bluuebunny/crossref_metadata_2025 huggingface dataset:
Zebularine exerts its antiproliferative activity through S phase delay and cell death in human malignant mesothelioma cells
Authors: Takemura Yukitoshi , Satoh Motohiko , Hatanaka Kenichi , Kubota Shunichiro
Published: April 2018

Malignant mesothelioma is an asbestos-related aggressive tumor and current therapy remains ineffective. Zebularine as a DNA methyltransferase (DNMT) inhibitor has an anti-tumor effect in several human cancer cells. The aim of the present study was to investigate whether zebularine could induce antiproliferative effect in human malignant mesothelioma cells. Zebularine induced cell growth inhibition in a dose-dependent manner. In addition, zebularine dose-dependently decreased expression of DNMT1 in all malignant mesothelioma cells tested. Cell cycle analysis indicated that zebularine induced S phase delay. Zebularine also induced cell death in malignant mesothelioma cells. In contrast, zebularine did not induce cell growth inhibition and cell death in human normal fibroblast cells. These results suggest that zebularine has a potential for the treatment of malignant mesothelioma by inhibiting cell growth and inducing cell death.
Effects of alcoholic beverage treatment on spatial learning and fear memory in mice
Authors: Hashikawa-Hobara Narumi , Mishima Shuta , Nagase Shotaro , Morita Keishi , Otsuka Ami , Hashikawa Naoya
Published: April 2018

Although chronic ethanol treatment is known to impair learning and memory, humans commonly consume a range of alcoholic beverages. However, the specific effects of some alcoholic beverages on behavioral performance are largely unknown. The present study compared the effects of a range of alcoholic beverages (plain ethanol solution, red wine, sake and whiskey; with a matched alcohol concentration of 10%) on learning and memory. 6-week-old C57BL6J mice were orally administered alcohol for 7 weeks. The results revealed that red wine treatment exhibited a trend toward improvement of spatial memory and advanced extinction of fear memory. Additionally, red wine treatment significantly increased mRNA levels of brain-derived neurotrophic factor (BDNF) and N-methyl-D-aspartate (NMDA) receptors in mice hippocampus. These results support previous reports that red wine has beneficial effects.
Repressing the repressor: Ezh2 mediates macrophage activation
Authors: Neele Annette E. , de Winther Menno P.J.
Published: April 2018

In this issue of JEM, Zhang et al. (https://doi.org/10.1084/jem.20171417) show that the suppressive epigenetic enzyme Ezh2 is an important regulator of macrophage activation. The absence of Ezh2 leads to reduced cytokine secretion and suppresses macrophage-dependent disease development. They identify the antiinflammatory factor Socs3 as an important target for Ezh2 and thus show that regulation of suppressive histone modifications controls macrophage activation in disease.
Lifting involutions in a Weyl group to the torus normalizer
Authors: Lusztig G.
Published: April 2018

Let

N
N

be the normalizer of a maximal torus

T
T

in a split reductive group over

F
q

F_q

, and let

w
w

be an involution in the Weyl group

N

/

T

N/T

. We explicitly construct a lifting

n
n

of

w
w

in

N
N

such that the image of

n
n

under the Frobenius map is equal to the inverse of

n
n

.
Spindle assembly checkpoint strength is linked to cell fate in theCaenorhabditis elegansembryo
Authors: Gerhold Abigail R. , Poupart Vincent , Labbé Jean-Claude , Maddox Paul S.
Published: April 2018

The spindle assembly checkpoint (SAC) is a conserved mitotic regulator that preserves genome stability by monitoring kinetochore–microtubule attachments and blocking anaphase onset until chromosome biorientation is achieved. Despite its central role in maintaining mitotic fidelity, the ability of the SAC to delay mitotic exit in the presence of kinetochore–microtubule attachment defects (SAC “strength”) appears to vary widely. How different cellular aspects drive this variation remains largely unknown. Here we show that SAC strength is correlated with cell fate during development of Caenorhabditis elegans embryos, with germline-fated cells experiencing longer mitotic delays upon spindle perturbation than somatic cells. These differences are entirely dependent on an intact checkpoint and only partially attributable to differences in cell size. In two-cell embryos, cell size accounts for half of the difference in SAC strength between the larger somatic AB and the smaller germline P1blastomeres. The remaining difference requires asymmetric cytoplasmic partitioning downstream of PAR polarity proteins, suggesting that checkpoint-regulating factors are distributed asymmetrically during early germ cell divisions. Our results indicate that SAC activity is linked to cell fate and reveal a hitherto unknown interaction between asymmetric cell division and the SAC.
Clinical Referral Laboratories in Rwanda
Authors: Rusanganwa Vincent , Gahutu Jean Bosco , Nzabahimana Innocent , Ngendakabaniga Jean Marie Vianney , Hurtig Anna-Karin , Evander Magnus
Published: April 2018

Objectives

We investigated the quality system performance in Rwandan referral laboratories to determine their progress toward accreditation.

Methods

We conducted audits across five laboratories in 2017, using the Stepwise Laboratory Quality Improvement Process Towards Accreditation checklist. Laboratories were scored based on the World Health Organization grading scale (0-5 stars scale) and compared with earlier audits.

Results

Between 2012 and 2017, only one laboratory progressed (from four to five stars). Four of the five laboratories decreased to one (three laboratories) and zero (one laboratory) stars from four and three stars. Management reviews, evaluation, audits, documents, records, and identification of nonconformities showed a low performance.

Conclusions

Four of five laboratories are not moving toward accreditation. However, this target is still achievable by energizing responsibilities of stakeholders and monitoring and evaluation. This would be possible because of the ability that laboratories showed in earlier audits, coupled with existing health policy that enables sustainable quality health care in Rwanda.
Police Stop and Search Within British Muslim Communities: Evidence From the Crime Survey 2006–11
Authors: Hargreaves Julian
Published: April 2018

This article discusses police stop and search within British Muslim communities and reports the analysis of statistical data collected by the Crime Survey of England and Wales between 2006 and 2011. The primary aim of the article is to determine the extent to which Crime Survey data support or challenge allegations of police discrimination against British Muslim communities. The context for the study is provided by criminological literature related to the policing of British African Caribbean and British Muslim communities. The article engages with the concept of ‘institutional Islamophobia’ and represents the first known study to model large-scale police stop and search data from British Muslim communities. Overall, the findings reveal a more complex picture of police stop and search practices within these communities than might be assumed from an uncritical reading of the literature.
Movements and geographic distribution of juvenile bluefin tuna in the Northeast Atlantic, described through internal and satellite archival tags
Authors: Arregui Igor , Galuardi Benjamin , Goñi Nicolas , Lam Chi Hin , Fraile Igaratza , Santiago Josu , Lutcavage Molly , Arrizabalaga Haritz
Published: April 2018

From 2005 to 2010, 136 internal archival tags and 29 pop-up satellite archival tags were used to track juvenile Atlantic bluefin tuna in the Bay of Biscay. Information from 15 pop-up and 5 internal archival tags was recovered. The analysis was adapted for a common treatment of both types of tag data, allowing classification of overwintering distribution patterns, fidelity to the Bay of Biscay feeding area, as well as of horizontal and vertical habitat utilization. Results show substantial geographic dispersion from autumn to spring, with high habitat concentration in the Bay of Biscay during summer, when bluefin tuna inhabit in the mixed layer. Of the individuals that left the Bay of Biscay towards the end of the year, a high percentage returned the next year, suggesting a strong fidelity to the area. Thirty-three percent of records during the overwintering periods revealed residency in the Bay of Biscay and surrounding areas. Half of the fish overwintered in the mid-Atlantic, near the Azores or Madeira Islands, while three (17%) made trans-Atlantic round trips, and one individual travelled to and remained off the eastern coast of the United States. These findings challenge previous assumptions regarding the seasonality and annual movements of bluefin tuna from the Bay of Biscay, while demonstrating extensive spatio-temporal dispersion.
A Pilot Study on Posterior Polyethylene Tethers to Prevent Proximal Junctional Kyphosis After Multilevel Spinal Instrumentation for Adult Spinal Deformity
Authors: Buell Thomas J , Buchholz Avery L , Quinn John C , Bess Shay , Line Breton G , Ames Christopher P , Schwab Frank J , Lafage Virginie , Shaffrey Christopher I , Smith Justin S
Published: April 2018

BACKGROUND

Proximal junctional kyphosis (PJK) is a common problem after multilevel spine instrumentation.

OBJECTIVE

To determine if junctional tethers reduce PJK after multilevel instrumented surgery for adult spinal deformity (ASD).

METHODS

ASD patients who underwent posterior instrumented fusion were divided into 3 groups: no tether (NT), polyethylene tether-only (TO; tied securely through the spinous processes of the uppermost instrumented vertebra [UIV] + 1 and UIV-1), and tether with crosslink (TC; passed through the spinous process of UIV+1 and tied to a crosslink between UIV-1 and UIV-2). PJK was defined as proximal junctional angle ≥ 10° and ≥ 10° greater than the corresponding preoperative measurement.

RESULTS

One hundred eighty-four (96%) of 191 consecutive patients achieved minimum 3-mo follow-up (mean = 20 mo [range:3-56 mo]; mean age = 66 yr; 67.4% female). There were no significant differences between groups based on demographic, surgical, and sagittal radiographic parameters. PJK rates were 45.3% (29/64), 34.4% (22/64), and 17.9% (10/56) for NT, TO, and TC, respectively. PJK rate for all tethered patients (TO + TC; 26.7% [32/120]) was significantly lower than NT (P = .011). PJK rate for TC was significantly lower than NT (P = .001). Kaplan-Meier analysis showed significant time-dependent PJK reduction for TC vs NT (log rank test, P = .010). Older age and greater change in lumbar lordosis were independent predictors of PJK, while junctional tethers had a significant protective effect.

CONCLUSION

Junctional tethers significantly reduced occurrence of PJK. This difference was progressive from NT to TO to TC, but only reached pairwise significance for NT vs TC. This suggests potential benefit of tethers to reduce PJK, and that future prospective studies are warranted.
Extrapolating the Limits of the Nasoseptal Flap With Pedicle Dissection to the Internal Maxillary Artery
Authors: Pinheiro-Neto Carlos D , Peris-Celda Maria , Kenning Tyler
Published: April 2018

BACKGROUND

The nasoseptal flap is the main pedicled flap used for endoscopic cranial base reconstruction. For large anterior cranial base defects, the anterior edge is a concern for the nasoseptal flap reach.

OBJECTIVE

To present a surgical technique that completely releases the vascular pedicle of the nasoseptal flap from the sphenopalatine artery (SPA) foramen improving considerably the reach of the flap.

METHODS

A patient with left anterior cranial base fracture involving the posterior table of the frontal sinus, who presented with cerebrospinal fluid leak and contused brain herniation to the ethmoid and frontal sinuses. Unilateral endoscopic endonasal anterior cranial base reconstruction was performed with left sided nasoseptal flap. The nasoseptal flap pedicle was dissected and completely released from the SPA foramen. The flap was left attached only to the internal maxillary artery (IMAX) vascular bundle.

RESULTS

The flap covered the entire left anterior cranial base, from the planum sphenoidale to the posterior table of the frontal sinus. There was complete obliteration of the cerebrospinal fluid fistula postoperatively with resolution of the radiographic pneumocephalus and the patient's rhinorrhea.

CONCLUSION

The complete release of the nasoseptal flap pedicle from the SPA foramen is feasible and remarkably improves the reach of the flap. It also increases the reconstructive area of the flap since the entire septal mucosa can be used for reconstruction and the pedicle length is based exclusively upon the SPA/IMAX.
Phylogenetic Comparative Methods on Phylogenetic Networks with Reticulations
Authors: Bastide Paul , Solís-Lemus Claudia , Kriebel Ricardo , William Sparks K , Ané Cécile
Published: April 2018

The goal of phylogenetic comparative methods (PCMs) is to study the distribution of quantitative traits among related species. The observed traits are often seen as the result of a Brownian Motion (BM) along the branches of a phylogenetic tree. Reticulation events such as hybridization, gene flow or horizontal gene transfer, can substantially affect a species’ traits, but are not modeled by a tree. Phylogenetic networks have been designed to represent reticulate evolution. As they become available for downstream analyses, new models of trait evolution are needed, applicable to networks. We develop here an efficient recursive algorithm to compute the phylogenetic variance matrix of a trait on a network, in only one preorder traversal of the network. We then extend the standard PCM tools to this new framework, including phylogenetic regression with covariates (or phylogenetic ANOVA), ancestral trait reconstruction, and Pagel’s $\lambda$ test of phylogenetic signal. The trait of a hybrid is sometimes outside of the range of its two parents, for instance because of hybrid vigor or hybrid depression. These two phenomena are rather commonly observed in present-day hybrids. Transgressive evolution can be modeled as a shift in the trait value following a reticulation point. We develop a general framework to handle such shifts and take advantage of the phylogenetic regression view of the problem to design statistical tests for ancestral transgressive evolution in the evolutionary history of a group of species. We study the power of these tests in several scenarios and show that recent events have indeed the strongest impact on the trait distribution of present-day taxa. We apply those methods to a data set of Xiphophorus fishes, to confirm and complete previous analysis in this group. All the methods developed here are available in the Julia package PhyloNetworks.
Draft Genome Sequence and Transcriptional Analysis of Rosellinia necatrix Infected with a Virulent Mycovirus
Authors: Shimizu Takeo , Kanematsu Satoko , Yaegashi Hajime
Published: April 2018

Understanding the molecular mechanisms of pathogenesis is useful in developing effective control methods for fungal diseases. The white root rot fungus Rosellinia necatrix is a soilborne pathogen that causes serious economic losses in various crops, including fruit trees, worldwide. Here, using next-generation sequencing techniques, we first produced a 44-Mb draft genome sequence of R. necatrix strain W97, an isolate from Japan, in which 12,444 protein-coding genes were predicted. To survey differentially expressed genes (DEGs) associated with the pathogenesis of the fungus, the hypovirulent W97 strain infected with Rosellinia necatrix megabirnavirus 1 (RnMBV1) was used for a comprehensive transcriptome analysis. In total, 545 and 615 genes are up- and down-regulated, respectively, in R. necatrix infected with RnMBV1. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses of the DEGs suggested that primary and secondary metabolism would be greatly disturbed in R. necatrix infected with RnMBV1. The genes encoding transcriptional regulators, plant cell wall-degrading enzymes, and toxin production, such as cytochalasin E, were also found in the DEGs. The genetic resources provided in this study will accelerate the discovery of genes associated with pathogenesis and other biological characteristics of R. necatrix, thus contributing to disease control.
Extent and Role of Pharmacists in Expedited Partner Therapy in the US [18I]
Authors: Park Sharon K. , Wong Alexander , Elias Nahed , Diniz Clarissa P. , Coleman Jenell S.
Published: April 2018

INTRODUCTION:

Providing prescriptions to sex partners of patients diagnosed with sexually transmitted infections (STIs) is called Expedited Partner Therapy (EPT). EPT decreases reinfection and further transmission, however barriers inhibit widespread implementation. We sought to identify pharmacy-level barriers to EPT by examining United States (US) pharmacists’ legal responsibilities and practices. We hypothesized that pharmacists’ EPT legal responsibilities would vary between states.

METHODS:

Laws, regulations, and guidelines from LexisNexis, Board of Pharmacy, and CDC were evaluated. Pharmacist responsibilities was characterized from Level A (pharmacists screen and prescribe EPT) through Level E (EPT not enacted). Descriptive statistics were performed.

RESULTS:

No state/territory was Level A. Twenty-three (46%) states/territories were Level B (EPT enacted and practiced, e.g. partner’s identification not required); 14(27%) states/territories Level C (EPT enacted but not fully practiced, e.g. partner’s identification required); 11(23%) states/territories Level D (EPT enacted but not practiced); and 2(3.8%) states/territories Level E. Oregon (Level B) has amendments and new laws potentially rising to Level A. Wyoming (Level B) implemented a state-driven EPT delivery system. Oklahoma, New Jersey, and Kansas (Level D) have pending bills. Kentucky and South Carolina (Level E) have struggled to pass EPT bills.

CONCLUSION:

Most states/territories permit pharmacists to dispense EPT at varying scopes of practice; however, no laws currently enable pharmacists to prescribe EPT. Pharmacists’ involvement in EPT, including the ability to prescribe, play a huge role in STI prevention and public health; thus, clearer and more permissive laws and regulations regarding pharmacists’ role in EPT are needed.
Primary shoulder replacement using stemless inlay arthroplasty as a joint preservation alternative
Authors: Davidson Philip A. , Rivenburgh Dennis
Published: April 2018

Background:

Stemmed shoulder arthroplasties are being performed at increasing rates with loosening and revisions on the rise. Stemless inlay arthroplasty may be an effective alternative. Our purpose is to report 5-year results of primary joint-preserving stemless inlay arthroplasty.

Methods:

Twenty patients (22 shoulders), mean age 60.41 (range, 43-80) years followed for an average of 68.14 (range, 24-98) months were evaluated prospectively using the Constant, visual analog scale (VAS) pain, Simple Shoulder Test (SST), range of motion, Short-Form (SF)-36 Physical Component score (PCS), and Mental Component score (MCS), and radiographs. The Student t-test was used to compare mean differences from preoperative to postoperative with significance set at P<0.05 a priori.

Results:

Significant improvements were demonstrated: Constant (39.4-82.05, P<0.001), VAS pain today (6.2-3.2, P<0.001), VAS pain (activity) (7.7-3.4, P<0.001), VAS stability (5.3-1.7, P<0.001), SST (3.8-7.5, P<0.001), external rotation (33.7-47.04, P=0.04), and internal rotation (Constant: 5.3-7.1, P=0.008). SF-36 MCS (48-06-51.5, P=0.34), SF-36 PCS (37.4-42.6, P=0.065), VAS pain (rest) (3.5-2.7, P=0.4), active (118.4-124.3, P=0.63) and passive forward elevation (131.3-142.3, P=0.25) improved but not significantly. Follow-up radiographs showed no periprosthetic radiolucency, subsidence, or progression of disease. No revisions were attributed to failure of the implant.

Conclusions:

Stemless inlay arthroplasty is safe and effective, showing significant pain and functional improvements at an average of 5 yr. Inherent joint preservation lends itself well as a primary alternative for symptomatic glenohumeral degeneration.

Level of Evidence:

Level IV, prospective case series.
Comparison of three surgical treatment options for unicameral bone cysts in humerus
Authors: Mavčič Blaž , Saraph Vinay , Gilg Magdalena M. , Bergovec Marko , Brecelj Janez , Leithner Andreas
Published: April 2018

Treatment of unicameral bone cysts (UBC) in the humerus with drainage screws is scarcely reported in the literature. The aim of this retrospective study was to compare drainage screws and alternative treatment methods with respect to the number of required surgical procedures to achieve sufficient UBC healing, postoperative fractures/recurrences/complications, and radiological outcome. Medical archives of two tertiary orthopedic referral centers were screened for all patients who were treated surgically for humeral UBC in the period 1991–2015 with a histologically/cytologically confirmed diagnosis. Sex, age, all surgical procedures, fractures, complications, recurrences, and the final radiological outcome were compared between patients treated with drainage screws, elastic intramedullary nails, or curettage with optional grafting. The study included 106 operated patients with a mean age of 10.3 years, with a mean follow-up of 5.7 years. The average number of UBC-related surgical procedures in sex-matched and age-matched treatment groups was 2.7 with drainage screws, 2.8 with intramedullary nails, and 3.5 with curettage/grafting (P=0.54). Intramedullary nails (odds ratio 0.20) and older age (odds ratio for each year 0.83) predicted a lower risk of postoperative UBC recurrence. Patients with drainage screws had the highest UBC recurrence rates and the lowest rates of changed initial treatment method. There was no difference between the treatment groups in the postoperative fracture rate, complications, or the final radiological outcome. UBC treatment in the humerus therefore requires approximately three surgical procedures, irrespective of the treatment modality chosen. Adding an elastic intramedullary nail to a humeral UBC cyst may reduce recurrence risk and prevent further fractures. Level of Evidence: Level III – therapeutic retrospective comparative study.
Poxvirus-Induced Vascular Angiogenesis Mimicking Pyogenic Granuloma
Authors: Aşiran Serdar Zehra , Yaşar Şirin , Demirkesen Cuyan , Aktaş Karabay Ezgi
Published: April 2018

The orf virus, a member of poxvirus family, is a zoonotic parapoxvirus endemic in many countries, mostly seen among sheep, goats, oxen, and may be transmitted to humans. Orf virus infections may induce ulceration, papulonodular, pustular, or ecthyma lesions in the skin. Rarely, orf virus provokes extensive vasculoendothelial proliferation by encoding an apparent homolog of the mammalian vascular endothelial growth factor family of molecules. The vascular endothelial growth factor–like viral gene product is expressed early during infection and could be responsible for the induction of endothelial proliferation. Here, a 6-year-old male patient with poxvirus-induced widespread vascular angiogenesis is presented, which developed ten days after a thermal burn.
Using Stratum Corneum Thickness and Configuration to Distinguish Lichenoid Dermatoses
Authors: Marsch Amanda F.
Published: April 2018

Background:

Clues in the stratum corneum (SC) can aide in histopathologic diagnosis of many conditions.

Objective:

To determine if SC configuration and thickness could help differentiate the lichenoid dermatoses.

Methods:

A retrospective study was performed. A total of 305 cases (55 lichenoid keratosis, 51 lichen planus, 7 hypertrophic lichen planus, 40 lichenoid drug eruption, 19 lichenoid graft-vs.-host disease, 14 hypertrophic lupus, 46 lichenoid actinic keratosis, 73 lentigo maligna) fulfilled the selection criteria. Cases were digitally scanned using the 40× (0.23 μm/pixel) mode of a Hamamatsu NanoZoomer 2.0-HT Slide Scanner (Hamamatsu Photonics, Hamamatsu City, Japan), allowing for the creation of virtual (digital) slides. SC thicknesses and configuration were assessed for each case.

Results:

Mixed SC patterns were common in cases of lichenoid keratoses. Compact parakeratosis was the most common pattern in lichenoid drug eruption. Tiered parakeratosis was the most predominant pattern in cases of lichenoid graft versus host disease and lichenoid actinic keratosis. Hypertrophic lupus had the highest average SC thickness.

Limitations:

The sample size for cases of hypertrophic lupus and hypertrophic lichen planus was low.

Conclusions:

SC thickness and configuration can be utilized to help differentiate the lichenoid dermatoses.
A Case Report and Literature Review of Scrub Typhus With Acute Abdomen and Septic Shock in a Child—The Role of Leukocytoclastic Vasculitis and Granulysin
Authors: Chang Po-Hsiung , Cheng Yu-Pin , Chang Po-Sheng , Lo Chiao-Wei , Lin Lung-Huang , Lu Chin-Fang , Chung Wen-Hung
Published: April 2018

Scrub typhus is becoming a clinically important cause of acute undifferentiated febrile illness in Taiwan. The incubation period is between 6 and 21 days after exposure. It is transmitted by chiggers (larva of trombiculid mite) in long grasses and in dirt-floor homes, with infection characterized by a flu-like illness of fever, headache, and myalgia lasting approximately 1 week. It has various systemic manifestations, including GI symptoms. In some, the illness progresses to multiorgan dysfunction syndrome and death. We report on a 13-year-old boy who lived in Taipei City and who had initially tentative diagnosis of acute pyrexia of unknown origin with high fever up to 40.3°C for 1 week, but later had thrombocytopenia and diffuse abdominal pain with peritoneal sign suspected acute appendicitis. During the clinical course, septic shock and disseminated intravascular coagulopathy (DIC) were noted. There were skin rash in his trunk and extremities and an eschar with black crust surrounded by a scaling erythematous rim on his right buttock. In addition, we got the information of his travel history in Green Island and Orchid Island for 10 days.

With the correct antibiotics, vancomycin, meropenem, and doxycycline, the patient was getting better and corresponding with high level of granulysin and tumor necrosis factor-alpha. The diagnosis of scrub typhus was confirmed by the biopsy of eschar and high quantitative real-time polymerase chain reaction values of Orientia tsutsugamushi (16sRNA and 56 kDa) tested by Centers for Disease Control and Prevention, Taiwan. Histopathological findings of the eschar revealed the leukocytoclastic vasculitis, crust and thrombus formation with many gram-negative microorganisms, O. tsutsugamushi demonstrated by 47 kDa monoclonal antibody immunohistochemical stain and electromicroscopy.

Outcomes:

After the careful selection of appropriate antibiotics including meropenem, vancomycin, and doxycycline, he recovered and was subsequently discharged 7 days after admission.

Lesson subsections:

This case highlights that scrub typhus infection can mimic acute abdomen and septic shock with DIC. This rare presentation of acute abdomen and septic shock with thrombocytopenia and DIC caused by scrub typhus should remind physicians to be alert to the possibility of acute abdomen and febrile illness resulting from scrub typhus.
Tranilast Blunts the Hypertrophic and Fibrotic Response to Increased Afterload Independent of Cardiomyocyte Transient Receptor Potential Vanilloid 2 Channels
Authors: Koch Sheryl E. , Nieman Michelle L. , Robbins Nathan , Slone Samuel , Worley Mariah , Green Lisa C. , Chen Yamei , Barlow Alexandria , Tranter Michael , Wang HongSheng , Lorenz John N. , Rubinstein Jack
Published: April 2018

Tranilast is clinically indicated for the treatment of allergic disorders and is also a nonselective blocker of the transient receptor potential vanilloid 2 (TRPV2) channel. Previous studies have found that it has protective effects in various animal models of cardiac disease. Our laboratory has found that genetic deletion of TRPV2 results in a blunted hypertrophic response to increased afterload; thus, this study tested the hypothesis that tranilast through cardiomyocyte TRPV2 blockade can inhibit the hypertrophic response to pressure overload in vivo through transverse aortic constriction and ex vivo through isolated myocyte studies. The in vivo studies demonstrated that tranilast blunted the fibrotic response to increased afterload and, to a lesser extent, the hypertrophic response. After 4 weeks, this blunting was associated with improved cardiac function, although at 8 weeks, the cardiac function deteriorated similarly to the control group. Finally, the in vitro studies demonstrated that tranilast was not inhibiting these responses at the cardiomyocyte level. In conclusion, we demonstrated that tranilast blunting of the fibrotic and hypertrophic response occurs independently of cardiac TRPV2 channels and may be cardioprotective in the short term but not after prolonged administration.
Estimating Fluoroscopic Peak Skin Dose Using Manual Calculations
Authors: Berry Kendall Elizabeth
Published: April 2018

Not all healthcare providers can afford to purchase commercially available programs that can quickly and easily provide peak skin dose estimations for patients undergoing diagnostic and international fluoroscopic procedures. The air kerma reference point exposure, Ka,r, available on all equipment manufactured after 2006, may over or under estimate the patient's peak skin dose. The total air kerma reference point exposure provided at the end of a case might be on the order of 20 Gy for a patient, indicating that a Joint Commission "sentinel event" may have occurred. An investigation to determine whether a sentinel event has occurred becomes necessary. This article will introduce information available to the investigating health physicist for data mining, how to process that information, and then how best to interpret the results. I have used this system of data mining and analysis to effectively influence how physicians performing diagnostic and interventional fluoroscopic procedures use fluoroscopic equipment. Arriving at an answer is not simple; it is time consuming, and the methodologies are imperfect. Your effort can result in improved utilization of fluoroscopic equipment at your institution which in turn will lower patient and staff doses.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN PATIENTS WITH NONOCULAR BEHÇET DISEASE
Authors: Raafat Karim A. , Allam Riham S. H. M. , Medhat Basma M.
Published: April 2018

Purpose:

To describe the optical coherence tomography angiography findings in nonocular Behçet disease.

Methods:

The superficial capillary plexus (SCP) and deep capillary plexus (DCP) and outer retinal and choroidal flow were evaluated using optical coherence tomography angiography. Perimetry was performed to correlate any microvascular and functional changes.

Results:

Capillary nonperfusion areas were found in the superficial capillary plexus in 16/20 eyes (80%) and in the DCP in 17/20 eyes (85%). Perifoveal capillary arcade disruption and vessel rarefaction were present in both plexuses in all cases. Capillary telangiectasia was present in the superficial capillary plexus in five eyes (25%) and in the DCP in all eyes. Telangiectasia of the parafoveal capillaries was present in the DCP in all eyes. The mean area of the foveal avascular zone was not significantly different from that in 20 normal eyes (P = 0.68). However, mean and central subfield capillary density values were significantly lower (P < 0.001 and P < 0.005, respectively) in the Behçet disease group. Perimetry revealed central scotomata on the pattern deviation plot in 12 eyes (60%).

Conclusion:

Telangiectasia of the parafoveal capillaries was detected in the DCP in all cases. Microvascular changes in the superficial capillary plexus and DCP in nonocular Behçet disease can be detected by optical coherence tomography angiography.
Significantly Elevated C-Reactive Protein Levels after Epicardial Clipping of the Left Atrial Appendage
Authors: Verberkmoes Niels J. , Akca Ferdi , Vandevenne Ann-Sofie , Jacobs Luuk , Hamad Mohamed A. Soliman , van Straten Albert H.M.
Published: April 2018

Objective

Besides mechanical and anatomical changes of the left atrium, epicardial closure of the left atrial appendage has also possible homeostatic effects. The aim of this study was to assess whether epicardial clipping of the left atrial appendage has different biochemical effects compared with complete removal of the left atrial appendage.

Methods

Eighty-two patients were included and underwent a totally thoracoscopic AF ablation procedure. As part of the procedure, the left atrial appendage was excluded with an epicardial clip (n = 57) or the left atrial appendage was fully amputated with an endoscopic vascular stapler (n = 25). From all patients’ preprocedural and postprocedural blood pressure, electrolytes and inflammatory parameters were collected.

Results

The mean age and left atrial volume index were comparable between the epicardial clip and stapler group (64 ± 8 years vs. 60 ± 9 years, P = non-significant; 44 ±15 mL/m2 vs. 40 ± 13 mL/m2, P = nonsignificant). Patients receiving left atrial appendage clipping had significantly elevated C-reactive protein levels compared with patients who had left atrial appendage stapling at the second, third, and fourth postoperative day (225 ± 84 mg/L vs. 149 ± 76 mg/L, P = 0.002, 244 ± 78 vs. 167 ± 76, P = 0.004, 190 ± 74vs. 105 ± 48, P < 0.001, respectively). Patients had a significant decrease in sodium levels, systolic, and diastolic blood pressure at 24 and 72 hours after left atrial appendage closure. However, this was comparable for both the left atrial appendage clipping and stapling group.

Conclusions

Increased activation of the inflammatory response was observed after left atrial appendage clipping compared with left atrial appendage stapling. Furthermore, a significant decrease in blood pressure was observed after surgical removal of the left atrial appendage. Whether the inflammatory response affects the outcome of arrhythmia surgery needs to be further evaluated.
Closure of Large Percutaneous Femoral Venous access using a Modified “Figure-of-Eight” Suture
Authors: Wyss Christophe A. , Anliker Oliver , Gämperli Oliver , Sürder Daniel , Biaggi Patric , Buhler Ines , Salzberg Sacha P. , Grünenfelder Jürg , Corti Roberto
Published: April 2018

Recent advances in different percutaneous treatments made insertion of large-caliber sheaths in the femoral veins more common. Venous punctures are historically managed by initial manual compression with subsequent application of a compression bandage and bed rest. We describe a modified “figure-of-eight” suture technique for minimizing the risk of accidental puncture of the vein while grabbing the subcutaneous tissue. We examined the safety and feasibility of this technique combined with early mobilization in a real-world setting. We performed a retrospective analysis on 56 consecutive patients undergoing percutaneous mitral valve repair using large femoral venous access. The patient population was heterogeneous and bleeding risk characteristics were common. Bleeding Academic Research Consortium Consensus (BARC)-classifiable bleeding complications occurred in eight patients (14%), BARC of two events or more in five patients (8.9%), and BARC of three or more event in only one patient (1.8%), which is a comparable success rate to large venous access closure with suture-mediated closure devices. No BARC Type 3b or BARC Type 5 bleeding occurred. During routine clinical follow-up, no groin-related problems were reported in all patients. Closure of large femoral venous access using a modified temporary subcutaneous figure-of-eight suture in combination of a light compression bandage and bed rest for 2 to 4 hours provides a safe and low-cost alternative to closure devices for early mobilization.
“A Drop in the Ocean”: A Reflection on the Application of Cognitive Analytic Therapy Within a Prison Setting
Authors: Roper Louise
Published: April 2018

This article reflects on the application of cognitive analytic therapy (CAT) with prisoners referred to a mental health in-reach team within a U.K. prison based on the author's experience as a clinical psychologist. The extent of mental health problems in the prison population and the provision of mental health services within prisons are summarized to highlight the extent of mental health need within this setting. The central concepts and tools of CAT that provided the framework within which this author's work was undertaken within the prison are detailed, namely, reciprocal roles and reciprocal role procedures. Personal reflections on the utility of CAT within a prison setting are presented, including how CAT informed understanding of risk. The application of CAT to the role of forensic nurses within mental health in-reach teams is also considered.
Implementing a Breastfeeding Toolkit for Nursing Education
Authors: Folker-Maglaya Catherine , Pylman Maureen E. , Couch Kimberly A. , Spatz Diane L. , Marzalik Penny R.
Published: April 2018

All health professional organizations recommend exclusive breastfeeding for at least 6 months, with continued breastfeeding for 1 year or more after birth. Women cite lack of support from health professionals as a barrier to breastfeeding. Meanwhile, breastfeeding education is not considered essential to basic nursing education and students are not adequately prepared to support breastfeeding women. Therefore, a toolkit of comprehensive evidence-based breastfeeding educational materials was developed to provide essential breastfeeding knowledge. A study was performed to determine the effectiveness of the breastfeeding toolkit education in an associate degree nursing program. A pretest/posttest survey design with intervention and comparison groups was used. One hundred fourteen students completed pre- and posttests. Student knowledge was measured using a 12-item survey derived with minor modifications from Marzalik's 2004 instrument measuring breastfeeding knowledge. When pre- and posttests scores were compared within groups, both groups' knowledge scores increased. A change score was calculated with a significantly higher mean score for the intervention group. When regression analysis was used to control for the pretest score, belonging to the intervention group increased student scores but not significantly. The toolkit was developed to provide a curriculum that demonstrates enhanced learning to prepare nursing students for practice. The toolkit could be used in other settings, such as to educate staff nurses working with childbearing families.
Factors That Influence Human Milk Feeding at Hospital Discharge for Preterm Infants in a Tertiary Neonatal Care Center in Taiwan
Authors: Pai Chia-Ming , Jim Wai-Tim , Lin Hsiang-Yu , Hsu Chyong-Hsin , Kao Hsin-An , Hung Han-Yang , Peng Chun-Chih , Chang Jui-Hsing
Published: April 2018

Human milk is considered optimal nutrition for newborn infants, especially preterm infants, and it can lessen morbidity in this population. Human milk feeding at hospital discharge may encourage breastfeeding at home. This study evaluated the incidence and predictive factors of human milk feeding of preterm infants at discharge. It included all preterm infants with gestational age of less than 37 weeks who were admitted to the Mackay Memorial Hospital in Taiwan from January to December 2010 who survived to discharge. Infants were classified into a human milk group or a formula milk group. Gestational age, birth weight, length of hospital stay, maternal age, maternal educational status, and morbidity of prematurity were compared between the groups. Of the 290 preterm infants, 153 (52.8%) were being fed human milk at hospital discharge. Compared with the formula milk group, the human milk group had lower birth weights, younger gestational age, higher rates of ventilator use, and longer hospital stays. These differences were not statistically significant for very low-birth-weight (birth weight of <1500 g) infants (n = 66). Multivariate analysis indicated that 2 factors, longer hospital stay and neonatal intensive care unit admission, were associated with human milk feeding at hospital discharge. These findings highlight the need for encouraging and helping all mothers, even those with relatively mature and healthy infants, to provide human milk for their infants.
Beyond BFHI
Authors: Spatz Diane L.
Published: April 2018

A report released by the World Health Organization states that worldwide less than 10% of birth occur in hospitals certified through the Baby-Friendly Hospital Initiative. Furthermore, the Baby-Friendly Hospital Initiative's primary focus is on breastfeeding for healthy, mother-infant dyads. This article provides alternative models for implementing evidence-based care during maternal-infant separation so that mothers can achieve their personal breastfeeding goals. These include the Spatz 10-step model for human milk and breastfeeding in vulnerable infants and the Breastfeeding Resource Nurse model. Clinical outcome data are provided to demonstrate the effectiveness of the models as well as a road map of strategies to implement the models and measure outcomes.
Clinical and Microbiological Effect of a Multispecies Probiotic Supplementation in Celiac Patients With Persistent IBS-type Symptoms
Authors: Francavilla Ruggiero , Piccolo Maria , Francavilla Antonio , Polimeno Lorenzo , Semeraro Francesco , Cristofori Fernanda , Castellaneta Stefania , Barone Michele , Indrio Flavia , Gobbetti Marco , De Angelis Maria
Published: April 2018

Goals:

The goals of this study were to evaluate the efficacy and safety of a probiotic mixture in patients with celiac disease (CD) with irritable bowel syndrome (IBS)-type symptoms despite a strict gluten-free diet (GFD).

Background:

About 30% of patients with CD adherent to a GFD suffer from IBS-type symptoms; a possible cause resides in the imbalances of the intestinal microbiota in CD. Probiotics may represent a potential treatment.

Study:

CD patients with IBS-type symptoms entered a prospective, double-blind, randomized placebo-controlled study. A 6-week treatment period was preceded by a 2-week run-in and followed by a 6-week follow-up phase. Clinical data were monitored throughout the study by validated questionnaires: IBS Severity Scoring System (IBS-SSS); Gastrointestinal Symptom Rating Scale (GSRS); Bristol Stool Form Scale (BSFS); and IBS Quality of Life Questionnaire (IBS-QOL). The fecal microbiota were assayed using plate counts and 16S rRNA gene-based analysis.

Results:

In total, 109 patients were randomized to probiotics (n=54) or placebo (n=55). IBS-SSS and GSRS decreased significantly in probiotics, as compared with placebo [(−15.9%±14.8% vs. 8.2%±25.9%; P<0.001) and (−19.8%±16.6% vs. 12.9%±31.6%; P<0.001)], respectively. Treatment success was significantly higher in patients receiving probiotics, as compared with placebo (15.3% vs. 3.8%; P<0.04). Presumptive lactic acid bacteria, Staphylococcus and Bifidobacterium, increased in patients receiving probiotic treatment. No adverse events were reported.

Conclusions:

A 6-week probiotic treatment is effective in improving the severity of IBS-type symptoms, in CD patients on strict GFD, and is associated with a modification of gut microbiota, characterized by an increase of bifidobacteria.
Gastrointestinal Bleeding With Left Ventricular Assist Devices (LVAD)
Authors: Malik Sarah , Malik Shahbaz A. , Ulmer Laura L. , Jha Lokesh K. , Strupp Michael S. , Raichlin Eugenia , Lyden Elizabeth R. , Hewlett Alexander T.
Published: April 2018

Background and Goals:

Gastrointestinal bleeding (GIB) is a significant complication following left ventricular assist device (LVAD) implantation. We evaluated the incidence, predictors, endoscopic findings, and outcomes of GIB in LVAD recipients.

Study:

Retrospective review of 205 adult patients undergoing HeartMate II LVAD implantation from January 2012 to June 2016. Patients were reviewed and separated into GIB (n=57; 28%) and non-GIB (n=148; 72%) groups.

Results:

Median time to GIB was 55 (range, 3 to 730) days. The GIB group patients were older (61±12 vs. 56±13, P=0.0042), more often underwent concomitant tricuspid valve (TV) repair (16% vs. 4%, P=0.007), and a higher percentage were assigned for destination therapy (75% vs. 55%, P=0.01). Angioectasia (33%) was the most common identified cause of GIB. Median time to endoscopic intervention was 1 day. The total number of hospital readmissions after LVAD was higher in the GIB group (median of 5 vs. 3, P=0.001), as was the total number of blood products transfused after LVAD (29 vs. 13, P≤0.0001). GIB was associated with an increased risk of death (hazard ratio, 1.94; 95% confidence interval, 1.16-3.25; P=0.01) and the mortality rate during hospitalization for GIB was 11% (P=0.0004). Receiving a heart transplant was associated with a decreased hazard of death (hazard ratio, 0.40; 95% confidence interval, 0.19-0.85; P=0.016).

Conclusions:

Older age and destination therapy as implant strategy were found to be associated with an increased risk of GIB, consistent with previous studies. A unique finding in our study is the association of TV repair with a higher incidence of GIB. Further studies are needed to investigate possible mechanisms by which TV repair increases the incidence of GIB.
Safety and efficacy of encapsulated fecal microbiota transplantation for recurrent Clostridium difficile infection: a systematic review
Authors: Iqbal Umair , Anwar Hafsa , Karim Muhammad A.
Published: April 2018

Background and aims

Fecal microbial transplantation (FMT) has been shown to be effective for the treatment of recurrent clostridium difficile infection (CDI). The efficacy and safety of freeze-dried encapsulated FMT for the treatment of recurrent CDI is unclear. We performed a systematic review to evaluate and analyze the current evidence in this respect.

Materials and methods

A systematic literature search was performed using the PubMed, Embase, and Medline databases until December 2017 to identify all original studies that investigated the role of administration of encapsulated FMT in recurrent CDI. The study included patients of all ages. Two independent reviewers extracted data and assessed the quality of publications; a third investigator resolved any discrepancies.

Results

A total of six studies, five case series and one randomized-controlled trial, were included in this review. Overall, 341 patients completed treatment with encapsulated FMT. Only three major adverse events were reported and no deaths occurred directly related to FMT. In all, 285 patients responded to the first treatment, with no recurrence during the specified follow-up period set to meet the primary endpoint. Forty-two patients underwent a second treatment, with resolution of symptoms in 28 patients. At least five patients were reported to undergo a third treatment, with resolution in three of them. Only one patient was reported to have received four treatments without long-term resolution of symptoms.

Conclusion

Low-quality to moderate-quality evidence showed that encapsulated FMT is safe and cost-effective for the treatment and prevention of recurrent CDI. Its efficacy is not inferior to FMT performed through the nonoral route. Randomized-controlled trials are necessary to compare its efficacy with oral antimicrobial drugs and also to evaluate the potential adverse effects associated with the treatment.