13–0.37; vaginal surgery risk ratio 0.07, 95% CI 0.04–0.12). This effect persisted when data were adjusted for other known venous thromboembolism risk factors such as age, race, cancer, medical comorbidities, use of pharmacologic thromboprophylaxis, admission status, and surgical time.

CONCLUSION:

Minimally invasive surgery is associated with a decreased risk of venous thromboembolism in patients undergoing gynecologic surgery, including hysterectomy and myomectomy. Although society guidelines and risk assessment tools do not currently account for mode of surgery when assessing venous thromboembolism risk and recommendations for prevention, there is a small but growing body of evidence in both general and gynecologic surgery literature that surgical approach affects a patient's risk of postoperative venous thromboembolism. Mode of surgery should be considered when assessing venous thromboembolism risk and planning venous thromboembolism prophylaxis for patients undergoing gynecologic surgery.
Posterior hemivertebral resection for upper thoracic congenital scoliosis: be aware of high risk of complications
Authors: Huang Yong , Feng Ganjun , Liu Limin , Yang Xi , Song Yueming , Zhou Chunguang , Wang Lei , Zhou Zhongjie
Published: October 2018

The treatment of congenital hemivertebrae in the upper thoracic region is challenging. The objective of this study was to investigate the outcomes of posterior hemivertebral resection for the upper thoracic region. Twenty-one patients diagnosed with upper thoracic congenital scoliosis were included. All of them received hemivertebral resection surgery via the posterior-only approach with at least 2 years of follow-up. The radiographic parameters and Scoliosis Research Society-22 score were analyzed. All the intraoperative and postoperative complications were recorded retrospectively. The segmental main curve was 35.9° before surgery and 7.0° at the last follow-up, with an average correction rate of 80.2%. The total main curve was 44.1° before surgery and 11.6° at the last follow-up, with an average correction rate of 73.9%. The caudal compensatory curve was corrected from 20.2° to 7.1°, with an average correction rate of 64.9%. The segmental kyphosis was corrected from 30.9° to 8.9°, with an average correction rate of 65.5%. The total Scoliosis Research Society-22 score significantly improved in all patients at the last follow-up, mainly resulting from the improvement of the self-image, mental health, and satisfaction domains. The following complications were found: one pedicle fracture, two malpositioned screws, one transient neurologic deficit, one implant failure, and four postoperative curve progressions. Although good radiographic deformity correction and clinical results were achieved after surgery, the incidence rate of complications was high at 42.9%; great care should be taken to prevent them, especially for postoperative curve progression (19.0%).
Late Awakening in Survivors of Postanoxic Coma: Early Neurophysiologic Predictors and Association With ICU and Long-Term Neurologic Recovery
Authors: Rey Arnaud , Rossetti Andrea O. , Miroz John-Paul , Eckert Philippe , Oddo Mauro
Published: October 2018

Objectives:

To examine neurophysiologic predictors and outcomes of patients with late awakening following cardiac arrest.

Design:

Observational cohort study.

Setting:

Academic ICU.

Patients:

Adult comatose cardiac arrest patients treated with targeted temperature management and sedation.

Interventions:

None.

Measurement and Main Results:

Time to awakening was calculated starting from initial sedation stop following targeted temperature management and rewarming (median 34 hr from ICU admission). Two-hundred twenty-eight of 402 patients (57%) awoke: late awakening (> 48 hr from sedation stop; median time to awakening 5 days [range, 3–23 d]) was observed in 78 subjects (34%). When considering single neurophysiologic tests, late awakening was associated with a higher proportion of discontinuous electroencephalography (21% vs 6% of early awakeners), absent motor and brainstem responses (38% vs 11%; 23 vs 4%, respectively), and serum neuron specific enolase greater than 33 ng/mL (23% vs 8%; all p < 0.01): no patient had greater than 2 unfavorable tests. By multivariable analysis—adjusting for cardiac arrest duration, Sequential Organ Failure Assessment score, and type of sedation—discontinuous electroencephalography and absent neurologic responses were independently associated with late awakening. Late awakening was more frequent with midazolam (58% vs 45%) and was associated with higher rates of delirium (62% vs 39%) and unfavorable 3-months outcome (27% vs 12%; all p = 0.005).

Conclusions:

Late awakening is frequent after cardiac arrest, despite early unfavorable neurophysiologic signs and is associated with greater neurologic complications. Limiting benzodiazepines during targeted temperature management may accelerate awakening. Postcardiac arrest patients with late awakening had a high rate of favorable outcome, thereby supporting prognostication strategies relying on multiple rather than single tests and that allow sufficient time for outcome prediction.
Advance Care Planning and Parent-Reported End-of-Life Outcomes in Children, Adolescents, and Young Adults With Complex Chronic Conditions*
Authors: DeCourcey Danielle D. , Silverman Melanie , Oladunjoye Adeolu , Wolfe Joanne
Published: October 2018

Objectives:

For children, adolescents, and young adults with complex chronic conditions advance care planning may be a vital component of optimal care. Advance care planning outcomes research has previously focused on seriously ill adults and adolescents with cancer where it is correlated with high-quality end-of-life care. The impact of advance care planning on end-of-life outcomes for children, adolescents, and young adults with complex chronic conditions is unknown, thus we sought to evaluate parental preferences for advance care planning and to determine whether advance care planning and assessment of specific family considerations during advance care planning were associated with differences in parent-reported end-of-life outcomes.

Design:

Cross-sectional survey.

Setting:

Large, tertiary care children’s hospital.

Subjects:

Bereaved parents of children, adolescents, and young adults with complex chronic conditions who died between 2006 and 2015.

Interventions:

None.

Measurement and Main Results:

One-hundred fourteen parents were enrolled (54% response rate) and all parents reported that advance care planning was important, with a majority (70%) endorsing that discussions should occur early in the illness course. Parents who reported advance care planning (65%) were more likely to be prepared for their child’s last days of life (adjusted odds ratio, 3.78; 95% CI, 1.33–10.77), to have the ability to plan their child’s location of death (adjusted odds ratio, 2.93; 95% CI, 1.06–8.07), and to rate their child’s quality of life during end-of-life as good to excellent (adjusted odds ratio, 3.59; 95% CI, 1.23–10.37). Notably, advance care planning which included specific assessment of family goals was associated with a decrease in reported child suffering at end-of-life (adjusted odds ratio, 0.23; 95% CI, 0.06–0.86) and parental decisional regret (adjusted odds ratio, 0.42; 95% CI, 0.02–0.87).

Conclusions:

Parents of children, adolescents, and young adults with complex chronic conditions highly value advance care planning, early in the illness course. Importantly, advance care planning is associated with improved parent-reported end-of-life outcomes for this population including superior quality of life. Further studies should evaluate strategies to ensure high-quality advance care planning including specific assessment of family goals.
Intra-abdominal Sepsis After Ileocolic Resection in Crohn’s Disease: The Role of Combination Immunosuppression
Authors: McKenna Nicholas P. , Habermann Elizabeth B. , Glasgow Amy E. , Dozois Eric J. , Lightner Amy L.
Published: October 2018

BACKGROUND:

Intra-abdominal sepsis complicates <10% of ileocolic resections for Crohn’s disease, but the impact of combination immunosuppression and repeat resection on its development remains unknown.

OBJECTIVE:

The purpose of this study was to determine risk factors for intra-abdominal sepsis after ileocolic resection, specifically examining the role of combination immunosuppression and repeat intestinal resection.

DESIGN:

This was a retrospective review of patient records from 2007 to 2017.

SETTINGS:

The study was conducted at a single-institution IBD tertiary referral center.

PATIENTS:

Patients with a diagnosis of Crohn’s disease who were undergoing ileocolic resection with primary anastomosis were included. Diverted patients were excluded.

MAIN OUTCOME MEASURES:

Preoperative and intraoperative variables, including preoperative immunosuppressive regimens and previous intestinal resection, were evaluated as potential risk factors for intra-abdominal sepsis.

RESULTS:

A total of 621 patients (55% women) underwent ileocolic resection for Crohn’s disease; 393 (63%) were first-time resections. The rate of 30-day intra-abdominal sepsis was 8% (n = 50). On univariate analysis, triple immunosuppression (combination of a corticosteroid, immunomodulator, and biological) and previous intestinal resection were significantly associated with intra-abdominal sepsis. Both risk factors remained significant on multivariable analysis (OR for triple immunosuppression (vs none) = 3.53 (95% CI, 1.27–9.84); previous intestinal resection OR = 2.27 (95% CI, 1.25–4.13)). A significant trend was seen between an increasing number of these risk factors (triple immunosuppression and previous intestinal resection) and rate of intra-abdominal sepsis (5%, 12%, and 22% for 0, 1, and 2 risk factors; p < 0.01). A trend was observed between increasing number of previous intestinal resections and the rate of intra-abdominal sepsis (p < 0.01).

LIMITATIONS:

This study is limited by its single-institution tertiary referral center scope.

CONCLUSIONS:

Combination immunosuppression and previous intestinal resection were both associated with the development of intra-abdominal sepsis. In light of these results, surgeons should consider the effects of combination immunosuppression and a history of previous intestinal resection, in addition to other risk factors, when deciding which patients warrant temporary intestinal diversion. See Video Abstract at http://links.lww.com/DCR/A664.
ASSESSMENT OF ANATOMICAL AND FUNCTIONAL OUTCOMES WITH OCRIPLASMIN TREATMENT IN PATIENTS WITH VITREOMACULAR TRACTION WITH OR WITHOUT MACULAR HOLES
Authors: Tadayoni Ramin , Holz Frank G. , Zech Christophe , Liu Xin , Spera Claudio , Stalmans Peter
Published: October 2018

Purpose:

To evaluate the anatomical and functional outcomes with ocriplasmin in patients with vitreomacular traction (VMT) with or without macular hole (MH).

Methods:

In a Phase 4, multicenter, single-arm, open-label study, eligible patients (VMT with focal adhesion, without epiretinal membrane, and with MH ≤400 µm [if present]) received a single intravitreal injection of ocriplasmin. Nonsurgical resolution of VMT (Day 28 [primary endpoint]), best-corrected visual acuity, MH closure, vitrectomy rate, and safety were assessed through Day 180.

Results:

Overall, 466 patients were included in the full analysis set, of whom 47.4% had VMT resolution by Day 28; resolution rates in patients with VMT without MH, VMT with MH ≤250 µm, and VMT with MH >250 to ≤400 µm were 43.4%, 68.6%, and 62.7%, respectively. Macular hole closure was higher in eyes with VMT and MH ≤250 µm (57.1%) than in eyes with VMT and MH >250 to ≤400 µm (27.5%) at Day 28. Overall, 30.8% of patients with VMT resolution gained ≥10 letters in best-corrected visual acuity at Day 180. Adverse events were consistent with the known safety profile of ocriplasmin.

Conclusion:

Ocriplasmin is effective for resolution of VMT without or with MH (≤400 μm); treatment outcomes can be optimized with patient selection.
RELATIONSHIP BETWEEN STAGES OF DIABETIC RETINOPATHY AND LEVELS OF BRAIN-DERIVED NEUROTROPHIC FACTOR IN AQUEOUS HUMOR AND SERUM
Authors: Taşlipinar Uzel Ayşe Güzin , UĞurlu Nagihan , Toklu Yasin , Çİçek Muharrem , Boral Bariş , Şener Burçin , ÇaĞil Nurullah
Published: October 2018

Purpose:

The aim of the study was to determine aqueous humor and serum levels of brain-derived neurotrophic factor (BDNF) in diabetic patients with and without retinopathy.

Methods:

The study included diabetic patients with or without retinopathy, who had an indication for cataract surgery. The study groups were diabetic patients without retinopathy (Group 2), with nonproliferative diabetic retinopathy (Group 3), and with proliferative retinopathy (Group 4). To quantitatively determine the amount of BDNF in samples, the RayBio Human BDNF ELISA kit (Norcross, GA), based on an enzyme-labeled immunosorbent assay was used.

Results:

The median serum BDNF levels were significantly lower in all the study groups than in the control group (P values: 0.038 Group 2, 0.02 Group 3, and 0.002 Group 4). Serum BDNF was lower in Group 4 than in Group 3 (P = 0.030), and in Group 3 than in Group 2 (P = 0.04). The median aqueous humor BDNF levels were significantly decreased in all groups (P values: 0.047 Group 2, 0.021 Group 3, and 0.007 Group 4). There was no significant difference between Groups 2, 3, and 4 (P = 0.214).

Conclusion:

The serum and aqueous humor BDNF levels decreased in patients with diabetes mellitus (DM) before the emergence of clinical signs of retinopathy.
Psychometric Testing of the Revised Self-Care of Heart Failure Index
Authors: Riegel Barbara , Barbaranelli Claudio , Carlson Beverly , Sethares Kristen A. , Daus Marguerite , Moser Debra K. , Miller Jennifer , Osokpo Onome Henry , Lee Solim , Brown Stacey , Vellone Ercole
Published: October 2018

Background:

Self-care is essential in people with chronic heart failure (HF). The process of self-care was refined in the revised situation specific theory of HF self-care, so we updated the instrument measuring self-care to match the updated theory. The aim of this study was to test the psychometric properties of the revised 29-item Self-Care of Heart Failure Index (SCHFI).

Methods:

A cross-sectional design was used in the primary psychometric analysis using data collected at 5 sites in the United States. A longitudinal design was used at the site collecting test-retest data. We tested SCHFI validity with confirmatory factor analysis and predictive validity in relation to health-related quality of life. We tested SCHFI reliability with Cronbach α, global reliability index, and test-retest reliability.

Results:

Participants included 631 adults with HF (mean age, 65 ± 14.3 years; 63% male). A series of confirmatory factor analyses supported the factorial structure of the SCHFI with 3 scales: Self-Care Maintenance (with consulting behavior and dietary behavior dimensions), Symptom Perception (with monitoring behavior and symptom recognition dimensions), and Self-Care Management (with recommended behavior and problem-solving behavior dimensions). Reliability estimates were 0.70 or greater for all scales. Predictive validity was supportive with significant correlations between SCHFI scores and health-related quality-of-life scores.

Conclusions:

Our analysis supports validity and reliability of the SCHFI v7.2. It is freely available to users on the website: www.self-care-measures.com.
Total Disc Replacement Surgery in a Professional Australian Rugby League Player: A Case Report
Authors: Gan Thomas , Rickenbach Andre , Scott-Young Matthew
Published: October 2018

Chronic persistent lower back pain due to degenerative disc disease (DDD) of the lumbar spine is a common condition in the athletic population, which does not always improve with nonoperative treatment. We present a case report of a professional Australian rugby league player with DDD of the lumbar spine presenting with persistent lower back pain, which was not responding to conventional nonsurgical treatment. He then underwent a surgical total disc replacement of the lumbar spine and was subsequently able to return to playing professional rugby league at his previous level of competition. This is the only known documented case of a professional athlete in any form of contact sport successfully returning to his previous level of function and competition after undergoing a total disc replacement of the lumbar spine.
Ultrasound-Guided Cubital Tunnel Decompression in a Collegiate Swimmer: A Case Report
Authors: Boettcher Brennan J. , Finnoff Jonathan T.
Published: October 2018

A 19-year-old female collegiate swimmer presented to our sports medicine clinic with a history and physical examination consistent with right ulnar neuropathy at the cubital tunnel. Diagnostic ultrasound (US) revealed compression of the ulnar nerve under the cubital tunnel retinaculum (CTR) with nerve swelling proximal to the site of compression. Electrodiagnostic studies confirmed the diagnosis of a moderate to severe ulnar neuropathy at the elbow. Treatment consisted of an US-guided decompression of the ulnar nerve in the cubital tunnel by cutting the CTR using a rotated stylet “v” cutting technique. The patient's symptoms resolved, and she was able to begin a swimming progression 2 weeks after the procedure. After completion of this progression, she was able to successfully resume full, unrestricted competitive collegiate swimming without return of her symptoms. To the best of our knowledge, this is the first description of an US-guided cubital tunnel decompression surgery.
Diagnostic Value of Elastography and Endobronchial Ultrasound in the Study of Hilar and Mediastinal Lymph Nodes
Authors: Hernández Roca María , Pérez Pallarés Javier , Prieto Merino David , Valdivia Salas María del Mar , García Solano Jose , Fernández Álvarez Javier , Lozano Vicente Desiree , Wasniewski Samantha , Martínez Díaz Juan J. , Elías Torregrosa Cristina , Santa Cruz Siminiani Antonio
Published: October 2018

Background:

The aim of this study was to explore elastography features and its ability to distinguish between benign and malignant lymph nodes by comparing the results with an anatomopathologic examination used as gold standard.

Methods:

Patients were randomized in 2 groups [endobronchial ultrasound (EBUS) and EBUS-elastography]. Echographic characteristics of the lymph nodes were collected in both categories. In the EBUS-elastography group, elastographic data were also determined.

Results:

A total of 100 lymph nodes were evaluated. Group 1 (EBUS) consisted of 57 lymph nodes. Group 2 (EBUS-elastography) included 43 lymph nodes. In group 2, lymph nodes with predominantly blue pattern were associated with a pathologic determination of malignancy, and the probability of presenting malignant infiltration with this color pattern was 86.7% (P=0.00004). Malignant lymph nodes presented less color dispersion (48.8 vs. 94.8, P=0.00013), higher ratio of blue pixels (66% vs. 32.5%, P=0.016), and higher strain ratio (7.1 vs. 2.48, P=0.005). The cut-off points to distinguish between benign and malignant lymph nodes were 4 for strain ratio, 61 for frequency histograms, and 52 for blue pixel ratio. The area under the curve of the ROC curves were 0.75, 0.83, and 0.87, respectively. Group 2 presented a lower number of nondiagnostic samples (2.3% vs. 21%, P=0.001) and a higher rate of malignant results (42% vs. 16%, P=0.005).

Conclusion:

EBUS-elastography is feasible during EBUS and may be helpful in predicting malignant lymph node infiltration. It could improve anatomopathologic sample collection and increase diagnostic efficiency.
Serum Fibrinogen as a Prognostic Factor in Sudden Sensorineural Hearing Loss: A Meta-analysis
Authors: Oya Ryohei , Takenaka Yukinori , Imai Takao , Sato Takashi , Osaki Yasuhiro , Ohta Yumi , Inohara Hidenori
Published: October 2018

Objective:

High blood viscosity has been proposed as a mechanism for sudden sensorineural hearing loss (SSNHL); however, the relationship between blood markers of fibrinolysis or coagulation and severity or prognosis of SSNHL is still unclear. The aim of this study is to investigate the relationship between serum fibrinogen and SSNHL.

Data Sources:

PubMed and Scopus were searched for English language articles using the following keywords: SSNHL, sudden hearing loss, sudden deafness, idiopathic hearing loss or idiopathic sensorineural hearing loss, and fibrinogen.

Study Selection:

The articles in the study related to SSNHL and provided data about the serum fibrinogen level.

Data Extraction:

The data included patient profiles, fibrinogen level, recovery, and treatment modality.

Data Synthesis:

Nineteen articles were selected. The aggregated data were analyzed using the random effect model. Two articles that included the fibrinogen level with recovery rates were analyzed for the relationship between the fibrinogen level and recovery.

Conclusions:

The average fibrinogen level was 318 ± 8.5 mg/dl (mean ± standard error, within normal range). There was no difference in the fibrinogen level between SSNHL patients and the control group. The fibrinogen level of the recovery group was lower than that of the no recovery group. This showed that a high fibrinogen level was associated with poor prognosis, and it could be related to the severity of the pathological change rather than being the cause of the SSNHL. SSNHL includes various pathologies; therefore, the appropriate therapy should be selected based on each condition.
Assessment of Vestibulo-ocular Reflex Gain and Catch-up Saccades During Vestibular Rehabilitation
Authors: Navari Elena , Cerchiai Niccolò , Casani Augusto Pietro
Published: October 2018

Objective:

To assess, in patients referred to vestibular rehabilitation (VR) for persistence of disability after acute unilateral vestibulopathy (AUV), whether the video head impulse test (vHIT) can be a useful technique to define the efficacy of the treatment.

Study Design:

Prospective clinical study.

Setting:

Tertiary academic referral hospitals.

Patients:

Thirty patients with residual symptoms after AUV were included.

Intervention:

Patients underwent a 10-week VR program.

Main Outcome Measures:

Evaluation of dizziness handicap inventory score, high-velocity vestibulo-ocular reflex gain, asymmetry index, and catch-up saccade parameters before and after VR.

Results:

All patients reported a clear clinical improvement after VR, also demonstrated by better dizziness handicap inventory scores (p < 0.001). A consistent increased gain and decreased asymmetry index were also observed (p < 0.001 for both). Patients did not show any change in covert catch-up saccades, while a statistically significant reduction of the number and amplitude of the overt catch-up saccades was interestingly detected (p = 0.009 and p = 0.030, respectively).

Conclusion:

VR is a valid approach for patients with residual disability after AUV. A reduction in number and amplitude of overt catch-up saccades seems useful to evaluate the efficacy of VR and to be related to clinical improvement.
Frequent milk and soybean consumption are high risks for uterine leiomyoma
Authors: Gao Mei , Wang Hui
Published: October 2018

This study aims to retrospectively analyze the potential risk factors for uterine leiomyoma and prospectively examine whether these risk factors can increase the incidence of uterine leiomyoma.

Women who attended our outpatient department from January 1, 2010 to December 31, 2010 were enrolled. General demographical characteristics, personal information, and living habits were collected. Univariate and multivariate logistic regression analyses were used to identify the potential risk factors. Follow-up was regularly conducted to complete the prospective analysis.

A total of 1273 women were enrolled including 213 uterine leiomyomas (case group) and 1060 nonuterine leiomyoma women (control group). No statistical differences were found on the age, marital status, number and complication of pregnancy, frequent physical exercise, frequent alcohol consumption, and family history of uterine diseases between two groups (all P > .05). Mean body mass index (P = .043), high school education (P = .041), frequent smoking (P = .030), frequent caffeine consumption (P = .019), frequent milk or soybean consumption (P = .025), and frequent oral contraceptive use (P = .034) were statistically correlated with the onset of uterine leiomyoma. Multivariate analysis verified that frequent milk or soybean consumption (7.349 [5.081–9.454]; P = .039] and frequent oral contraceptive use (8.103 [4.486–12.583]; P = .018] were the independent risk factors for uterine leiomyoma.

Frequent milk or soybean consumption and frequent oral contraceptive use are associated with a high risk of uterine leiomyoma, and proper education on the prevention of uterine leiomyoma is highly recommended in clinical practice.
Effects of the portage early education program on Chinese children with global developmental delay
Authors: Liu Xiumei , Wang Xue-Ming , Ge Jing-Jing , Dong Xiu-Qing
Published: October 2018

Children with global developmental delay (GDD) were trained with the Portage Guide to Early Education (PGEE) program.

In the treatment group, the PGEE program was performed on children with GDD (45 cases) through a combination of family and hospital interventions, in a 1-to-1 ratio. The Gesell Infant Development Scale (GESELL) developmental quotient (DQ) and social adaptability were measured before and 6 months after PGEE implementation in the treatment group. These parameters were also evaluated in a control group (30 cases) during an initial visit and 6 months later.

Before the PGEE intervention, no significant differences were observed between the general characteristics of children in the control and treatment groups. Six months after the PGEE intervention, the DQ values of the children with GDD in the treatment group (64.7 ± 9.5) were significantly higher than those before treatment (54.6 ± 9.3) and those of the control group (58.3 ± 10.2) (P < .05). The PGEE intervention significantly increased the DQ values on 5 aspects, including gross motor, fine motor, adaptability, language, and personal social activity abilities, and the scores on the Infants-Junior Middle School Students’ Social-Life Abilities Scales (SM scales), as compared with the control group (P < .05).

The PGEE program improves the DQ, social adaptability, and prognosis of children with GDD.
Improvement of quality of life in diabetic patients treated with percutaneous transluminal angioplasty
Authors: Bernal Páez Fernando Luis , Alcaraz Baños Miguel , Felices Abad Jose Manuel , Bernal Belmonte Ana , Gijon-Nogueron Gabriel , Pardo Rios Manuel
Published: October 2018

To assess the quality of life (QoL) of treated patients in order to evaluate the success of peripheral transluminal angioplasty (PTA) and correlate physical parameters with clinical progress at 6 months post-PTA.

According to TASC II classifications, 69 patients were selected for PTA. Clinical evaluation and diagnostic tests were performed before, after and after 6 months following PTA. The SF-36 QoL questionnaire was added as an additional parameter.

Fifty one patients were included in the study. The ankle-brachial index (ABI) increased from 0.49 ± 0.11 before PTA, to 0.81 ± 0.14 after PTA (P < .001) and 0.76 ± 0.10 at 6 months following PTA (P < .001). Transcutaneous oxygen pressure (TcPO2) increased from 28.05 ± 3.15 mm Hg before PTA, to 39.89 ± 4.12 after PTA (P < .001) and 46.4 ± 3.81 at 6 months following PTA (P < .001). The lumen of the affected blood vessel increased from 29 ± 18% before PTA, to 81 ± 10.3% after PTA (P < .001). SF-36 values increased from 29 ± 18 before PTA, to 81 ± 10.36 at 6 months following PTA (P < .001).

The improvement of QoL is the parameter that best describes the symptoms and functionality of the patient, therefore, should be used to determine the successful PTA. Although ABI and TcPO2 with arteries functionality and tissue oxygenation, they are not show a significant correlation with all parameters determined in the QoL questionnaire.
Chronic inflammatory demyelinating polyradiculoneuropathy
Authors: Hu Bolin , Zhou Yibiao , Lu Xiaoqing , Xiong Qianqian , Liu Qing , Qi Xueliang , Ding Weijiang
Published: October 2018

Rationale:

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a disorder characterized by a symmetrical, sensorimotor involvement and slowly progressive onset peripheral neuropathy. Peripheral neuropathies have been reported in some central demyelination patients. However, the central nervous system focus in the CIDP patient can mimic neuromyelitis optica have not been recognized by most of us.

Patient concerns:

The numbness and weakness of limbs about eight weeks.

Diagnoses:

Chronic inflammatory demyelinating polyradiculoneuropathy.

Interventions:

Immunotherapy with intravenous immunoglobulins was applied to this patient.

Outcomes:

After 1 year follow-up, the results showed there was still slight numbness of all limbs, and he could walk slowly without help. Gastrocnemius muscle atrophy did not aggravate.

Lessons:

So It is suggest that CIDP can combine with central lesions mimicking neuromyelitis optica. We should take the diagnosis of CIDP into consideration when we find focus in central nervous system.
Closed reduction of the traumatic posterior-dislocation of hip joint using a novel sitting technique
Authors: Zhou Yabin , Zhang Cheng , Zhao Shimeng , Wang Qingxian
Published: October 2018

Rationale:

Traumatic hip dislocation is a common joint dislocation. Delayed reduction has been shown to increase the risk of avascular necrosis of the femoral head. Most of the traditional methods must be performed under general anesthesia or spinal anesthesia to relax hip muscles. Anesthesia will prolong the interval between the injury and the reduction.

Patient concerns:

16 patients presented with hip pain and a leg shortened, flexed, internally rotated and adducted.

Diagnoses:

X-ray and CT-scan showed acute closed posterior dislocation of hip.

Interventions:

Closed reduction of the traumatic posterior-dislocation of hip joint using a novel sitting technique.

Outcomes:

Among these 16 patients, 15 hips were successfully reduced using the Sitting Technique (table 1), indicating the success rate was 93.8%(15/16). A total of 12 patients were followed up, with a mean period of 23.5 months (range, 6–72 months). Among these 12 patients, 10 patients (83.3%) had excellent grade, 2 patients (16.7%) had good grade.

Lessons:

Sitting technique for treatment of traumatic posterior dislocation of hip joint does not need anaesthesia, which it shortens the interval between the injury and the reduction and saves valuable time for 6 hours of joint reduction. On the other hand, this method does no harm to the physicians’ low back.
A giant hemolymphangioma of the pancreas
Authors: Chen Qingyu , Xia Jianguo
Published: October 2018

Rationale:

Hemolymphangioma of the pancreas is an extremely rare benign tumor; only 10 patients with this disease have been reported to date, the majority of whom were women.

Patient concerns:

We describe a 28-year-old man who presented with abdominal pain and discomfort. Computed tomography and magnetic resonance imaging data showed a huge heterogeneous solid cystic mass at the retroperitoneal pancreatic head. The maximum cross-sectional lengths of the pancreatic lesion were approximately 12 × 8.5 × 12 cm3.

Diagnosis:

Hemolymphangioma of the pancreas.

Interventions:

The patient underwent a pylorus-preserving pancreatoduodenectomy; surgical excision is the main treatment for this type of tumor.

Outcomes:

The patient followed up regularly in the outpatient department for 6 months after surgery, and no sign of recurrence was found.

Lessons:

Although it is uncommon, clinicians ought to consider the diagnosis of hemolymphangioma of the pancreas upon detection of a pancreatic cystic lesion exhibiting fat or calcification.