bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural variation in the
HAN1
gene confers chilling tolerance in rice and allowed adaptation to a temperate climate
Authors: Mao Donghai , Xin Yeyun , Tan Yongjun , Hu Xiaojie , Bai Jiaojiao , Liu Zhao-ying , Yu Yilan , Li Lanying , Peng Can , Fan Tony , Zhu Yuxing , Guo Ya-long , Wang Songhu , Lu Dongping , Xing Yongzhong , Yuan Longping , Chen Caiyan
Published: February 2019

Rice (
Oryza sativa
L.) is a chilling-sensitive staple crop that originated in subtropical regions of Asia. Introduction of the chilling tolerance trait enables the expansion of rice cultivation to temperate regions. Here we report the cloning and characterization of
HAN1
, a quantitative trait locus (QTL) that confers chilling tolerance on temperate
japonica
rice.
HAN1
encodes an oxidase that catalyzes the conversion of biologically active jasmonoyl-L-isoleucine (JA-Ile) to the inactive form 12-hydroxy-JA-Ile (12OH-JA-Ile) and fine-tunes the JA-mediated chilling response. Natural variants in
HAN1
diverged between
indica
and
japonica
rice during domestication. A specific allele from temperate
japonica
rice, which gained a putative MYB cis-element in the promoter of
HAN1
during the divergence of the two
japonica
ecotypes, enhances the chilling tolerance of temperate
japonica
rice and allows it to adapt to a temperate climate. The results of this study extend our understanding of the northward expansion of rice cultivation and provide a target gene for the improvement of chilling tolerance in rice.
High-strength steel components produced by hot metal gas forming
Authors: Jirková Hana , Jeníček Štěpán , Kučerová Ludmila , Kurka Petr
Published: February 2019

Advanced high-strength steels are promising materials for a variety of applications. They can be used in the automotive industry to reduce the car body weight and thus the fuel consumption as well. Very good mechanical properties can be obtained in martensitic steels by the quenching and partitioning process. Making complex-shaped parts using a single forming step is now possible with hot metal gas forming. Several heat treatment sequences were designed. One involved plain hardening to a temperature below the martensite start temperature. Another sequence was intended to explore the influence of the quenching and partitioning process. In this steel with a carbon content of 0.42%, tensile strengths in excess of 1800 MPa with elongations above 15% can be achieved.
Structural studies on bacterial system used in the recognition and uptake of the macromolecule alginate
Authors: Maruyama Yukie , Hashimoto Wataru , Murata Kousaku
Published: February 2019

Alginate is an acidic heteropolysaccharide produced by brown seaweed and certain kinds of bacteria. The cells of Sphingomonas sp. strain A1, a gram-negative bacterium, have several alginate-degrading enzymes in their cytoplasm and efficiently utilize this polymer for their growth. Sphingomonas sp. strain A1 cells can directly incorporate alginate into their cytoplasm through a transport system consisting of a “pit” on their cell surface, substrate-binding proteins in their periplasm, and an ATP-binding cassette transporter in their inner membrane. This review deals with the structural and functional aspects of bacterial systems necessary for the recognition and uptake of alginate.
Arabic language in Zanzibar: past, present, and future
Authors: Gintsburg Sarali
Published: February 2019

The debate on the status and the role of Standard/Classical Arabic versus Dialectal Arabic in the Arab World has a long history. In parallel to this, voices calling for giving Dialectal Arabic the status of the official state language and cancelling Standard Arabic altogether are becoming louder. This debate is being fuelled by the rapidly developing theory of superdiversity which claims that, due to the rapid changes that happened to the world after 1991, and increasing globalization associated with worldwide migration, easy access throughout the world to internet and social networks, video hosting services and satellite television, societies all over the world have become extremely diverse linguistically. This theory also draws on language ideologies, the concept that suggests that the traditional idea of a “language” is an ideological artefact. Is this approach valid for understanding what is happening in the Arabic language? I will attempt to answer this question by examining the status of the Arabic language on the margins of the Arab world – in Zanzibar. For centuries, the Arabic language has been one of the key languages spoken in Zanzibar, but it has now been practically replaced by Swahili.
Quantitative phosphoproteomics reveals mitotic function of the ATR activator ETAA1
Authors: Bass Thomas E. , Cortez David
Published: February 2019

The ATR kinase controls cell cycle transitions and the DNA damage response. ATR activity is regulated through two ATR-activating proteins, ETAA1 and TOPBP1. To examine how each activator contributes to ATR signaling, we used quantitative mass spectrometry to identify changes in protein phosphorylation in ETAA1- or TOPBP1-deficient cells. We identified 724, 285, and 118 phosphosites to be regulated by TOPBP1, ETAA1, or both ATR activators, respectively. Gene ontology analysis of TOPBP1- and ETAA1-dependent phosphoproteins revealed TOPBP1 to be a primary ATR activator for replication stress, while ETAA1 regulates mitotic ATR signaling. Inactivation of ATR or ETAA1, but not TOPBP1, results in decreased Aurora B kinase activity during mitosis. Additionally, ATR activation by ETAA1 is required for proper chromosome alignment during metaphase and for a fully functional spindle assembly checkpoint response. Thus, we conclude that ETAA1 and TOPBP1 regulate distinct aspects of ATR signaling with ETAA1 having a dominant function in mitotic cells.
Spectroscopy of a tetrahedral doubly magic candidate nucleus 16070Yb90
Authors: Saha Arunabha , Bhattacharjee T , CURIEN Dominique , Dudek Jerzy , Dedes I , Mazurek Katarzyna , Gozdz Andrzej , Tagami S , Shimizu Yoshifumi R , Banerjee Sudhee Ranjan , Rajbanshi S , Bisoi A , de Angelis Giacomo , Bhattacharya Soumik , Bhattacharyya S , Biswas S , Chakraborty A , Das Gupta S , Dey B , Goswami A , Mondal D , Pandit D , Palit Rudrajyoti , Roy T , Singh R. P. , Saha Sarkar Maitreyee , Saha Sudipta , Sethi J
Published: February 2019

The decay scheme of $^{160}$Yb nucleus populated in the $^{148}$Sm($^{16}$O, 4n)$^{160}$Yb reaction at 90 MeV has been studied. The gamma-coincidence data have been collected by using Indian National Gamma Array (INGA) composed of twenty Compton-suppressed Clover-Germanium detectors. Compared to the prior publications, the level scheme has been significantly modified owing to the observation of triple $\gamma$-coincidences and the measurements of $\gamma$ intensities, R$_{\theta}$ (asymmetry ratio), DCO (Directional Correlation of Oriented States) and IPDCO (Integrated Polarisation Directional Correlation of Oriented States) ratios.

Theoretical results relevant for the exotic shape-coexistence related to the present context are presented and discussed. They illustrate the consequences of the fact that $^{160}$Yb is expected to be a doubly-magic (Z=70 and N=90) tetrahedral-symmetry nucleus as predicted by other authors. The historical criteria of identification of such a symmetry in nuclei are critically revisited in the context of the actual measurement and interpretation of its results and the precise new criteria are formulated employing recent results of the Fukuoka-Strasbourg collaboration.

The experimental results are interpreted and discussed in detail. Limiting values of branching ratios for transitions observed by other authors but unseen in the present work are estimated. The population criteria of the $\beta$ and $\gamma$ vibration bands are revisited and discussed.

Although no indication of the presence of the stable tetrahedral configuration has been obtained, arguments are given towards the possible presence of the $Y_{32}$ (`tetrahedral component') vibrations around the ground-state equilibrium. With the improvement of the spectroscopic information provided by the new data the way is opened for designed experiment(s) based on the unambiguous identification criteria of tetrahedral symmetry presented in this article.
Citywide Control of Aedes aegypti (Diptera: Culicidae) during the 2016 Zika Epidemic by Integrating Community Awareness, Education, Source Reduction, Larvicides, and Mass Mosquito Trapping
Authors: Barrera Roberto , Harris Angela , Hemme Ryan R , Felix Gilberto , Nazario Nicole , Muñoz-Jordan Jorge L , Rodriguez Damaris , Miranda Julieanne , Soto Eunice , Martinez Stephanie , Ryff Kyle , Perez Carmen , Acevedo Veronica , Amador Manuel , Waterman Stephen H
Published: February 2019

This investigation was initiated to control Aedes aegypti and Zika virus transmission in Caguas City, Puerto Rico, during the 2016 epidemic using Integrated Vector Management (IVM), which included community awareness and education, source reduction, larviciding, and mass-trapping with autocidal gravid ovitraps (AGO). The epidemic peaked in August to October 2016 and waned after April 2017. There was a preintervention period in October/November 2016 and IVM lasted until August 2017. The area under treatment (23.1 km2) had 61,511 inhabitants and 25,363 buildings. The city was divided into eight even clusters and treated following a cluster randomized stepped-wedge design. We analyzed pools of female Ae. aegypti adults for RNA detection of dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) viruses using 360 surveillance AGO traps every week. Rainfall, temperature, and relative humidity were monitored in each cluster. Mosquito density significantly changed (generalized linear mixed model; F8, 14,588 = 296; P < 0.001) from 8.0 ± 0.1 females per trap per week before the intervention to 2.1 ± 0.04 after the percentage of buildings treated with traps was 60% and to 1.4 ± 0.04 when coverage was above 80%. Out of a total 12,081 mosquito pools, there were 1 DENV-, 7 CHIKV-, and 49 ZIKV-positive pools from October 2016 to March 2017. Afterward, we found only one positive pool of DENV in July 2017. This investigation demonstrated that it was possible to scale up effective Ae. aegypti control to a medium-size city through IVM that included mass trapping of gravid Ae. aegypti females.
Outcome measures to be considered on asthma in elderly
Authors: González-Díaz Sandra Nora , Villarreal-Gonzalez Rosalaura Virginia , Lira-Quezada Cindy Elizabeth De , Guzman-Avilan Rosa Ivett
Published: February 2019

Purpose of review

Asthma is a chronic heterogeneous respiratory disease which is characterized by airflow limitation and variable respiratory symptoms. Asthma in patients more than 65 years of age has an important negative impact on quality of life. The pathophysiology and treatment of asthma in older patients are not as well identified as in younger groups of ages. In this review we intend to outline characteristics found in elderly adults which distinguish them from other age groups of patients with asthma.

Recent findings

With increasing age, there are alterations in the innate and adaptive immune responses, known as ‘immunosenescence.’ These age-associated modifications include an altered response after a pathogenic exposure or tissue injury, moderately mediated through an irreversible loss of cellular replication and defective tissue repair.

Asthma is a consequence of complex gene–environment interactions, with diversity in clinical presentation and the type and intensity of airway inflammation and remodeling. Age-associated changes in lung physiology and morphology may occur and contribute to asthma. Aging is correlated with a notable decrease in elastic recoil, greater chest wall rigidity, and poor respiratory muscle strength. Underreporting of symptoms by elderly patients is common because of multiple underlying causes.

Video abstract

http://links.lww.com/COAI/A17.
Initiation and Rapid Titration of Methadone in an Acute Care Setting for the Treatment of Opioid Use Disorder: A Case Report
Authors: Hemmons Patrick , Bach Paxton , Colizza Kate , Nolan Seonaid
Published: February 2019

Background:

Although methadone is an effective treatment for opioid use disorder, its initiation requires prescribing at a subtherapeutic dose with subsequent titration to a therapeutic dose over many weeks. Accordingly, the methadone induction period can be a challenging one for individuals and can be associated with an increased risk for ongoing illicit drug use and consequently overdose. Given its capacity for regular clinical assessments, acute care settings may offer a unique opportunity to reduce the duration of the induction period for methadone maintenance therapy.

Case summary:

We report a case of an individual who successfully completed initiation and rapid methadone titration for treatment of opioid use disorder in an acute care setting.

Discussion:

Utilizing divided dosing intervals and regular monitoring for toxicity, the patient received a cumulative methadone dose of 130 mg total within the first 48 hours of admission with continuation of a similar dose subsequently. No adverse events occurred over a 9-day follow-up period. The case report described here highlights the potential acute care settings may offer for the successful initiation and rapid titration of methadone for the treatment of opioid use disorder. Such an approach could significantly reduce the induction period associated with methadone maintenance therapy and its associated negative outcomes including ongoing illicit substance use and risk for overdose.
Contemporary Trends in Cesarean Delivery Utilization for Live Births Between 22 0/7 and 23 6/7 Weeks of Gestation
Authors: Rossi Robert M. , Hall Eric , DeFranco Emily A.
Published: February 2019

OBJECTIVE:

In 2014, the Society for Maternal-Fetal Medicine, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists published an executive summary of a joint workshop to establish obstetric interventions to be considered for periviable births. We sought to evaluate changes in practice patterns since the publication of these guidelines.

METHODS:

We conducted a population-based cohort study of all singleton live births delivered between 22 0/7 and 23 6/7 weeks of gestation in the United States within two time epochs: pre–executive summary (Epoch 1: 2012–2013) and post–executive summary (Epoch 2: 2015–2016) guideline release. The primary outcome was the difference in the rate of cesarean delivery between pre–executive summary and post–executive summary guideline publication. Secondary outcomes included differences in rates of individual and composite neonatal interventions (neonatal intensive care unit admission, ventilation, surfactant and antibiotic administration), maternal adverse outcomes (intensive care unit admission, transfusion, hysterectomy, uterine rupture), and neonatal mortality. Multivariable logistic regression estimated the association of delivery epoch with outcomes.

RESULTS:

There were 15,846,405 live births in the United States between 2012–2013 and 2015–2016, of which 14,799 (0.1%) were singletons delivered between 22 and 24 weeks of gestation. Among these live births, 7,374 (52.3%) were delivered in Epoch 1 and 7,425 (47.7%) in Epoch 2. Cesarean delivery rates increased from Epoch 1 to Epoch 2 (24.3% vs 28.4%, P<.001), which was attributable to increased cesarean utilization during the 23rd week (36.3% vs 40.8%, difference 4.5%, 95% CI 2.3–6.6). Likewise, the rate of composite neonatal interventions increased (50.6% vs 56.9%, difference 6.3%, 95% CI 4.6–8.0) between Epochs 1 and 2, in association with a slight reduction in neonatal mortality (67.2% vs 64.6%, P=.009). There was no statistically significant difference in composite (8.9% vs 9.5%, P=.261) adverse maternal outcomes between delivery epochs.

CONCLUSION:

The frequency of delivery by cesarean in the 23rd week increased by 4.5% after publication of the periviable birth executive summary. The observed increase in cesarean delivery and composite neonatal interventions between delivery cohorts was associated with a small reduction in neonatal mortality.
Ulipristal Acetate for Disseminated Peritoneal Leiomyomatosis
Authors: Benlolo Samantha , Papillon-Smith Jessica , Murji Ally
Published: February 2019

BACKGROUND:

Disseminated peritoneal leiomyomatosis is a rare condition manifesting as hormone-sensitive soft tissue nodules lining the peritoneal cavity. Given the extensiveness of this disease, surgical management is challenging, making hormonal suppression the primary treatment.

CASE:

A 23-year-old woman presenting with abdominal pain was found to have innumerable abdominopelvic nodules on imaging. Biopsy of these lesions was consistent with disseminated peritoneal leiomyomatosis. Treatment using leuprolide acetate led to satisfactory results but was discontinued owing to vasomotor symptoms. Treatment was changed to cyclic ulipristal acetate, a selective progesterone receptor modulator. Over the past 2 years, the patient has completed five 3-month courses of ulipristal acetate with excellent symptomatic and radiologic response.

CONCLUSION:

The use of ulipristal acetate may be an effective, novel therapeutic option for the management of disseminated peritoneal leiomyomatosis.
Noninvasive Prenatal Whole Genome Sequencing
Authors: Sullivan Haley K. , Bayefsky Michelle , Wakim Paul G. , Huddleston Kathi , Biesecker Barbara B. , Hull Sara Chandros , Berkman Benjamin E.
Published: February 2019

OBJECTIVE:

To assess pregnant women's views and preferences on noninvasive prenatal whole genome sequencing.

METHODS:

A survey was offered to 805 pregnant women receiving prenatal care in practices affiliated with a large, tertiary care maternity hospital. Respondents were asked to envision undergoing prenatal whole genome sequencing and discuss their preferences and reasons for receiving different categories of genomic results, organized by actionability, severity, prevalence, and age of onset. The survey also queried respondents on their preferred role for clinicians in prenatal whole genome sequencing decision-making, and on their demographics and genetic literacy.

RESULTS:

From June to August 2017, a total of 553 respondents returned the survey (response rate=68.7%). Respondents were most likely to want information regarding serious treatable childhood-onset conditions (89.7%) and least likely to want to receive information about nonmedical traits from prenatal whole genome sequencing (40%). The most frequently cited reason for wanting medical prenatal whole genome sequencing results was “to prepare financially, medically, or psychologically for a child with special needs.” In total, 10.5% of respondents wanted clear recommendations from clinicians about the categories of information that are most appropriate to test for, 44.7% wanted clear recommendations plus all options presented, 26.2% wanted all options presented and joint decision-making, and 13.2% wanted all options presented and independent decision-making.

CONCLUSION:

Respondents generally preferred to receive all categories of genetic results pertaining to medical conditions and wanted the information to prepare. More than half of respondents wanted (at minimum) clear recommendations from clinicians when deciding which prenatal whole genome sequencing results to receive.
Joints for joints: cannabinoids in the treatment of rheumatoid arthritis
Authors: Lowin Torsten , Schneider Matthias , Pongratz Georg
Published: February 2019

Purpose of review

An increasing number of patients with rheumatoid arthritis (RA) are using cannabis to treat their symptoms, although systematic studies regarding efficacy in RA are lacking. Within this review we will give an overview on the overall effects of cannabinoids in inflammation and why they might be useful in the treatment of RA.

Recent findings

Peripherally, cannabinoids show anti-inflammatory effects by activating cannabinoid type 2 receptors (CB2) which decrease cytokine production and immune cell mobilization. In contrast, cannabinoid type 1 receptor (CB1) activation on immune cells is proinflammatory while CB1 antagonism provides anti-inflammatory effects by increasing β2-adrenergic signaling in the joint and secondary lymphoid organs. In addition, the nonpsychotropic cannabinoid, cannabidiol (CBD) demonstrated antiarthritic effects independent of cannabinoid receptors. In addition to controlling inflammation, cannabinoids reduce pain by activating central and peripheral CB1, peripheral CB2 receptors and CBD-sensitive noncannabinoid receptor targets.

Cannabinoids might be a suitable treatment for RA, but it is important to target the right receptors in the right place. For clinical studies, we propose a combination of a CB2 agonist to decrease cytokine production, a peripheral CB1 antagonist to prevent detrimental CB1 signaling and to support anti-inflammatory effects of CB2 via activation of β2-adrenergic receptors and CBD to induce cannabinoid-receptor-independent anti-inflammatory effects.
Neutropenic Enterocolitis in Critically Ill Patients: Spectrum of the Disease and Risk of Invasive Fungal Disease
Authors: Duceau Baptiste , Picard Muriel , Pirracchio Romain , Wanquet Anne , Pène Frédéric , Merceron Sybille , Mokart Djamel , Moreau Anne-Sophie , Lengliné Etienne , Canet Emmanuel , Lemiale Virginie , Mariotte Eric , Azoulay Elie , Zafrani Lara
Published: February 2019

Objectives:

Neutropenic enterocolitis occurs in about 5.3% of patients hospitalized for hematologic malignancies receiving chemotherapy. Data from critically ill patients with neutropenic enterocolitis are scarce. Our objectives were to describe the population of patients with neutropenic enterocolitis admitted to an ICU and to investigate the risk factors of invasive fungal disease.

Design:

A multicentric retrospective cohort study between January 2010 and August 2017.

Setting:

Six French ICUs members of the Groupe de Recherche Respiratoire en Onco-Hématologie research network.

Patients:

Adult neutropenic patients hospitalized in the ICU with a diagnosis of enteritis and/or colitis. Patients with differential diagnosis (Clostridium difficilecolitis, viral colitis, inflammatory enterocolitis, mesenteric ischemia, radiation-induced gastrointestinal toxicity, and Graft vs Host Disease) were excluded.

Interventions:

None.

Measurement and Main Results:

We included 134 patients (median Sequential Organ Failure Assessment 10 [8–12]), with 38.8% hospital mortality and 32.1% ICU mortality rates. The main underlying malignancies were acute leukemia (n= 65, 48.5%), lymphoma (n= 49, 36.6%), solid tumor (n= 14, 10.4%), and myeloma (n= 4, 3.0%). Patients were neutropenic during a median of 14 days (9–22 d). Infection was documented in 81 patients (60.4%), including an isolated bacterial infection in 64 patients (47.8%), an isolated fungal infection in nine patients (6.7%), and a coinfection with both pathogens in eight patients (5.0%). Radiologically assessed enteritis (odds ratio, 2.60; 95% CI, 1.32–7.56;p= 0.015) and HIV infection (odds ratio, 2.03; 95% CI, 1.21–3.31;p= 0.016) were independently associated with invasive fungal disease.

Conclusions:

The rate of invasive fungal disease reaches 20% in patients with neutropenic enterocolitis when enteritis is considered. To avoid treatment delay, antifungal therapy might be systematically discussed in ICU patients admitted for neutropenic enterocolitis with radiologically assessed enteritis.
Potential role of cyclin-dependent kinase 4/6 inhibitors in the treatment of squamous cell carcinoma of the head and neck
Authors: van Caloen Gabrielle , Machiels Jean-Pascal
Published: February 2019

Purpose of review

Human papillomavirus (HPV)-negative squamous cell carcinoma of the head and neck (SCCHN) is mainly driven by genetic aberrations involved in the cell cycle pathway resulting in cyclin-dependent kinase (CDK) 4 and 6 activation. This supports the investigation of the activity of CDK4/6 inhibitors in this disease. We review the therapeutic potential of CDK4/6 inhibitors in SCCHN.

Recent findings

CDK4/6 inhibitors in monotherapy have demonstrated cytostatic activity in HPV-negative SCCHN. Combination with epidermal growth factor inhibitors, with phosphatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin pathways inhibitors or with immunotherapy, have shown promising preclinical efficacy. No strong predictive biomarkers of response or resistance have been firmly identified.

Phase I clinical trials have demonstrated that palbociclib or ribociclib in combination with cetuximab is well tolerated. A phase II single-arm trial combining palbociclib/cetuximab has shown promising results.

Inhibition of CDK4/6 represents a new potential treatment for HPV-negative SCCHN patients. Randomized clinical trials that investigate these compounds in an unbiased manner are needed to fully evaluate their efficacy. However, it is unlikely that all the patients will benefit from this new approach. To determine a molecular profile/phenotype that will predict CDK4/6 inhibitor activity, researchers will have to take into account simultaneously occurring events in the cyclin-D/CDK4/CDK6/retinoblastoma and associated pathways.
Achieving a Complete Clinical Response After Neoadjuvant Chemoradiation That Does Not Require Surgical Resection: It May Take Longer Than You Think!
Authors: Habr-Gama Angelita , São Julião Guilherme P. , Fernandez Laura M. , Vailati Bruna B. , Andrade Andres , Araújo Sérgio E. A. , Gama-Rodrigues Joaquim , Perez Rodrigo O.
Published: February 2019

BACKGROUND:

Patients with rectal cancer who achieve complete clinical response after neoadjuvant chemoradiation have been managed by organ-preserving strategies and acceptable long-term outcomes. Controversy still exists regarding optimal timing for the assessment of tumor response after neoadjuvant chemoradiation.

OBJECTIVE:

The purpose of this study was to estimate the time interval for achieving complete clinical response using strict endoscopic and clinical criteria after a single neoadjuvant chemoradiation regimen.

DESIGN:

This was a retrospective review of consecutive patients managed by 54-Gy and consolidation 5-fluorouracil–based chemotherapy. Assessment of response was performed at 10 weeks after radiation. Patients with suspected complete clinical response were offered watch-and-wait strategy and reassessment every 6 to 8 weeks until achievement of strict criteria of complete clinical response or overt residual cancer.

SETTINGS:

This study was conducted at a single tertiary care center.

PATIENTS:

Patients with complete clinical response who underwent a successful watch-and-wait strategy until last follow-up were eligible. Dates of radiation completion and achievement of strict endoscopic and clinical criteria (mucosal whitening, teleangiectasia, and no ulceration or irregularity) were recorded. Patients with incomplete response or with initial complete clinical response followed by local recurrence or regrowth were excluded.

MAIN OUTCOMES MEASURES:

The distribution of time intervals between completion of radiation and achievement of strict complete clinical response was measured. Patients who achieved early complete clinical response (≤16 wk) were compared with late complete clinical response (>16 wk).

RESULTS:

A total of 49 patients achieved complete clinical response and were successfully managed nonoperatively. A median interval of 18.7 weeks was observed for achieving strict complete clinical response. Only 38% of patients achieved complete clinical response between 10 and 16 weeks from radiation completion. Patients with earlier cT status (cT2/T3a) achieved a complete clinical response significantly earlier when compared with those patients with more advanced disease (T3b-d/4; 19 vs 26 wk; p = 0.03).

LIMITATIONS:

This was a retrospective study with a small sample size.

CONCLUSIONS:

Assessment at 10 to 16 weeks may detect a minority of patients who achieve complete clinical response without additional recurrence after neoadjuvant chemoradiation. Patients suspected for a complete clinical response should be considered for reassessment beyond 16 weeks before definitive management when considered for a watch and wait strategy. See Video Abstract at http://links.lww.com/DCR/A901.
Role of Magnification Chromoendoscopy in the Management of Colorectal Neoplastic Lesions Suspicious for Submucosal Invasion
Authors: Kawaguti Fabio S. , Franco Matheus C. , Martins Bruno C. , Segateli Vanderlei , Marques Carlos F. S. , Nahas Caio S. R. , Pinto Rodrigo A. , Safatle-Ribeiro Adriana V. , Ribeiro-Junior Ulysses , Nahas Sergio C. , Maluf-Filho Fauze
Published: February 2019

BACKGROUND:

Correctly predicting the depth of tumor invasion in the colorectal wall is crucial for successful endoscopic resection of superficial colorectal neoplasms.

OBJECTIVE:

The aim of this study was to assess the accuracy of magnifying chromoendoscopy in a Western medical center to predict the depth of invasion by the pit pattern classification in patients with colorectal neoplasms with a high risk of submucosal invasion.

DESIGN:

This single-center retrospective study, from a prospectively collected database, was conducted between April 2009 and June 2015.

SETTINGS:

The study was conducted at a single academic center.

PATIENTS:

Consecutive patients with colorectal neoplasms with high risk of submucosal invasion were included. These tumors were defined by large (≥20 mm) sessile polyps (nonpedunculated), laterally spreading tumors, or depressed lesions of any size.

INTERVENTIONS:

Patients underwent magnifying chromoendoscopy and were classified according to the Kudo pit pattern. The therapeutic decision, endoscopic or surgery, was defined by the magnification assessment.

MAIN OUTCOME MEASURES:

Sensitivity, specificity, and positive and negative predictive values of magnifying chromoendoscopy for assessment of these lesions were determined.

RESULTS:

A total of 123 lesions were included, with a mean size of 54.0 ± 37.1 mm. Preoperative magnifying chromoendoscopy with pit pattern classification had 73.3% sensitivity, 100% specificity, 100% positive predictive value, 96.4% negative predictive value, and 96.7% accuracy to predict depth of invasion and consequently to guide the appropriate treatment. Thirty-three rectal lesions were also examined by MRI, and 31 were diagnosed as T2 lesions. Twenty two (70.1%) of these lesions were diagnosed as noninvasive by magnifying colonoscopy, were treated by endoscopic resection, and met the curative criteria.

LIMITATIONS:

This was a single-center retrospective study with a single expert endoscopist experience.

CONCLUSIONS:

Magnifying chromoendoscopy is highly accurate for assessing colorectal neoplasms suspicious for submucosal invasion and can help to select the most appropriate treatment. See Video Abstract at http://links.lww.com/DCR/A920.
Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation: Meta-analysis of Safety and Efficacy
Authors: Yi Fang , Hou Wenbo , Zhou Chao , Yin Yuxia , Lu Shoutao , Duan Cuihai , Cao MingKun , Li Maoquan , Toft Egon Steen , Zhang Haijun
Published: February 2019

Background:

Radiofrequency ablation (RFA) and antiarrhythmic drugs (AADs) are the main treatments used for atrial fibrillation (AF). In recent years, a number of articles comparing the 2 treatments have begun to emerge. Though, the influence of follow-up time in the meta-analysis was not considered in these articles. However, more recently, large-scale clinical trial articles have included follow-up with the patients up to 5 years after treatment. Therefore, the aim of this study was to assess the impact of variable follow-up times on the recurrence of AF by observing both the short-term and long-term efficacy and safety of catheter ablation and AADs for the treatment of AF.

Methods and Results:

The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random effect summary estimates were calculated as standardized mean differences and odds ratios with 95% confidence intervals for continuous and binary outcomes. In this study, 9 randomized controlled trials (n = 1542 patients) were included. The rate of recurrence of AF with no limit on follow-up time, >12 months, >18 months, >24 months, >30 months, and approximately 36 months was compared. Furthermore, the gap between the RFA and AAD groups in the recurrence rate of AF was found to decrease inversely to follow-up time. When the follow-up time reached 24 months, the difference between RFA and AAD was relatively stable with an odds ratio of 0.45 (95% confidence interval: 0.32–0.62). Overall, RFA decreased adverse events in the remaining trials; however, AAD performed better in terms of safety and had fewer adverse events with RFA usually causing more serious complications.

Conclusion:

RFA is more advantageous in terms of recurrence rate of AF than drug therapy. In addition, the analysis suggests that this effect persists during long-term follow-up; however, these benefits appear to decrease with longer follow-up time. Finally, AAD performed better in terms of safety and had fewer adverse events.
The Detection of Bacteria and Matrix Proteins on Clinically Benign and Pathologic Implants
Authors: Walker Jennifer N. , Pinkner Chloe L. , Pinkner Jerome S. , Hultgren Scott J. , Myckatyn Terence M.
Published: February 2019

Background:

Bacterial contamination of breast implants causes infection, can lead to capsular contracture, and is implicated in breast implant-associated anaplastic large cell lymphoma. Bacteria, however, also colonize clinically benign breast implants and little is known about the biologic signals that trigger the switch from a benign to pathologic state.

Methods:

Explanted smooth as well as Biocell and Siltex textured breast implants associated with clinically normal and pathologic conditions were analyzed in this observational study. Immunofluorescence and bacterial culture techniques were performed. To avoid sampling bias, implant surfaces >25 sq cm were analyzed.

Results:

Bacteria were detected on 9 of 22 clinically normal explanted devices or periprosthetic capsules, including 40% of Biocell tissue expanders and 75% of Biocell textured implants. Staphylococcus epidermidis was identified in 67% of the bacteria-positive capsular contractures. Fibrinogen was present on 17 of 18, and collagen on 13 of 18 analyzed breast implants. S. epidermidis co-localized with collagen, while group B streptococci and Klebsiella pneumoniae co-localized with fibrinogen.

Conclusions:

Bacteria are often detectable on clinically benign breast implants when a multimodal approach is applied to a substantial proportion of the device surface to avoid sampling bias. The impact of bacteria on breast implant pathology should be studied in the presence of an adequate negative control group to account for clinically benign bacteria. Disruption of the interaction of bacteria with matrix proteins coating the surface of breast implants may represent a nonantibiotic strategy for the prevention of breast implant bacterial contamination.
Development of a Plastic Surgery Supply Cart: Patient Outcomes and Quality of Care
Authors: Fahrenkopf Matthew P. , Eichhorn Mitchell G.
Published: February 2019

Background:

Plastic surgeons experience unique quality issues related to the specialty nature of patient procedures. Lack of accessibility to specialty supplies is a rate-limiting variable that impacts treatment efficiency and hospital resources. This study had the following goals: (1) to develop a mobile plastic surgery cart and (2) to assess the impact of a plastic surgery cart on time to treatment of consults.

Methods:

Two plastic carts were developed using preexisting hospital supplies. Cart composition was designed and approved by hospital staff. A prospective study was conducted to assess overall time to treatment of patient consults throughout the hospital comparing a plastics cart versus a traditional hunt and gather methodology. One surgeon recorded time to treatment with and without the plastics cart for each consult during on-call duty hours over a 6-month period.

Results:

A total of 40 patients were treated for either head or neck (60%) or hand-related (40%) cases. The average time (minutes) to treatment across all procedures with the plastics cart was 3.7 ± 1.9 versus 46.3 ± 60.0 without the plastics cart. The maximum time to treatment was 9.5 minutes with the plastics cart and 3 hours without the plastics cart. Usage of the plastics cart resulted in a significant reduction in total time to treatment of 42.5 ± 60.3 minutes (P < 0.0001).

Conclusions:

A specialty supplies cart has quality improvement implications for patients, physicians, and hospitals. Increased accessibility of specialty supplies may significantly reduce the time to treatment for plastic surgery patient consults throughout a hospital.
Protocols for Reporting Speech Outcomes following Palatoplasty or Velopharyngeal Surgery: A Literature Review
Authors: Kummer Ann W. , Hosseinabad Hedieh Hashemi , Redle Erin , Clark Stacey
Published: February 2019

Background:

To determine best practices, surgeons who perform cleft palate surgery or surgery for velopharyngeal insufficiency need to be able to compare their outcomes in normalizing the velopharyngeal valve.

Methods:

We conducted a comprehensive review of articles that reported speech/resonance outcomes following palatoplasty or surgery for velopharyngeal insufficiency. We analyzed protocols that were used and how the results were reported. We found 170 articles, published between 1990 and 2014, that met our inclusion criteria.

Results:

Most studies (66%) had a sample size of <50 subjects, were retrospective (67%), were not blinded (83%), and did not report the use of reliability (68%). Most studies included 1 evaluator (27%) or 2 evaluators (30%). Only 80% of the articles specified that at least one speech pathologist was an evaluator. Most articles (56%) did not specify the speech samples used, and 65% used an informal test or did not specify the type of test used. Most studies used a perceptual rating scale for articulation (75%) and resonance (83%). Only 39% of the studies included an evaluation of velopharyngeal function. Finally, objective measures were used in only 28% of the studies (9% used aerodynamic measures and 19% used nasometry).

Conclusions:

Because these articles showed significant variability in how speech/resonance is evaluated and how the outcomes are reported, it is virtually impossible to compare results to determine best surgical procedures. Suggestions are given to standardize outcome measures to improve comparability of data.
Effect of Inhaled Lemon Essential Oil on Cognitive Test Anxiety Among Nursing Students
Authors: Johnson Catherine E.
Published: February 2019

Nursing programs are stressful learning environments, and students are expected to maintain high academic performance to successfully graduate. Cognitive test anxiety has been minimally studied among nursing students, including how to successfully manage. The Cognitive Test Anxiety Scale (CTAS) was administered to 31 students before and after a high-stakes nursing examination. The intervention was inhaled lemon essential oil delivered via a personal nasal device. Neither the control nor the experimental group demonstrated a statistically significant change in the CTAS score from pretest to posttest (P = .19). More quantitative studies are warranted with undergraduate nursing students, the CTAS, and aromatherapy to reduce the burden of cognitive test anxiety.
Benefits of a Home Treatment Program Using Guided Imagery Relaxation Based on Audio Recordings for People With Fibromyalgia
Authors: Onieva-Zafra María Dolores , Parra-Fernández María Laura , Fernandez-Martinez Elia
Published: February 2019

Despite the plethora of treatments available for patients with fibromyalgia, there is insufficient evidence to date as to what the ideal treatment approach is. This study sought to determine the effectiveness of a home program of audio-recorded guided imagery relaxation on people with fibromyalgia. This experimental 8-week longitudinal trial design was undertaken with 60 people diagnosed with fibromyalgia who were randomly assigned to either a guided imagery intervention group or a control group. Pain at tender points, anxiety, self-efficacy, quality of sleep, quality of life, and the impact of the fibromyalgia were determined at baseline, at 4 weeks, and at 8 weeks. After the guided imagery intervention, we found significant differences regarding trait anxiety, sleep quality, and tenderness at some of the tender points. There is a need, therefore, to develop and evaluate interventions that may enhance the quality of life of those affected by this disorder.
Effect of Age on Procedural Success, Complications, and Clinical Outcome From a Large Angioplasty Registry
Authors: Mousavi Mehdi , Poorhosseini Hamidreza , Nematipour Ebrahim , Kassaian Seyed Ebrahim , Salarifar Mojtaba , Alidoosti Mohammad , Hajizeinali Alimohammad , Nozari Younes , Amirzadegan Alireza , Hosseini Seyed Kianoosh , Fathollahi Mahamood Sheikh , Movahed Mohammad Reza
Published: February 2019

Background:

Increasing age appears to be a risk factor for adverse outcome in patients undergoing percutaneous coronary intervention (PCI). The goal of this study was to compare procedural success, complications, and 12 months major adverse cardiac events (MACE) based on age using a large angioplasty registry.

Methods:

This registry included 10,412 patients with at least 12-month follow-up from April 1993 to April 2011. Patients were divided into 3 age groups: group 1 age < 60 (n = 6195), group 2 age 60–75 (n = 3724) and group 3 elderly age ≥ 75 (n = 493).

Results:

Procedural success rate was not significantly different across the 3 age groups. (96.9% in group 1, 97.1% in group 2, and 96.1% in elderly group, P = 0.759). Procedural complications occurred in 179 (2.9%) of group 1, 98 (2.6%) of group 2 and 15 (3.0%) of elderly group (P = 0.678). In-hospital complications increased with increasing age (311 [5.0%] in group 1, 235 [6.3%] in group 2, and 46 [9.3%] in elderly group; P < 0.001). Twelve-month MACE also increased with increasing age (235 [4.1%] in group 1, 169 [4.9%] in group 2 and 26 [5.7%] in elderly group; P = 0.021). Multivariate analysis showed that age was not a predictor for unsuccessful PCI, procedural complications, or 12-month MACE. However, increasing age was independent predictors of in-hospital complications and death.

Conclusion:

Despite increased in-hospital complications with increasing age, procedural success, and complications were not higher in elderly. Our data suggest that PCI should not be denied in elderly if indicated with procedural safety similar to other age groups.
Adherence to NSTEMI Guidelines in the Emergency Department
Authors: Gilutz Harel , Shindel Sevatlana , Shoham-Vardi Ilana
Published: February 2019

Background:

Adherence to guidelines for the initial treatment of ST-Segment Elevation Myocardial Infarction has been thoroughly studied, whereas the study of emergency department (ED) adherence to guidelines for Non–ST-Segment Elevation Myocardial Infarction-Acute Coronary Syndrome (NSTEMI-ACS) has been much scarcer. The recommended guidelines for the initial prompt workup and treatment of NSTEMI-ACS remains a challenge.

Aim:

We studied adherence to guidelines for NSTEMI in the ED.

Methods:

A single-center, retrospective study of consecutive patients with NSTEMI admitted to a tertiary hospital and discharged alive between March 2013 and March 2014. ED records were manually reviewed for adherence to prespecified parameters. Cases with sudden death, shock, or type-II NSTEMI were excluded. Canadian Triage and Acuity Scale score system was used for triage in the ED.

Results:

Adherence rates were 33.3%/24.6% of 240 patients for ECG/troponin obtained within 10/60 minutes receptively and 31.3% for anticoagulation within 15 minutes from diagnosis of ACS. Females were less likely to undergo electrocardiography (P = 0.009) or troponin-level tests within the specified timeframe (P = 0.043). Many cardiovascular risk markers were missed. Global Registry of Acute Coronary Events score was not used to risk stratify patients.

Conclusions:

Prompt identification and early medical treatment of NSTEMI in the ED is lacking. Better computerized medical history assembly, attention to typical and atypical clinical presentation, and the employment of an appropriate cardiologic risk stratification method may unblind the treating teams at the point of care and improve adherence to NSTEMI guidelines.
Diagnostic and Prognostic Role of the Modified Diamond-Forrester Model in Combination With Coronary Calcium Score in Acute Chest Pain Patients
Authors: Lavenburg Philip , Cantor Gregg , Agunloye Olufunmilayo , Bhagat Aditi , Taub Erin , Teressa Getu
Published: February 2019

Background:

The aim of this study was to evaluate whether pretest probability (PTP) assessment using the Diamond-Forrester Model (DFM) combined with coronary calcium scoring (CCS) can safely rule out obstructive coronary artery disease (CAD) and 30-day major adverse cardiovascular events (MACE) in acute chest pain patients.

Methods:

We retrospectively evaluated consecutive patients, age ≥18 years, with no known CAD, negative initial electrocardiogram, and troponin level. All patients had coronary computed tomographic angiography (CCTA) with CCS, and our final cohort consisted of 1988 patients. Obstructive CAD was defined as luminal narrowing of ≥50% in 1 or more vessels by CCTA. Patients were classified according to PTP as low (<10%), intermediate (10%–90%), or high (>90%).

Results:

The DFM classified 293 (14.7%), 1445 (72.7%), and 250 (12.6%) of patients as low, intermediate, and high risk, respectively, with corresponding 30-day MACE rates of 0.0%, 2.35%, and 14.8%. For patients with intermediate PTP and CCS ≤10, the negative predictive value was 99.2% (95% confidence interval: 98.7–99.8) for 30-day MACE while it was 92.62% (95% confidence interval: 87.9–97.3) for patients with high PTP. Among patients with a high PTP and CCS of zero, the prevalence of 30-day MACE and obstructive CAD remained high (7.07% and 10.1%, respectively).

Conclusions:

In acute chest pain patients without evidence of ischemia on initial electrocardiogram and cardiac troponin, low PTP by DFM or the combination of intermediate PTP and CCS ≤10 had excellent negative predictive values to rule out 30-day MACE. CCS is not sufficient to exclude obstructive CAD and 30-day MACE in patients with high PTP.